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HomeMy WebLinkAbout1807A WORKERS'COMPENSATION pECLARATIQN� � �. 76n563 1,Oie1 '�,AP�L,:'C�TI�1"� FOR LLE�TR"�CML^,PC1F�'T � � � I hereby affirm that I Nave a cerirficqte of consent fa self CE�WG . , ., _ , � nsu a ce t f cate f w k Compansation ins��ance; � E COUNTY OF LOS ANGELES BUILDING AND SAFfTY , ��( c r e o t ereo c 3800�La6 C.) �� ' �#l�, � W ���� � �{,�p� �p �� . ... . Po�t�o . � o pany�*v��-+-���i,�-rr ' - �. fOR APPLICANT'f0 FJLI.�IN P.' . � - JOB ;1+'�j �r /1,�..,,,,/�L,..,Y-�,V� � Cerlif�ed copy�s herzby furmshed . , ; NewResi�lenhal�Bldgs.$�°��Cj ' EACK NO:���. FEE.� /+�DRESS {� L L-(l[3t'fG � '�� . I 8 2-Family,Sq.R 1L6LL_ S� . _ $ LOCALITY. Q 1�.�(�,"�" . ,�Certified copy is filed with ihe couniy 6u Iding inspec• � , = n�nde�p�aAmenf.. , (.- (� . Multi-famlySq.�Ft. {R055557. .. . . � Dt1ie�`�-?`��Appl cant�a���;�"��� Residential Swimming Pools FlRM NAME . . -L =�LERTIFICATE OF EXERAPTION-�FROM WORKfRS'� - / � � L �' �'�_ :MAIC� f �� (CL. �,µ� `� `� ���: ± ��COMPENSA710N INSURANCE - Outlets:'Rec_LigM Sw._ -ADDRe55�i�� � �Th�.� it l�� '- r F�,S�so —��t. �-Y1Q 5�3- Th`is aeciion neod notha com lafed if'ihe workinvolved b � � , �ITY ��Tel.No. fhe permif i4�For orre hundred dollqrr-($100)or'less:),�� .Y TAtal No.� � �.� Additional � 1 cerfif ihat im7he erformante ofl�ie�work for_whi<R ihis - . � _ �P�ANCHECk -� Y P . '- , - APPLICANT . perm't is�issued,I shall noi ernpioy ony�person ro dny anner . - � � so�os fo become sub�ect to the 1Nprker;'•Compensat an Laws. Lighting F'xtures Firsf 20 ADDRESS � -� - - . . � '.. �. � Fotal No.� �ddilional . � � � '��CITY TeL No. �ate� � Applicant� � �.� � . Fixed Applionces No7 Over 1 HP �- - PERMIT:- �L I— � NOTICE TO APPLICANT;'If, after moking this Gert f¢pte�of � � APPUCAN7 ���T� C«{�, � Ezempfion, you should-�become Su6jecf fo ihe;Wbrkers' � Rqnge_Heater_D.W._ � r�C. /�,�p .Compensofion provisionsafihe:Lobor'Eode,yoa musl forth- . Oveo _�Dryer�—W.M.-- � � ADDRE55'75GJ���.�{.�. .,'-""���• w�iih comply with such pfov s ans-�.or� ihis peimit sholL be 7ap _fAU —W.H.--� � � � deemedteuoked -� -�,� Hood _-Fan �_Ofher_ � tYTX-�������� - �Tel-:�No.��2(8) ' � LICENSED CONTRACTORS�QECLARATION�- � � � � �� ' � 710ENSEOR � �( �7 � I-�here6y affirm fhat I gm licensed�und"erprovisions�of Chapter 9 Disp."—Room A r Cond.`--� . . .REG.-NUMBER- "I'�O�� � �-� -�C�ass.-�:.lQ.-- _ ' (comrtiencing wifh Seclion.70p0)of Divis on 3 of the Business -�� �� DISTRICT NO. � � . PROCES ED BY�� _ �, and Professions�Code,and.my IicenSe.is��infulltoreeandeNect.. PowerApparatus$Large Applionces� �. . , _ � � Size 8 Type HP,KW,KVA,o�rKVAR' - � LicenseNumber �����2LicClass ��� � . UpiollncL.�� . . � � FINAL . . . . ... . . .. ., V ' E�I� ���C. � . . .� S�J..C'.,_83 Over 1 fo 101ncL � � DATE s/�/�r��. ._ AUDATION Q... Coniracror . ' Date _ .Over 10 to SO�lncl. �C � - ' � �� �" � '❑ � . . � . . ...�.� FINAL .. . . . . . .-.V I am.exempi unde�Sec - Over 50 to 100Jnc 8Y ��., � � �B.$P.C.for this reason - . . Over 100 �. - � Z ;".'.' . . .. . . .: Date: Services.Swbd:,-�AACC&Panelboards. ... .-. _. .", . . . . . � � . � -0�-�00 Amp.Under 6W V, . , � � � � Signature ��: 201��-�1000Amp.-.Unrfer6f16V �. .. �. . ' . .�.... . . � � - - �Over 1000 AmP.or Over 6W�V . . � . . c j ��.!p . ��. Exemption for Reg.Maini.EIecL � - � � . � � � ����. � � ��a•r..e a� � � �SINGLE FAMILV � - Femp.-Power Pole��&Appurlenonces � . � � � . � HOME OWNER-BUYLDER DECLARATION � � � i •��°��J.�� . S gn with One 8ronch C rcuit ,� � I hereby affirm ihat I am exempf from ihe Contracror's License� Additiorcal Sign 9ranch Qircuits � - - � - � � -- - a o o���,'� �.� Law for ihe following reoson (Sedion 7031.5, 8usiness and . � . . Professions.Code): .��� � , '� � . � � � ' � � . �." . � N�:sc�Condu'ts&Conductors :.. ..- . . . . .... . . . - n�•�7-�.'�. .. I,as owner af the property,will do ihe work and ihe� , sfructure is nof�intended or offered for soie(Sectiorr �-, Othe��(See Complete Fee Scfiedule)_ ► � - _ � 7044,Bus ness and Professions Code). � � � � � � �G�ONSTRUCFION LENDING AGENCY � - � - � � � � - � - � -� I hereby offirm ihat there is a cpnstrucYion lending pgency.for . . � � . � ihe performance of the work�for w6icFi tFis permit is issued �PERMIT-FEE - � � � .(Sub`-Total} � � � , - � � �- (Sea'30ff7,Civ.C.). � . . � � � � . � � � - � � -. � .. . . ..-. PLAN CHECKING-FEE . .- . . . .. -. . . . . .. , . Lender's Name� ���- . ,�. � .. � ;/D . . . . _ , � . � � - � � PERMIT ISSUING FEE � �. . � � __ lendei's Address �� � � � �� '-.'- � . - > I certify that I have redd ihis.application anil state ihak� _� TOTAL�FEE � �.�,/I �. ', _. . ., above informafion is correct.I agree to comply with all County � � , - � . . � � �� - ardinances and State laws regulating Electricol w ring�,�and . . _ _ - � - � � � -� r hereby authorize representafiyes oflhis County fo enter upon � � � . - . � , � . � �� � .. ihe o ove-mentioned property forinspe hon purposes ." � � � - , � �L1LDf/�/�(L/��/J�-�U���S`��,j . ���:..SEE RfVERSE FOREXPLANATORY LRNGUAGE� . .. . .. . . . .. . . . . Signo�ureofPeiminee � , �� - � Date��- � � - �.� - � . . - . � - _ _ _ �. ' .. . � .�,. ' .:: ,..- �.. 4 `,' . . .. ...�, , ., ... i � . >, ;.�. � . .:.. � ...: � .�,. 'a �� .,. ..,. w :: � _. „ �,tw_x i. . , . .,., � : .e R . . �w .. . . . . ' . . .. .�.. '.. � . .-<.�_. 3 .. .�. . . s § 3 .. . � .,� .. . . �'.-4. .• S . ° �:a JYPPiFbVA� DAT�- .. ..,'S7GNR. RE '.. ."_ " .-.. , .��.' „ �':' ,� 04VN���U ILDE7�DECIARATI�1 " r.' ,t;a.�. �� � � - ' ;TEMP PDWER'f'WLE �,;;.��- -�;^ .�,�I, 'S,;'�� ` �� ' ` � ���;� �hereby crffirm th6t 1 a�m.enempi from ihe Cohiroctor's I ''..... ..�.. . . : , ' - • •. - . .—. "� . ` '. � ,�-.... � ��.. , A. �.,Lisense Low,�or tbe following reps9n (Sectlon.703i-i5; � UNDERSLAB WORK � ..� .' ,. , , ' . .. ." . Suslness pnd�Professipn3 Cade):Arry city or county whiefi _ � - � '�" ' ` � r,e i1�r 'n'ermi,til4 tonsfruct altee,�im rove,demolish. - '.., < ROUGN GONDUR - . �.. . , �:., .�:.._ :' .; q �s P ,: P . . � � ' . .::� � �� ' •,- . oc'�" �tr'any�strUc°t�r'e,p"nor fo�It"s^lsstiartce,'of5o�re- . � �� ahIIkING '-� .. �� ��"' . . � . . . . 1: y � , , „ ,� , ,., " �, . , , - quiroalhe�plica�lfOrsvchpermlt.toiile.a-signadsfate- i � ., . �:_ p�x7'URES . ' . .. � . : .. . ...... d p t h p f h � , . ment fhat is•hcense ursuon �o t e rovlsions o t e . �, ,� � . ;��, � � � � , :� . �CoOtrottor.'s LiFBrlse LaW(CFapter 9{commencing wi�h . - �." POWER AUTHORiZED " " �-" � � �'� � Setiion 7000),of'Qivisiqn�3�of the Business and Profes- � � - - � - � � UTILITY CO.-NOTIFIED � � � '� � ; . .� sio�s Code}qr�tNc{(he is exempT tli,erelrom pnd the bpsis � '�� � -� � ` . . for:_the aHeged exemption.,Any.vlolatlon of�Ssc}ion . . . -. FINAL-......�- .- n .. . ;.� °, �,-�' � �.�7Q31.5 by�anY:app�cant�for a�permlf subjects the dPP���- . . ... . . �Gn.fer,e.rs�eilitE „ . . - "-�-� � `� `, , -�• -mni fo a clvll penalty o$not more fhpn five hundred� . ..- � � .ND7ES -. � . . � .' ... doltars($S00).: � - , �';'t� _ i ; .� . ' , .,.. � ..�I,as owncr of the:preperiy will do the.work.and . ' � '..; _.R '. � ,. � . . _ . � ....... - ... . � ( � ' .not iptended ar offered for sale. .�:.� . ' � .`;.�`- : ...+... , : �.'4;" "''� � . � .. � � -��.-. '., � tSec.j7041 BosihessondPro�essians�ode• iheContrac- - - �: - -� �•�� ' � ' - � ����. � ' � '� "t6ds 4icersse La4v does nof apply to an�owner.of property ` � �.` " ^ �`�� � ' � � � ��� ' � - who bullds ncJmproves rBereon, and�who does such, , ` � � �� .. . . ., . -�•� �.. . ' . .���� . . - �'��..-. ::� . � work hlrriself-�proVlded,fi�at suefi improvd'menfs are nof -� ..� . . , � . "..�.. ... .'.. . .� . � -�'��inlanded-aYoffered��ior inde.If,bov�ever,ihe buFldingbr , . �T� .. .,�A �� � . - � � � �imprdvemeniis said wHhin.one,year of eompletion'r��the . �' � ' � .�. � � � . �- �- . � �� � ' ' '�'oivner-buNderwiifh6va��1he6urdenofprovinglfiuf'hedid . ���' �� .,^� '--�, `- . . " . �� . � ; �;`��. ..' � .-. . � ;no,f.6uildorimprovefor;'I�bp`u�Poieofsale.) � � ,. . . , _ _.. . .. ... . . . , ,,. , ,. � . ,I.am.qxe{rtpt under Sec,� .� � - -.. . .. _ .. . .. .. - .�� �� .. � �. , . . . . �. � .. . .. . .� B.R.RC..far this reason � . � . . � . � � . . �, .._. _ .. . . . ., , .. � -:, .. Dpte. � . � ..� . :. , Owner _ .. ,_ • '. _ .? ' •',- , . ,.,'. ,;. . ,,, . . . .. � � . � ' � � � - ' � , . 'ti\� - ' � ._. ...._..: ..._..... .... _.... .... . . � � � . .� - . .: � . ... . . . . .. ' , . � . . . '. �c i� . . - � . � .,.. .._...�.. .. . . . . ... '. � .