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HomeMy WebLinkAbout1814A '. -.: � �-:.-.�:--� ' -. � ,.. . . ... _. _.. . . . ... .. .. . . . . . I � � WORKERS'COMP�NSATIO�N�DECWRATIQN �6Ab43 :10/87 ;�Qpp�1e�q�10.N FOR :��.L'E�TR��CAL� PERl�II�IT � � . � I.here6y affi�m ihol I hnve a cer�ificaip pf consent�o sEH� � � � 'P 1^IG . om�e�nsa—r�o�.ao�e, .� Fok nreucnNYTA Fiu-�r�- toe .-_ DING AND&AFETY , 8 insore,or a rerhf cale of Workers'C p �COUNTY OP LOS ANGELES BUIL t o c t'f < rh of 5 .3800,Lab.C.J . . ���� t;�( e►�tc� (4�� �. Cro�-1-er�Dri've � acy o Compbhy . . - . � ADDRE55 . Certified�copy is he�eby furnished. New Residenhal 61dgs.& :Fy�p;�� ��'�N -No. . . EEE ` 1&:2�Famil S F1.������ � � $ LOCALITY � -�(�"�"' �Certified wpy is 4iled with�the counry building'i�speo- y' q NEAREST ' � . tion department. .- � �i� ��—,(Q��� ," Mulh-family Sq.Fi. _ GROSS ST � � �� �1{�C Gl�-t�' 1 Residential�Swimming Pools OwNea OR �� �„n�:.,� � � � Date Appl cont -., . . �� � �� � . FIRM.NA�AE - Y I�.7�� l.+l � � CER71fICATE OF EXEMPTION•FROM WORKERS' .� p�tlets.Rec�L�9ht�5w��' - �� MAIL �j�Q� � �.�'J„ G�_ , . I/1t� � �- COMPENSATION INSURANCE .� '� � � �� � naoae55�� `-i�Y L��f-. IJIJ F��s,2� V"�—Lkt� �43—�71 (Thissecfion-riaod no�be�.eompleTed�if ihe work`involved by 7otal No -Addiflo�al � CIN Tel.N the permit is for one kun8tod�ddllora(5100)"or less.) � �-- � � � �PLAN CHECK" �� � ��� - - " -- � I�cerYfy ihat in the peFfofmance:diihe work.:for Vuliich this � - � � �. . �� . � '- � PPLICANT': - � - permit is issued,I shall'npt employ any person in��any manner- . APbRESS � �� so�as to 6ecome subjed'rto the Workers'Compensahon'{a�ys '� Li9hiing Fixtures -Firsf 20; . - - � - ' Total No,._� _ Addihonol qTY� Tel.No. . Date � Appl canf- "� � - Fixed Appliances Not�Over 1 HP � PERMIT �1' `�l n��.�,G NOTiCE TO AVMI�ANTi'It, afier making iVns Certifimte of .� � � APPLICANI 1 C('Cs-_�t � ( �. Compe satio 0o s�houfd��become`'�sbbject to�'tFe VJorkers` Range_Heater_D.W. — � , _ p � n provisions of the Ldbd[Cade,you.must�forth- Oven Dryer —W.M.—� � � ADDRESS �Z5 G �_ �e� with complywith=such provisrons�or iMs,-permit�ghall be iop _Fq�. —W.N�-- . � � � deemed.cevoked. . � Hood _Fan _Other_� . �� CITY..� ��! � (d�� �TeF.�N��� ��-�-'� . +LICENSED;CQNTRACTORS:DECLARAiION .�. � � � - . - 710ENSE OR - I here6y affirm thoi Pom licensed under prowsinns�of Chapter 9 ��Disp. --Room Air Gond. - -- REG:NUMBER.. � � �- - -���-Clpss.C-�---t � .(commencing w th Section 7p00)of Division�-J of the Business . powe�Apparaf�s 8 Large�Appl ances . . � DISTRICT NO. PR ESSED BY �,� � and Professions Code,and-my license is m f�ll force and effect`�, , � ���� � ' . � -� ��� �� �� � .r� � Size 8 Type�HP,KW,KVA,or KVAR� p License Number ��.��`��Lic.Class ��� �� .�Up fo 1-Ind.-. . . . � -FINAL ..... . ..� ' � ... . V .,��1 1_.. _'CIp.�., ��iC.-r'7_"1 _ :Over 1 to 10 Incl. . . . ..... . � DATE ��.�0�b� VALIDATION Q Coniractor �TC G�IL.I�� Date {�J-�'••� . 0: . ..-- ❑. . . . . . . . i�ver 10 to 50.Incl. , FINAL � . W� I am exempt under�Sec.�. �Pver 50 fo 100 Inc B� . d � B.SP.C.for this reason Aver 100 - � � � , � . . � " � Services,Swbd:,MCC 8�PanAlbadrds� .. . ► . . . . . . . . .' . Z � - ��Daie: ` 0-2W Amp.Under 600 V - � . Signoture � � 207-1000 Amp:Uhder 600 V-. . . ' , . .. . . . . .. . . . �. ❑ . . . . . - . . Oder 1000 ArnP.or Ovec 600 Y . ... . .�. .�+-� PJ},(.�{� .�� Exemption for Reg.Maint.Eled. � � --����- � � SINGLE fAMILY . � - . Temp.Power�Pole B Appurtenances ... .. .. . . ._ . .. ,- . _. x%e. ... � •? � HOME OWNER-BUILDER DECLARATION �. � Sign with One Branch Ciicuit . , � �'I here6y affirm lhaf I om exempt from fhe ConiraCtor's License - � � �.' 4 S,fi`���. , Law for ihe following ieason(Section 7Q31:5, Business'and Additiono-I S"rgn�Branch�Circ�its . . Professions Code): � � � � . . � . . . � . u °/`�,�J v ❑ I,ps owner ot Ihe.property, 'll do ihe work and ihe Misc.-Conduits�&Conducfors� � - � _ -, - . � � � �� � �� � siructure is nor intended or offered�for safe��(Section Other(See Camplete Fee�S<beduleJ�— � ►�. , ��� '�-4`� , 7044,6usiness and ProfessionsCodel: - . CONSTRUCiION LENDING AGENCY � � � � � � ' "� �� � � � I hereby affirm ihot there is a consiruction lending ogenty for . � ' �� . � � . , � � the perfarmance of ihe wo�k for wHich this permit is�ssued - `pERMfT FEE � - �- � �- �� �-(Sub-Tofalj- � - - - �-- - - � (Sec.3097,Civ.C.). � . . � .. . . � ... • . . . . � � . � PLANCHEGkINGFEE�.-'� .. . .�. � . . . .- . - ... '.�--- - . Lender's Name . � � . . . � � - . ... . . /f1 -� .. . . � � . � - PERMIT ISSUING FEE � � � . .. /V . � . . .. __ . _ . Lender's Address � � � '. . .� I certifylhot I have read rfiis�application and�state that the iOTAL FEE - .. �. � . .� . .� . . .. . . obove information is correct.I ogree ro comply with all Counry . - �� � � . . . - � . � I ordinances and State laws reguloting.Electrical wiring,and � _ � , _ ._ , _ _ � � �. � � , . . � � . . .... . � . hereby au�hnrize representatives of rhis County to enrer upon. � -� � � , e,� ve-mentioned roperty for inspection purposes. SEE REVERSE FOR EXPLANAT4RY.LANGUAGE.- th abo �lA/t2A `� �.r�r� 8-2.��'83 _ Si9naWre of Permitiee � � Data�� - � . , � � � � . . . � q� �.�;,- TM : � ; � _ , .,;- � . ,, ,; , ,., . , -; ,:. , . � .. : . , - , . � v �_ ..... .� _ ��:' � � �' • � � � . 6z 2 , s��'. e ' - ApBRGVALs' DATe�� . � � OW.N��G6U4D�C7C-ELARATION' ,;� ,�"F � .. "SIGNATURF � � � - � . � � iTE1�1lP.PONlER;'P�LE �� � ��4,; � � . I heraby pffirm fhat i am exeFnpt from ihe�Contractor�s �� - - ,license Law,for the.following reason (Sectipn 7031,5; � - ' UNDERSLP.B WORK . .. . . Businaas and Professfons Code):Any city or couoty which . , s ,�',. , � [....,; ,� RQUGM C6NbUlT -��+ �.� ... .'.. - ... . :,: . . . �� �requires:p pecin4t}o mqsirucf,olt�r,.improve�demolish, _ , ' � ' - or`�epri�r any-sfiruat�fre,pFior to'iis�issuance,�also re- . ;,�y, N7IRING � .. . qulrestl}eqpPlieantfd�sue�rpermitio.illeastgnedstota � � ,_: ,"� �. . �., .. t . �, .. �.. FI,XfiURES -� �.--. . -�. . �� .Y� � , ��... Confhaetn a L�'enses�uCha�fer�,9h commencns of iFe . - � . � . - �� � P P � . ' - ' . . .� A �. . 7og with '. � � � -��� � . ' � POWER AUTHOKI'ZED'-��. - ���--� � � � ' � � � - - � . � Sectian 70p0)���Of Div(sion'�_of the 8uslness and Frofes- . � � � -�.slons Code,�:or�fiat he is exempt therefrom ond tha lias�s . .... . ...... .. . . UTILIN�CO:-NOTIFIEQ �-�� �.' . . �� . . . ::for Jhe.alleged,eXemp}iqn.. Any xioldiiqn of Secfion - FINAL�� � . �'������ `,� �� ` . . - ' :.�.`_, . .��.�� 7031.S.by 6ny tlpplieanfi.for a-yermH wbjeets.fha oppli- . ' ' � �-�� ���� nfer,on ronE � � , - cont fo a.eivil penvlty of not more thad five hundred . '-- .. = NOTES . .. � � � .. . . �., dollars($500).i� �. ., . � ` ' , .� � z � -; . � :: �" .....� . .....❑I.,as owner of th�.Property wf II do rhe:work,�,and.. � "�� � � � � �''� � - � � � �' -�-� ihe:strutture-is qot iniended or qffered far gale..�� -. ,'� `^-''4 ., i. ,,..� :i . .- � .. �.. .. . � . '�� .. , .�... ..�; ..'�(Sec.7044,.Buainess and Profesiions�Coda iheContrac. . � .. �. . .... :���. . .. .s� � ,�- ._. • , �tor's liceris�t8w dees�noF applytq art owner:of�pnoperty � � . . -��' ` � '� � .:' , , . .- . . .. � .. � . ._. � - ,-�... ,;,., -". � who bWfds or improves thereon, ond who'�does-.such '' - �� � ' �. �"� � ' " -work AlPoSe�f prnvidad t6dt suoh�improvemenis are not� . -u� � ��� .. . � �. - . - , � � '��- �intended�ono{fered foasa(e.If;however,+he bu'rlding or� ...., �, rt `�� .. .. . ...... .':' � _` -improvement'is sold wifhin one yeor of compfefian,the . ..".:.'� ...�; . � - ;:.,. owilarvbuAderwtllh60e�}he8urdenaiprovingtFrotfied�d . � , ,- �. . , . � .n,o,t bu"rfd or7mproveSontk�purpo5e of sole.J.. . . . " . � . . .. .�... .. . .... .. -; �, ;�,I 4m3exa[np!under Sec.��� ,: .; �..a , . .. . , , . y ,, : „ , -� �,.. � . . . . . .._ . . . .. -.> . � � �- •�-r .-.�.. _ , . .._.... �, �. - ..,_.,.. . �;: . . . -,;� .. � ... � . 8&.P.C:forthis.reason . - . � . � . - .. � � - � . ._ .._ ... . r::...� -_. .�.:. �: �Da4e�. . .. . . . � . . . , . . . . , . . . Owner - . . . - . � . . ,74, . . - ...' _ _ . ._. .. ... � ' _ - .. . . . . . . .. , . . ' . _. � . . �'t � . _..-