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HomeMy WebLinkAbout1027A (5) --,�.,��,.:�.�._. ,_. I Fereby.ofO mE ha[IOh PE�NS�A�IONID�EC�LA�RAT�IOent to self- .,�a,E-�6G '°'°'..:� ,.:..,,,�P,P�.�CATI.O�V �F4R_�LECT.RICA.L .P.ERMIT Insure,or a ceqrtificahteey�a9f fWorkers'Compensat on Insurance. (,_OUNTI(QF t0�/4NGELES BUILDING AND SAFETY � o����ed't✓p��Jv/��00,/La�6.C�.1 . .. .. . .... .. . . . . . Polity No. d Compony -�R7;/��'���4✓��� �� -FOR APPGCAN7�T0 FILL IN JOB �/� � � r� ✓ � Certified copy is hereby furnished. EACH NO. FEE ADDRESS �- New Res dential Bldgs.8 Pools . � Certified mpy is filed with the munty building inspec- 1&2-Fami�y,Sq.Fl. $ — S LOCALITY ���.���� ��l/ lio. deportmeni. Multi-fomily Sq.Ft. — NEAREST / r'^ r CROSS.ST./��Lriy�'6,i,/7.G� � �. /f'C//f� 'y Residentiol Swimming Pools f Da1e�� Applicanl.-���` �� `.✓� OWNER.OR �� � i��� FIRM NAAAE ' .. . ... CERUEICATE OE EXEMPTION FROM WORKERS' Outlets:.Rec�L�gM �Sw.� I MAII . COMPENSATION INSURANCE � � • ADORE55 l�r'J'�' G „S' (This.section need nof be tompleled if the work involved by First 20 Total No,� Additional CITY�• � - �:� Tel.Na. �y,��.�,�, ' ihe permif is for one hundred dollars(5100)or less.) - - P�AN CHECK � i cenify rhot in the performance of�he work for which ihis nPPLICAM permif is issued,I shall not employ any pe�son in ony monner so as�o become subjecf}o.the Workers'Campensation Laws. Ligh�ing Fixiures First 20 ADDRE55 Total No. .� Additional - CITY Tel.No. .. .Date Applicant. Fized Applionces Not Over 1 HP PERMIT N NOTfCE.TO APPUCANT: If, ofter making this Certificate of APPUCANT{` . ���j� ,�rv Exemption, you should become-s�bjeci to ihe Workers' Range_Heoter_�.W. _ 11L� Compensa�ion provjsions.of fhe Lobor Code,yo�must forlh- Oven _Dryer _W.M._ ADDRESS with <omply with such provisions or this permit shall be 7op _FAU —W.H.— ����� �--'�T L-� deemed revoked. Hood _Fon ^Other_ CITY��ij��'�/ Tel.No. 3 -✓�91 . .LICENSED.CONTRACTORS DECLARATION Dis _Room Air Cond. — u�ENSE OR - I hereby affir,mJha)I am.liceosed under provisions of Chapter 9 P" REG.NUMBER Class. (commencing wl�h Secifon 7000).of Division.3 pf the Business DISTRICT NO. PROCESSED BY and Professions,Code,and my license.is in full force and effect. POwer Apparafus&Lorge Applionces �O U .3S,.r� �� � Size 8 iype HP,KW,KVA,or KVAR� ..._..._LicenF.e.Nu/.C�her � 6 Li0..Class O-7 . / Up to 1 Ind. FINAL [C .._ C,o.n,tractor�/�- %��N7i+A� . . " G .. .Ovsr..l to.l0lncl. DATE � . VALIDATION � . y Dote ''� f pver 1D to�50 Incl. �`���� - (,F) � . FINAL ���� a I am e empf under Sec Over SO to 100 Irrc BV ._...._.._ .,,8„B,P,C fpr..thi.5.feason Over 100 � � Dale: Services,Swbd.,MCC 8 Ponelboords � � � , � � � � -" ......'...".......�.._ . � 0-200 AmP.Under 600 V Signqtu�e .201-�1000 Amp.Under 600 V � � ❑ Over 1000 Amp.or Over 600 V � . Exemption for Reg.Maint.Elect. SINGLE FAMIIY � r I ii!.�R Temp.Power Pole&Appurtenances � � � . . .. ....HOME.O.WNER-BUILDER OECLARATION Siqn with One Branch Circui� o es �: c 2 I hereby affirm ihat I om exempt from ihe Conhactor's License qdditional Sign Branch.Circuits � � T Law for fhe following reoson (Seclion 7031.5,Business and � . .� �C�`v .Professions Code): . . . .. . . , . ❑ I,as owne�of the property, Misc.Conduiis.$Cond�ctors � � �, C��J�` will do ihe work and the ' . a,e, " '1� srru,cr.ure..js not intended oc.offered for sale (Section Other(See Compiete Fee Schedule)_ � � - � 7044,BusiAess and.Professions Code}. ��j�.�G�.,�d . ...._.CONSTRUCTION LENDING AGENCV - � I hereby affirm�hat there.is.a construulon lending ogenty for . the perfocmpnce of the work for which�his permit is issued PERMIT fEE (S�b-Total) �� � � (Sec 3D97,Civ.C.). . PLAN CHECKING FEE � � � � ._.._,,,L,e.nder_5.Nqt7le �I,1 � PERMIT ISSUING FEE (V � - . . . Lender'S A � � � � �� �� � /p(� ,,7�,' � ..,. ..s{.d.�e,�s. OC O..W .. . . I certify that I hove read rhis application ond sta�e ihat ihe TOTAL FEE - above informalion is correcf.I agree to comply with all Couny� '-'"��--�- �----��-��� �,�------ � ���--� - �� � � . . .. . ordinpnces and Slafe lows regulating Eleciricol.wiring, ond � � � � . hereby authorize representatives of ihis Counry to enter�pon � � � � � ,t�bove-mentioned property for inspection purposes. ,SEE.$E�/ERSE_FQR EXPLANATORY.LANGUAGE �L J��d���� �' __._ Signafure of Permittee �e � � � � � . _.. _. _ __.._._ .__��._._— ---=— . ��_,.--- .:,,: ..�,.s. ,—. ._.�._ _ _...._.v _....... .......... _......_._......_..,_ ------ _ .__�._... ---- �,��� ------__:_ __._._-- -- ,,.�_�� � � _ ---- :. — _ �... :,,� <�r _.___....__ �__�_____ __.___ _�.__.w..._.._ _;,�. _-._ _._._.__ ._.. .: ._ _::, S ---..__. ._.._._._.. _,..... . ..— , .. ..�,.�.. - _ .. ,, ., . �———____ _.___.___. ___�__ �._.�_ �_ _..._ _.. ��8 szO,e�5G5.._G�9RJa�..� � �. . . _......_�_._.a....._...2"_'_v..�........,.w......._....._.�... _....._..... _.,.,__�._ . �............._. ..,_... . . , .„,.i> �3 -., ".__.._ .,___...,_..... .,_._-.... .............._.....W..........._. 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