Loading...
HomeMy WebLinkAbout1285A (6) � WORKERS'COMPENSATIONDECLARATION �6AbQ7 �o�e� qpp��CAT10N �FOR ELECTRICAL PERMIT � � I hereby otfirm ihar I have a cerniicate of consenr to self �E-� ' insure,ar o cerYficate of Workers'Compensation Insurance, COUNTY OF I.OS ANGELES - BUILDING AND SAPETY ��or c .���tif.J'�rrd opy thereof(Sea 3800,Lob.`C.) - �,-_e� Compony��/�a� FOR MPIICAM TO FllL IN � JOB �♦ • // Cerlified ropy is hereby(urnished. New Residenffol Bld s.R EACH� NO. FEE ADDRE � (>$�' � C e r i i f i e d c o p y i s(i l e d w i l h i h e c o u n f y b u i l d i n g i n s p e c- �8�-F omil y,S q.F.� S = S IOCALITY '� � a0 ti ep imenL Mulri-fomily Sq.Ff. NEAREST W. � ,rf1,/ Residentiol Swimming Pools CROSS ST. Date_�j��Applican��/��//r/{/ OWNER OR . FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Oufleis:Ret_Lighf_Sw._ �'�� �� 3 COMPENSATION INSURANCE F,s�� a.DDRESS (Thb��c}ton nwd not M templM�d tf}h�work tnrolwd by Tmal No. � GTY Tel.No. fh�p�rmit B for on�h�ndr�d dollan(f100)or I�ss.� Additional Q� PIAN CHECK � I certify thai in 7he performonce af�he work for wF1icF1 fhi5 APPIICANT ' permit is issued,I sholl not employ ony person in ony manncr : . . so as to become subject lo the Workers'Compensation laws. Lighting Fiztures First lU ADDRE55 � � Total No. Addirionol �"'�, ��a�� CIN. TeI.No. °PP' Fixed Appliances Nol Over 1 HP ' pEpWdT T�.iCE TO APPUCANT: If, oiter making this Ceriificate af - AiFIICAM �I `. Eaemption, you shou�d.become sobjec� to Ihe Workeri Ronge_Healer_D.W._ . '. Compensafion provisions of the Lobor Cade,you must farlh• O�en _Dryer _W.M._ . ADDRES$ �O�g� I!�� with comply wifh such provisians or Ihis permit sholl be 7op _FAU —W.H:— deemed revoked. � . ' CIiY G'ft Tel.No. . � .LICENSED CONTRACTORS OECIARAT�ON Hood _Fon _Other_ . . O�5 �.�ROOm Air Con(J. � L�CENSE OR /J � !hereby affirm�har I am I�censed under provizions of Chapfer 9 P' RFG.NUMeER Class. �� � (commencing with Seclion 70pO)of Division 3 of ihe B�siness Power Apparat�s 8 Large Applionces DISTRICT NO.. PROCESSED BY Q� and Professions Code ond my license is in fu11 force and eHect � /a U /�)') 2 /*�I]� Size 8 Type HP,KW,KVA,or KVAR � ttcense Number�I"�V Lia Closs=� � � Vp to 1 Ind. FINAL � .���y��,� � 8� Over 1 to 101nc1. DATE ����� � Conlraclor Date� �'/ V IIDATION ❑ Over 10 fo SO Inct. FINAL W I om exempt onder Sea Ove�50 to 100 Inc. BY ��L �� B.&P.C.for this reason �°ef�� , . Z � Date; Servites,Swbd.,MCC&Panelboards ' , � 0-200 Amp.Under 600 V , Signoture 201-1000 Amp.Under 600 V � DOver 1000 Amp.or Over 600 V . . Exemption for Reg.Maint.Elect. , ��� SINGLE FAMILY Temp.Power Pole&Appurlenances � � HOME OWNER-BUILDER DECLARATION Sign wNh One Brancfi Cirwit � c�-'� 2 H rJ A I hereby affirm tho�1 om ezempt from fbe Controctor's License Additional Si n Branth Circuils� Law ior the following reason(Seuion 7031.5,Business and 9 , , �•.s a . i 2 Professions Code): � � M;sc.Conduiis&ConduUors � �. �,e •7 a�2 � I,os owner of the property,will do the work and the structure is no� intended or offered for sale (Seuian O�her(See Compleie Fea Schedule)_ '. � �� 7044,Business and Professions Code). . e o c`/JO�c> CONSTRUCiION LENOING AGENCY O S.C Jr"S 6 I hereby aHirm lhat Ihere is o conslruction lending agency for the performance oi fhe work for which this permit is issued PERMIT FEE (Sub•Tolal� � � � (Sec.3097,Giv.C.J. � PLAN CHECKING FEE � � lender's Name �^1 � VERMIT ISSUING FEE - �V � - � � �� lender's Address �O . 1 certify ihm I have reod this appl�co�ion and s�a�e fho�the TOTAL FEE . � - � above informalion is correcL I ogree to tomply with oll Counly . ordinances and S�ate lows regulating Electricol wiring,ond . ' . � hereby a�thorize represenlatives of this County to enfer upon �he ob e-mentioned property for inspec�ion purpose SEE REVERSE FOR EXPLANATORY LANGUAGE ���- �°� ��$/�. Signaturc of Permiltee Dale � �. . __ ... ., � . . . ,. ' : , ' .. . ;, , �. � ,. , .., . , ,.. c,. . , .. ,..._ . . ..., . . ., ,. . _ ..;;�t. . �.,�- .:._'.� . ��AFa OVQCS � . •, OATE_. ��r� '-'�r -----._ �._.-_.-- ----._._ _O�YN° -BUIlDER OECLARATION�� �.*.� ., _. . �.. � .- , . _ .__ - ' _.,.�_ . .-- - '' -� �, �, � -� - SIGNATURE �.� .�.� { . . .` .7E/hP.COWER:�FtCLE. ... .t- .�. .�� . .. • . ` . I hereby cffirm�thar�I a 1<e�mpt from the�Cant tlor's F �. � _.- �J . : � . � . �� . .._�_ , ��__-_ . . _ .,..Licenso 14w,for the following reo:on (Secfmn 70J�:5. ^ ,., � .� ��--- . . __• - --� - UNDERSlA8�W02K_. . ._. , J 4� .-�,�� -. . . � � . . �� __ _._ ., Eusiness end Prolossions Code):Anycltyinr coonfyw!th ----- ---' �--�.,`ROUGMCONDUIT-.- - ...'-�_"' _' _�_ � ' ,. - . ... -��- .c�rarepa7rC y�s�rotlu�reS'pNor i'oclfs'ssae��`dalso'+rr, i ..' .�, �. , ... i. -:, .`\..^ r � �� `.� ❑ ' Y ��c'r e� � .. __._ __. . - ___ W7RiNG"' ;��..�- - ;..�0 ' C'C^ y�'i� ' , . . , 9ufr�sfhoc��plimntfar,s�chpermNlo/ilecslgnedstofe. I ` '� � . ' i, � . � �� ' menl thaf hC Is 11cen�edpun�an!ta}heprovlslons o/fhe i � ' � _.� f!�'.TUkES-:�' :�; - �_, .� - � ' � -�--- -- - � �-'' � � . � Controctor's, (censa Lpw Cha ter 9(commencln wlth � s"•`:��. ���_.__ _. -_`%��FOVJERAJTHDRIZE��� - --�-- ��-'�- -�-._-.._ �'-� '� -�------- '� ��� �� �Secfion T000J of�Nlston J of�hc�Buslness rnd 7ro/ez� � � ,. slons C?de)or that h^is eacmpt fhemfrom and fhe 6asis ' �� UTI!ITY CO.NO71FIE0 j � � ; ' - i, f .....for the„al7egod�¢xempllon.�Any vlolo�ion�ol SoNlon � ---- -.._- .___. . FlNAI "��' �---`�.._- �---.'__..--' :',�= - �.'�� •�'' ... . ony appltrnn�(or a permit svbJects fhe opplf� � ��-7031 5 by � . -..-_ ...-... ...-.. ._..--`-�--'- .: ..'. mn!ta a Uvll penc!fy of ncf more lhan livo hundred � .'.. NOTFS -. nlc�o ronl I � :"- -�- ' do1lcrs(SSGOf.: . . . . . � . _. ._ __. .. __ .._.._ �. ' . ' - _._ _ __ . , . . . ._ - �. :�.... ., . ;'�� . . � .:`. �; ,. . . ` . I,os cwne�.c{iha p�repe fry will doJhe work. .�d � - `�` � � ,, ihc�st�ctvro is no�.lntendo or o e�rod{or sole.. , . � . .. . . . � .� , . ---. . . .__ .�. _ � .. � .��..(Snc.704i.^wslnos�and Prolnssbns Cod�,:..7hn ConMac- , . � .� . , . , , . .. . ' � � -� -�� - --� ' ���� ��--� �' " ��� lor's licenac Lcw daos not apply to an ownar of pr�porry . ___._ _ . . _._ _. _' ._.__.___. , ', � �,.' t , . �-- •. � ' ! '�� ., �-,, . , who 6ullds cr�Improvcs tbervon, andwho'does such ,_ �.,...', i ' �-� �- � � work hlmsaN prodfded fh6t iuch'impro�am¢nts are no� I: _.___.__ _ ._... .....__ ......__ _.__.:._:__�, �I . . . , �-.. . . � .. '� ` .. ..� .'�-'�-� — ".._'.. .--�'-._, ... ..' . . .. ... . .... . .. .:�,•,�Inlended or olfercd for iole.11.fiowever,�fhe 6ulfding or � �� � � . •��improverr�ci�l!a so(d Wllhin bne year ol[omple/ion.Ihe � ! � ' � � - � ' '- 'ownerbWfdor'w(IlhovefBeburdeno�provingfficthedid � . �'. . � �,.. .�.. , .,� . . , •. . � ' . , - ; �. � .. p , �,. ..,_P, _ . � �:`.' '� . ; • i .: �.' . no,_�uTld or.lm rovo(or IFo our arsof salo.. .., . . � : �. . . . ._.--_____.._ . ... _.._.- --... - � , �,� , . . - � _ .. , . ..-. , �----� . . . . � \� _.,� tam�xenol un er ScF '-- � .__:._._. . . . . , �.� -`-l y_..,. ____. ..__..._. I �. . . _ ._ ._. .. ._. . _ .. . , . ,. _...... .... _.. __. '� , �;' � ....... , _ .. . ..___._ . . ` � . .. f . ., . � ,� - - -- ---� __ _ .8 8 P.C.for.this reason ' �. , , �„ , , - - -— - _._ _----- , . _ _. . , � ,... . � � ; , - ___ _ _. --_ _ _ - -_ - ---- . i , .,. ; . :�,_ , -Da.�_` ' �- �'- -__..- --�� � � � � '- ---. .... __. :. \ ' �. ' � i � Owner .. � . - � : . , � � _ i .__. _.. . :_____._,___; .,.,. _.. .�........ . . . ..� , .,.... , . . . . , . . � f I i . �.. . . . ,. , . . � � ' .. ' .. . . � - __`�._ _ __ _'_I_-_". . ' - . . „ ... i . . . , .. . . � �. , . � , � .. .� ... • . . : . � , � � , � , • �._..,'_.__�_"_____.___.I.'__'_ ."____--'_ ,. . -: . .-.,• � � i _-_-._ __._._.____' _';� . � � . . _. _ . _ . . _ .. _ ... _ .__ _ ��-.�.,-:..,... .-,��. .f. � � . . . � . � • _. ....__ .� ._._'.' _._"__'_. _..._...__ __"_.._'____'_. __._ , ...,...,n:,' „� , i , ' . ... - . . � . ... , ` ' .. . ... ' ,, _ ; I ....._. .... _.� u _... .. ._.""' ` .. � �.. � . . _.._... .�,..• � . _ ... � . . , �.�;. , ., __ ..__ .._...._.._ _ . . _ :-: �... . _. . .,.,;, ..., . . . , .. ,. i . ..,. . .... �,..�... . ... . . . . .. .. ..... _ `� _ , � . � . . ' .���,.. � ( �\J ,��' 1 -