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HomeMy WebLinkAboutNo Permit Number (5) , `_ L WORKERS'COMPENSATION DECLARATION jaA�� �o�e, APPlICATlON FOR ELECTRICAL PERMIT � 1 here6y a(flrm�ha�I hove o certificote of conseN to se�f CE-Bo6G insure,or a cenifica�e of Worke�s'Compenso��on Insv.ance. COUNTY OF LOS ANGELES BUILDING AND SAFETY or o cerfilied copy Ihereof(Sec.3800,lab.C.� B],d �Ij(R A-2 TR1�43718-2 O�Y No.054336 Gompony WaUSaU fpll MVLICANT TO fHL IN J08 Certi;ied copy is hereby furnished. New Res�den�iol Bldgs.8 Goofs EACN NO. fEE ADDRE55 207�� {I—� �. Crest lane � , � Cenified capy ie filed with�he coonty boilding inspeo- �8 Z-Family,Sq.FL 5 ^ S ���^��rY .43718-2 � tion deportmenr, Multi•fomily Sq.Ft./„i 52[� NEa.ReSi . � Residentia�Swimming Pools - OWNERSOR � pote�—�g—�7 Applimnl eerner Electric� 1 . � FIRM NAME ' TIl@ William L on Compan � CERTIFICATE OF EXEMG710N FROM WORKERS' putlets:Rec_Light_Sw._ ODRESS 19 Cor orate Plaza � ' COMPENSAiION INSURANCE firsl 20 (This s.c�b��..d nor b.compl•t.d ti th•wo.k tnvolwd by 7otol No. Addirtonol ��TY New ort Beach CA Tel.No.g33-3600 � � th�pvmif 1�br on�hurrdnd dollan(f100)or I�ft.) I certify tha�in the pe�formence of�he work for which�his qppij�N7K ' permif is issued,I shall not emp�oy ony persan in any manne� , � so os fo become subjecf to ihe Workers'Campensation laws. LigMing FiaN�es Firs110 ADORE55 � ' � ' Tolol No. Additional dTY Tel.Na. Date eppliconl Fixed Applionces No�Ovei 1 NP veRMii NOTICE TO APPLICANT: If, ofter making rhis Ceniiicate ol AaPUCAM Berner Electric Inc. . E.emption, you should become svbien to rhe Workers' Ronge..._Heoter_O.W.� Compensation provisions of the Labor Code,you must(orlh- Oven ,Dryer _W.M.._ ADpRE55 7 E .t G•,an B1 Vd. ith comply ilh such provisions or ihis permif shall be Top _FAU —W.H:-- � deamedrevoked. � Naad _Fon _Other_ CITY COTDfIfl CA. 91T�h9��- 734-317 � UCENSfP CONTRACTORS�ECLARAiION uCENSE OR I hereby affirm thor I om licensed under provlsions of Chapter 9 Di3p. _Room Air Cond. �— REG.NUMBER 485322� e�au. C 10 r (commancing with Senion 7000�o(Division 3 of the Bus�ness DISTRICT NO. PROCESSED BY O ond Professions Code,ond my Iicense is in�ull(orce and effec�. Power Apporatus 8 Large Appliances +�y�, Size&iype HP,KW,KVA,or KVAR � / •(�41� V License Numbe� 485322 �ic.Ciass �-'10 FINAL � Up�0 1 Inci. DAiE 9-28-87 ove�i�a�o i„d. 4��lL�" YALIDATION v . Comronor8�Tf1PL E12C. Date Over 10 to 50 Ind. . ❑ FINAL ,/.,�--- . a �I om exempt under Set. Ovar 50 to 100 Inc. BY '9v � 8.8P.C.for Ihis reason �°ef�� � � z , Dofe: Services,Swbd.,MCC 8 Panelboards , 0-20D Amp.Under 600 V . Signature 101-I000 Amp.Under 600 V OOver 1000 Amp.or Over bOp V ' . Exemption for Reg.MaiM.EIeU. 'r T 2�jr,.3� SINGLE FAMIIY Temp.Power Pole 8 Appunenancas � �Q��A�¢v HOME OWNER-BUILDER DFCIARATION Sign with One Bronch Circuit , I hereby affirm thot I om exempt(rom Ihe Contractor's License qddilional Sign Branch Circuits � �. Low ior Ihe following reason($eUion 7031.5,Business prtd Profess�ons Code): � ❑ I,os own¢r of the ro er� M;sc.Conduits 8 Conducbrs p p y,will do ihe work(nd�he p�her See Com leie Fee Schedule strucNre is no�7Nended or offered(ar sale Sectio� ( P �— ► �70dA,8usiness and Professions Code). � CONSTRUCfION LENDING AGENCY I hereby a�Pirm thar Ihere�s a co�sbuction lending agency for the performance oF Ihe work f0�which fhis pe�mit is issued pERM1T FEE (Sub-Total) ISec.3097,Civ.C.). , . PLAN CHECKING FEE � Le�deri Name PERMIT ISSUING FEE �O O lender's Address 1 tertify lhar I hpve reod Ihis opplicolion ond siole�hat�he TOTAL FEE . a6ove informalian is carrecl 1 agree to comply with oll Counry ordinances and Sra�e lows regulating Electrical wiring,ond . hereby autharize representarives of this Couny fo en�er upon � � fhe ob4ve-mentioned property/o�inspecrion pu.poses. SEE REVERSE FOR E%PLANATORY LANGUAGE ' �!r �.,.7l.C�/1— 9;���`� ignafure o£Permilree � Date , , .. . ': :...�_ .�.�: .. -�_ � .. . . . .. .. . . . _ __._. -BUILD RA . � „nce�ov��s ._.onie.__ •'"- '� �� � �OWNER ER DECIA TION .. ._ -�- - SIGNATURE - ......-. _. . .. . ... -___ .._._ . . . ''-��� - �-��� �� � � - 1Ef.'.P�FONIER CO;E. � � - '�-� -�� '' - � � �- '�� I heroby affirm thar I am exempf from fie'Controctor's _ _ . , . . . � . . . " - Uc�nso�.Law for �he�following�reasan (SecNon 7031.5. '. _._. .. .._.____.___.. UN�ERSLF9 NlOnK . � - -. - � :. , . �.,'.- . � Husiness and Prolesslons Code):Any clry ar county wfifch - �- - --- � -� - � ROUGH CC?1DUR � t�"t � � r� �._ .:� - - - - , �roquGes a permff}o consfrucl,alfer,tmprove,demalish. ��� - � or ropa�r ony zlrudurv,prPor to ifs�tisuencei olso re� � " � �� -- - � � � -VJiRNG- -- � - - � � quirosthoepplicontforaushpermMto(dc as�pnedstafo� - �- -� � �-� -- � menf that hc Is flrnnsedp�rsuoni�o fhoprovts�ons o/tbe ._ ... .. _.. ... . . . . PtXTU2E5- ' . � . . , �. Controctori Ucemu Law(Chapler 4(mmmencing,with� � {._ " � _. •�.� �. POVlER,htiTHORiZEO. . ..� , � �-- -. . � ' � ' � � � � Secllon 7000)ai,Divhlon 3 of Ihe 6usiness and Proles- , ���� � � . sionx CodoJ or}hqt he 7s cxempt therefrom cnd fF.e 6asis . UTI�ITY CO.NOTIFIFD �� ' ,...(or Iho cfleg3d azompHon.�Any vlo!otion o( SaUion -.. . � � . . - - P� � c� .-. , ... .•.'- ' . 70.31:5 by any oppUronf ior a permit sub�ec�s�hA oppli- _ ' FINA! ..Glilor oie,ironf �-�� �- eanf To a eivtl penolty of not moro tFan fivo bundred . .. ._ _. _ .. . __ .; . . .. NOiES � . " ..�-.� .. '. doflcrs(5500).: , . . � � . __ _ . --�- - � - — -� -,-,. . , , , . ., . ._ __ . . ._ , � � � ', - " -❑l,as owncr of the properry will do9he work;and � � • � � dhe strucNra is nal�in�ended or oF{ored for sa1e. ���- � . , , , . - . ,. „ _ . .. _ � � � � (Sec.70S4,Buslnas<endFrolesstonsCode:.�TheControc- __ - � � - - ' ' tor's Liconso Law does not oppfy fo on awner of proparty � ,~- . , � -�. � . .., � � -.• . � , � who 6uifdt or'fmproves Ihereon, ond who does wcb � ' � ' �-� � �'�` � ` '� � �� - ��� � � �� work h/mseff provlded thaf such Improvements ore nM � �� � � � � � - - ---.--- - - � �� �� in}ended ar of{ered for sale.If,'however.fhe 6ulldrng or . . _�._ .. . .... . . . .. .. .. ' � Impruvement 1^sold wllhin ano yoor o(complel�an.fhe � � ' ownerbuilderwl(1 have Ihe 6o�rden of proJing Ihaf he did � � � � no�butld ar fmprove for the purposo of sofo.J � . ... --..- _ - . . . . . . ' � � I am exempt undvr Sec. . ' � . .. . . . :. .. -. � _.. . ��- ... . . ..� .. � B EP.C..fcr this reasor. �.. , . .,�., -.. ... . .. . � ._ .Gate^. � '-` - �. Owner . � � . ,`-r-J�-^ . _ . . � _ . . . . . .. I . . . . . _ _ .,.,. , . . . , . . . . _ �.