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HomeMy WebLinkAbout1377A (7) ... _ .. . .___ .�. _ _ _ . .._._ _.�__ _ . . . . .� _ _ - - . . _.. .... .. _ _ . _ � � � ( WORKERS'COMPENSATIONDECIARATION 76A663 10/ei APPLfCATION FOR ELECTRICAL PERMIT �] , -hereby affirm tha�1 hove o certificate oE consent to self �-� � . e rificota of Workars'ComPe�sara„i„su.a�ce. COUNTY OP Lq5 ANGELES BUILDING AND SAfETY L� . >rsarcaniFed cop thereof($ac.3800 Lab.C.) , - - .. .f '�1.Cn - �ai�cy No.� Ld'pany �� FOR MPl1GNT TO iLLl IN JOB '�. �Ceriified copy is hareby furnished . . New Residentiol Bldgs.8 Pools EACM NO. FEE ADORE55 `Z � � CertiTied copy is filed wi�h the caunty building inspec- 1 8 2,Family,Sq.Ff. f"�oo S — S LOCAUTY uon deponmenr. Multi-fam7ly Sq.F�. � — NenaESr �{�. � � caass 57. � ReaideMial$wimm'i Popls OWNER 04 �y �Date_E ' _1" ' Applicant � . � FIRM NAME I�I �� �� CERTIFICATF Of E%EMPTIpN FROM WORKERS' � � � nUa utlets:Rx�Light�Sw._ ��Z 4 U - COMP£iJSATION INSURRNCE � � nOORE55 O �Z ' �(This s�Nton n��d no!b�aempfd�d if th�work inrolved by � First 20 ' � �Th�pvmlf ia{or one hundrad dollan(5100�or I�n.) Tmol No. q����o�a� CI7Y �- Tel.No. ; ;I certify rho��in the pe�formance of�he work for which ihis qpplNC.CpNiK � � � permil is issued,I shol!no1 employ o�y pe�son in any munner , so as fo beco e s bjec�fo Ihe W rk C,�m�pe n Li9hting Fixtures Firs�20 ADOR£SS � .0 �'6l� �W�'�� Additiortel � �� !J S Tmol No. � QTY � � Tal.No. ' Dote � PPIicnN Fixed Appliantas Not Ovar 1.FIP PERMtT , NOTICE T PUCAN7: If, aFf a cing Ihis Cenificale of ArPUCANi �C �����. � Exemption, you should become subiec! to the Warkers' Range_Heorer_D.W.._ ' Compensoron prov�s�ons of rhe lobo�Code,you masl forlh• Oven_Dryer _W.M._ ADDRESS Z - �C V n . ilh comply with such provisions or this permif shal� 6e �Top _FAU _W.H.— deemad revokad. � CITY 0 '' � ei.No. � V � LICENSED CONiRACTORS DECLARATION Nood _Fan +..Otbar_ Clisp. _Room Air Coad. — uCENSE OR . . Clpss. � I heraby aHirm Ihat I am ii<ensed unde'provisions of CFapler 9 REG.NUMBER i� (<ommencing with$eclton 7000)of Division 3 of Ihe Business power Apporotos&Lo�ge Applionces DISTRICT NO. . PROCESSED BY y ond Professions Code,and my license is in f�ll force ond effact. � d �.�+ j�_ Size 8 Typa HP,KW,KVA,or KVAR � � �I License Number��m�`'� Lic.C4loss�✓� �p to����� FINAL � , � - V ��I� Comractor�lq�+11�-'�',v���"`6aie 7.��L.T Over i to IO 1ncL DATE ,;,�1-,I�;/ , . VALI�ATION Q � �f Ovar 1010 SO incl. FWAL � ~ �� ❑ i am exampr under Sec. Ove�50 l0 100 Mc BY '�} � W .�. 6.8P.C.ior 7his reoson .Ovm 100 1 l' � 'C�'4'��~'� Z �+ � paie_. Services,Sw6d.,MCC 8 Panelboards ► - � � � !I 0-200 Amp.Under 600 V i J Signa�ure � 401.1000 Amp.Under 60p V � , � - . � i� ❑ � Over 1000 Amp.or Over 600 V ,' Exemp�ion for Reg.Maim.Elect. � . � - SINGIE FAMILY Temp.Power Pole 8 AQpurtenantes / 00 f HOME OWNER-BUILDER DECLARATION Sign with qne Branch Circuii � � 1 I hereby aHirm thm I om exemp�from the Conrrocior's License qddi�ianal Sign Branch Circuits Law for Ihe following reoson(Secfion 7031.5,Business ond � Pro(essions Code): �,1�•T�,7 a 1,as owner of�he properry,will do the work ond the Miso Conduits&Conducbrs- i O svuctvre is no�in�ended or offered for wle(Section ��tie�(See Complete Fee Schedule}_ ► �'• .•� �`� . 7044,Business and P�ofes:ions Code). ' '�•2��0 CONSiRUCTION LENDING AGENCY - � ��- .. I hareby 6ffirm�hot there is a cons�ruction lending agency for . ����2 ra�rJ Q� the performonce of 7he work for whith ihis permit is issued PERMIT FEE � � (Sub-7o1aI) `�a� - � �� � - - . ��� . - . (Sec.3097.Civ.C.). : � . . . . .. � 7 PLAN CHECKING FEE � � O 2 Q�J-8 U Lendar's Nome �� A'}Q. ��Ct F�c. � . . . � .. � . .. . , . � `,�r� PE�MIT ISSUING FEE. -- . � Q � � Lender's Address �1 L! S'#-.�.� � .__C_!i/ + LKl � � � i cer�ify thot I have reod�hls oppGca�ion ond sm�e�ho�1he T TAL FfE ��„$"�7 . . _ . _ __. above infprmotion is corc 1 ogree to comply wHh all Coumy ��. - ordinanc and State I s ego Elacbicai wiring,ond _ � ' hereby horize rapr enl r v of I s CouMy ta eNer upon � � � � the o v .la�emionad ro er - o ' spection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ✓ln, . v� ' 1 . . , . ; . . . i nature of Permirlee o�e ' ' . ... . :. .. . - _.. . . .. . ... . � .. . _ .. ........ ...'. . ..: OWNER-BUILDER DECLARATION ' � . ' �'APPROVALS � DATE --. SIGNATURE- .. . . , -.` . ... .' . . . �, , ?EMPr�POWER PpLE � - � � � - � � � I hereby affirm that I am exempt fram Ihe Conrracror's �� -� � � � �� - - - - - - ' � � , Licenao Law for tha following roason (Sactlon 7031.5, � UNOERS�ABWORK - . .._ ' � BuatnessandProfesslonsCode):Anycltyorcounrywhich � � � ROUGH CONDUIT . � - � � � ' , �� � - ' . ' reqyylres a permlf fa eonsf�uct,alter,Improve,demobsh, . . ...._.. . � � _ ' or repalr eny slrudorc,prlor fo l�s Issuance, olso re- �. . WIRING � - � � � . � qulnstheapplicanffarsuchpermltroflleaslgnedstme- � - �� -� - ' � FIMURES � . ' . , � � " menf Iha1 h�Is Ifcensedpursuanf l01hn provlefons al/fio � � � '- "��� �"- .�^;Confrocfar's tleense Low(Chapter 9(rommoncing wi�h � �-� �---- �� "--- "�" POWER AUTHORIZED' ' - -� � � �� � �� � Sectlon�7000)o/Dlvlslon 3 0/fhe eusinaas and Proles- , . slans Code)or lhot he Is exemp�thorefrom and the bosis '� - - �-- � � � UTIUTYCO.NOTIFIED � � � !or !he alloged oxomptlon. Any violatlon o( Socllon �� . . . . . . FINA!- - -- �' `� . . . --.. . . .. . . 7031.5 6y any apppcant for a perm7�sobjeels the appli. . n(a�on ranf - . ��. � cont lo a elvtl penally ol noY marc fhan,llva hvndred ;. -. .. -. . ._. .NOTES . . . , . . � _ ..dallars($500).: . ' . . � �. , �. . .. . ' - ' � � � � � ❑I,as owner of the property will do the work,ond --' � tha strocfoto is nm intcndcd or offered for sale. - � , � _ _ �� � ' � � - � � - . � �.(Set.70��S,DusinossandPro(essionsCode: iheConfroc- ��. � � • lor's Ltcenso Law does nol oppfy fa an ownor ol properly ' . _ . �._._. . . � .. � .. . � ..__ __ . . who hutfds or Improvos}hcreon, and who dovs sucfi work fi7meelf prov7dod f6ot such-Improvomen�s are nat . � � . - � - � - � �� . . � - . � .9ntended or ol(ercd far sofe,1/,however,fho bullding or � � ' � � ' - Ymprovemenf Is sold wl7hln ono yoar of compfe�lon,Ihe � . . - . . . , � owner-bullder wilf hove thc 6orden ofprovMg thaf he did � -- � ' � ' - nof 6u(Id or fmprove lorJ6e purpose of sale.J � - � ' I am exempt under Sec. � , . . _ _ . ._ __- . , � . . ..,., � � . ._ . �. . . . . . _ _ . . . .B E P.C.for fhis reason � ' � _ . . . .. � : � .. -0ote - . . ... . . � . Owner � � . � _ . � _ . . _ . , ' . . .. . _ . . �. . . . . .. . , . . . �, . � -, ., �� �. . , _.. .._... . . . ---�-- - . �.1'� � . . . .. \