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1809A
_ � '.. W9RKER$"COMPEN5ATIONiDECLARATION, � 76Ah63 .70�87 �:A�PL'���Tl��� ���R E�L�rRr�R��L�L���-P�RIY�I'I'T .. � . I�hereby affi[m thot I haJe a cert ficafe o#c,onsenf to self��. �����'�r���'���`��i � . . _ '� ins�e,or a�erifi�ate of Worker5'CompensoNon Insurance,` ��, COUNITY OP LOS ANGELES BUILpING AND SAFfTY a t f d o y her f 380tl,La6 f - r � � - L � �.������ /'/J _ ��y�o. Company ��� , t"�*'- . ... fOR/1P.PL{CANT TO�IFl�1f�'�� � J08 �.�-�.7.1�_Q �/9,��(��,�� . Ce��fied coPy s he�eby fumished ,,-. . New Residenhal Bldgs. � Fe� ��.. ADDRE55 1� � (.%r VT'TL.Y ��� � . �Certified co ii f led with ihe cbuniy buiJding nspec- 1&�2-Fam ly,Sq.�Ft�,� — $ " �� LOCALITY '����-�" _ � EACi-I NO ��, tron�department ��� � � � - MuHi-fesmily Sq.�Ft. � - NEa.Re57 M CRO$fr SJ. �- �,-��' -- � ���� ��?��-'1.� Residenfiol5wi.mmingPopls OWNEROR � �Data A'PPlicanY . . . . � �J.�_ � . � �CERTIFICATE OF EXEMP7fON PROM WORKER$'� �_' FIRM NaME� � YI�1 F' - �� � Outlefi(.Hec�Light�Sw� -'MAIC �e7 �A�, �'� " COMPENSATFON INSURANEE• �.* � � �� - . � - auDRa55G�E�I �, �l/lJ .� ThlrsecTiod�nead not be�Oin laTed if ih•o work'Iifvolvod b Firsf 30 � P � Y Total No. Additional -- - G7Y.,.,� TeL N .- �� � � 'the permi'rt ie fur one hundred dolkrs-'(5190)�or fess,)��` �.� . , ��� � i.certify that in the per#ormrinte�of the work fbr-�whicfi�his � � . PppN�H�iK . . . " . , � 'peimit�5 issued;I sholl'noi employ ohy,p�rson inany mpnner �� � � � � � �.-� . � � . . ., � - �so��ns to become subje�t to�the Worke'rs'Compensa.fio"n Laws.< Li9hting Fixtures First 20 -ADDRE$S � � - � . . . .. . . � � iotal No.�. . ��-. Addi�iona.l . -.�. : ,.. � . . .Date ' Applicaro � .' . ..�. . . . . . . CITY�'. . . '.: TeF:�No. � .. � NOTICE TO'APPLICANT;If��, aftr making this Certificate of FixedAppl qnces Not Over_P HP PERMIT �1 i� ����� �.Exemphon, ydu should".become sufi�eci to-ihe<Workers� . Rortge_Heoter_D.W._ APPLICAM L Campensafion provisidtisof the La66r�Code,you_must5orih- Oven _Dryer _W.'M:— � . � ADDRESS ' - �� � � � � 7�'��S—� A. C. with cqmply�w th such.prowsrons�or hhis permit shaVl be Top." _FAU �. —W.H.�— � deemed revoked .. - . ,,: '. Hood� � �� � . ��. CfTY���( ��l�,�o 'Tel N .,:. r.u; _ .'� � LICENSED CONTRACTOR$DECIARATION� �- � � �Fan � Other_ D's Roam Av Cond: � ' lICENSE OR p l9�il��7 ..Clpss�:.j Q . I hereby affirrn�Yhaf 1 am lieensed under.provis ons.af.Chopter 9 P' ` � — . - REG.NtlMBER �-CJ `Y L� . ( �g ) e Businesl power Apparatus.&Lorge Applionces . � DISTRICT NO .-���� � � PRO SSED BY . .�„ and Professipns Code,and m I rense sin full force qnd effect. � ,, � � � - - � - Y ' Size&Fype HP,.KW,KVA,or�KVAR Llc n eeNumberA ��I�����L'rc.'CI ss�� Up�to 1 Incl.� � .." FINkL�, � . .-. -. .. �'V Conlraciot�--�(�1��-- ���' Date �'��+���. ' :.�� Qv.er 1 ta 10 Incl� 6ATE. .��A�Q c� � � VALIDATION ... ,�p �.. . -� . .. Over 10 to 50'Incl . . , ' - . . V FINAL , .� I am exempi.under Sec ���,� - Avec 50 fo 100 Inc. . � BV . - Q '. B.&P.C.for tihis reason . ��� -Over 100 ; � . � .. . . y .. . . . . . � Services.Swbd.;MCC&Paneltioards . � � . . . .. . . .. Z , . Date: , 0��.-2Q0 Amp.�Upder bOQ V � � . � � -�. s9„ow,e zoi_.t000 AmP;u�der boo v _ _ �1,.�?0.�A � � -Exempiion for Reg.Maint.ElecF. �� :, . . .. . � --.. - . ..-:- - �.;�• ��s�d.•a - Over lOQO Amp:or Over 600 4 � ` � SINGLE FAMILY . � � Temp:.Paiue�Pale&Appurienonces. � I hereb affvm haOWNER-BWLDER DEGLARATION .. � � - � � � . � � � - .- � '" � - �j a'�"J�;�(�-g��j �� 1 t I am exem t from ihe Con}ractar's License Sign with One Branch Crrtpit . � . � � . � g ( - Additionpl Sign BranUh Circuiis� � '�. � Profes�ionseCodeWin reasonPSection 7031.5, Bosiness pnd .� _ �� � � �". � � - -��ee"�f1��;.�3-U� . � �� � � � � Misc��Condvits 8 Conductois� . ... . .... . . . . . .... . .. . ..-.--- .Q��,�Q?—��J � I,as owner of the property,will do fhe work ond the � � � --struciure is not intended�or offered for sole (Seci on �.. O�her(See Complete Fee$ched-uleJ_ , _ � . . - _. . _. .. � 7044,Business and Professions Code) � � - � � �� - � � �- � � - -CONSTRUCTION LENDING AGENCY;� � �-- .. . . � . � -. .. .. . . . _ . .. . . I hereby affirm ihat ibere isa consiruction lending agency for . � �� . � , ihe performance�of the work for which tbis permif is.issued 'PERMfT�FEE �� �� � - � ��� --�Su6�-Toial) � � -� � . - �-- -�� . _..__ . � (Sec 3097,Civ.�C.). ' � . . � � . .. � � . . - . . ' �. - � . . � �. � � � ..- PL�AN��CHECKING.FEE ._ . � . . �.. . . ... �. . �_<�.. � . .. . . . . . .. Lender's Name � - �-- �- ��. - .- � . � � . �� � . PERMI7 ISSUING FEE . .. _ � .j�, . . _ ,.� _ . � _ � � - Lender's Address . � � � . . � � . . - . . ..... . I certify that I have read`ihis appFicatfon and-stote ihafihe � TOTAI FEE .�, �.� � - - � . . above informpfio�is correcC I agree to mmply with all�Counfy � . . . - . � � � �- �� - � � � ordinonces and Sfate�Is�ws regulat�ing Eledrical.wiring,and � � � � " � � � . y otborize represenfatives of fhis County to enfer.upqn - �� .� �� � �� . � - --" � . � � � � � -� . - -� he�eb a �he bove-menhoned rope ty fori�spedion pulposes. � I � - � � � � SEE REVERSE FOR'EXPLANATORY LANGUAGE _ ���� ��� �T�L'J�. Signafure�of Permittee . � Date- �. . �� �. - � . - � � . . r?r� . .�°' . .. -. , ` ' : �� � � . . . . � . � „ �. :. , _ ,�,�:�. , .. , a..-,� ., . i � ...� , . � �. . . . _ . .. ., .. .. ,2 � - , .. . ._ . �^'.... .. . " . . . . .... �.i �_.. . ,�,.. ;` . , . � , „ " " ��SIGN 7UR� .i'' ' ' 'y F �W�`HUILt��RDECIARAT��hL . : i .. � -� s _.�... AP�ROVa1LS ��� . DRTf . -�... .-' . � '6�p, ,.. _ .... .... _,._.. � .. . . . � � ��T6lhP.'$61F,JE��4E ' �.� `,``: � "r ",� ��� �"`E�" ' �� � � I here6y affirm thot I�am exempt�from ihe�Conhacto(s � :.---.-. .-.. - .. .-.... � ' - ' �� �• � . � ,, - .._Licsnse�-Lawlfoe.The following'repson (Sedion 703C5i . �. . � ��UNDERSWBWORK ' :_' '..:. :�_ . .. _. .:'� , .�. . �� BuslnessandPro/essionsCode):AnycityoFcountywNieh . . .,.p '<�R6lfGF1,CDWD'l?IT . ���� ..�... �.....' ' '.�...;�, -��: , � ` ���.requires:a perrblt to construct,aHer,improve,�deMolish,� , r " ,;+; . �,-.� -.�.';�... � _ - . � ...:�. ' � ��� . ; �.or repo-i?-any'atnYcilY7e,p"rfn�-fo�i/s 7ssLante, a/so re- � . ��� � ;pWIRING ,—,�'jf�o.Q � , _quires.fhe�Opplieartifpr�sliCh�pePmlHofileas�gnedstofa- , � '� �" ' �� - " ' � " maM fhoi ho Is Geensed pUrsuumfo thr provlstons of�he �,� s^ '. `FWtTUR�S �,. �- `� `:: �. , i; � ; . . Co�7trocf9r;s Liearrse Law(Chaph�9(commencln9..with .. ir. � � POWER'AUTHOkIZED � ' � ' ��Sect7on,F000)of�tvisron 3 of t eBusfness.��and-Prefes• ' _� � � � J � � � " �� .- slons�Coda)or ihot he is exempt therefrom and the 6asi,s ,- .- . �-.. . ._ .. -.. -UTIUN C�:�NOTff1E0 � . .� -.; � - - . .,.-for.ihe�alleged exemption. Any.violotlno-;pf Seciion ' ' �/- ... -.".� . �� ,.":' .-..-70.?1:Sby�anyappf(eonffor�a-permitsublsctsihe;appfi- , HW4L _ , , .. .-� ..��- ��� � � �qfer on-�rt'ianE _..; ���� ' . ca»t to o clvil pend'Ity of nof mbre tFdrt five fiundred - ' . :�t - .. ` �_..�. � � � - , �. .._ NOTES _ ... �. . doliars($_S00).: . . � . ., - ...r � .� �,f�� � - �. ; , � . , Q I�,ag owncr.of the property�will do)he�work,o�nd � ,� ...__ ... _�.. . .,., . , . .' , � � .�.� , . � ��.-:1he suucture is not intended or offered fo�sole. �. . a..,• ;;.,.�- :'\��.�°'s . , , . . � '�.-(5ac.:7044,�BusFness:andProPessLonsCode:�_LheContrac- ,'-.,. y- v . � . ..., � ,,,. �, .., ... .•<,-. -.,. ' .-..... �'� ' . � �;.�'. ..' dor's.Gcense taw dcesnof applyto.�ort owner o1 propor0y . _" !:'S _. �:. �. ':!. s.. :�-.�;, ;". . '. ' ��' . � . .. . .:,... _. .-, ... t ,.., who 6uilds er.�mproves thereon, and�wbo�does�.suth . . .. . ... �.. . . ,._. . . _ . . . , �,..,.�� �. ����:, , '� � ��: '.... � work Fftnaelf rovided thot such�-improvemenfs are not � _ . P . ,, _<-. .._....-: ..-..:. . . �-��- ., ...... . `.:�a�rrended or o#faredi�for sale.If,.however;the build'vhgnr . ... ,.. ��.� � . . , ' � � ' � "��lrnprovement ls so�d wlihln ona yea�of�wmpfefion�,the � . ...�' _r` . � . ,�:..- -'�. . .-... � "'�`�'owner-bullderwi11ha4etheburdenofpeoving�fhofFedid . ��',-� � � � '�. . . :� . ,�. ,�..�, �.: . . ..-..: � � � .._..� ., _.. ._:._. -- � - �,.- ,-�„-; . , .�� ,nqf,hu71d ar improve��fbr§fhe pv?pp�e of sole.J . .. ��_.. ..�, � ... �.,_-. ,� . ,. � , ....:., ._,.� -: _ .�. ._. . ��..I Gm exem,pt-under Sac �--. .. . . , . � � r , , _'. i „, _ : __ .- .;.. . � t ,.�t �, .. ..�. . . - � .B.&P..C.for.this.reason . ,:... . . .. . .� ' i . -: . � � , �� �� - .. . i . .�.�,. , , . . .�,.. � � . , . ... . � . . . . . . ��,� - ,: . ..Date. . ._. _ . . � �. .: ;: ._ :. ... . : .. ... . . _ . , , . . , . � �. . . . . . ' � ., � . . � � Owner ' � �� - , � ..... . . .. .c. . .:�_., . .. .- �:. .�.�. . ,. - - , . ..� ,- . . . . . ,.. . _ . .. _. . - . � � � .. . - .�..'�, � � , � _.. ..,...._._ ._._.. _ .. - . . . . � .. -.,.. .. _ . .,.t�., . . , . .. . k;*�`.'.,:. . . �. . . . .. . . . ,-. . •, , . , , � . . ..�� .. ,,,,... .. , <.,.:. . ..,... ,..,_. . ��..,,, . . ' ' . ,. . . , . � - - - � � ., .:.,. , : . :...,. ..... � .- ., :�.� :: �.: � ..." ., . ,. . . .��. . . . ... ,. ':' . y.,.` , .;'. ��: � �. - . - . . . ,. . . ,' � +° . ; r : , •�. . . _ � . , ,_ ' ": ::.'.,. �- 4..1"' �_..t ,,. .-,.