The URL can be used to link to this page

Home My WebLink About1242A (6) _ _-----,-_ _ _ _____._._�_ _ WORKERS'COMPENSATION DECLARATION � 7GA663 io�ei `� N�`r� � I hereby atfirm that I have a�a��,F��a�e of consent to•seli �E.�. APPLICATION FOR ELECTt�ICAI PERMIT � , insure,or a ce�tifmte oi Wo�kers'Compensation Insu�ance; � COUNTY OF LOS ANGELES `BUILDING AND SAFETY or a certitied copy thereof(Sec.380D,Lab.C.) � �..P�olicy No. Company ^ i FO�wr►IICANT TO f4l.IH � �� // R� . Cerlified copy is hereby furnished. New Residentiol Bldgs.8 Pools �� FEE ADDkE55 4�O ❑ !"i � � 5 — S LOCALITY m�y � C Certified copy is filed with 1he o il ilding ins o- ��g 2-Fami�y,Sq.FI. � � tion de rr Muhi-family Sq.Ft. — NFAREST .N � CRO55 5T. /�lJ /� Do�e � Residentiol Swimming Pools � OWNER OR ` R FIRM NAIV�E Y1s � CERTIFICATE OF EXEMPTION FROMIWORKERS' Oullefs:Rec_light_Sw._ DDRE55 ��p COMPENSATION INSURANCE First 2D '� (TAis aeNfon nNd not bs compl�f�d il lh�wo�lt involwd by Totol No. Additionol CITY �' Tsl.No.� � ' 16�p�rmit fs 1or on�hundnd dollan(SI00)or I�n.) PL4N CHECK �. 1 certify that in Ihe performance of�he work tar which�his qpp��qM . permit is issued,I shall not employ o person In mpnna � so as to become subjetl lo Ihe W Com ion Lc Lighting Fialures First 20 ADDRESS � � Total No. Additionol � �/h p1e?�d�� APPlica QTY Tei.No. � NOTICE TO AYPUCANT: If, oNer mo ' this Certificate of Fixed Applionces Nor Over 1 HP FfRMiT �ng A7PLICANT O�i�� Exemption, you should become subject to the Worke�s" Range_Heafer_.D.W._ Compenwrion provisions of the tabor Code,you musl(orih- Oven _Dryer ._W.M.— ADDRE55 iih comply wifh such provisions or ihis permit shall be Top _FAU _W.H.— ' deemad revoked. q � CITY Tel.No. d 'Hood _.Fan _Ofher_ LICENSED CONTRACTORS DECIARATION • UCENSE OR I hereby offirm Ihpl l om licansed unde`provisions of Chopt�r 9 Disp. �Room Air Cond. — REG.NUro�BER Closs. (commencing wuh Sectlon 7000)of Division 3 of the Business � DISTRICT NO. PROCESSED 8Y and Professions Code,ond my licanse is in(ull forca ond effec�. Power Apporotus 8 Lorge Applionces . /O 0. ' � Size B Type HP,KW,KYA,or KVAR 0 , License Number Lia Closs Up ro I IncL FINAL V Over 1 to ID Incl. DATE .Z��ws(• yq��DATICN � Cantracror Date Over 10 to 50 Ind. � ❑ fINAL I pm exempt under Sec. Over SO to 100 Inc. BY sr(�UdsL � d B.BP.G For th�s reason Ovcr 100 z Date: Services,Swbd.,MCC 8 Panelboards �,L , . 0-200 Amp.Under.600 V Signature � 201•1000 Amp.Under 600 V � OOver 1000 Amp.or Over 600 V � . Eaemption for Reg-Moint Elec�. SINGLE FAMIIY Temp.Power Pole 8 Appurtenonces HOME OWNER-BUILDER�ECLARATION Sign wi�h One Bronch Circui� I hereby affirm thof I am ezempt(rom Ihe Contrdcbr's License Addillonol Sign Broncb Cirtuils ��2 u'C{i Law for the following reason(Section 7031.5, Business and � Pryfessians Code): � • � o 0 2 ➢� I,as owner of Ihe propeny,will da ihe work and 1he hi;sc Conduits 3 ConduUors � • •2�j,5 Q , ��y s7ructure is not intended ar affered for sale(Section Other(See Complete Fee Schedule)_ � •2�J.v 0� 7044,Business ond Professions Code). CONSTRUCTION LENDING AGENCY G�� O"��rJ I hereby affirm tho�fhere is o construction lending agency for , the performance of fhe work for whith ihis permit is izsued � PERMIT FEE - (Sub-Totol) �' . - .- (Sec.3097.Civ.C.). . � PIAN GHECKING FEE - Lender i Nome • ' ' PERMIT ISSUING FEE �U �. � Lender's Address • I ce«�fy Ihot I have read this opplication and s�a1e thol the TOTAL fEE d.�s0 above informotion is mrrect.I agree lo comply with all County _ ordinances and Slot laws regulp' Electriml wring,and � . hereb utho��ze r r seMative f this Counly to enler upon , fhe o 1'•ne propert or inspection purposes. SEE REVERSE FOR EXPLANATORY LANGl1AGE �� 7 /o�,� ' �b-Permiltee Date --- --- ._ _ __--_ _ ______/ _�---. _-_ - _ . t , ;` - � . OWNER-BUILDER DECLARATION , � � ' APPROVALS �ATE 516NATUR€ - � TEMF.POWER POLE ' . I herc6y offirm Iha�I am ezemp�from tho Comracror's - litonso Law for tho tollowing fCO50O (Svc/ion 703L5, � � � . . UNDERSIAB WORK Business and Professtons Code):Any nfy or county wh�cb ' • ROUGH CONDUIi - �raqvlras o permlf to consfruct alter,lmprove,domof�s6. . or repa�r any sfrue}ure,prlor fo!fs lss�onco, also re- � • WIRING qulrosfheopplleanf(orsuthpermlffolileoslgnedsfato- � FIXTURES � ment that he Is Ilcansedpursuanf fa 1ho provlsions ol}he Conlra[for's Llcense Law(Chapfer 9(tommendng wkh � POWER AUTHORIZED Setfion 7000)of Dlvfslon 3 of fho 6us7ness and Profes� stons Code)or fhaf ho fs exemptlhcre/rom and the 6osls �- � UTILITY CO.N�TIfIED for Iho allsged cxemptlon. Any woloHon ol Seaion fINAL 7031.5 by any appllcant for o permit sub�ects 1ha opp/i- �n(er on �rosf canf fo a clvil ponalty of nof moro fhan five hundred � NOTES , dolfars(S500f.: �� - - � ❑1,as owner of the proporty will do tha work,and - � Iho siructure is not Intonded or offered for solo. . - (Sec 704�,Buslness and Prolass7ons Code: TBe ConMoc � br's Llcense Low docs nof apply lo an owner ol property �who bullds ar Improves }horeon, and who does suth � - work himself provldad Ihaf such Improvemenh arv no� � . . � Intended or ollered for salo,!!,howover,the bu(Iding or ' Improvement Is sold withln one year of compleflon,fhe , owner-6uilderwill have fhe burden of proving}haf he did � nat bulld or Improvc for fhv pvrpose o(sale.J � '� I am oxompt�nder Sec. . 8&P.C.for this reason �r1r�0�� ,� -�. � ^� oa�� pwner