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HomeMy WebLinkAbout1808A ,.�. .... . . , i ' WORKERS'CdMPENSATIONQECLARATION � 76A6E3 io/8i APPLiCA'�l�I�l f�R ELECTRt�+�Al PE�MIT " � � ���� L�6ere6y affirm that I have a �ific'pte of consent to Felf � � . . � insu e a certif cate`of Wolke s Compensp�iv�Insuronce, , �'�� �OUNTY Of L�5 ANGBlES ' BUIL[fING AND SAFETY ��or cerlf c ihe�aF ygppb,�,�lo6 C) ��y�/ypy� ��-� � ��j����� `A��+-'1�IG��i_.. � FORAPPLICANT70FILI.IN'` , ... . .108 /+ ^,�,� . �ty o Co pa Y -.. ���..� �r trr� 1/f �L�.�s� Certrfied copy is he+ebp 4urmsFed .;. New Residential Bldgs &J�QI.5�� EACH NO FEE � ADDRESS R�Ce hfied mpy is filed with the�.couofy buildmg inspecy 7&�2-Family.Sq:Ft.�t-+� = $ �LOCALITY Q� . . � � tion-de arfinen�. � - i � � Mul�i-fam ly$q�.Fi.�_ "NEAREST , . . �j p �y�� PP } ' �7 p(��� Residenfial Swirriming Pools���� OWNER OR. �.. �Dole�S�"'�.S-GC7 A licant�l����i."-"^„' � �.. d , : - �FIRM NAME', � 'GERTIFlfATE OF EXEMPTION FROM CN�RKfRS' � -� � � L "�:�Mnfl /� f�4� ��}��),, !�� � - � � COMPEh15ATIQNtN$URANCE ', Ou?�eK:�Rec Light Sw. . �9 . � IrADDRE55C,:._.��1 ����tT�'i cJ�� '�E� - FirSt_20 �� ✓ �y� � (This section�nsed notL'e�cnmplefed'.if 1he�work�iyrolMed by Total No: - � -GTY � Tel:N�.- � � � fFe permif is�for ooe�hu�dred ddllars{¢100)or:l�3a.)`�� � . Additional '.�"L` �� . I cerri rha}in�rHe` erformonce of�?he work'forwhich�6is � . � . � ... . PIANCHECK''- � � - fY P . . . �.APPIICANT.- . . perm't rs rssoed I sholl n�oi emp7oy�onyperson m any manner - .. � . � � - �so as to became sub�2ct�tb the Workefs"Compensation Lwws � L 9hting Fix�ures First 20 � �ADDRESS' � -� . .. �. �� Tolal No. �� �.� Additibnol . . . .. .�., �� . CITY- Tel.No. Date � Applic i , �� �" Fixed Appl ances Not Over 7 HG � � . PERMIT � NOTICE 70 APPLICANT:�If oft r moking th s Cert f cate of � � , . .�'�{�� ����G - Exempt on .yo should��.6erome s�b�eci ro the-Workers' Range=...Neafer_�.W:— � AP7LICANT . Co pe�nsolian provis ons of ihe Labor:Code,you�rriusi��fortk-. � Oven�_Dryer-:_W.M._ � � ADDRESS �.�'�.'.C'-�.� _ �7 . with comply'wdh such�.peovra ons.�oF iN s permit.-shall be- Tap,-�FAU `_W.H.— � � �.deemed revoked. .� . �� .� Hood� , � . . . . -" � CITY�.�`�'��.� .-.Tel.N --`Z18� . _Fan -_dther_ � LICENSED CONTRACTORS�QECJARATION. � - � � -uCENSE OR . ��.,p�j��� C�_,.J.Q ' 1 Fiereby.affirm that I�am Iicensed�nderprav vons of thapfer 9. Disp: _Room�Air Cond. _ �:REG.NUMeER �) "i C�pu. (mmmertcing.with Seciwm7000)of Division 3 of the Busine§s � � - � �ISTRIC�NO , " PROCE D BY and�.Professions Code,and my I ceose�is in fuil furce and effe<f. PowekApparafus 8 Large Applionces�. _ , . . � „ . �,_ . : YQ � � � - ! �J�, � . �,� Size 8 Type HP KW,KVA,or KVAR� � . � Q License Number �•��"'"�Lic.Ciass V. (fl. � Upfo]IncL � . - . � FINAL . . . ` . � ... V Contra<tor��i +���'L ��ate ��G7� ..-.��� . Over,�it9)Oincl.:� ' � DATE j�^ O_ �. .,. .. VALIDATION. Q ❑ .,Over.70fo501ncL .. FINAL - � .. I am exempt upder Sec � Over 50 fo�1.00 Inc. � .B.Y_ � _ , Q � B.&P.C,for ihis reason � Qyer 100 . � . � � � Dote: -� Services;Swbd.,MCC&Panel6d8rds . � ,�-► � � - :- , -� � � � � � , 0-�200 Amp.Under¢00 V , , sy�or��e ,, 2oi-i000 AmP.u�de;aoov �i 8'4,8 A Over 1000 i4mp'.ar Over500 V � . �� Exemp�ion for Reg.Mdin�.Elei�.-�� . � . . . �. .. .. . .. . .. . - �,.'�a e e a �2� � � �SINGLE FAMICY�;� � �� iemp,Power.Pole&ARpurfenon.ces - � � .HOME OWNER-BUILDER DECLARATION - �-� Sign wilh Ona Branch C rcmf � � � •'��g'.�`� . �1 hereby.aflirm that I am ezempt from ihe Conhacror's ticense� qdditionol$i n Brpnch Grcuits -� - . . � � . �.� � Law for fhe following reas6n($ecfion�7031.5,Buvness and , . , 9 � -.. � , �:Q,;};>�.'�-- . Profess'onsCode): � -.� . � � . , ���. � .� � � . ❑ I,as owner af fhe property,will do the work and tbe Misc Candwts&Conductars - . . . � �� - - �� - - � � � U 4,4'�-g�J � siruc�ure is no�intended or'o$ered tor saie(Section I P e e)_ ;► � . _ Other See Com I te Fee Schedul . 7044,Busmess dnd Professlons Code). ,, � � � . � �� � � �� � - ��'CONSTRUCTION CENQING.AGENCY . � . . � . � --. -� ... �, .�._-. I hereby affirm-ihat there is a construciion lending agency for . � � � . � the performdnce of the work for whieh this permif is issued -PERMIT�FEE � � � � � �� �- -{Su6-Total) ��� � -� � �� � . - . . (Sec.3097,Civ.C). � - � � . � , . . . . . ... . . �. � . . . . . � � PLAN GHECKING FEE �, . � .�.. . .. . _ � � lender's Name . . .. . � . .. . : � �D . . �� ..� .. .. . - � � - . PERMiT ISSUING FEE . �. . � � Le.nder's Address " . � : � � � �� � - � ��-� - � I cerffy that I have iead ihis applica�ion and state..that�the TO.TALFEE � � ,. .,� -.� � � �. _ _._ abov mformmion is mnect.I agree to comply with all Coumy . . ., . . � ordinonces and Stote laws regularing Electricol w ing,.and , - . , - � � ' � . � . . v .hereby authorize represeniati.ves of ihis Cour3ty+o�enier upon . . -. . - -��- � � � . � � � - � � � � �" � � � - the bove-menti d property for�nspectwn�purposes � � ;���SEE REVERSE FOR�EXPLANA7ORY,LANGlFA1GE � ,�] ane ,C11�.o`�����=k- �'�-83 Signoture.af Permiiiee . � � Dafe , � � � . - �. _ � � ._�� . - . � � . . . . . � . , , , . ; , ,. . � '"� � . ,. t , . .,. _.2. _ APP s $IGNATURB ��.._ .�.� . , �R-BUILD , ,,.� __ �., . . � �OVaC5 ��` �DP.fiE�.,.. ..,��" .. .,, �,: „ .�. _ �•�� ��b�EUkRF�.TJOfi" - �` � . ��� �� -TEN6P.PbWE'R�ALE�J . v. '"=' f � �` .� `.,. �" " ' , a�herebX affirm ihat I am�ezampY��from'fhe Cortracior=s � � � �, UNDERSlAB WORK . ��-" .. ,e . .. . _ ���-� - �. �...4icerase taw 4qr ihe followi g reaso�,(S�dion 703I,S`, . . ..-.._. �.�.... .�_�_.. . ... � � '.. -Business ond:Profesalens Code:Art ef� } y y or counfy wHtch . ' ..;;.� ; ,�.�•„ ,�?�f(OWGk,C#.ONbUR ��.. '. � ..,. �..-' , �"` .. �� �(;, requ4�gsqp ,�t fo co�nstruct,after,]mpro.g,demollsh, L , . � � � or��r"a'paTr an��si�uCiVre;�priBr Ta ris-tssvance,a{so�se- _ _ :WfRI�IG � , qvires�fhegppllcantforsuc6permi�tof'rfeaslgneds+ote- ., ,,, 3 _. , . k� ,'.. ��� �s'�Q OWEREAU7HOR12�D � !�� '..�. �� +. ' ��,. � Section dF�L��Divis�o 3�of the Bu@provisionsofthe . . �> ;,.Conf p (go,mmenHdg.wlYh� , �� � � � � �� . 00) ifness ot1�;Profes- . � � , � �� �� � : � ' ' ' , � 'f� sions,GpdeJ or:thot he is exampl.iheYefrom and ihe,bosls � �. . �� � � - �� �-- -�UTIIITY Cp:�NOTtFIED - � � ; �, ' � � ': fo�.the.aile�/ed �xemp�tion. Any.vlofotlon of Section '� � �+ `c� .. '.`. ° .��7031.5 by..any opplic6nt for a pecmlt.subjec/s.the oppfi- - . . . � FINAL � � G-nl�¢r on,.y�ranf ,_ . . � � � ' . cant to a c�vl/penally of not more thon flva hondrad . � -.NOTES � � � � ddllara($500)..:.- L �, .. - � � -�j a � ` ' " � �� - . ❑I,as owner af the p�opsrry wilf do the�work,and � �'� " .� `�� �-, "� ���� - � '' fhe_shuafqre 43 hot intendW.or offered For sole. �-.- ��- �i, . . � ' �..,`.. ` �'� .. � � . �. .. . ....(3ec.X04{�8usf�iessarrdProfessiensCade. TheContrac�� e..�;4 � ` �..�.. r � , . .. . .. ' ..+ :...' � �� . . �r:.. . � � xors ticem3e iaw does»o�apply to an-owner oi propacty . � -r..� '..� .' '�-�', .. � .. . � � .. `... �. who buifds o�irriproves thereon,and-who daes such •�� ' - "�''�• •�� �� �.� -� Work h7mselt�lidovidwd ihi5f such�imprOvements a�e not . , � ' . .� � ,. ..' .' -- � " �..�)ntended.4r offered for�sofe:lf�,howeve�,fhe�bui(ding or _ . ._.,. . . . . .,:.. - � _..... . ...,.. . � ' '"" � '- '' �' � - �� ` �improverr�ebf�`fi soid�within one year o4�complefion;tiie ...--` ';. . . .,�� ,.<; " . . , � � �.�����i��j�� . .ownervhulldeMwlflfiavetkebuttlenoiprovingfRofhedqd . ' ��� ... _ . �. �� �. . � �:: ., . . .:.:: . mprove dorlthe purpdsg;of safe.J . ,. . ..., .::. .. , ..._: ... na86ui(d orr��.. . . .:. . _ � . �;, . � - � �� . .. . .. � ..�.. : . . � ...�. � :�., . . ,� - .. . ::1 ari{axe�pf underSec: .� . ; � _. _, . �. . � . . .. ..� .. .. . .�. . •� ..� �. � �� .B.&P.C..for fliis reasort � . . -- �.._. , .... ._,,.�..� . .. . �—" .�� ,.,:.... .. -. � . ' . _ . . .. . . . . . ....Date_ . ..�.._. . . . .. .. . . , . . . . . . . . . �., . �., . .. . . �, - Owner . _. �� . . � . . � . . .., . . . .. . . '.. :'. . ;.' . . �._- .. ' , ., �'.. . . . . . � , � ... . '�.,. � . . . . . ';� i