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HomeMy WebLinkAbout1777A (10) ; WORKERS'COMPENSATIONDECLARATION 7aA6a3 l0iel qpp��CATION FOR ELECTRICAL PERMIT � . 1 hereby affirm Ibar I have a cerlificale of consent b self CE-B05G insure,or a certif�cme of Workers'Compensaron Inwrance, COUNTY OF LOS ANGELES BUILDING AND SAFETY ', or a certified copy thereof,(Sec.3800,Lab.C.) ld ��2R a—� ��, P❑ol�i�y No.��543',6 Company W3US8L1 FOR A►PUUM TO NLL IN � - JOB � � Certified topy is hereby fornished. . New Residentiol Bldgs.8 Pools . EACH NO. FEF ADDRE55 20783 A-D �. CT2 t ane � .� Certiiied copy is filed wiih the county boi�ding inspec- �8 2•Family,Sq.Ft. � E — E �ocnutv. 43718-3 , � � .tion deparfinent � � - - � Multi•fomily Sq.FI.�VS`LA — � O ( NEnREST , ResideNial Swimming Paols � CROSS ST. -�� Daie Applicanr Rerner Fl artri T I , OWNER OR � FIRM NAME The William L on Com an '.. ' � �-�CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec_Light_Sw._ ��� ate P1,dZa ', � �- � ��� COMPENSATION INSURANGE � ' Fir51 20 ADDRE55 � -(Thta��t}ien nNd not b�complN�d II IA�work fovolv�d 6y Totol No. Addi�ionol " UTY N2W ort Beach Te1.N�.g33-3600 �th�p�rmN Is for on�hundr�d dollan(3100)or less.) � . I I certify Iha1-in the performonce of the work for which this - pppNjGqMK . , ��permit is issved,1 shall not employ any peison in any manner . . �. �so as to betome subjetl to the Workers'Compensolion Laws. lighting fixlures Firsr 20 � AODRE55 � ��'� . . � � � - �. Total No. Additional ' , , �Date ePPlicanl � CITY , Tel.No. �, �NOTICE TO APPIICANT: If, aftei making lhis Certifito�e of Fixed Appiionces Not Over 1 HP pEgpqii � Exemption,�you should become subject to the Workeri .-Range_Heater_D.W._ . . . ArvuUNi Berner Electric ItIC. �, Compenw�ion provistons of the Lobor Code,you must forth• Oven _Dryer _W.M._ . ADORESS 75 East Grand Blvd. � ��wilh comply with soch provisions or ihis��permit shall be 7op _iAU —W.H:— �. ,deemed revoked. . � .� � . CITY COTOf12 CA. 91719e1.r�io.734-3171 � LICENSED CONTRACTORS DECLARAiION Hood —fan _Other_ ' - - �Dis _Room Air Cond. _ uCENSE Ok . ��hereby affirm ihot I am licensed vnder provisions of Chopter 9 P' REG.NUMBER 465322-� ciass. C 10 � .(commencing with Section 7000)of�ivision 3 of ihe Bus�ness POWef A DISTRICT NO, . , PROCE D BY .. O}�.' I and Professions Code,ond my license is in full(orce and effect. PW�a1os 8 Large Appliantes� 0� � - � Size d Type HP,KW,KVA,or KVAR ?/ �� �� C7 license Num6er 485322 ��- �;�.�cia::C�0 � Up to 1 Ind. FINAL �� � �� � - - � � . Over I to 10 Incl. DATE ,r � ', yAUCATION U Berner Elec. oa�e 't �, ConiroUor Over 10 to 50 Incl. ❑ FINA W I am exempt onder Sea Over 50 to 100 Int., BY � n.' � Over 100 � � B.&P.C.for this reason � � Z . � � -- � �- � - � Date: � �� Services,Swbd.,MCC&Panelboards , ��, , . . 0-�00 Amp.Under 600 V . . ,`1 �7,7 A . � .. .SignaWre . .201-1000 Amp.Undar 600 V . , . . . � � �� Over 1000 Amp.or Over 800 V ... , . . . �• • •'� Exemption(or Reg.Moinf.Elect. � SINGLE FAMILY � Temp.�Power Pole 8 Appurtenances - � � � • 1 9 1.4 6 � . HOME OWNER-BUILDER DECLARATION Sign wilh One Brancb Circuit. �, x � I hereby affirm that I am exempt(rom the Coniractor's License - Addirional Sign 6�anch Circai�;` ' � �. • • 1 9 l,4 b c�. Law for ihe iollowing reason(Seclion 703I.5,Business and ' ', Professions Code): � � � � ' I 2,�4—.8 7 ❑ 1,as owner of the property,will do the work and the Misa Conduits 8 Conductors � � � ' s�ructore is noi iniended or offered for sale(Section Other(See.Comple�e Fee Schedulej_ , . . . , . � �� 7044,Business and Professions Code). �. � CONSTRUCTION LENDING AGENCY - ��, � - � � � I hereby affirm thot there is o construc�ion lending agency for � . 1he performonce of ihe work for which this permit is issued � PERMIT FEE . � � � � ��(Sub-Tolal) � � � - '�, -� � (Sec.3097,Civ.C.�. � . � � PLAN CHECKING FEE � � ' � � � ' � - � � ' �� � - � � lender's Name �� ' PERMIT ISSUING FEE � - � � �O �j � � �� �. Lender's Address � '� . I certify that I have reod this applicarion and atate�hat the � .TOTAL PEE . . . .. . - . ..19�� [y � . �� . � � above information is correct.I agree fo comply wifh oll County . �. � ordinances ond 51ate laws regvlo�ing Eladrical wiring,ond � . . � � � - - � hereby ao�horize representalives oi Ihis County to enter upon '� . �he above-mentioned property tor inspeciion purposes. SEE REVERSE FOR EXPLANATORY IANGUAGE �.��Aeeo, �.en,.i,rri /Z/-�7 ' gnalore of Permittee Dote - � ���. � � f�� � � F: .. � L I , r. . . ' . . , � . a ... .. ..[ ..i . .. .. .�H. �. . . �` . . (' ... .. � �. ., ., . . 1� ..; . . ' � .. . . i .. � � 1"-i.. , 'f". �. �"'ti. c�,1:�� � �.�� ,.: ��i ..., , .� . _ ' ' . ., � . .. , . . .�. r_,.._............._�. _�._..�..__... '� � � . �rc . _._. ._._._...� � _._ --S�GNATURE�� � ' F;'�`h�NER-BUILDER DECLARATION .. ! APPROVALS.. , -�_�' -___OATE.___ _ . t -' . . ; a � .: -, -- . —� - _ - � � '` � UN�Ei`iPOwER PO E - '.- �--- -�- --� - � � � �� I hereby affirm�1hot 1 am e empt�frOm 1he Controeloi s ; ��1 '; TEMP. , " _ ____ _ _ ' __ -' "_ .. ,• .,I ..licenso�Low for,the.following�reo;on (Soction�7031:5, � "- ' '--' " "� "��" SLABWORK ���: �� ..; � ��� � ' ` 8uslnesscr.dProfesslonsCode):Anytl}yorcoontywh7ch � __ ..�. ., � .. . . �--- - � ----�-- ROUGH CONDUIT ,�,� `�f�, � �� � ,,, ,. ,,, . requfros apormif fo consfruc�,al�cr,Improve,demofish, � T-.. ._._. .,., _. �. .. .. . .. �_;.-.--� i ��. - � • . -,:..�or-ropaic.anysltucfurc,'�pr7or'fo�Ils Issuanre,�olio'r¢- � , \,.. , . ... .�. :i.' . ' ' �"� ��-I WIRING'.�.'-.-- ---''. ', � �� ' .,.,, : 9vlres ihe appllcvnt/orauch permlt fo flle o ilgned sfafo- , -._•_ ___�. '-_. ' �� ^��� ;-� � . „ � , "�-----' ---� ``��� at6sfs71cenaedpunuantfo�hoprovlslonsofthe . - , . FlXTURES�. � - . . ment tb . ;' -- -� - -"-'... __ . , . �., —�- ' -" -'- . �' --_- ..._ ' ntradori fcertse.[aw Cho ter 9,(commendn wHh i Ca L i :.. �� � - � _"'_-'_` '_POWER AUTHQRIZEO -�_.. - --.-- '.- --'-.--', 'r.".��'.� . '� .'... ' ��� Sedlon 7000)o/Dfvisioq]p/thc 8usiness dnd ProSes- ` � . ' ;„�. ,slons CodoJ or,lha�ho ls exempf lhere/rom ond fhe 6azis� ;__A________ LITIIITY_CO,NOTIFlED':;:.: ; �� ' i : _.,.,,for.fhe ol7egsd.exomptlon.�.pny vloloNon�o/5ecflon -- _' � FINAL ' '�'� ' �-. `3 - � ..-..- --'- �� '"'i "�.;t` � '.'�� ,..7Q31.5�by ony oppllcanf lor a perm�t subJeds]he a�pli- � __ . .___-.._...__.. _ 11�cr ort rOn�;�.. i . . .____._�.��_ ._ •'��� ' cant fo o clvll penofty o/not moro fhon Rvv hun red 1__'___^ „'- NOTES ��: '.. � i .�- ...'` i dallars(S500f.: � ; . _ - ___. .___ _..__._. .- � -�� � ,..;.. . ,.. .�.,i; ---- ---._ .. . .. _.' . ' �;-,� ^ `�„'= ' -^."� ���.� ''� . ' ; �' �. . ......�., .......� � :.�.;tha str�uci ro i nn trinte'nded oroffared fo�saleWork,pod � � . ... _ � . . .. . . �� "�� � � " ' �� nc___ �, .(' ; .. �„(Sec,-7044,Bvs7noss ondFrofeseions Cade:��The Contrao- . " �+' :� '�- �,�_.i_�, i � � , ..-_ „ .. __.., ' - - - - -- - - ' � ' - : �for's Llconxo Law does not apply b an ownar o(properly � _1"`� . ' �; � i��� � ' , •-'�f � �� � � . ��i . ..�, i.' . _ :,y_ c,.,., . � � o�does�suth .. �... ._____ _._ . '_ ._ .__ ' . ... _.._"_'__'� -._. , .., , .,,, . .t . _'_'� , i -... • .. ; , tnfendsd��roffercdo�sole.�(�howevq�e�enlsarenol � - �-� � o bu!lding or A~ V�� - ! � �lmproJement Is�so1d wuhln ono yavr'ol compleflon;the ��' i I - . ''� , ' � ' � �' -owner-bullderwlllh'avofha6u�donofprov'Mgfhafhedid � � - � nof butld or lmprove{or fhe purpose o!sa(e.) , " � � � � , � i : �____-�.� � . �" ' ''---_''• • �, '� .� _. ., _ .. �-�� ,. . ,. i . � -�--._. '__..---- � . � . �. ._-- � -- �. ,__ , � ' � . '. I am exempt undor Soc. , � ------- � �..._. . , , . _ _ .. . , _... .. - - --- -- • . , � - -' B&P.C.for_this rcason ' .. ; ; � - _ _-- . ' .• , , I . „, . . .� ' . , I .... ....: . .._ ,_. -� . ._ ....--- -- . ___._. ... .,,. . . .. � _ ' " � " f . � ' � ---''- ._...._. - . -.. _. __... ... .. ik '� ' _'_""_ __ ' " ,.�.. � � ._ DOfB _ " � _ ._ � , �, -- i . I Owner . . ,. . ,„�. .. � .- - `-----�------ .. . ., . . -r � i� � . � . �- „ , ,. � � � .,'�.' .. . , . � -. .• '--- ---�--- - -----_. ._ ��� � , - .�_ ....� . 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