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HomeMy WebLinkAbout1347A p.v��.r » w t������. ,,�..��.r-, ,� . WORKER5'C6t�.IPEFI5�"II�N`�'CLAF�AI'�N ����a 76Ass 10'si� /( p� p '�°��� �� I nereby affirm that I have a certificate of corssent to se�f msu e. CE=8o6�G � A�PLIC/'��I�lY„FO�`�L..E�1!�I��������'�� � _���� or a certificate of Workers Compen,aton Insurance or�certified COUNTY OF L�S AN��`LES� BUILDWG AND SAFE7V coPv Ynereot(S�.3's0�$:Csr,.�C.} . ..: ...,,..,.......` �.. . .. ..,f..a. : �..' .�r..� ..�j �e .. .F�, M q� �f`� .N,._ �'-.':: POItcY No ' � � Companq' ' •- �.. �... . � � �� POR..:APPL(CANT TO'FI'LL'�N .�� .,�, ., JOE � � c � EACH P10 ���FEE ❑ .. . ' . _ . .. ,. x: ADDRESS . . .. .. �... .... �70 Ce�fified copy is hereby furrnshed. „ , , Nevr Resitlentiz�Bdgs&Poois �LOCALITY ;� �:: . . .:_. . �_... ..., g 5 ..�6f�MoA-+(� tJJt� � � Gertified copy is filed wdh Ihe county building msPecticn 1 8 7-Famiry SG.Ft. " . - . tle artment . .. . . Multi-fzmily Sq.FL NEAREST / /� . p . . ..ROSSS7. �� S/4 p7/t� t, A+ U/� �Date � �� - A plicant� . . Resitlentizl Sevl ' Pool� !JnER OR . . n ,�: �j,� `..� tS 'Fa,,,Nr,r�e wA �'G ANt „ a��,, -�. ' , -� CERTVFlCATE Z5F'�E���p`T��O��U,�OR�S���. Outlets:Rec—.Light�sv��.-- j 1 ��. :�.-;., COMPENSATION IN$URANCE !ADDFESS . .,,..,f6� �L ^�� �^�............ .. .. . Filst 20 . �(This section neail not he completed if the work involveq 4y the Total No. � Additional- GTY �N TeL No.��58'�g' .permR is.for one huntlred dollars($'100)�or less.! - � � aLAN CHECK � .� � �.I certify that in the performance-of the work for v�hich this�permit I I qppuCpNT � C�u'.ti�Rr- ..-..�.�.„.:...::.:..:.:. is issued,I shall not employ any pers n in sny manne bo"as to� ��� y " become subject to 1he Wprk@rs Comp nsation Lavss Lighting Fixtures First 20 � ` � ADDRE55 . �� Addi:ichal _ � ... Total PSo. .. . .. ... .. G�7Y 7e1.No _ ,�;. Date . APPican . . . . . .. ..,. --- � ....,_ �..�.. ._.,.,.,. .,.�. :., .. ... � ��� � F��zed Appli2nces Not Over 1 HP PEPMR „ �.., +r-�...-.. . ., .NOTICE .TO APPLIL�ANY If; .after making this Cerhficate af qPPUCnnY �W/��►�,. ,Exempuon,you should become sublect to the N/ork�rs Compensatron . Range— He2?e�_�DNI. _ �: . . I . ,.__._. ....:. . _ ,. ..pmwsons oi the Labor Code you mist fortqwith comply v itn such Oven_ Dryer_.W M._. � A�GRESS .. ' . ... .,.,.�.s.. ' .,. �prowsions,or this permit snall be ozemeo revok d Top FAU .l/H. . - ' �� � �LIGENSE��CONTF{ACTORS�ECLA�A�`P�N �'� Hood� Fan _ Other_ CITY Yel.No , . .I hereby,�aHirm tha.I.am licen.,ed untler proe�isions ef,Chapter 9 Disp. — Room Air Contl. uCENSE 6R _... � ���g,-�- � ' (commencing vrdh Sectiqn 7000)of�-Divisi6n 3 of the 8usness,and — REG N�'v�BEq � � � __._..,... ...� .a.-;�wY _�.. ••-�^'^' � DISTPICT ti0. PROCESSEb Professions�Cotle and my license is tn}ull force and effcct'�� power Apparztus R Lcr_e Appliances. i �� �� Size&Type HP,K1N.F(VA,or I<V.4R � � � .,�_.� � . ...� License Number -.. Lic.Glass � � � Up��to f fncl. ' FlNAL V CoMractor . ,.",�"` .. .. ..�.. ,�.. Over GO to'�1061nic. ` —_ BIYAL �:...'„ VALIDATION_. U ❑ I am exenpt urMer Sec - - __�,_,...„„ "^''� Services,Swbd O�dCC BOPanel6oards n q�/ Z �Pte 6.&P.C.for th's reaso� � - -... ...:. •,..-.--^.,.-- Date: . ... .. 0-200 AmP Unde�600 V � . � �.,L�pN�I,L�� '�"Z..'�-E� �~1 Signature � .^ ^�!� 20'I-1000 Amp Jnder 600 V �1 � . ,. "._ _. .�.. . .. � � � � �-� �-�--�-- -� - - � Over-1600`timo.or Over 800 V� � E�mphon for Reg.M mt Eleck � � �� � � - SINGLE FAINILY ��� �<,,. •_ Temp.Po�ver Pele&Appw(enznces I HOME�OWI�fEfi B�11LD"F�i�DECLA�IAYI�N Sign viith One Branch Circuit I herebY affirm that i am ezempt from the Contrzctor s License Lavi qdditional Sign Branch Gircuits� . . foi the following reason(Section 7031 Business and�Profeasions� Codep � �� . �- � Misc.Gonduiis&CAnduGtors ; L.as o�mnerbf the property,will do�the work ana the structure_ �� • �- � is not intended or offe�ed for szle(Section 7044 Business- Other(See Complete Fee ScheCwe)_ � and Professions Code). - .......:...::;.::.. .. . ....:..�....... . _ _. CONSTRUCTION�LENDIIJG"AG�EN'�V � ��� ��� �� � �M1 �'����A 1 hereby sifirm that[here is a construction lending agency for tne � •�-��-� �� ty'o o e o c? performance,oF thz work for which this permit is issued(Sec.309Z PERMIT FEE�� � -� � �Sub-To?ai? CIV.C.i. .. ,-, _ I M �3 0:5 O PLAN GHECKING FE�-��� .� . � � Lenders Name ..:. .. ..,, ...... . ,�. � ... . . .... . . . .._... ,-.. `� � e .:; c.3 G�ti W � , � . . . PERh41T ISSOING�FEE�� , . Lenders Address � ..._._....... .....a.,..�w<.�,�, . .. . . . . . ....... �Y.��'-�7 l certify that I h$ve reatl this application antl state thst the above � TOTACFEE . „,. , _.. .....�.. ..:. :r..�>. ' information is-correct.I agree to compy v✓ith all County ordinances . and State lav✓s 2gulating Electrical wiring,antl hereby authorize , ., � . '. �reprC-Sbnt2lives tfii Co nty to enter upon the a6ove-mentioned �•""�""""-"""�"��' -`�`6�'� ������\� propeiry"f . s ctio P Do s. � a.. . ,�e.rr•�.�,r*e..�..��„�x.+�,,.�.+wr���..r«++.,.��.... .. SEE�pEVERSE"�FOF����If�Yll'S�6�Y�4�L�NG�AFaE�m��. .. . � ; ,_3-�' �'� Si ure of rmittee Date � � � ,. . . ..., . . i..,. . _ . .. .... -.�, ...,..:. '.�., ...� ��;;. .: � ,.:. . .. � . ,:a . _. � . , � i -+.r n.y„�„ ... �..�.._,-_.a..�._�:��: ,..... . __ . 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