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HomeMy WebLinkAbout1651A (9) _._ _ _______.. ._......�_ __. _ . _ _._.-__�: _ ---__ ._�__-.�,_.._. _ . WORKERS'COMPENSATIONDECLARATION ���3 �o�B� qpp��CATION FOR ELECTRICAL PERMIT � I hereby offirm Ihal I have.a cerlificofe oi consenr to self �E'� � j� insure,or a cert+Rcate oWe'o•1>e�s'Compensation Insuronce, COUNTY OF LOS ANGELES BUILDING AND SAFETY �� or a cer�i(ied copy ihereof(Sec.3800,lab.C.) � Ll P❑ol�ity No. Compdny FOR A/►LIUNT 70 F0.t IN JOB Certified copy is here6y furnished. New Residen�ial Bldgs.8 Pools EACH NO. FEE /+DDRE55 � .��-Certified copy is filed with rhe county building inspec- 1&2-Family,Sq.Ff. S — E LOCALITY p� . rion deparlmenL Muhi-fomily Sq.Ft. — NEnaEST Resideni�ol Swimming Pools CRO55 57. i � Date Applimnl OWNER OR FIRM NAME S � CERTIfICATE OF EXEMPTION FROM WORKERS' � i� COMPENSATION INSURANCE � Outlets:Rec_light Sw• s 3 � qD�RESS M, - hi�s�clioe nNd nof b�eem I�f�d if tb�work fnrolwd b Firit 20 � P Y Totol No.� Additional CITY Tel.No� 4` � ', 1h�p�rmN b for on�bundred dollan(5100}or I��s.) I certify Ihot in the performance of Ihe work for which this A P�ICP,NTx permit is issved,I sholl not employ any per5on in any monner . so as to become subject to the Workers'Compensai�on laws. Li9hting Fixtures Fin��0 � ADDRESS. To�ol No. .�— Additional CITY Tel.No. - Dofe �pp�i[ant Fized App�iances Not Over 1 HP PERMiT . NOTICE TO APPLICANT: If, after moking ihis Cerlifitole of ADPLICAM . Eaemp�ion, you should become subjecl to the Workers' Ronge�Heoter_�.W.— Compensollon provisions of the Labor Code,you musl forth- Oven _Dryer —W.M.— ADDRESS with comply with wch provisions or ihis permit shall be Top �FAU —W.H:— ' deemed revoked. Hood _Fan _Other_ CITY Tel. �o. ' � UCENSED CONiRACTORS DECLARATION LICENSE OR � I hereby af(irm Ihot I om licensed under provisions of Chop�er 9 �Disp. ___.Room Air Cond. — aEG.NUMBER °�• , (commencing with Sacfion 7000)of Division 3 of the Business power Apporotus 8 Large Applionces OISTRICT NO. OCES BY p}„' . and Professions Code,ond my license is in full force and eifect. � O� ' � . , Size 8 Type HP,KW,KVA,or KVAR U � Ucense Number Lic.Closs - FINAL � Up l0 1 Incl. � . Over 1 to 10 Ind. DATE �!��/ VALIOATION �,. � Conrroctor Dare Over 10�0 50 Ind. S` ❑ FINAL �� E+�� A W �. I am exempt under Sec. Over SO to 100 Inc.� BY �� O: � B.&P,C.for ihis reason Ovcr IDO t�• • '2 z � � Date: Services,Swbd.,MCC&Panelboards � , � • •2 9.2 5 0-200 Amp.Under 600 V , Signolure �Ol-1000 Amp.Under 600 V � . e •�y,�5� � ❑ � Over 1000 Amp.or.Over 600 V � Exemption for Reg.MainL Elect. - � � 2.� �]—8(j , SINGtE FAMILY Temp.Vower Pole 8 Appurtenancez � HOME OWNER-BUIIDER DECLARATION Sign with One 8ronch Circuil . I hereby offirm that I om eaempt from the Convactor's License Additional Sign Branch Circuits � � Law for�he fallowing reason(Set�ion 7031.5, Bosiness and , - �oiessions Code): I,os owner of the property,will do the work ond the M,sc.Conduits 8 Condudors — , structure is not imended or offered for sale{Sec�ion Other(See Compleie Fee Schedule)_ � 7044,Business and Professions Code�. �. CONSiRUCTION LENDING AGENCY � I here6y affirm fhoi there is a construction lending agency for . the periormance of the work for which this permit is issued PERMIT FEE � � (Sub-Toial) , � � (Sec.3097,Civ.C.). ' PLAN CHECKING FEE - � - �� � , lender's Nome � PERMIT ISSUING FEE � � - � Lender's Address - � I certify fhai I have read�hfs applicaiion and stare Ihat the TOTAL FEE : � ,� above iniorma�ion rs corred.I a9ree ro comply wiih all Coonty or nces and SIa1e lows reguloting Electricoi wiring,and � . here outhorize representarives of this County ro enter upon the o -menfoned property for inspectfon purposes. _ , . . SEE REVERSE FOR EXPIANATORY LANGUAGE C � Signolur of Permitlee ate � a _ � . . . .- . , ,. . . . .. .. ... _ _.. , _- .. ._ . , . . . . .... . . � ,... _ . ...... � �. _ .. , . . . ..-..i . ,.. . . . � .... ... .... _... ..._..._.._' " .. . .._._.»._. . .. ..... _,. . __ O'vVN�cR-BUILDER�ECLAP,ATION � s AFPROVhLS ..� .__.DATE.__ ..SIGNATURE-.. � : � ._- . _.. .. . . . .. . �, �:. �..: � � � ;-,��,a �.: :•�.� , - � � - . - ----' - � --- -- . ... � ' � iEN.P.POWE,ri POLE. � -� -- - � - -" " � � � ' � I horoby nffirm that�I am nxemp�from��he Conirac'to�'z � �- ' . . _�.�. .. _._ _ __ ._ .. . . . - censo Law for-Iha follawino.rea:on (ScrNon:J071.5, __.. Li � � �� ���� �- �� ' t1NDERSLA9WO�K � � � �- ,, . ,�.�,':� - GuslnecsBndProfesslonsCode):Anycltyortounfywh/cf; ! •-, __ - __. ' ' � � - �-. � . �.,.-., ,.� requlres c permi�}o mnslruct,olfer,fmprove,demolish, --�- --� � ' - -'"���- ROUGH�CON�UIT � "�� ' .._.._....... -� ----. . . � ;! . �� �-� �� �-- or repufr cny efrotlure,�prJor to lfs fzsuanco, olso re� ��--- - -- --'� ' ---. WIRIM1G�=' :�:. . ' . .;• ,.� , qvlrea fhe opppcnM(orsuch permN fo 11fe a slgned sfote� ':-.__.. __,_�.._ __ - FIXTU2"eS"'.._t,-�' . . ... �_;. .. ,._ .. .-. , . � . ., mcnt fhct Be ts f�censed pursvart to fho provislon-o/the . .. .---� - .. . .=..- �:.�. ."�- '�Contrcrtori Lltensa Law(Choptor 9(ccmmantMg�wifb � , . '�'i.�,. � � . � .. . . ._. . �-���� � '�.� POV.'ER F�UTHORReD- -- - ----� --�-- -- �� � -" '" � � � Seclion 7C0.^)01 Divislon�3 0/fhe Dvsiness end Groies- � � � , sior.s Codoj or thol ho Is oxompf tberefrom ond Ihe bnsis ! _.____, __ ._ _.__ UTILIN CO..NOi IHED� ' . ' _ _.,. � ,� (or ehv alinged exomptlon.•Any vlo/ation of Sectbn .--- FINAL ' n c7 ` - ....... ` .��- .' .... . . ...... . 7G37:5 6y any applicon!for a permlt subJects'7he apph- �__ .__-__ __ ... _._ _. . _. .0 n�ar on J�ron� : �,..: �. .....- ' canf la a elvfl pexnolty ef not more ihon ilve hundred . � ����' ' NO7ES � ..-`��r-'_. � doflors(550��).r . ' . __.._, .._ .1;1' .. _ ., ._ _;.. _ _ .... . . � .' „ ., .., .... , .._.- �]C."os'wnirnfondedro��, . .__ _.. _.... -� , - �, �� perry w111 do thc work,and - tha�str�ture s no i t offa�ad for sala. . � � ' . �, ' .._ ... . � .__ �� . � ���.. (Srsr.�04d,OuslnessandFrefesslonsLodc:�.7heConfror .. ...'..-- - . .---. .-.., -- . � �. � :: . . . � �..� �tor's L(.enso low doas nol opply to an owner olproperfY. .. --.. . ,... '� . -�� . . .,,,. , . . �,� ; who bulfds or'Improvns Ihoreon, and who does�such "".... .-.-.. �:._..._". -...-.-.... ;' ... .. - . �� . . --��. . . _:.._ . ... '� � work hlmsefl ptovided Ihd!such'Improvemen}t are not � - �� ---� -- �� �� -�-� -"-""� �� ��- � " �� ' " ! . �'��IMendedarolforcdforsole.lf,'howeve�q�he6ulfdiogor ......--.. . .'_. .-�,..�._......•.... ..... ��_ _:. �. . � . ,� �Improvement�ls sofd wl�hln one yoor of compleffon,'tho . � � . � . . . � _ � ��ownerv6ulldo��w111 have�he 6urdon of praving ihof he did � ' �- � '� ' - � � no+6ulld or lmprove�or�he porpose of solo.), ' ._ . -__._. . .. _.___. _ . i� • .... .__,_.. __. . .' '_'__ � ,.... --- �. � � ....-. I am exempt undsr Soc. - __._. . . . �, � . ..._.....__ .. . . . _._. ____... .. , : � . , . .._ _. . --._B&P.C..for_this.roason � _ .. . . ....__.. � . , _ , . .�.�. ,i ,: ...,. , -Da�e . • ... . , ,. � Owne- ,. . � . , , . �... � . ._.__..... _ . - . ,.., .. � �.�. . .�, . - --. �:� �. .._ '._. i.___ . . ... � , . . .. , � .. . �. .. � � , �- .. . . • . , . , �. . .. . . . . . . . . . . . � � . . . . --._ � .. . . -� . _ � . .. .. �-