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HomeMy WebLinkAbout1383 (11) WORKCNS'COhIPENSATION UEQ.ARATION 76��� ������ � APPLICATIONV FOR ELECTRICAL PERMIT � � � I her�;l�iy nlfirm thnl I hnve o certi}icole of consent lo sr,U �f-5�5G. msur�, or a cr.rn`i�aic of`Norkers'C,VRI��t`lI5C1�10l1 i�,.su����a:e, tOUNTY OF LOS ANGELES BUILDING AND SAFETY or n cnrtifird cupy iheraof(Src.�fiO0,Lab.C.1 i Pnlicy No.__...—..—Con�pnny...._...._'—"'_— _ _'FOR APPLICANT TO Flll IN JO'S � � � Ccrtiiiedco� <hcrnb�fvrnishad - AUDREtiS� r ._S��. I Y'� l New RP51(�P.I111C1I HI<��5.E PC�VI5 EACII NO. ftl: �c./n,. � ❑ IOCALIIY �� Cer�ifi�d cppY is fded w'rih rhe couniy building inspec- I 8 2 Family,Sq.Ft."__'_ S -�^ �o��f�r,,•-• � lion deF�nr�i}icnt. A1ul�i f�mily Sq.Fr._.�.,_ CR(15551'. �jl��_S Residential5wimrningPools pW�ERCR L' �A �'./ �� � pritr,_-....—_.._Apnlicnnt Flk,V,MAV,E /t - /"( la�,[_ . CERTIFICATE OF FXEMPTION FROM WORKERS' � �d/+�� OWlr.isr Rrc.._ ii�ht_.__Sw.._ AUURE55 i COMPENSAfION INSURANCE �� _.__ firs�20 `-- --`-- (This sotiion nead not be complefed if 1he work involved by foial Nv.__.. Additional CITY Tel.No. � 1he p¢rmit is for ono hundred dollars(5100�or loss.) '— � pLqN C:fiICK �� �� .. 1 ceni(y 5hot in ihr,performurice ot ihe wor!a for which�his I qa'rLICnhT _____" . permit is issued,I shall not en�ploy rniy person in nny monner se us�o bocome si�hjeeU fo the Workers'Compensnticn Larit. �igl:ling I�ixNres F�n�20 ._ .__�__— AO�RESS - -- - .. Additionnl , , lok�.d No._.__ ... . CIIY ieL No. . . Dn�e _��_Applienm�.�+�*r� Fixed Applinnees Noi Over I HP Pi12Mii � ' � NOfIC�Pi1CANT: If, nlier irioking ihis Cor�ificoic of � qvFLICANi ���� �cv•..�. Exeinpliun. Vov should l�emrne su6jecl In Iho Workcrs' Rnnyc—Hcatar_U.�V __ - � Cornpensahun provisiuns oi Ihn Labor Code,yov musl forih Uvr.n _.__Dryer -._W.Pd _ � ADDRESS!"" 7 with comply �vid� such pruvisrons or Ihis permit sFi:dl he Top —fAU —W.H.-- —��"�5 �'�..�� - � .'' demned rErvoked. ' CITY , Tel.No�j�'+' �y// �:: � Hood _-Fnn _Olhr.r-_ �r,il�__.. IICENSCD CONfRACTORS UFCLARAiIOIV � UCFN f UR �� � ' � I hore.by crffi�m ihot I am licnnsc�d undcr provisions nf Chnpicr 9 Disp. _12nom Air Coad. _..- — gFG.P'Ub11il k `�J�6�.L Clnss.�`-f p , (commenc�ng wuh Seiiion 7000)of Divis ori 3 p(ihe Susinr.ss �P I UISiRICT NO PROCESSED BY � . ond Professinns Codr.,unci my Lmnsc is m full lo.cc nnd cffeU. " �O'Nr A(]�)OlGIUA&Lnryc Applim��cr.s { - -��— ---� � . 1 ��.� } Sirc k iypr.HP,KW,KVA,a.0 KVAR � O .. . Liceus�Number�f��S✓�—lic.Class ��%C7 J� _.._._ Up i�>1 Incl. I .__' FINAL � .� � C T�_��' . ,����-5.�. ��� ---- Ovcr 1 to IO lncl. C.. .._} nATE '----"` ATION '• VAIID � . onlwe'or. h•e 1�Dut� �./ ,, ! � • � ; ;; ...._...._ Over 10 to 50 Ind. �_- - -.'--F_- . L � �" ' � —..'_ ' .._ flNn . I am�xr.mp�ondcr Sec.-.'—.---.— i: - Ovcr 50 lo Ip0 Inc. _� BY p � � B.&v.C.for ih�s�euson---..— ,_. � --.- Ov�r i00 -- .'--------- "� � . i .. . � :Services,Swk�d.,MCC&Pnnelboards � o� , � / .Dntc: '�— ; 0 2W Amp.Under 600 V __ . K � 9 � ^+� "�6 � ...— ` f . t Si,ncAuro 1�i,. _.��.- a? ` 201 -1 WO Am�_Undar 600 V �-- __ /��� I� , i ;❑ Ovr,r 1000 Amp.o:�Uvr.r 600 V ___— Ezrmp�ion for Re� Mninl.EIe.cL � I i SINGLL FAPJ�ILY � �� �' ` u�� `y :7ernp.Power Folr&Appurtenunce, c '. � HOPAE OWNFR-BU!IDER U[ClARA110N �I " % , � ; i$Iqn.viih One Bronch Ciruui �—.._ . � ' ' i 1.�l�i . f hr.rr,by aftirrn Ihnl I o�n exr,mpl from ihe C:or.lror.trn'a Liccnsc � 3. iow for the Followinq iecson(Sar6on 7031.5, Business und ��A���itionnl Siryn Rrc�ru.h Circuil� �_-.. .-.—�.. � � .°rc:o;r:.ns:oJ��j. �� � ' f J ll��v� . � � I,<�.�s owner of!ha pronerly,wi!:Jo the.work und ihe ,Misc.Conduits R Condiictorti /' R y �,- � . f ��_ � �.�1 .�" I � skur�ure is noi inlendn�i pr offered for sal�.lScc!�on 4Uther(Se•Coinpl�:lr F�c Schedule)- ..__ .. .� T. 7 0 4.,B u s i n e s s o n c l P r o l e s s i o n s C o d r.). �_�.. E � C'ONSTRUCTION I FNDING AGFNCY �—�—"—�---- -�- - - � � f . I hnreby nffirrn ihnl Ihme is a ronslrucfion lending uqen<y for - - G. � , ibe peilorrnnncc of thc work for�,vhir,h Ihis DPlllill IS issund P{RMIT FEE (Sub Totnl) (� � �s« :;��,.��� �,. —j—�- PLAN CHECKING FEt. LAII(ICI�S Nnme—.__._._......._--' � '�. PFRMIT ISSUWG FEF <<� �' '�, � Lendor's Address_..—...-----' '-- �v1 7. 1 ceriify�Fol 1 hmie rnnd t}iis npplicalim�i ond siote o-�o�+r�E TnF/�t FFF /�. 4��+ J ; � � nbovo in?o:mntion is rarwct.I a�rec lo cornply wdh all Counly 8 ordinances ond Slate laws reyulolinq Flcdri«al wirinq, and E� `� �hr.r�by authnri�e r��>resentplivcs ot ihis County lo r.nter upon �. . 6 Jhe nbovo-menlioned p�o��erly for inspccrinn purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �, r� ,6l.��eio'�-_ , — :. (�. � Sic�nr��un.• f Peim:i.c -.. Uwe � , �' . ...,.,,. �.,-.�.. p ,�>.,... .:�.p:,u q��i � � �; \ i � \ , �\ \ � � \\ �\ ; `� �. \ \ \ � \ �. \ `\ , \ �� �� � \. � \ °�� � 1 `,. 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