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HomeMy WebLinkAbout0718A (4) �WORKER$'COMPENSATION DECLARATION ���3 ���g� ppp��CAT10N FOR ELEGTRtCAL PERMIT � �I hereby�affirm that I hovc a cerlificale of conseN to self �E-806G inwre,or o tertilica�e of Workers'Compensa�ion Insuronce. . COUNTY OF LOS ANGELES BWLDING AND SAFETY - or a cer�ified copy thereof(Sec.3800,Lab.C.) O[y No. Comppny FOR AI►tICANT TO FUt IN )pg T �/ � Certified mpy is hereby fwnished. New Re:idential 81d9s.8 Pools EACH NO. FEE ADDRES$ � U-1� � Certified copy is filed with fhe couNy building inipec- 1 8 2-Family,Sq.Fl. S — f LOCALITY tion depariment. Multi-lamily Sq.R. NFAREST �, + . Residen,iol$wimming Pools 0�Of! ` b CROSS S7. �,1 Date Applicant A��. OWNEROR » FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' p�tleu-Rec_light_Sw.� �^�� COMPENSATION INSURANCE Firit 20 ADDRESS Rn'1 L (This s�cfioa n��d no1 b�complN�d ii th�work Involv�d by Total No.� Additional. C�TY Tel.No. g6Z fh�p�rmil Is for on�hundr�d dollon(f100)or I�ss.) I certify thot in Ihe performance of ihe work for which this PLnN CNECK ermil is issued,I 5hall no�em lo on � APPLICANT p p y y person in ony monner �� hlin Fiatures First 20 � - so as to become subjecr fo�he rke�s' ompensaiion lows. 9 9 ADDRESS � / TOtal No. Addilionpl � .. Da�e B%�_�'LAppliwN CITY � ' Tel.No. Fi�ed Appliances Nol Over 1 HP VERMiT NOTICE TO APPLICANT; If, ofle mg n Cerliiimte of � p� EKemp6on, you should becorne subject to �he Worken' Ronge_Mealer_D.W._ APP����`�T G�+^-C-U .pr� .W Compensa�ion provislons of the la6or Code,yo�must for�h- Oven _Dryer _W.M._ AODRES$ ��3 with comply wi�h such provisions or this perm�t sholl be 7op ._FAU —W.H.— " 3� `/�� deemed revoked. Hood _Fon _Other_ CITY Tel.Wo, d y LICENSED CONTRACTORS DECIARATION uCENSe OR Disp. _Room Ai�Cond. _ � I hereby aHirm lhot I am licensed under provisions of Chapler 9 RfG.NUMeEa !� O Clou.C- -rj3 (tomme�cing with Section 7000)of Oivision 3 of the Business power Apparalus 8 Large Appliances DISTRICT NO. PROCESSED BY 0}..' and Professio�s Code,ond my license is in full force and effect p G� Size 8 Type HP,KW,KVA,or KVAR � �., V License Number Lic.Closs Up to 1 Ind. FINA A / � Conrroctor Date ��I'�J—B�+n �— Over 1 10 10 Ind. �p'T �/ VAl1OATION O OOver 10 lo SO Incl. fINA . W I am exemp�under Sec. Over 50 to 100 1nc. BY - "~J CL :071.8A �' B.&P.C.for this reoson Over 100 z Services,Swbd.,MCC R Panelboards ► � o e 2 �O�e' 0-400 Amp.Under y0p V '� �'� Signarure 201-1000 Amp.Under 600 V � • •J Q 5� D � Over 1000 Amp.or Over 600 V . Exemplion for Reg.Moinl.Elect. • o e 3 p,5 0 u SINGLE FAMILY Temp.Power Pole 8 Appvrtenances � D'S,� 5��6 HOME OWNER-BUILDER DECLARATION Sign with One Bronch Cirtuit I hereby affirm thm I am exempr fram ihe ContraUor's llcense qdditional Sign Branch Circuifs Law for ihe following reason(Seciion 7031.5,Business and Pro(essions CodeJ: ❑ I,os owner of the propeny,wili do Ihe work ond Ihe M;sc.Conduitx 8 Conducfors � slrutWre is nol intended or offered for sale(Section Olhei($ee Complele Fee$chedule)_ , � 7D44,Business and Protessions Code). CONSTRUCTION LENQING AGENCY � I hereby affirm rhai there is o construUion lending agency for - � fhe periormance af ihe work for which Ihis permit is Issued PERMIT fEE (Sub-Total) � � �, (Sec.3097,Civ.C.). � PLAN CHECKING FEE � Q Lender's Name � � PERMI7 ISSUING FEE ' Lender's Address � 1 cert�fy�hm!have read�his applicolion artd sroie�her ihe TOTAL FEE � � , a6ove informotion is correct.I agree lo comply wirh all County ordinonces ond Stole laws regulaling Eleclrical wiring,and - hereby oulhorize representatives oi fhis County to enter upon � �he above-memioned propeny ior inspection porposet. SEE REVERSE FOR EXPIANATORY LANGUAGE , �' YS^YS� Signo . lee Da�e ..... . .. ... ..__._ . . .. ` .. .. ... .. ___.. . ._.._... -OWNER-BUILDER DECLAP,ATION . . . . P.PPHOVALS ' DATE . __.SIGNAtU<c '. . � - . . . .. .�: . . � . . _ ... ._ _ _. _. . -.. �. - -'. :..:. ..: . . TEId?.FOVJER PO:E. .. �� -. -�- .. ----..... :'..�' : ',-, � .. .. . I hareby afiirm tha!I am�ezempf from Ihc Cantacror's ' � �` ' � �.� .�.: � ,..Licenso Low for tf�e follawing reoso� !Section 7031.5. '�. -'���- � � - "�" UPJDERSLA9 VJCRK - ��� -��� � � - , , �., .. � ; Cvslness and Fro(esslons Code):Any city nr counfy whlth � �- - - -- ---- ROUGH CONDUIT � �. �-��'//,r�8��?� �_� �_'' � ��- -�� . � raqulros o pormR fo consfrutl,alfer,)mprave,demolish. �� � - . . WIFMG �--- .��/T/lJ� � '.. .. ..; . � qobssfheoppllcaMfo suc6permft'fofllcaslgneds�eto- � ' " - � � '�-"�� — - ' � ment/htrf he Is llcensed pvrsuanf/o iho provlslons o!fbe . � .. .. :� . ...FIY.TURES .. .. . . -.. -� � �- -� � �� � Con7roctcr's Lkenso Low(Chepfor 9(commenUng w1�h ����".- -� . �. . POV:ER AUTHORIZE� . . .. _. -. -. ,. .. ... �.. �.. .- - '�.. ..�.'�� ' ' �� Sectlo,��:000J ol Orvislon:3 0(ffic Sus�ness rnd Proles- " - � . sio.ns Code)or 1hv!ho�s exompf Ihc•relrom cnd Ihe 6asis . .UT�LITY CO.NOiIFlGD� . ' -. (or.1ho.allcgod exempJlon. Any vlofa6on ol Secuon . HNA: S �7 - � - - - . ' � � � � 7031.5 by pny appllccnl far a permtt sub�ecls the oppU� ' � C�r.�fr�nn��i�onl " ' - �� : cool fo e dvll.pencl�y ef no�more fhon livo hundred - vores , - ao�ra�r�sso��:: t _ _ _ � _ - _ _ _ . _ , - , � -� � - � � _ ❑I,os owr,er of the propeny wiq do_the work,and � � ' . Ihc Y�uctvro is not inter.dod cr ofiered fa sole. � � � �, . �� '�. ��� ., .� ...(Sor.J044,3vsfrtes:andPwfesslons Code: She Con7ae � � � � � ��� � ' � � - /or'Sllceme lew does not opply fo en owner ol property . . .,. . .. _ � � � . .- ' �� � � ' � � ' who b:dJds or'Improvos lhereon, end who does such � � �� '� � � � --- � ��-" � �--- �� - �� � work hlms3llprovldnd IF.at soch�lmprovemenfs ore nnt `. ., . - ... , - - � . ' . . ...-�. ---..-�--- .- .....-. -- ' ..,"' - � lntended or of(ored for sole 11,hewever.�fho bulld�ng or ' � � " � � ����� � � � � � � ��lmprcvemenl Is scld w'fhin one yocr ol;omplafion.Ihe . '� � � '�, �, . ' '� �- � � , ' �owor,r-bvHdcr�wtll hcve t6e bu:dcn ul proving tbm he d�d ' ' � ' � ' - � ,-.`cf butld or Improvc Ior thr purposa of salo.J . . . , . a. • � . , ,,. . . ...� -�.. __ . . , � . . ..� -- .. ... . . . ..---_: . .. . :� _. _ -.. . I am exempi under Sec. � - - •� -- � --'- � � . �� .. �. . .� ," - - �� -- � .� „� , ' � - -- .... _ . . , ,.__..._._. .. .. _. .__. . . __. . ' . _.B 8 P,C,for this reason_• �� � ._,_ . . . . �.. � '_ ._ . ._.. .'._. .._.._._. . �, .. , . ...,,. . . .. Oate _ . , . � �� Owner_ - �� � i . � . . ... . . . . . , . . ., . � . ,