Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
1651A (22)
WORKERS'COMPENSATION DECLARATION 7enss3 ioiai -' 17 � , �E-� QPPLICATION FOR ELECTRfCAL PERMIT � � 1 hereby affirm that I have a certificate ot conseM to setf insure, � a a certificate of Wwkers'C.ompensation Insurance,ar a certi(ied COUNTY OF LOS ANGELES BUILDU+IG AN�SAFETY �j ��?RY-N+.ered( .3`8Ct0.L C.! ��,+y� r . PdiCy No... 4 -. .. �.t.lF��E 1�(J�O Fdt APPUCdNT TD F1LL NJ� . . JOB / / �,e ❑ Certified copY is herebY furrashed. New Res�tial BId9s.-&Pods - :: .EACH. NO. .FEE A�anEss l��!� �C..O � . : . . . . 1 8 2-Family.39-Ft _ $ _ $ LOCALITY Certified�COPY�s filed with the county Waldirg inspection MEaRESF- . -.tle ment. , - . Muiti-family Sq.Ft �Q�� _ Qate_���Ap�carrt��t3-I����L-��'� Resitlential Swimming Poots � . ���� �` � 6 �/ �1!/j�,c�y��.,�1FICAFE OF EXEMPTIflM.FROM.WORKFRS' putlets:Re��Light_Sw.— t %���r n �- J _� _1 CAMPENSAT10hfIN5URANGE . . S � AODRESS! S3 fl�Gti YKJ SS/�t {T1vs sgCtion need not be completetl it Me work imolvsd by the First 20 .. � perm,t is for one hundred dollars(S7003 a fess.) - Totat Na. q����l G4TY_���y���. - - Te4.No.��f-8�7� I certify.that in tt�pectormance o1.tM.wock tor wpich this.permit �N�� � - . is igwleci,I shakt not empby aIry person in.arry manner so as to ���� 6ecome suhjeCt k0 the WatkerS"GOrtiRenS8ki0n t.�w5. �-. � Lightitg Fixturev Frst 2Q. �A[?RRESS-- . - . - . ..._ . .. . . Total Na. Pdditional �C1TY .. Tel.Fb. . 6ate � �- .APPIicaM. . . ,Fized APdiaru�.es Not�Over t HR � - NOTICE�TO APPLICANT: Y., atter� making this Certrficate of ���� • `�C �� Exemption,you shouid become subjecf to the Workers C_ompeiisatbn ��— Heater_ �.W. _ d�/� �provisions of the-Lah�r Code.Y�u-+ruisE"tortfinx3h corz�je:"wlth such - Oven_DrYer_ W.M._ ADDRESS `�/0 /n� /-H�ELi�� _ prOvisio76s�Or this Pemvt�ShaMbe:deertied.ievoked .--�:_-. Top _ FAU . . .. . . _ W.H.— /�r.y (I ..�_ .tJCENSEf3 CQNTRACTOR&[3EGtARAFK3N_..__._.. � � Hood_Fan _ Other_ CITY- f Tel.No.7 7!`G�6 I he[9by_effirm that 4 am�iceFtsed ufldCr pr6vi5roF1S of-Chapfef 9 pn,,,,, LICENSEOR / ' SC6mmer�gwsth"Sect�s-�H��i-oF$ivis�rr3'v€'{��esa-ard ..- ��`-- -�[_COE�._._�___ �f�tdUMSER. ._._��/O-�".. .. .__.. Ctaas � , ?fotCssionS C9de:fl(IA itry-tiCense-is IFFiUN f6[Ge-afid-ef#ecG- PovRf F1PParatu5&_C.ar9e Apptlar�eS €llS7RtCT Pi0 Pf�CE Y � - � Size&Fyp2 HP,KW,KUA,pr KVAfl� / ra ��.� �R � . License Number �3f�°� Lic.Class � � Up h� t Inci. FINAL ` �f J� ! � Contractor/��U-1,ti.�?'�+-t�JDate ._. Over t to t01ncL �ATE / oF- C! YAlIDATIQN Q� � � � _ �. .. Over 70 ta 56 1nct. . Fl ��-1 amezemotautde�Se�._ . :._-_. . Oaer-50 ta 1Q0 Inc. gy a __.___ _.__... ._._ _ _-__. Over t00 . . . B$P.C.for this reason t!) ; . .Services,Swbd.,MCG&Fana�baards_ � � - �- .� Z ; - Date: 6-200 Amp.Under 600 V 1 Signature - - 20i-10D0 AmR U�er 600 V �- . � ------__- ------�--�---------- �--.._. 6rer 1000 AmP.or Over 600 V� �� � �Exemp[ion for Re9�o7aint.Elect. -._ .. . . . . . . � ___._._____.-___SHJG�E FAMftY-_�________._._ �TemP Power Pole&FWPurlenances . � � �--- - - HOME OWNER-BUfLDER�EGLARATtON � �Sign wiN One Brerich Gircuit � � � 1 hereby af£irm that I am exem.�t trom the Contractors License Law tor the tabwing reas€ui(Sectio�703�.5,Susiness a�!Rofessiats ��10^a�Sign 8ran�r Circuits CAde): - . . �ff - Misc.Conduits 8 CaMuctors � ❑ . I,as owner of the praperty,wilf do the wwk and the structure is not interWed or offered for sale(Section 7044,Busir�ss a�r(See Complete Fee Schetlule)_ �_ - arid Professions Code). �� ��� A CONSTRUCTION LEN�IRJG AGENCY - � A' � • " •L i hereby aftirm that there is a consTruction lermirg agency for the _ + • •� C.7 J� performance of the work for which this permit is issued(Sec.3097, pERMfT.FEE . (Su4-Totai) .. . Civ.Q)• . . .Pl.AN CHEGKINC�FEE . � • ° e� L I�;u Lender's Name � :� . . � . ,, . . .. . . .. . . _ __. . . . - PERMIT ISSUING FEE� �� O�!.� �'-�� - Len�r's Address. - .. . ._._ � .. ._. . . _ . . . . .. _. . . _ .. . - - ----- - - .. {certify th�}1-have read�this appiwatlort and state that�the above _ TOTAL FEE .�..�. -.... ...- iniWmat� -�s correG.I agree to compiy with all County ordinances . . _ and '-�aws regula' ElecVinl wirinq ud herehy.authorize - - � - . - repre ` atives of th� ounty to enter upon the above-menti�ned -� - � -� � pro rty or ins purpose ___SEE REVERSE FOR E%PLANATORY..LANGUAGE_ g� q - Signature PermHtee Date �_ - . � N�='3 Y . C� y � �y.C6l tG"6f . .. N � �G"� �, ��A O N �_� ' . . . . - �.J y C .�,.. W C G' ���3 O �,� N - . .� - y� CJ � � � � G . . a,a ' � "$,}' �' 63 m .N � n O .�L+ ps�,.�-n — .Y. i.). c�,T� � o.� . . - - �. '6.�� � � �O'�n�.'� p . p� 'TC t �� �, ��n . - . . . _ . � '_ p � � p . _ , —� �. t' �,� � n"c'��co a; �-� ac�-a 5�m . - , °m�' tp m.°s,�- � ;� e �o� � m °�' � . � � �:�° ��i�.���:�.. o�c�d o��',`�y,� �i'�a�-9� 2�i. � - . ' . r - � p�._�y '� V�._ �n v+ _ � � . ; _ Y� ci="'�d � ` an.. �d'i� p ��p u, c �� � � , � - . F .. (� �O 3e,`ffiw'� �3.Lm7.���O� `��'� ��� �� $ � `- � N � . . . . ,� � � �.� `'C�.C...M� c� p� 0 .�- 0�p � a� � i(� c5 W � ' _ ���� .o� o v� o oC �'� �'iac _ � °r - .. - Q ° � in � �v'�i c .ty�, � 0' a' u, U3 c�a . �ci Qo ��' o yo c� '4 �� � '� '� 'tt' ..a_' � � J2 c�E � a � � 6�-c�.�� � � ` jmic m :'q ` ��y y:,�.�xn'. c ..�� �� � o m� '� g '�� a G � - ' . ma � � � m .Y�p �¢ ^ � � c-"�� ���� y 3 . Et? E �'� �� c�� a � ., � d � � ct �4. .E oN C N-o � n ro� N� d,. �,� � � c� g � ...� p O ,Z A'o 'm"�cs ��q�� a v M Nv���� dts � •'C� � .L.� N N �S C3 x � cJ rta a p-� � : � �- F-1� .;Jf � S�- ' ,�J _ .. ' .p �o� ss �h�}��C�i � �, ^Q� • �i � F'c� a � . . �g�r��=j y��6 'Upy�p,C �S�AJ� ✓ ' - ; .. � � v � �1 w .N U ro �� . . . wN � � O p R� _ . _ - . t `� .� � . � . . . `. � ``4 , . i . � ' _ - - _ - - , ., � � � � , 1, �� �� �� . - ` � �,:4 �;F ; ' � N�1 � � � � 1 � , �, � ; , �� _ ; �` , � _ . �,N � � ` � � ' � i; �i . x � � � "\ ` � � `� k i . �. �, � � `� i ' t 1 �� , � i.. - �i � 5 i , � ,'� �\ l t , . �.� - � � � � � , ,t t •� ;,; � i ` _�'�, t , � . . �j C' . 4 ; , ' '' ` , �; t , ,� i ,� � �i t� �' r +� � 't, ,\ ` `, 1 ,�� 1;i � � , � o a ` � �` � ; `� , t . . . N � . 1 �� ,l , ,t . ,�``t \ � 'i's t��4 1 � �, �. � .� ,� , 1 t �i 1 ._ . } � �_. ' r - .Y ,l,� � . .. A� , �, ` �'' ', '., `.� x', j �.,.��, `} - � � � � d;�` �N . . ,` ,� � .O � 6 � �� �NiJ 6. 'y �J �t W � �st� . � � � 1 , - ' .,5 1 Cl 7i ..� V c) G-' W 1%j k 2 �t-p 1 ',� ',-_ � � � '� ` � ; }�� � 1 � � a O � 2 y r � � _ A � � �� , . �a d w � �� x � .5�_i$ 4 � _,,. � � � � � �t �� \ . ,� �. � ,. , ` ` , � i" °:' w ; ,'`� , ; � 1 1 � '` ` ,` ' � � i + , , , . � �� � ' . ``� t` � � `� ` �, . . � `�� � -, 4 4 } j i ``�i +\ ', ��� � � :.. . !., � `,�` , ` i � , �� � ' �. . � . �! �,i .�f ��'�.� , . � ; \ , i ,, ..,� . . ,�