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HomeMy WebLinkAboutNo Permit Number W02KER5'COMPENSA710N DECLARATION 76A663 �o�e� ppp��CAT10N FOR ELECTRICAL PERMIT � I hereby affirm �hot I have u cerlificote of conseM to self �E'�� �ns�re,or a cerrficate oi Wo�ke�s'Compensaiion I�surance. COUNTY OF l05 ANGELES BLIILDING AND SAPETY or o cerrified copy�hereo((Sec.3800,lab.C.) Bld 1133 B-2 OcyNo.054336 �ompa�y WaUS`dU FORARLICANTTOFlIUN �oe 2fl715 A—D E. CTest Lane CeniFied copy is hereby furnished. New Res�deniiol Bldgs.8 Pools EACH NO. FEE �ORESS � Certified copy is liled wifh Ihe counly building inspec- 1 8 Y-Fomily,Sq.F�. E — 5 LOCALI7Y TR 43718-2 tion departmenr. ' Multi-family Sq.Ft. 4S2t1 -- �BO 96 NE/+RESi CR055 5T. Dore 9-28—$7 AppliwntB2Tf12T EIBCtT1C� In , Residentiol5wimmingPools .. ' owNEROR FIRM NAME The W11112RI L O!1 Compan � CERTIFICATE Of EXEMPTION FROM WORKERS' Outlets:Rec_Light_Sw.� �''�P'�� COMPENSATION INSURANCE ADDRE55 Thla s.ctlon nod not b�com I f�d if tM work Invalwd b Fim 20 ( o• Y Toroi Ho. ada�ro�oi ��TYNew ort Beach CA se+.Na. 833-3600 th.p�rmH i�!or ens huadred dallors(f700)er I�ss.) I certify thot in the performonce of�he work fo�which�his qpp�IGiNTK permir is issued,I sholl nof employ any person(n ony manner . so us to bacome sobjeU io the Workeri Compensatian Laws_ Lighting Fi.tures Fin�20 ADDRE55 � iolal No. Add�lionol CITY Tel.No. Date epplicant Fixed Applionces Naf Over 1 HP PERMii NOTICE TO APPLICANT: If, ofter making this Cartificate of APPtICANT Berner Electric If1C. Ezemption, yoo should bemme subject lo fhe Workers' Ranga_Heater._D.W._ Compensation provisions of the Lobor Code,you mus�forth- Oven _Dryer _W.M.� ' AODRE55 ith comply with such provisions or this�permit shall be Top —FAU _W.H,— C17Y Tel.No. deemed revoked. � COS0f12 CA 917.19 734-3171 Hood _Fan _Olher_ � . IICENSED CONTRACTORS DEClAHA710N UCENSE OK C�O 1 heraby affirm fhot 1 om licensed under provisions of Chapter 4 Disp. _Room Air Cond. — REG.NUMBER-485�22 ' Gass. . (commencing with Section 7000)oF Division 3 of ihe Business DISTRICT NO. PROCESSED BY p}„' and Professions Code,and my license is in full force ond effect. Power Apparatus 8 Large Appliances � � � � Size&Type HP,KW,KVA,or KVAR license Number �+85322 � u�.ciass ��� � FINAL a up ro 1 Incl. �-�^ PPf1PT' F�PC, pQ�e J—Z8�B7 Over I�o IO IntL 9P'�f� �V.� VAUDATION � ContraUor p- Over 10 l0 50 Ind. FINAL � W ❑ I am exempt under Set. Over SO�0 100 Inc. BY N 8.8P.C.for this�eoson Over 100 Z DO1e: Services,Swbd.,MCG 8 Ponelboords � , 0-200 Amp.Under 600 V Sfgnowre 201-1000 Amp.Under 600 V OOver 7000 Amp.or Over 600 V . . Exemptio�lor Reg.Moinf.E�ect. SINGIE FAMICY Temp.Power Pole&Appvrtenances HOME OWNER-BUILDER DECLARATION Sign with One&anch Cirtuit %'-1 2 5 6 A I hereby affirm ihat I om eaemp�from Ihe Controtfor's License qddi�ional Sign Branch Circuits Law for Ihe following�eoson(Settion 7031.5, Business and �r• • •• •2 Professions Code): , ❑ I,as owner of the prope�ry,will do the work ond�he M;sc Gonduits 8[onducrors � • 1 9 1.G 6 strudure is not intended or offered(or sale(Seclion Other(See Complele Fee Schedule)_ � • • 1 9 7.A b� 704d,8usiness and Professions Code). � CONSTRUCTION LENDING AGENCY � �Q� 6—8 7 . I hereby affirm thot there is a construction lending ogency for the performan<e of the work far which rhis permif is issued PERMIT FEE {S�b-iotai) (Sec.309�,Civ.C.). PIAN CHECKING FEE � Lender's Nome PERMIT ISSUING FEE 10 50 � tender's Address � I cer�i/y thot I have read ihis applimtion and stoie ihat the TOTAI FEE � � �9'I 46 obove in�ormotian is correct.I ogree ro comply wi�h all County� ordinances and State laws regula�ing Electriwl wiring,and hereby ou�horize.epresenrarives of ihis CouNy to enle�upon• � the obove-meNioned property for inspeclion purposes. ,/� SEE REVERSE FOR EXPLANATORY LANGUAGE �-�/4��C'A �l��,�n�L—P/tr �7 SJ��JZ �Signa�ure of Permittee Dote . . �.�.. � .. � �.....'. ...-'. �:OVJNEF.-6UILDEROECIARATION. . . . ... . � ._.. _ . ... • - ' ; _� avaPOVAtS .. DA7E .` "'� � . .. . . . - .. ., . �� .�. . StGNATURE.� . _ . .._.. --_ . . . �-- � �- - � � � ' � � � 1 hare5y Q{firm Ihn'1 r.m�nxempt�from ihe Controdo�s � TE11.P.PO4VEP,Pp,E. � � � � �� - . ... . . . . . � � � � .�licerso lovi,for tha�iollowi�y reo:on (Secnon 7031.5, � - " -�- � ��� �- - � UNDERSLAB V.'OnK . .." . - - � ��- � �, � � Eusfness and Professions Code}:Any cl�y or county wBtch � ROUGN CO`Jb11�7 �� � � ���� , requlres a pormlf to consfrutt,aRer.�Improve,demolish, __._. __ _ ... . _ - . . _ � , � __.� . �-� or repufr any slrudure, prtor to Its Bsuonce, olso�e- �--- - - -� - ���� �- � WiRln6�- -�� �' - : . � qulree tfie opp!lmnt forsuch pe�mH�o ftle a signed stare• - �� - ' - � �mcnt ihef Fe Is Ilcensed pvnuanf to thv provlsfons ol tAo'� ' . .. . _ . �. _ . . �.FIXTURES- --'-� � � Cantroctar's ifcensa Law(Chapfer.9(commencing�.wllh � � -- � .. F�'s1ER nUTHORI2[D'. � � �- � ' � - - �� Sectlon 7000)ai Dwtslon 3 0(tfie Business artd Profes- . � . . st�m Codo)or fhaf ho is oxempf fhereFrom ond Ihe 6a:is UTI!ITYCQNOTIFIED" � � � .lor fhe-alla ed . _ .__. .. c-� g exempfion. Arty vlolefion o! Section . . FINAL �rzlc�en ym+t! -� . . 't . 7G37.5 by any oppflmnf for a permlt sub/acfs fhe oppli- , - � - - -� -� �- - , . tont to a dvl!penolty of nol more thtrn Iivc hundred � � NOTES - . -"- - � doflars(5500).: ._.. . _... ..__ . . __ _ _._ . . .. . . . __. .-' -- . - � � � � � . . �,�1,a:owner af tha prcperty w�ll do ihe wcrk;and � � � tho strouuro is not intended or offorad fo�sole. {� j�, (Sea7044,QosinessandProFesalonsCoder ThcContrac- _W(r.__.�'�.-���;eD�C � �OOf'S-fd( QJ1 1�1�" .}a%s Lltenso Low�'eet no1 apoly fo an owner of properly �7 � n�y,,, � � �� � � who bullds or'Improves fhoroon, ond who does such �_____�,L46�d'��`Y-�.�'``�_._-,���`_�'�l"� � � � �� , work htmielf provid�d tha!sucfi fmprovements arc nof ' � � '� � - �-'�- � � -- , ^� �lnfrntiedor offored lor sale.IL however,��the bollding or � . . �.�.��� ..'.. ... �. . _...... • . . �� � �lroprovemonf Is sold wi161n ono yoar ol tompfetion,fhe � ' _ ' ' 'ownerEulld^�wlll htrve Ihc 6urdon of proving lhot he did � � ' � � � � ' . notbulld or tmprovc For tho purposo ol zole.) . . � .. _ . .. .._. _ . . '�' . . .. .... . .. . .. . . . . . ....�.I am exempt under Se,. . 1 . . ... . ... .� - � ..._B Z P.C.-for.this roason I _ .._ . . _.. . .-- -... . .. . _. . _ - .. . - . '. . _ . . . ,. _ _. . . . � � . - . -��-Date- . . � . . Owncr ' . � .. . . � �. , . '' f � , .