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HomeMy WebLinkAbout0983A I herebyOafrmtShatOTrhaNe arceOrtificat L fR onse�n 76A663- ., .., .. A.�� � -. . ..: . . . "iWOi ���a"'�'�`."�'`�"`�°'.�` �E.Sa6��z-$o, APPLICAT�Ib1����51�L���I�C��L M�T� � t to se�t COUNTYOF LD�ANGELE$" BUILDINGANDSAFETY � - insure,or a certifmate of Wurkers Compensation Insurance,or . a certified copy thereof(Sec.3ff00,�Lab.C.) - - .-+..-.�. - � ' � - � � � FOR APPLICANT TO FILL IN � ,Jpg � � ��I Policy Vo. C:ompany EACH NO. FEE �+DqRESS / D /J,�'_ i � .� .� �.�. . . � ��- � � New Residential Bldgs.&Pools ' � Certified copy is hereby fumished.. 1&2-Family,Sq.Ft. $ — � LOCALITY � � ��y� QA G ,� Certified�o � Multi-family Sq.Pt. — NEAREST C, � py iz filed with fhe county building inspection Residentlal Swimm'mg Pools CROSS S7 /}T department. OWNER Oi3 / � ����/ FIRM N�AME /JS C Date Appiicant Outlets:RecF,Y�ight_Stro.� �j.1�' MAIL � � � First 26 U ADDRESS � CF,RTIFICATF OF F,XEb1P'CION FROh1 WOR�KCR5' � Total No. �� Addiuonal �� �Z CITV ��j` el No. �- - y, COAdPENS�TIOV INSUR.4NCE� PLAN CHECK O ' ,1 APPLICANT � . (This section need�not be completed if the work involved „Z.(j°[f - by�the permit is for one )mndred dollars ($100) or lessJ �ighting Fixtures First 20 qDDftEss � Additional / [cettify that in the parformance of the�vork for w ' this F zed ApplianC�t Over 7 HP CITY Tel No. U permit is issued,I sh21]not employ any person��in a anner - PERMIT �/ � � so as to become subject to th'e K�oikers'Compensa L:�w�s. Range_Heater_D.W._ APPLICANT�yz�/J'•�/LJ{/��. /I y Oven _Oryer_W.M._ ADDRESS O� � . I . . � � Top —FAU —W.H.._ 7 Uate���pplicanh ' Hood_Fan _Oiher_ GITY ���C �l- Tel No. G� � s' � IYOTICF.TO APPLiCAnYT`i�Cf,��aftei' akmg this Certificate of Disp. _Room Air Cond._ � �ICENSE oR e_`� Exemp[ion, you should-become �subject to the Workers' REG.NUMBER '�> Class / Compensation provisions of the Labor Code,you musf forth- power Apparatus&Large Appliances � DIS7RICT NO. PROCESSE BY with comply �vith such provisions or this permit shall be j deemed revoked. Size&Type HP,KW,KVA,br KVAR i �rj ���� - Up to 7 Incl. � � � Over 1 xo 10 InCI. � .� FINAL � LiCENSEDCO'.V7RACTOR�SDECLARATION ���� '�� i DATE � �A fa.� VALIDATION . , � . Over 10 to 50 incl. I hereby afCrm th�t I am ticen3ed�under procisio�is oP Chapfer � Over 50 to 100 1na FINAL _ 9 (mmmencing wi[h Section 7000)of�ivision 3 of the Rusi- Over 100 BY �yy�e7 %yc�j ness and Professions Code,and my license is in fulf forca and ' effect. � $ervices �,1 �/� „3 0-200 Amp.Under 600 V �-'"�'� � License Numbera;����+�� Lic Ctass C�G 201-1000 Amp.Under 600 V • Contractorf�'GL:�� -i/11i'�/�a[e ��' /�"��� Over 1000 Amp.or Over 600 V - HOMEOR'NPR=6UI�DER'bE�CY.ARATICSN-������� ��� Temp.PowerPole&Appurtenances - I hare6}� affirm that I am exempt�from the Coniractor's Sign With One BranCh Circuit License Law for the follo�ndng reason (Section 7031.5, Busi- Additional Sign Branch Circuits ness and Professions Code): � Misc.Conduits&Conductors �0 9&3 A � I, as owner of the property,will do the cr-ork and the Other 1See Complete Fee Schedule)— shucture is not intended or offered for sale (Section #• •• • e? 7044,Rusiness and Yrofessions Code). con�sraucnoN L�nn�vc.�ceNcv I • 1 Q 9.9 0 1 hereby affirm thxt ihere�is a constructi6n lending ngency for [he performance of the work for �rhich this permit �s P$RMIT FEE ISub-Totap 6r �� e'e � Q y'�C�(}� issued(Sec.3097.Civ.C.). Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) -' 2� � �8� Lender's Address PERMiT ISSUING FEE r�J I certiFy that l have rexd tfiis applicadon�and state ihat the� TOTAL FEE a) . r' above information is cortect.I agree to compty�i�iih all County ordinances and�State laws r utating Electrical w�ring, and hereby�uthorize represen[ ve o£this Co ty to en[zr upon the aboce-men ioned Prope tY or inspec' purposes. ...._.. ...._._...____........._....__...._.._........._. .-._ ...._........__.....__.. SEIi�REVE}2SE FOR EXPLAYATORY L:�NGTiAGE'���� � Signa u e of e mittee Date . � ' . •' , �D�'a`Ii�z.Z2-E3i1iL�3L�b I3EC'�.AR.$TY�N .�= _ .. . - 1 izere,�y;;CCirn SSfat�I zn eEempY i;om the�onicsctoi s � � � iNSPECTOR'S >.SCL`ilSE �.Ht4' 1C1 Sh0 :�U3'�O!Y'ett�:(:35Urt(SeCfiOtt 70.iI.�, AFPROViaLS ��� OATE � S�GN.STURc c'.^p,o � . .� . � ' � ' � ' j TE:1!P.P�WER POLE I I �� - -. .... . . ��:iLreSSo��r e.5 FOPPPF➢ii?� io Ce ist�+Ct,�aTlfrQ e.nj,YGe.�, . . -+a��yl.. r�` .`-�-- � � � a rro�:sh.or repa�r ary s�ruc.u;e,✓r:c�;ro:•^ ,ssu�rtnc•z. . ' ' u�oE�s�Ae wcRK .' - �-�v_:1�'� �,>>---� aP� reyuires fhn u,.^.prica�at fo� such permir ro !e a ---- - , -� ' � ��FOUGH COIVDUIT � - eagr.,: sta!en:er,c ;h.at he is i%crr:;ed �ursunna trs %r.z . r------ i —""—'� ryre.isiores ot.he Con:rcemr's Licri�se f.ax�/('paFre,g .. . .- ., 'WIfiING ' � ! (eorr,rnerrc;�r,4^witfr Srctioa 76QOJ oi�fYra�ton 3 of thc —�--�`- � L`ruinPs; an,''1'ro e•s'a;s t'od�) er ihat�he is esr.rnnt , � � . '. �F4X7liREg". ..�;. ' . . ' 1`''� � � the�e}'ra.m,a!:d tlr¢basi.;for the alreged zxe:nption..nnc . . , ' ,POWER AUTFIOR.IZED ' � - ViOSPtx070f Secriar 7C3;�.�byunyapplicuntjor¢prrm%t . I;TILiTY_CO.NQTiFIED��� ' SFiBi¢c'fS?hP�Opli4'¢Yit t0 U CiVle'penG%iv esf na!n'!r,re iFc)i , o � � —.,�. ' —i j;ve ffundred doi?crs/$SCO).: ' . . . �F1NAL � LdZ�^,���•�+r �2e�st�- T�:. . . 1-=,a�o��.nc_oC 41se peopecty uili dc fh�u:w'r,s�rn � _ . � --��� �-�� ��� ti�e structure is not infer.de�.ar ef:ered fo.sa1e. � NUTES , . ._ . . � , �lSec. 70�4, du.cJnes�c�.rt irolessinr.s Cods: The Ces+- . . . . . trar-!nr''s �sr.er�.ee..�_�w dce;rri�op�ll' to .n owner oj' _.. . ---� . _._._.__._._,r.._.,__�.._..----- . �--- �vo�erry wi,�-euitds eV:rnproves t?;erevr�,and��Pro�oe,c . � . ' .. . - � , .a:�cN wor4 itimse;°' �ra�ided thut�surh.IrnDrnuemexes ,.. -- '- . ._-----..-------.__.--' -_ .arC�.nrt�rrete�naetl�or a;`fe.rer!yor sa:e.�if�Ynwercr. tne � � . . ... �~� �� - - . h,::ilding-or 4rrrrroczmen� is sofd cvirhin one y�eur nf , _ -------_--� -ro.r,p�etion. �h: cranerL•urid2r :vil! heve �D:e b::reteta - '�. � .' _. . .. ' .. � of.proviirg�rhrlt ha dirl not ouilrl or itnprove jor r}+e . , � ------- . .. . ..-- purpe.re or sele.) . — �--_.'--- g a�n ee�mFt dir,��r 5ec. ..V _. " � _i-- i�&P.C.for trz�s rc&sori_�.____._.._._.._. .. . . � •L'ate-- � � . t:cc'tt�a_:...,_..0 . , �c:�.�-'--- - � ----,----- ___.____ _________ � R-w, e e�-a�� ....-� -- ---�- -�- ---------��-�-----�-�----._....-------�---- . , " ��� � , . �. . . . .. _�T�� ,t.-�r — �.. . ^ A �..,� ; , :. ,