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HomeMy WebLinkAbout1229A (6) � _ .__,___ _ .:___. __ __. . . _._. . _,. .._. _. _ . ,, - RKE S'GOMPENSATiONDECLARATION ��, 96p663 10/81 � APPUCAT�OfV ��M./�S. E�GCTRICAL PERIY►IT , � � � � I hereby affirm that 1 have a certitimte of tonsant�o self tE-BObG ' � ; i irrsure,or a certificate of Workers'Companaatbn Insurance, CQUNTY OF l05 ANGElfS' BUILDING AND SAFETY ! ;.� -or o certified copy thereof(Sec.3800,Lcb.C.) . . .�,, .. � - � . . . . . : .� �.�., ,�� .. , I. . } . . �.. ._ � ., �. �. .., . . . . . PolicY No.�.. . ..�Com n � � � ' .. ' �FOR MPIICANt TO FIIL IN '�.- � J09' ..' . ^,�� .� ° � Q.� Cartified cTo Is hareb furnished. � � - � ��6ACH NQ. pgE . �� A�DRE55 �� - F/��,Q C� x.�C.- �'� - PY Y . : . New Residantial Bldgz.8 Pools �� � .��Cartifed copy is filed wlih the counry building Inspec. ,' � �1 6 2-FamilY.5Q.FI. .�-S 0.3 � i —� 5 / .. LOCALITY . � �M�d 2 ! . tipn departmenl.'- . � . . � � �-�Mulli•famlly Sq.-Ft, - h1EARE5T � � .� . ..-Residenriol Swtmming-Poola � - ��� �h . , � . � I��, .�. � � Dale � Applicont � � �� ���� � . � � � � ' fIRMNAME M1G�IAEG� /�A.�4 � � i � �'CERTIFICATE OF fXEMPTION'fROM WORKERS' OuHets:Rec�ligh>�Sw.3 -' `�« � � � � �i ' j � . �� "�.. COMPENSATION-INSURANCE-.. . . . � Ao0aeS5-I AHAald �BAK , . � � � his tedlon need not 6e eom tefed if fhe'work Invofvod b Q � F���� ' �T P . Y Total No....rG.� ..Additicnol�. . .CITY'�L 'I AMOND �. � Tel.No 7KJ 6/'� �7 �. " . .Mhs parmlt ls for one hundred dotlan(S70p)or less.)��� . .. . � '�ptqN CHECK � ' � � - i certify that in the performdnce�ofihe work�for�wfikh ihis - , , � � � �'' APPI.KaNT ,di..7i �At � �. permif is issued,t ahoil nof employ ony perso�In nny:monner ' �� ' �- ' � � - � . ��so oa�o become subject ta ihe Workers',Compensariod{.aws.-� LlgMting Fixtures�" .'�.First 2D � �APDRE55 � �- � �� � � � � . ,�/�y��, ��Total No. ��`Additional � �i � � � Date�a��7-.pPliconr�., �.�� �'` �. CI7Y.. � .. � - Tel.No,- ; . � � �, � NOTI TO APPLICANT: lf, of�er�makm iMis�Cerhf�cate of Fixed Appliantes Not Over i�HP PERMIT . i 9 � APPLICAM �E ,.41.. IwtilE� ` Exemption, you :houid become'subjec� to-�rhe�Workers'� 'RangeY..,Heater_O.W,� � . � Compensation provis[ons�of tba labor Gode,yov must foNh- �Oven.�.Dryer��W.M._ � � ���- ADORESS . � � � � .- � - �� . -with comply with such.:provisions,or thu petmil sball be ;Tap. ..-...fAU�. :---W.H.-� - �' .�. CITY". . .... . -.-..Tel.No. - . �i. � � ���. �deemed revoked. ..... ,., . .. � ';. Hoqd �.Fan ,�O�her._... � �. � .. . , �. �.��� �� �LICENSEDCONTRACTORS�DECLARATiON � �.�Diap. -� � -dCENSepR ��, . �� �.t hereby offirm thai f em licensed under praWsians of ChapiecA ---���oom Air Cond. REG.-NUMBER� � - -� ��-� - C�Q�• � - ��� . �,(commencing wilh Section 7000)of Division 3 of tha 8usineu power Apporatus 8larpa Applto�ces -'�, DISTRICT NO. _ . PROCESSED BY �. ( � ; ond Professions Code,and myllcense is in fuli force andeffect. . � . . � -.� � � � � � y � � . , . ��� �Size 8 Type HP,KW,KVA,or KVAR � CJ ,c„��a/ � -�� � �� Limnse Number � Lic.Class� � ' � �� - - , � � � FiNAt � ��- ��� �� � - � + V , ��Up to I Incl�.� ,. ;. '� - -� �,� .� ..�_ Over 1 fo 101ncL . . . DATE �, VALIDATION� � � Q CoMroctor � � � Date Over 10 to SO Incl. - - I � r � ❑ .. .. . - ftNAl ; . _ . _ . , .. , 1 am eaempl.under Sec. Over 50 fo�100 Inc. - BY �� �. �� B:&P.C.for ihis iecson ' Over f00 � . � � � . ... � � .� _.. .. . . �.. Date: . �:... . Se.vice's.Sw6d.:�MCCB�Ponel6oards'. � � �-� r. __ -. . .�_ .. � .. � . ����D-'l00 Rmp.Under b00 V - � . . . . � � - .. . �Signature � � ..20i-�7000 Amp.�Under b00 V . ... . . . ......' `.. �'.... ', � � -� . - - - . .. . .. pver T000 Amp.or Qver bOp V . . �'�2 2� ., �. I ; Examplion for Reg.�MaiM.Elect. ' � � - '�� ���� : , - .. ��SINGLE fAMIIY �:..� - ' �� � . 7emp.PowarPole&ApPvrtena�tes. . . .. � '�_�: ... #..��� • •2:. � � . HOME OWNER-BUILDER DECLARATIOM Sign with One Braach Crccuit � � �� �� :� • ,�'�.6 2�.�� ' . ��.I hereby offirmlhat I om ezempt from the Contraator'n Licenae �.. ;q��tionnt Sign Bronch Cirwita � � � -� � � � . - � - � � � Law for the following renson($acfipn 7031-5,BuSiness ond . . � , . . �3��b,�•�_� �Pro7f�e.s'sy�i ns Code): � � . .- . � � �� � -. �• .,� � . . . LJ �f,as owner.of Ihe property,will do lho work and�thc Mis�:Conduits 8 Conduaton � .. � ' � ' �� '{2 5�$�1��., . � structu�e fa not imended or offered for saie (Section, 4�her.(See Complete Fee Schedule)�. , � - � � i , . . . . � ...:�. ..... .. ,.. - 7044,Business ond�rofessions Codej. ' �� � � - � � �.� -. . ` � � �' ��� �- � CONSTRUCTIONLENDWGAGENCY � �� -' � . �' �� � � -- � � ��-� ' ,.. .. ... , . . ._. � � .I hereby affirm rhar�here is o�consiruc�ian lending agency for � , . . � - � � � . - � . - � � � the performonce of the work for which th(s permit is issued-�- �PERM�F fEE �� �-' � �� ��� � (5ub-Tololf ,'� �- �-�- �- � '�-��-�-�� ---- � ---�� .�- ��'�, � ,(S8G 3097,Civ.C.). . . . . , .,�. . �. .. � � . .... �� 2���9{� .. ' � . . � . � .. - .. .. PLAN CHECKING FEf . .. . . �.. . , . ,_.. .._ . . � �., , ._... . � . � . Lender'a Name ��- . � . .. ... . ... . , . . . .. . �. , .. . #� • • �.�� � . �..� . - . . . . .. �PERMIT ISSUING FEE .. .,.:, .�1�0 . . . � � ,- � �, � lender"s Addrosa . �� � . � � . . `. . . . � �. � �..• '((G�(�� � '� I ceAify��lhat I have read th'rs app�ication ond sroro thot Ihe TpTAL FEE �'.. .�_, .�' :.� -. � �,. � .,,,. � ' . ... ... . ... . .:. . ._ .. . ;. . � abave informatio�is canect.-t agrae�o comply with oll Counly . � . . � N G�„ � ' , � � . .• � � 4�6�� � I � ardinances aad�5�ote laws regulating Eleciricol�wlring,and .: �. '�� . . . . � . , � �hereby aothorize rep•esen�otives of this Coon�y to.e�fer upon �,� �� � .. � ,� . ��� . . � . �,�,2 Jr y$4 , �. � �he above-mentioned property for�nspection purposes. SEE$EYERSE FOR EXPLANATORY IANGUdGE ' � �. - ,4�;'I�.+�.�.i , � � - . ignarure of.Perminee .������ - � . � . . . . . . � i : � . �� , . � . ;. . � . . . .. . . . . . . � .. �� ,�I� � �� �'�; r!�'�',* ,r�:��+. . �.�r,�a � ". — ot� k, �..�ib v . ,�..�I : 11�f�L� 411��/4�'�i 7�� • - .�.�,.,.�r b _ . � � +r..ii�� `.4• ,� �, r .. � � � . .. ...,.. , ',.. . ..,.�'. ..�. . . ...... .... ._. . . . . .- - . , ..,... . .,. ... .. . ' _______ e • � � , ,..,:,'. � APpgOVACS �. � � � ��A7E... ..._S1GN RE . . . . ..__i' . . �OWNER-BUiLDER DECLA�ATT�R, ,� . . .. . r:.. . _, . � _.. . . _ .._ . .. , �. : � � �� � - �--�' �- � ' � " `���' 1 heieby affirm�that I�am ezempt from iha Contractor's �. ! ��,'i 7EMV..POWERPOLE��: �-4.'„ = yt, ' ' . . , .. .. ._.._ ._ _. '.. — .`� ' ..�:�:. � License.Law,for.ihe following reaso�n,(Sect{on 703i�.5; . _ �'� ? � .?�. WNDERSLABWORK � .;.;� ___ . ' ... ._.._.._ ...�. __.. �l � '-'-.-:�'� ; BusMessondProfasslonsCode):Anyctfyorco�ntywhlcb �' .�.... ..-... . ' "� ROUGHCONGUIT . .`. .: . . . . . .. ..... - � :. ..,. . ,- ._o�9��ye ny sfruN reRsprfor iloelfsi aPuoneedalsolsh, � � , �:. �� �' �..�� ` - msn�af h�7sf I�nssd pursupni fo�hellerovielons ef rs . ... � .- . .. VJIRING ..�.. [, ..� . - 4 PP Po g ate- . . FIXTURES � •- . . ..._._... . � . . p the � �.. � .�., , -... .... , '- . '.... �,� . � ,, ConMpelori Geena�Caw(CFopfer 9(commancing wlfF ' � -��- -� POVJER AUTHORIZED �' ' � . Sectlon��.7000)of DiviB(on 3�01 fhs Bvsiness.and�Profvs- . - � � - , , . � � sbns Code)orThat he ia exempt Ihereirom and!he 6as[s � . . --.. '.�"�`� ..'.''���UiILITY CO.�NOTIRED �..,. � �� � � (or the olla ed . - , � ; , � 8 Oxempfipn. Any v(olaflon of Seetloa ` n . c� ...- ...-.. .-... : , -'� ���. . .�.:70.?1.i.bYorry�aApllcant for.a p�rmlt eub�eds the oppll- I . ' .. _.�.. .. _ �. _ . . FINAI.-. .. ... ... 4nEar�ort..!'rortf � .. �. . . , , . . � 'cvnt�a a eivll�penalfy oi nof more thdn/tve hundred E �, � .�. ,. _. _ .:.�._,._ .. P�pTES. . ..... _.;.. ', . ' : . — ' .. . 'dofl6rs.(5500).:.t..�'3.`' . . .,. .`, . , . . .�- , . , _,_.._ . _ .. , . . .`,.� � ,., . � . . , " . -❑I;as owner of the,p�oparty wil6do�rhe work,�pnd .. , ,. . . ,.. �. _„ :: . . . . . ---.-- ... ' .. . .�.. -. , '. .': .'� ..'��'� - ....,,.dhe�atr�eTure Is not i�tended or affered for.yale � .., '_ . . . . � ��� � � � �� �•'.,.�� � : �- � � - - "` -< -�(See.70N,Buslncss and Professlona Code=� ihe Contcoc-� ; : ; �,. .._ .. .. . .__. .. ` .....--..... . . �------� .:- ... -. ..----� � ' � - i � '. ��tor's Utense Law dass irof apply}o on owner Of propeeey �', . .�_.'._... � _...__..-- - ..:-.--. ...._.. __..'.' ; � ' �`..i_.... .,,�:.. . . who Iwllds or fmpraves thereon, and who does sutb . �� . . � . i� -�� � work h7msAli piov)dcd�ihaf such��mprovemenfs are not i ��. . . ...... . :.... �...,._.. ..,.._,.,,..�. . � . . �� .. ... �.�. o �• � inlended eroifered fer sale:If:however,the 6utldtng or , .. ..,. . . ; . . - - �� � ^��irrf�rovemant Is so18 wifhln one�year ol compleffon,Iho . � , ,� , � . , � ; � . . ' -ownerbultderwJff have+he burdan Of prov�ng thof he dld � „ ::..... `, .... , ...':_`. : , ' : .��. �. ��.�. � : , i'.�.--..��; � nof bvtld br Improve for the purpose o/eafo.) ... _. . .__ . . ._ ......_. ... � .. . i . , . . . :. . -.. .__ ._ . .. . , ._ ... , , �� � ��� � I am exempt under Sec. .. ;.. .. _.... . .__.. ._ . . , . ._. .. . - ..,.�, . . ., .. ..__._. . ._._.. .._.._. . �. , . . .. ..._. �..__ . .....� .... ; .. . . , :- , _.__.8.8 P.C..#orihis reason � „i � , _ _ � ; . .. , - � .. ._,.. __._._, . . ... . . . . ... . . ... ._.Date......... - ' , .,_,.... . . _. .. � -., -_ .. __ ... � . . . . , . . , � . . - . � ' � i;.. �� .;. .�.,� . � ; � Ownsr , . , . , � � _ , . , .._ . . . . . , . ,. . . , - - � .�� . a� . . . . . . � . r... ,�, .,......... . .. . . � `.�,.. ...._ . . . .... __._.___... .._ ... _ . . . . -',i. .i: . .. � . . , '" ' ' . ' . .. - , { , , . .. �.�.i.. .. . . . . . . i . , . . . . � . . . . . �... .. :., . , .. . . � . ...� e � . . ,, . . ' �'�` ','"'....` . ' � , ' .. , . � . . . . - .w _.._ . .__, .. .......:...,.. .._�... . ............ .. .,. ' �.. :,� . .. . 5... . . . � ' . . . . . . ,..<. �1>.. . , . . . . . ' . ' . , . . � � � `•� � -, . � . . . . . �, . , � , �..r..,r , � �� . � . . � . .. . .... . . ' - . ,.l...