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HomeMy WebLinkAbout1812A _ _ :, : , � � WORKERS'CQMPENSATION DECLARADON - ��"� �Q�87 �APf L-I�A r I�F� F�.R� GC��rTR�fCA�<R�RM�� � � � I�hereby pffirm ihat I haqe a certifico4e of cpnsent to self �I �. ������ . . .� . �.. . � . . �� -in5ure,or 4 cerhf'cate of Workers�Compensotibri Insurpnce, '�Ltif�� �/y COUNTY-0F LOS ANGELES � � - �BUtLDING AND SAFETY . . �� ��cer��Op�tn�re-a,�f S�yc.3800,Lab C.) .}�. ��� n�/�. ��^#!y .� ,. .� . _ ... . [�� o. � Cifmpan����"-�'"�' 'u"L ,. ` FOR AVPLICANT TO FIfl1N, ..'. � �. JpB � r e�� Q /+��.,�p� �, ��vp . ertified�copy s heYebx fumisked. New Residen4al Bldgs.$�P� : "�`LW N�- FfE�_ AO�RE35 �[�GJD'✓� C��f'�U�T�r C� 1 8 2-Famil 5 �Ff Si � � � LOCALITY` � �(�,-�" �Ce tified-mpy is filed with ihe cbuniy building.in;pec- Y G� � _ �. uondepartme�nt�� . � �� Mulii-fqmilySq.:Ft. NEaRESi . � �f�-�'��. ��.� `��y�! Residenfiql Swimm'rng Pools OWNEROR [�, - Date . ApphCant . . . . . FRMNAME� � .. LL.Cr( (�� ' � ��CERTfFICA7E OFEXEMPtiION FHOM W,ORKERS` � � � � LSw.L � � � - �� �'�� � �j�p� �y Ouflets:Re< Light aDDRE55-. -� �- �� COMPENSXaTIOA}`lNSURA,NCE� - � � � .� . ��� '`"CTY'[ . ��'�`L� �(This se�fion�need not 6B�rom lateil'ff ehe work.invoWcd 6 ' �� First 20 .. . P Y Total No. . CITY - �.. Tel.No. � �he permi�-ip'iorone hundred dolldrs��(5100)��or less.} ' . , . �.Additionol� ' � �� I ceriif-tFat�in ihe e�foimance of��ihe�w'ork'foi which this ' .. PiAM CHECK' ' � . �- . -. � Y P . . \ APPLIC4NT. � permit is issUed,I shall noYemploy anM�person�in any mdnner � - � . so.�as to beebme su6�echto�ihe Workers Compensdtiorv taws. Lighting F xtures � �Fir5120 ADQRESS` - � � � � � � . Totol�Na. .. 1 Additional .. CIiY � Tel.No. � � Do+e � Qppl conf � -- Fixed.Appliances.Not Over 1 HP . ' PERMfT �7� IQ�,�,- � ' NOTICE�TO APPLICANT:-If;�5fifer mak�ing this Certifiwie.of � � � � - qppuCANT L-1,1� ��l�-�--1 Y•� � � . Exemption, yd shoqld�6ecome�sobjecY ta �he�GVorkers� Rpnge_Heater�D.W�.— � - . , �. (G Compensation provisions��o"f ihe LaborCode,�Nau muat%forih- Oven �Dryer —W.M.�_ - ADDRESS�5 �-��- ,��y � withh compiy�wihh sucli'p . �. p .. s e Top� _FAU � —W.H.-- ,� � .���� q deemed revoked �'�°vvans vn this ermiY hall b,. Hbod _.:.Fon _Ofher_ - � CITY�'���Q.}-^��d��� �Tel.No:�j-�8- - . �..LICENSE�CONTRACTORSDECLARAT�ON �� �. � � � - LICENSEOR (_��A.q. � - ��v ��. I��h�erebgoffirm ihat I am licens@d under!prowsions-af Ghapfer 9 -� Disp. .��Room Air Cond.��—�� � �- -REG.�NUMBeR��. `TL.� -- --����'S��C� . (commertnng-wilh Secliort7000}of bi�..isiom3 of36e Business� � � � - � DISiRICTNO ���� � �PROC SED BY ond Professions.Code,ond my license is"n fu1!fo�e and effect. Power.Apparotus 8�large Appliances. �. . /j . , ._.,..�. � � �� �f Siie&Type HP,:KW,KVA;ocKVAR' , � Gj � (� � License Number �����^-��iic Class�—�� � .. . .Up to 7 Ind!���� � � - . . F,INAL .. . . . . ... --�. U �Contra<ror��'y �'eG'�.�Date ���Z+�7 C7� . -'T"�-'.Overlto)O,JML . . . . . - DATE- .'� �.� . .. VALIDATION � - � . �� Over i0 to 50 Ind. FINAL. r �❑ �I am exempf under Sec�.. � � Over.50 to 100.1ric.-. � BY � . . . ., 4, 8.8P.C.�for ihis reason -. � Over 700 . . � � . Z. .. .. . . � Dare. � ���� Services,Swbd j AACC&Panelboards � ... ► . .. . . . .. -. � — . 0;-2DOAmp._Under600�V� � -Signature ����. .� � � 2d1=100DAmp.-Under�600�V . . . . . �� .. . . . . .-z.'�.'��,j..g .%�}.- . � ❑. . . . �. .. : . �. . . .. Over 1000 Amp.or Over 600 V _.. .. . .. . . . ... . ' Exempiion for Reg.�Ma nt.Eled. � _. �#�s s'o�a o`f . ; - -SINGLE FAMILY - � � � � Temp..Power Pole;&�Appurtenances �. - �� � ' � 1 �' &V��•-� 1�� HOME OWNER-BUILDER-0ECLARATION. � Sign with One Bronch Cvcui�. � � y - I hereby affirm thpt I arn exempt from the Contractor's License � � ��- - �' . .•.�'�e o.``j� � Zr-i Law for the following reason (Secfiorr 7037.5,'Business ond' �dditional S7gn�B�onth GiicuiR� . -- - -. -�. . . .. -... .. Professions Code): . . . . - � � - - � � �9,Q.�r'-gi'j � � �. . . . . .� . . . . Misc.CondwS 8 Conductors�� � � .. . . �_ .. . . '..-.- . ' . I,.as owner of the properfy,will do the'work ond the Other',See Com fefe Fee Schedule_-� � � strudure�is not�intended�ar.offered for saie(SeUion ( P ) _. ._ � 704A,Business and Professions Cade). - � , ' � CONSTRWC710M LENDING AGENCY � � . . . . . � . : � � . ��. .._-. . . .. . ... . I here6y offirm tYipf there is a construdion lending.agency�for . , . � . ' the performance of the�vro[k.for which this permit is issued. P€R/v11T'FEE � - - � � � �� � (5u6-Totol) . � . - - � '� � � . . . _. � (Sec 3097,Civ.C.). . - . � ._ � : . � ; - . . � . . . . - . . . . : .� . . - ' . ..:FLAN-EHEGKING FfE _. �� . . . . ._ �_ .. . .. . �. . . . ., . �Lender's Name � , . /�. . . . . ... . . . . . . - � - � - � � _ PERA4IT�ISSUWG-FEE - - .. � . Lender's Address � � - . ,. / . . , � � I certify thot I�have read this,applicption.ond state.that ihe � -�TOTAL.FEE � - . � �,� � � � above information is correct f ogree to wmply wilh.all Counry � � _ � - . . �- - � � . � - - � .ordinances ond S�&te laws regulating Electrical�wiring,-qnd . . � � - . - . � . . . . . . . ., . ... . the a ove mentioned p y in p .,}purpose�� .SEE'REVERSE FOR EXPLANATORY LANGUAGE� � -' � herebyau�ro�ert forf ts�ecfionf to�G���, - � : . . . .. . . . .. ... Signoture of Permiitae--�`���C���Date � . . . . . . . . _ �. ;,� �,. ,.: ., . { ,�,. � SIG� ....` . - . . ��'> � -, . E ,. . . .:. . ..,...,-. , _.�_ � � - -� � �,�, , . , ",� ;`, ,._, , . . -. . , APp�b\/AlS DATE-, t �,i q i QYSfJ��BUII[iE�"iflECLFkh�A�N . ' � s . ,s . . ,..� _. .. . . '.. .__ NATtJRE ,.. . :. , . -- �- � � ,_'TEf.N,P,.POWERPLIIE �..,:, +,;;- - . �"� ', - .."+,�;� �� �' `�` I hereby affirm}hat-1 am exempt from ihe�Cdntractor's -� - � _�- ��--��� ' ' �� ` � "��- . � �' �� � �� �� Licenae Lqw;foc 1he.following,.eeoson ($ettion�703i:5, � . � UNDERSIAB:WORK �,; . � . , . � Business antl Professions Code):Any.ci?y or countywHicfi � . ..,. � �.. ROUGH C IT' . ... . . ' .. � �.. -. reqvf�'esyo�r�n,it ho.cdn'siruct,alter,t,rnProve,demollsh, � � '�'� � '�,. � �<. . : .� Q�� .� , �" � orf�polf any stfuc7uFe.�prlor to�ts'tssuarCte;�alsp re- . - � �� , ,..-. ., .��: �WIRING �:,:; �,., �.- � . �''. '� , . . qtitresfhe�GppReantfortuehparmNtofileasignedsf6�e- � ' FfXf=pR�S ;' . .. ment that ha is-licansed pursadn�to the.provia(ons of the r; , �, ,-, . ; . .. , - � :. , ' , Coptoacfor'�Lieense Law.(thapter 4�{commencin9:wi,tA � POVJH2 AUTHORIYED ' �-�� � - , � � SecfioA 7000)oE Dtv]sion�3�,of,the Businsss and Pro/ei- � " . , � �' - � '� . .� � sions Code)or�lhat 6e is exernpi iharefrom and tF�e�6asis � - .....'.. .-...�. .. UTILIN�CO:�NOT�FIED �' .. . . . .. . . ...fot.tNe alleged exempPion..(Any..:violotion of,�5ection ` _. ._ .__ _ . ... _ .-FINAL. - �nfar on ronf .. . � . . .7D37.3 6q any:epplicant.fora-permit�suhj�tts:th�e app[i- � , . , cant to a clvll penalfy of nof more fhan five hundred � ._. ._.- -. NOSES .: � � : , . . doifan($300).:._ �. ' � .�. �� � � � ' � �.;b I,o¢owner of the.propersy will da the work,and ' � �" � �'�� � the��siructreis�noi'intendedQro4fer � .. . -; . -r.� , : . :� , . - ..�. _ . � ' N.. ed for sale.� �� . � , ,y;�5� , ,, p;` ., " . '�:. .., �_.-';. . .. ' . ` -. .,:�..__ .-.(So6�70d4.;Bqs)n6ssandProfessionsGode:� ,The-Confrao- . ' r.,.�. , , . . ... .� � .�: ... . ; �;...- . .. . � '� .. 'aor 3 Lltense laiw doss��nof opplyicart owner of property, � .i"- " -' ��- 7�r.: .,, s ��-.. �� � . ' , , .; �� . �_ wfia bui7d;or improves ihereon,�and who��r/oes���sur6 � - � ' � �� � � �� - ' ' work hrmaalf-pEovldad Thdt sutB'(mprovements are nof .y � :� '� .'�. .� .. . ._..' ..... �� ".. .`��'�: ,�... . �intendedoraflered�farsale.lf;however,�he'6uild)ngor � . ..� ..,., ...:� ...: ,., ,. . . � � ", �� � "� �� � :.�. - :..::, ..,._ '- improvemenPissold wkliin%one yearof�compleiiom,the ,. ..� . ;:..�, .,. . � . � . � � . . �-. ow'rieh.$uildbrwf)ihbve}he�66rden5fprovingfhnlhedfd . :��� ..� . . . .. � � . . . ..�� � . . �''� - � ' ."n.�}:.b.uild or(mprove:{orfiha.p,iuPP�e�of sale.}. . . .. I arnjexe7�t undar Sec. + ' , , . . .. . � a :! .. .47}: ,. . . . ...... _., ... ..._, .. : . '. . _.„ . ..:.- ��" . , . . . . . . .. . :... . .8&P.C.for ihis c�ason �- ' � -. _. . .:.�.. . � . � - � ... . '....... � --�_� .. ;� � . . .. Dafe. - � . � .� : .. 3. . . . _ . . ,... . . .' ...� . .Owner ��'. . . . . . .. - . , . . . .. .�.,;-., . . � . . �•�.,� . : .� . . " .��. . ._-., . .. . -�. . � . . . � .. . :.. , .. . . � � ... � . .� ..,_,_.� ....�... . . ..'.... _ � .�� ..._.. � . � .. � . . . ..._. . �. _ . . ., r ... .,� ,.. . .. . . .. � � . � , . . 4`y ' � � . _. ...-_._ . .. . ....... . .. . ..�. . � . ' . . . � . _�... . .. '. .. . � .. � .� . .. . . . . ... . .. . . .. - .a.l ,� .