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1044A (5)
"� � � �r.�iYn e'."`Fii�+fms�v,.s;s..,ss-ceeh .'s�es„'�°tYRt#-i '*�'' � 4%�k'�,w.�:'. ��}- �5A663 10!51 woRueRs�c���nts�ri�'r�`6��a� �PPL�CA�����Q� �E�I��A�E�� ,� � � .I hereby affirm thzt I have a certficzte ot consent tc selF insure �`e�� - _�__ _ . .-- - �- � �..,.�- � ., _k �-m..P _2. - . .,.. . � or a certificate ot Workere Compensajion insurance,ar a certified COUNTY O��LOS kNGELES� BUILDING`AND SI�FET� �copy{yh'e.reoi}�(Sec 38GG,Lap C.) �{ . �. � � ,� �.-- �� -��. ``' � � , . �,/l/ j,�!S�i/i k2i t�.°�3 �!�� „` FOR APPLICENt'y`f6FILL YfJ` .- ,�, . ,.�` JOB +�p� . . . . <- . :... , ,.,, '" f �� . ADORESS R.SJ�y�<"��.��l�' ..pf ..Policy o ComRamJ 1° . .._ �. ...,� - . �❑ Certrfie�co{sy is ozreby fumished _, , _ . .. New Resrcientia(BId9s.&Pools � -. EACH NO -FEE . - , ; - .:❑ � .-� .,., . :, � . � - 7&2-Fami!%.S4.R. ._ .:.�.5. ._ �.- < iQCALiTY �T37'&IPr'� . . .. CertifieA copy is-filed with fhe�comty builtlmg rnspection � ��' - - Multi-12mi1 �Sq Ft -�.. . — NEAREST ., . -. � tleP rtment = - . Y .. . ,_,� � CRbSS�.�„_ _ .. _. �'� �p " C� Restlential-Swimminq Pools �OWNEa oR �+ 1; {.� �-,. ,. .-.._ 'Date�' � �f�S ApPlicantAt'�1;1i�or c7�YtJlf/T�'Cf+1 - .. .. . .- �£� �.:�J t(l. . y �:,���¢ FIRM NAt7E � � " CERTIF(Z'AT'E OF�E"�M1'�`'�Oh FM.I�i'��J��i� . Outlets Fiec—Light.._Sr.� ��-_. �'�� coMaErlsaTlonilN�[?t��ntc:� ' " nooaess 1-7�!4 j 3�'1% h i LC �o� (This section rteed not be campfetad�A the work�imrolved 4y�the����' First�0. : - , , _.. _ . - Tot2 No.:.. - -Additional - CITY�fz��� ' Te1i.� q -:;permd Is.for:ane hundred doliars�(ffi100)or lessj - ._ . . - . " � �. -"-�� � - �.. ,...._ ..... ,.�.«....,.�,< -_. . PLANCHEC . . 31 certify thai.in tYia per�rmartce of�the Nrork far wh�ch this pe[mit � qppCiCANY :�_.;.� „ „ _, � __;. .-z I�is isSued;I-shali not erriploy any persan I��any manttef'so`as-to'� ' � -��� " � ,. �:become subject to the�Workers Compensaton Iaws. . � Lighting�Fixtures� . First'20'�- ADpRESS -�� � . � . , . ..:.. ..W.,...,. �.3..- F>. . .. .:,., . . " ..� �. Additional . :..� .,�.: :- - -��� .. � 7ntal No. - � -.-- � �CITY �- TeCNo -Date � �.�.APplicant �- �. _ _...,..,.., . . . .. .. .,..�.,:.W ...��•�.<,�«w . . .-.�.. - - -� Fizetl Appliances Not Over�t�HP - I aERfdir c '-NOTfCE Tt>"'J1��`C�IJ(��affer �makirg this C rtlfiCaie �of - �APPUGarf' /J1fC JF� 3 . �',J � ;,Exemption,you should 6ec�me sub�ect to the UUprke�s Compensation - Range_.Heater,� DVV _ _ , . _ � � � =� provisions of.the Labor Code you must forthvrith comply ✓dh such Oven _ Dryer_ W.'J _ �.I ' � � � ADDRESS��f` � Ra���� . �promsions or this permit shall oe deemed 2wkea Top - ��FAU - W H �. - C j��tJ� �� _ U� +�3:� _. ., .n�,+ve.�.�.�ra�,c;�.;� — — .� CITY� Tel��.3 ,_�, LICENSE�'CONTRA��� ATON �� Hood—.Fan _ Other_ � � . � . - -I hereby affirm th�[I am icensed unper Frotnsipns of,Chzpter 9. p� --�- �Room Air Cond.��� � ucENSE Ca Q' 'p class./� / - . P —. — . .. RcG NUJBER �63�.7�' _ ,..4 CS (commenc�ng wRn Section.700C)of bivision 3 of.the Business�and � - ��.. � - ' Profes5lMs��Code,and my license is i�fu��fome and effaCt _: ppy��r--Apoaratus.&�azce ApplianCes � . . oISiRICT ti0 ��- � PR S5 BY ���� 0- .. -�. - ... (y� ��::�� �.- 5ize�ffi Type-HP.'KUJ'.KUR,or'KVi�R� � �.... . ... �. LicenseNumbe� �-�5���� Lic Class=�L— Upto 11nG. � � - � - FINAL � -�f C^ �--��., -¢ver 1 to�101nd. DATE . � ...� Contrac.t�idflti JTalJ'li�ll0i�Date �� 2•�� . - . .. .. . :. . . . . . .. � ✓ t,l��... .VALIOATON ... r0 . ❑ _... . - " . . �Over 10 ta 5d InCI. FINAL .. . . . � I am.exempt unqer-Sec �._ w..-. ...�...-- . --Over-.50 to t961nc. BY � _..:_.. ,_ . _:__.__.. ,.-. -. . _. _Over 1�0 � . . .. 0. . BSP.0 for this reason .« -a-�a„�����_ - . . . .�.��. � �. -t. . Servicas-SevliC.,MCC&Panelooa.rds�-.� . ► � - F�-,�i;;-�t:k'.'-.� Z . "� , -�-�.-:-•-- _��ate. ���� -- 0-200 Amp Untler�B00 V �� � .. Si�natur@ . . . � � � � :� - 2D7-�1 U00 Amp Undei'�600 V. �... . � � . . .�0 ;.:.��y.�•�.�... g ..,,_ -__';.� ...,... :. -, . . . . _ �-- �:- " '�" � � - Over 7000 Amp or Over 800`/ .�!; � �. ..❑ ._ . .. , .. _.. ._ ... . _ . . . . .. . .. . . .. ._�1'.�� . . . Ezemption for Re9.Mamt Elert. ...__ �-'. gINGLE FAMICY ' -...��-. W�, --_>-,.�.. T mP Po�er�Pole&ApFurtenances -.. . _ . . e '� �'. •.=� . . HOME OWN�R BJICD�R`iS�GLA'FS�dI"� m .SiSn uvith One Branc Circuit � � r� ^ I here6y affirm that I am ezemr±from the Contractors L�cense Lav,� .qddition2l Si�n�Branc'n Cvcuitg �-� , . J¢b L-��• �� - `or�the folloidinQ reason(Section 7031�.5,Business-and Profession��. � � � .-. � - '�ode):. . .. _., �,...- .. - . -- .&fisc:C6nd�i4 R�ondi:c�c�s .-.... .. . . . . � . . .. 1,as owner of Ihe.properfy,will do T^e vrork�and the structure. at�e��See Complete Fee SCnedule)_ � is nci intended a'offe etl`or sele fSection'044.Business� .. . . . . ► _ . - - - - -----�-�- -� and Prof9ssions Gode). � . � . � CONSTRUCYfd�N�CENb��'.�GE°�'I�V`��6�aYx�...�z . .. . � .�_._. .. ..� .. _. _ .. . _ . . � _. -:...:.�:_. .._.... ._. _. . .: �. afflrm tha[lhere is a constructon lending 2,qency`or the - "`"� _... _..... ......___. ,nce o`tnz vrork for v.�hich ihis permit is.issuecl(Sec.3097;�� PERMIT FEE- � ������. � tSub-Totel) �� � �-� � � � � �-"�� � � � � -� . . . . _._ ,.. . ..-.., .. .,�....,H . . . ��� . � � -- PLAN`CHE�KfI'�E�`K�E....,..�, .. _ -.:.:. . _. .. . Nsme - � . � -�-�...-�--. _._, . ._ . . . . .. - . PERMIT ISSliIPTG�=E�..�.�,v.F . �� . . . . . . .Address ��� ._ �.� - ... -, . ,._. . ._ _._ . ..._���� `i [hai I have Yeed.this application and�stzte that the above - - �TOTAL FEE�-� �.. � � _ ...� . -. . . . . ion is correct.I agree to-comply Nnth al!County ordinances -- _._ . . -� � . .. . �� -- � . ,. te(aws regulafing Eiectrical-vnnnu and_,herep5' autborite _._ �:-- . .-.:. - �- , . -�-- -- � � �ati•-ies of this�CounlY��eriter�pon thg.abc e nentror,ed ._� - - +-�.-- ` - ' ..�. .: � . .. �..-�'..`�..:`... .... ._ ,... .. . .- . .. �<,a., �...�..�.1:�.�.,-,�._.,:�..Y. .......�„ . fOr-i�s0ection.puYpbs2s ..:.. . � .. e.._.,,.-ss�.«,,.�.. ,.;,.,.,.,Es,....__._......-. �- � -�-� SEE-REVERSE-FOF3 EX�lAF1fiT0"k�`T'Cil'�1GUA�.,E � - � - ��� � .. . �- �.j�-� �. -• t[ee � .�Date ' : .. � � . -_ _ .. ,: tD . �' k�.. t .;_x:: "` �,� ,�t.t...�,_,t,. - -,� r� -� �_s� - , a.r.�'� `x -�c�t��S-."'�'`. � . _ ,:. ._�� .t v � , s� �. = , . r�. , � . �.: ., ,� �— , , �. -- , ,..� � . _ .,� _- ' ; �-- � . �_ -_ _ _ - ; �_ ..�.z ; - ; :: . ,,� :. ..,_r, , _p�,�� . .�,� , w.. __.._._... _: ; . ...,,a.. .. _...,.,._ >..s , �_:' df[�E�BJ�E�Gwi. c�L;+�iy1�'i�4 �.�. ,..:,- _._,._ _m_ ..�- , ..--�- . - .• . , _._ .....:.,..... . --�--�_ s: ___ tv PEv- a `: � . . . . _ .:�i��o � ..� � ( �:�.E �� I,5.�. 1I" + � .. . . - .,� i! m -�..p-�•cm h Coit acto s Lcense '�; .-._�. 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