HomeMy WebLinkAboutNo Permit Number WORKERS'COMPENSATION DECLARATION 76A663 ,o�e� ppp�,�CATION �OR ELECTRICA! PERMIT
I hereby affirm thot I hove a certifim�e of consenf to self CE-8(MC �
insure,or o cerr+hcate o£Workers'Compensorion Inwronce, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy ihereof(Sec 3800,Lob.C.)
Bld 4�27 B-2
Q�Y No.054336 Compony WaUSaU FOR A►/GIGNT TO i1LL IN poaess 20730 A-D E. Crest Lane
CertiFied copy is here6y furnished. New Residenlial Bldgs.8 Pools EACH NO. FEE
O Certified copy is filed wilh the county 6uild�ng inspec- ��Z-Fomily,Sq.Ft. 5 — S LOCALITY TRdk43718-2
- fion deparimenr. � Mulii-/amily Sq.F�. � • — NEAREST
9-28-87 Berner Electric Ifl . Resfdentfal Swimming Pools cRo5557.
.�ate qpplitoM t OWnIER OR
. fIRM NAME 'TYIE William L on Com an
' � CERTIfICATE OF EXEMPTION FROM WORKERS' Outlets:Rec_Llght�Sw._ '�'�'41�
COMPENSATION INSURANCE F,s p .4D�RESS 19 Corporate Plaza
(Thb t�etlon n�ed net b�eompl�ied if/F�werk tnvoh�d by Tolal No. Addiiional GTY NeW ort Beach CA Tai.No. g33-3600
th�p�rmi}�a 1er on�hundr�d dellon(f100�or lo�.� ,
I certily tha+in ihe performonce of fhe work lor which this vU.N CHECK
parmit is issued,I shall not employ pny person in any manner . APPIICANT
so as to bxome subject to Ihe Wo�kers'Compensotion Laws. lighting Fixtwes First 20 ADDRESS
� Totol No. Addilionol
Date oppiiconl CITY Tel.No.
�NOTICE TO APPIICANT: If, ofror making this Certificore of Fixed Appliances Not Over 1 HP pERMiT
Exemp�ion, you should become subjact ta the Workerz' Ronge_Heater_D.W._ APPLICAN7 Berner Electric, Inc.
Companw�ion provis�ons of ihe Labor Code,you must forth• Oven _Dryer �W.M._ ADDRESS 75 East Grand Blvd.
wifh comply ith such provisions or fhis permit shall 6e Top _FqU —W.H.—
deemed revoked. � Hood _Fan _Other— CITY COTOf18� CA 91179 Ta�.N�. 734-3171
� LICENSED CONiRAGTORS DECIARATION tiCENSE OR
�hereby offirm fhpt I om licensed undx provisions of Chopte�9 Disp. _Roam Air Cond. — REG.NUMBER 485322 Closs,C��
(commencing with Sedion 7000)oi Division 3 of the Business . DISTRICT NO. PROGESSED BY
and Professions Code,and my license is in loll forte ond effecf. PO"'e�Appara�us 8 Lorge Appliances � ��-y n})
Size 8 Type HP.KW,KVA,or KVAR /n (�j
License Number 4A5322 Lia Cla:s �-�� Up to 1 Ind. FINAL �
Over 1 lo 101nd. DATE 1I .D� p
Comraao.Aerner FIPr. Do�e 9-28-87 I9 L7- VAIIDATION
❑ Over 10 ro 50 Inci. 'U
FlNAL
I am exempt under Sec. pver 50 to 100 Inc. BY p„�
Over 100 N
B.BP.C.far this reasan . z
� Daie; Services,Swbd.,MCC 8 Panelboards ► —
0-200 Amp.Undar 600 V
S�gnqture 201-1000 Amp.Under 600 V
aOver 1000 Amp.or Over 600 V
Exemption for Reg.Maint,Elect.
SINGLE FAMILY Temp.Power Pole 8 Appunenonces j�� '2 6,� A
HOME OWNER�BUILDER DECIARATION Sign wi7h One Bronch Circuif
I hereby aifirm Ihol I om ezempt from Ihe Conlroc�or's License Addirionol S�gn Bronch Circotts �*� ' ' ' '2
Law for the following reoson(Secrion 7031.5.Business and .
Professions Code): '
� Misc.Candui�s 8 Conducrors � • 1 9 1.4 6
1,os owner of Ihe property,will do the work and�he
slrucNre is nm infended or offered tor sole(Section Other(Sae Complele Fee Schedule)_ , • • 1 9 1,tt b c=.�,
7044,Business ond Protessions Code). �Q� 6-�'7
CONSTRUCTION LENDING AGENCY
I hereby aHirm rhaf tbere fs a constrodion lend�ng ogency for
the performonce ol Ihe work for which�his permil is issoed PERMIT FEE � (Sub•Total) .
(Sec.3097,Civ.C.).
PLAN CHECKING FEE
lendei s Name
PERMIT ISSUING FEE 10 50 .
lender's Address
I cerfify thot I hove read this applicotion ond state fhot the TOTAL FEE
above informalion is correct,I ogree to comply with oli County
ord�nances ond S�aie lows regulonng Elecfrical wrting,and
hereby authoriie represenfatives of this County to enler�pon
�he/o�bo�ve-mentioned properry for inspection purpases. SEE REVERSE FOR EXPLANATORY IANGUAGE �
�QD.c-Co��nn.�tlr/ti �-1-�-27
i5ignalure of Pe�mittee � Da�e
-- -------•--- • O'vVNER-BUILDER DECLARATION
� . . .... .. .- . _. � ��"AFPP.OVALS � , DATE � �'C1�'� .. .._ ___. _ _ . _ _. - _ _ . , . ._ ._ . .
SIGNATURE � - �� � -
-� - � -� � �T6V.P.POV/ER POLE. ,--- ' . .'. '. ,. .` '��' 1 hereby affirm tkot I'om�axemPt'from the�Controc�orb
- , .. . . �, . �Litensa Law for �ho-followiny rea:on (Soclion 703I.3,
"'�-�- -�'----�--�- � � UN7fR5LA3 V,/ORK � • �� ��� �. ,-' �_;��' ,. ,� .,. � p�slnezs and Prolessions Code):Any clly or county whlch
� ' -�-orQropol�-ar.y strt��onsfruct aHcr,Improvo,domolish,
. ... -. -._.. . —. ROUGH CONDUIT -- _ ��.__ . _ .. .... ... . i .
_ ro V�res a ermll
, , . � . -. 'ucfure,prlor ro f�s �ssuanca,afso're-
. �- �--�� � - _� -- VliBR1G ,_ qufreeiheopp:lmntforsuchpermlttoRleaslgnadsfafo-
� ' � � � !� � - � � � -�' --� � � � � mcnf}helhcislicensedpursuartftothoprovlslan:offfia
� .. ._ . .. �_.. _ _. FIXTU2LS -.-'. ." � � . ��.Contractor'a Licertsa Low(Chapter 9,(commendng;wllh
,_.���'.� ..�._; ._ ' � � .'_� FOWER AU7H'JRI2ED. -- _._ _ _. . ___ '. _ .___ ' ....- `.� 000)af
Soction 7 DlWsion,3 of fhc 6usiness and Profes-
- . , � ' ,, sions CodoJ or that he Is exempt theref�om ond Ihe basis
UiIIIN CO.NOTiFiED�� � for fho..afla od exom tlon.�An
-. - - -. .---. .- ... _. . . 9 P Y��lolction of Saction
FI1JA1 ' - - � - - � � �7C31.5 by any opplicanf!or a permlt subjec�s the appN�
.,{, c7 „ . �. .. �.
_.._ Gn(cr on ,Yronf , � con}�o a Nvll penOffy of nof mo�o}hon flve hondred
._ ._- �_ ._. __._._.__ .
� � �� NOTFS . � , --- - - � � dollors(5500).: � -
_._'_ '... __ _._.__ _.' _ __ . . . . i� i,. . � . � .. _ ." _
. , � � � �� ,.[]I,as owner of the property will do Ihe work,and
" ' - th�,structuro Is not intended or offored for�eala. .
. . .. � _ � . . . ,., . ,
' � , - -. ; - - - --. .� �� . . ' (55o.70S,f,DaslnessondPro(eseionsCodo: 7heConfrac�
__ ,
t� ' ' � '� ---- •� � ' . tor's Llcanse Low dees nof vpply fo an owner of properry
�, . � . . . � � . ' ., , who bvifds or�lmprovcs fhoreon, ond who does such
- -- - - � -�- -- - -- - -' � � � " " ' work hfmself providod Ihaf sucb Jmprovomenfs ore nm
.. . . . . . ., . .
�' � � � -� --- -� -- -� � -�- � '- � ' � � infended or oHarcd fo�solu.�f,however,fhe huilding or
� ���� - � ��� ��� � �- �� . �. improvemen!Is sold wilhln one yeor of complefion;tbe
, , . �, -� � � � � � ownor-6uildorwtl!hovo Ihe burdort ol proving Ihaf ha did
� ��� ' � ' ' " not 6ulfd or improvr far ihe purposo of salc.)
. , � . , : � _. �. .. . .- .
_ f � I om exempt uader Sec.
_._.._
. . _ . _ �-
� — .. _. _ . _ .... _ _ B$P.C.for this reason �
--. _. .... ... .., : . - _. .pote _ . ._ _..
" ' Ownar � �� '