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i .�._ _., ... ., .._.,,-. � r��9D%Y3/87 `'. ` ._.. ,..., . . ... . . . . _ I . . . . , . �. . . . E.._. ..__._ _� .� ,...�� . . i_-. .. . . , . . . . � ' - OW R���COMPENSAiIONDECLARAi�o� � : qppL1CATION ���4R�E4ECTRICAL PERIIAIT � 1 Fiereby affirm thaf I�have n certificata�of tonsent�o��self. ��E_�- . . ..� � � im�6ra,or p eertificate of Workers'Compensat�on Inaurance, COUNiY�.OF 1.05 ANGELES � � � DEPT.QF PUBIIC WORKS „ of_qFe�Qfi copythereo_fLSg4,3800.4ob.t.) . . ' . . .. . '� ... � .:� ..�I.. . � . . � . . Xtl}W HX� � ' . . � 'Polic No: 3 E"Sm n � � �� � � � !OR APPtICANT TO FlLt IN . . lOB � . y P'A Y � A�DRE55 � � C � �Fi. I � �Certified copy is�heroby furnished. ' . New�Residentipl Bldgs.&�Pools . � EACH Np. FRE. � . � J��,.,,/�Certi4ied copy is filed with�fhe� ou t buJding' peo-� i 8 Z•Family,,5q.Pt.� � S � —� S � � tOCALITY �p� &�d� . �� � ' W-"�tio de rtment. .. Multo-famil S .FL. . - �� NEAREST ' . � �� �-.���� � ReaidenNal Sw mm�ng Pools o�NER� C�� �.�Dafe ApPlimnl-� � ' ' - �}� � - � FI M NAME� � � � � `CERTIfICATE OF EXEMPifON PROM WORKE 5' � �� � � � . .� Outlets:ReclV .tlqht�5w.�� .. `'�' �' ��t . i � �� � � - - COMPENSATION MSURANCE ��. ' � - -.FIfEt 2�'� � ' AboREss ��(This sbcfton�need not be eo�npiefed ff ihe work�involved by Total No.�� CITY� , � - � � Tel.No.� �� � - � 1he permtt la for one hundrad doflara{5100)or bss.) ' . . Additional. � , � PtAN CMECK . . I certi(y ihai In fhe per#ormonce of the work:Fer which thia : � . . . . � � APP�ICANT . - permit is issued,I shofl not empioy ony rsan in an onnar � � __� � , � � so as to 6ecome au6jecf to the Worker'Compens i n s. � � L�9hiing fiztures� ��F1n120 ADDRESS . � � � ,. �)��� � . . , . - AddiNonol � ' . TacLNo. C17Y� �''�'�� Tel.No.�,---�' i �O1e !�WP���p�� . Fixed Appllences Nof Ovar 1 MP - � PERM�i ' . �NOTICE i0 APPUCANT: If, aher.�ma in9 lhis e�tifitata . . . APPLIGAT�ON�C.�►1 �.� I, � . � Exemp+ion, you shovld��become su6jeai to the�Work s`�� � Range— Heater_D.W, � . , . . � ���Compensation provisfonsrof the tabor Code,you must forth• `Oven �Dryer�—W.M.-_ ADDRESS� �� � �!. with�comply.with such.provisions or this permit shall_be _Top � —FAU ---W.H--- I� , �� � � � , � deamed rovoked. � � : . .� .; . � � �Hood ��. . � ��fY... . . ... . Tal.No.q'8���'f . �Fon �Othar_ - �� �LiCENSED CONTRAdORS�DECLARATION�. . -' � - � 4iCeNs�oR , .�,�S.�.,�,�. „1 . - Diap.� ,..�Room Akr Cond. �-�� Claas. I hereby nffirm that I om.licensed undar provisions of ChaPter 9- �. � �, , . REG.NUMBER� . :,�commencing with Section 7000)of Division 3 of the Business power Apparotus 8 Large Appliances . � DISTRICT NO. ,� � PROCESSED . j �^ � and Professions Code,and my Iicense is in full force ond effect. � -� � � ��� . �• a � �, _ ��. Size&Type HP,KW,KVA,or KVA � . � �v � ticense Number � ���Lic.Class r✓.-.1_ .��Up to 1 fncl: � � FINAL . � .. . . . �'� . � � Oreri fo 101ncl. 1 O DATE VALIDATION j � � `: ' -Coniractor � . � � �r�Date"� �pver 10 to 501ocL . . . .. . � � U . , ._.. ..._� FINAL � � � � ❑ .I am exempt�nd r$ea , ... �Over SO to 100 Inc. .. BY �. . .� -W . � � B.&P.C.for this reoson � � � � � Over 1p0 . � � � 0. . � �� . - . . . . �-.� . Servtaea,Sw6d.,�MCC B Ponalboards . � . �: . � . �. . . . . ... .. �. � � , � � , �Dare: . �0-200 Amp.Under 600 V - .. Z �� ' �� Signarore � � � �Ol-�10(3��Amp.Under�600 V � . . ... . . . .. '." . ..i . � Q� � -� . �� � � �-�- � . � � � �� �� � Over 100D Amp.or Ovec 600 V� .. . . . . . . .. , � ..� . , Exemptlon for Reg./J�ainL Eleci. � . . . . , .. . . .. .� .. .. , _. ... .. . . .:. . SINGLE.FAMILY��. . _. � - . Temp.Power Pole&Appunenances . . . . . � . � � �� . . � ���HOME OWNER•BUILDER DECIARATION - Sign with One Braoch Circuit � � ��4 6'7 A' . � I heraby aff�rm rhat I om�exempt from tha Conirocror a Licenae � � � �� - � ' - � � . . Law for fhe followinfl�reason(Secrion 7031.5,8usiness ond.'.. Additional Sign Branch Circults� � , . , . ... . .�.#•a • • •21 Professions Code): . � . - � � : . � . � ' . � ... . . . ; . Miac...Conduits&Condunors -� ' `��J�2 5� ❑I,as owner of the properry-.wil1 do the.(�ork ond I�he p�her See Com lete fee.Schedule � � �- 3�2 5 � ' afrncture is not mtended or offered fior wle Section) ( p � � �w 1 i � � � 8usiness and Professions Cade).- - � - -' " � � � � � . , .� CONSTRUCTION IENDWC>AGENCY � � . �.. � , . , . . � fl 9�D�.',8,S� . �. 1 hereby affirm thot there is a construction Iending agency for �.�� � � - �, . , ; �. �� the performance of the work for which this permB�:7s issued PERMIT�fEE�. � �� ���5ub-Total) , ' . ,_. ., . , . . . „„ I , . . (Sec.3097,Civ.C.�.�. . . ... . . . . , . I ,... PLAN,CHKKING FEE .. ' . � '� . �,�. � • . . .. ' - . .. ., i . �. �Lender's Name .. . ... . .. . � . . . � � � . � i � �� Lender's Address � . . � � - PERMIT 15SUING FEE ' � . . . . . . � .. .. . . �. ... '� � .i 1 certify ihof I have read�his appfica�ion and sta�e 1ha1 ihe � � TOTAL FEE � ' . - �� - - �. , , � �'. above informatian ia rrecf.I ogree to comply with all.Couny . .. . . . .. , . . .,. �,� ... . .. .�. . . . . , .. ., ....... ; .. . ordina es and Stot aws regulating EleciNcal.wi�ing,and � � � � .. ' � � . . . . , .. . ' � . � i .. ' ` hereb Whorfze re r senf rves of this County to eater opon ,� ,. - ' - . : � � �� . , . . . . � , . � � �- ' � �the ve-mention pro rty 1or in$pac�on purpo�qses. '�.� SEE REVERSE FOR EXPIANATORY LANGUAGE � ' � � . - � � � �� I � � [ -{f A�?'� . ; � - v ! �„ � SignatureofPerm tee � .Da�e . _ " �. .�� � . . � � � � � , ; �,'. . � � .. � _ �.. . . -_ � . . . . , . . . . . . . . � � , ,..a , ; .' : , � . ,, � ... '..i. �. �� " ... ...APPROVALS -..' DA7E� � �SIGt��UR�S . . . ... _ �. ._ . ON/NER•BUtLDEp6ECLApA'�1f5A .. i �..: •�_�. ; .. . , . ,.. .. TEMP.PQWER POLE . :� � .. � � ,:,-� `- � . � � . ``'� � . ��� _ . ... ... .. ���;:°,�_ � � -�------ .. , 1 hereby aHlrm that 1.am exempt from the CantractoPe ..... y.. _ ' ONDERSLAB-WORK ��; . . , . . . .. . ' � � Ucenee Law for the tol Iowinp raeson(SecNon�0.?1.5,BNslness . ` `��a:��''E 3. ..-�`. ';• � � � ,> � . . � � � 'y �,eed Pro(essians CoQeJ:Arry c7ryCrcounty,whkh reqplies a permlt , -- ��� � , � ROUGW�CONDUIT � - � '� � � �_ .�.�•.:g; .,:ja•.conSiruct;affel,imp�ove,demolish�oo��repali�8rry.structure, � _ .. . ' ,E . WiRiNG'_i .. . . .. . �,. . � �— � �.- � �--- - . � ;: '� " � � � `� pdgrMltstssuance,elso,requlrestheeppflcant./orsuchpermitm � ' - -..-... . a%1X'ITJf{E3�..- ' �; + ' �' . ~... . ; ;..�.� . file a slyneQ stafemBnt that he(s llc6n5dd pwsu9nf to the PrOVF � � � � �--,. � ., '� ' srons o/the Coniracror's UcenSe law(dNapter 8,jcommencMg . . . .. . _�_ ,, . _. _..... POW EA AUTH�RIZED .' 3 r ��� -�. . . ' `.. " �� �. � . . . . wfth SecBon 70f701 ot�plvlsfon 3 ot the Busfness and.Professkns � , UTILITYCO.NOTIFIED... . ' � . . . Code)ortfrathelsexempttherefromandthebaslsior�.Meellepetl . . . . ..-...- . -. ...- . r c� ' ' . _ .exemption..Arry ylofatior+of Secibn 7037.5 DY enY appikanf for a � �- ' . _ ' FlNAL ��....... � ,Lnfer�ort.tronf..+ _-. ....� � . . . . �� permJt su6leois�.Me apW�ant ro a clrl!penalty of:rrot rtrore ihan �..... .. � . . . . . _._ . .. . . , � . _ - �.., : ' �� fl�re�hundred ddlars(5500).: , i�� . ....._._ ,. NOTES � ��, �_ � ._.. , - ., 1 '';::.�:�. 1. ,::;;.';1� �... j��...,� � -.. _ . _ : , CI 1,as ownar of tha ProPerh will do the�rOrk,and '� • �•..�' � ''��.'. �'ry �.. . . �, � � � �. the 9trt�eture Is not intended or ottered loraele. ,. � � �� l ..., � '� � c ��- _ . . . �, . . �. . . (Sec.��7044.8u81ness and Pro(assfons Code:-Ihe CoMracMr's J �_..�_s._ .1� .. S: . . . . .'... _ . . ... , �r . � �' ��..-�:_. �. �,. �- .��-. �� .. . ' .� �. �; sucen mProvements teappJy ro an� ���who DUUas or ���- �' �'�t � . . � . .. Improves Mereon,arM who tloes such work hlmseff prov(detl thai � ..� :�: .. . , ,... .. � � ...Irowever,fhe buPMin or lmprovemeniJs sold�withf�r sele. If, . .. � g n orre year of �•� �� ' �� � - � � � � �completiwi,tRe owner-0uikfe`rwtll have the Durden olpravinp that ��, . .� . : , .. ., �. . . . .. .,. � . he dfd.not bulld or fmPt9ve lor fhe purpose of aefe.) ..'..� . � � _ _ t ,<, i�a` E' . �_ � ` � , ._. , � �' �", I am exempt unde[SAa., � ;' �, _ 8 8 P.C.for thls reaeo� ' Dete _ _ . _ , _ _ . ..- ��,- _, , i Owner _. , � : ; � � . . . . � . �. i � , . . .. . . .. .... , . . ( F � .. , . . . . . `� � :� y� 1 . �t . i 1