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HomeMy WebLinkAbout1290A (6) _ -- , _ _ �- - : . WORKERS'COMPENSATION DECLABATION 7eA� ,��81 qpp��CATION fOR ELECTRICAL PERMIT ' , I hereby afihm that I have a cerlificafe of consent to self C6B06G � insore,or a cerfRco�e of Workeri Compensat�on Insu�once, COUNTY Of LOS ANGELE$ ' BU1lDING AND SAFETY ' o e�{rY�x' J��Q�c p�y`lh�ereof(Sec 3800,lab.C/.�) . P❑o c�j f0�._'"��J�Compony�`��� FOR ARIICANT TO Flll M � !00 ; /j, Certified ropy is hereby furnished. New Residenlial Bldgs.8 EACH NO. FEE ADORE55 /(� �� � Certified topy is filed with the county building inspea 1 8 2-Family,Sq.FI.� _ — s � LOCALITY � de rtmenL � /�L,�y Multidomily Sq.Ft. CROSS 6T.� ` ' Date � Applicont�//'//w c71�,� Residenlial5wimmingPools OwNEROR FIRM NAME -� CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec_Light_Sw._ ��� �/ � COMPENSATION INSURANCE F.s � ADDRESS . + /� � (ThL a�cHon nMd not b�complN�d if 1h�work fnvolwd 6y Tofol No. Addiiionoi CITY �U�� Tel.No. tM p�rmit it for oro hundr�d dollon(SI00)or I��s.) � PIAN CHKK I cerlify that in the performance of ihe work for which�his pPP�IG4NT permit is issued,I shall not employ any person in any manner . . so as to become subject to the Workers'Compensction law:. ��ghting Fixtures First 20 ADDRESS � Total No. Add�tional CIN � ' Tel.No. �� °PPlicant Fixed Appliances Not Over 1 HP vERMIT / 1v..�ICE TO APPIICANi; If, ofter makinq this Certificote of APP���qNT// (' Exemption, you should became subjecr to �he Workers' Ra^9e_Hea�er_D.W._ � Compensarion provisions of tha Lobor Code,you must 4arth- Oven _Dryer _W.M.� ADDRESS y� ���� with comply w'th.suth provisions or this permit sholl 6e 7op _FAU _W.H:— � deemed revoked. Hood �Fan _O�her_ ' CITY � ^/ Tel.No. LICENSED CONTRACTORS DECLARATION � UCENSE OR �}y,� �here6y affirm�hat I am licensed under provisians of Chapter 9 Disp. _Room Air Cond. _ REG.NUMBER (/LJ�� ��O � D (commencing wifh Section 7000)of Division 3 of ihe Business DISTRICT NO. PROCESSEO BY pr„' � and Professionz Code,and my litense is in full force and effecl. P�`�er Apporotus 8 Large Applionces �. �� /✓�j� Siza 8 Typa HP,KW,KVA,or KVAR L� U , license Number Lic.Class�L�_ Up l0 1 Incl. FINAL � ��f � Over 1 to 10 Incl. DATE :/� i1. � VALIDATION � Controc�orG��J��I'�Date� Over 10 to 50IncL FINAL � W � ❑ I am eaempl under Sec. Over SO to 100 Inc BY � a Over 100 � � 6.8P.C.for rhis reason � Z Do�e: Services,Swbd.,MCC 8 Panelboards � � , . 0-200 Amp.Under 600 V � . Signature 201-1000 Amp.Under 600 V � QOver 1000 Amp.or Over 600 V , � � Exemptian for Reg.Moint,Eled. � � S�NGLE FAMIIY Temp.Power Pole 8 Appurlenonces � � HOME OWNER-BUIIDER DECLARATION Sign with One Branch Circuit . . �� 2 9,�n - I hereby affirm thar I om e.empr from ihe Contractor's Litense qdditional Sign Branch Circuits Law for the following reason(Setlion>031.5, Bosiness and �t. •• • •'� � Professians Code): ' � ❑ I,as owner of the property,will do the work ond fhe Mrsc.Conduits&Conduclors � e-0 6 d 8 6 � � strudure is nol intended or offered for sale (SeUion Other(See Complele Fee Schedule)_ , � � •6 6.8 b cS.i . 704G,Business vnd Professions Code). . s . � CONSTRUCTION LENDING AGENCY : � O��L S�S 6 I hereby affirm that ihere is a construction lending agency for '. , ihe performonce of ihe work for which this permil is issued PERMIT FEE (Sob-Tofai) �, (Sec.3097,Civ.C.). , PLAN CHECKING FEE �. � - � � lender's Nome '. /� �, � - PERMIT ISSUING FEE � - Lender's Address �� � � I cenify�hat I have read this opplicoiion and s�ote thot the - 70TAL FEE , � . above information is mrrect.I agree to comply wilh oll Coumy . . . , � ordinances ond Slote laws reguloting Elecirital wiring,�and �� � , hereby au�horize�epresentatives o(ih�s Covmy 10 eN r upon � � � the a ve-memione�operty for inspection purpos SEE REVERSE FOR EXPLANATORY LANGUAGE � � ; r� . � � /a'' �gnatvre ef Germinee Dole ' . . . . P � . . . f' i- . ' ' , , _ ..-._ . . . � . .. . � . . � r�. .. ... . , .. . � � . . .. , .. .. . ,. .,i .. ... �, ._ . � ., . ... � . .. �, .. .. . . . . , . , - .. � ,-_''�.'� t ,. _.. ,. .,. � �S- .,, ._ .�._ , . .. . � . . � � . . , . . . . . . ,�.�, ,� � �<,rPROJdlS � oAre_�.._ °`� 'M _ .__� _ __'_ �-- OkJNEP.BUILDER DEClARATION�.��.r ' � '��, l \ ��.: � .. � . TEh1P.�... . .__. SkeNATU4 . .. _ . , - �FOY✓ETi POLE, . �-':�.- --.; �{.;-.,� � �.= � '' I horoby nff rm iha'I a� r.xempf from��he Cont at cr'c �-' - � " '-' ' ' � ,_%� ___ . . � license, lqw for Iha.�following �eason (Senlo 7031.5. ' , � ,.� _ . . _ _;_ '___-�., . -__ _ -.v' '.- " . �-�-- � _ .y :-. .. ,-� -�-�UNGERSLA3VlOr'.K- � � � � ,- � , _ ., . ,; .• � BminasSartdProfesslpnsCode):Anycftyorcauntywhlch - ROUGH CON�UIT � �- -._._. _____L - - ��:�.� , .-. � ' -_. .. 'requlres a�perr»Iltcconst�uct,o!fer.irrprove,'demolioh. ..._ -___ .. _._.. . � . ., _ . � � � � ���� �' -- or re Ir any�s}ruNure,�p�Jor to Hs isivanc ��clso��n• .-.: PQ �-�--- ,--� �- INIRING- , '�� -���-� D��_ y , �j ' . . . � qu(rosfheoppllmnNorauthpermftioRlecslgneds�ate- � � ' �,`�- ` � . .,� , . , — � "` � �- ' �� . �� menithelhelsl(tensedpursuantfolheproWsfon:olibe . � ...' . :�_.'. fIXTUFES ._ .<.': - ' . ,� • . . . -- --'- --'�-- —� -� '.-�'. . Contraclore!lcense Law Chapte�9(commencin wi�R `` "• � 'r- POVJEkAUTHORf7ED .:___�. . ___ . .-__..__._. �. "':. , .- ..-.----.:.'�.'. •, .� �� ,Sodion 7000J of DiWslon 3.ef 1he Bus7ness and Prolas� � . , . , siorts Codo)er ffiaf bo!s oxempl lherefrom ond the basis __ .._. . _ ... ... ._.._".... VTI:INCO.NOTI'rIED._' _i ,' ; ', I � ior IF.e-al;eged esempNon.�Any vlolofion ol Sarnon FWAI . ._._.__ La(cr on �r�nf':.__ , ':,..,.�. , . ; �r...��, . . _ .�J031 S by eny epplicanf!or v permlt subJects the oppl�- . _______ ,_ , � .--.-. .- ..- -----. .. - .---.. •.`-, � cant fa a clvJf penafly ot not more thon/ive handLed _ . . ' � NOTES � { j '.., . -�.._. ' ors'S500J.: .. . - ��, dolf ._ ._ ..._ . _. ._ � � � .. , • � ' - �❑.,ca owner of tho property will do L�e work, �+d � - . .f����,'�•. ���` ���.� � � �I ,thu sfrurt�.ro is nct iMendsd or affered foi sale... . : , ���� �., � ., `J '., . ... ;. . � ' _..., . . _ � .__ � . � �(Soc.iW�f,8�slness and Profossions Code:�The Contrac- i ,... ,., .. :, - �_.� ' .'+. -�--- : � ,..• -. . ;.•� �lorilkenee4awdoosnofappfytobnownero(properly , �,� �+� � � � � � '-� � � � � i , .. � who bu;lds or�lmprovas Ihoroon, ond wfiddocs snch . � I � � � � '�� �-� � ����- ' � � � -'- '' ""��'� �� �--� � - work hlmsoll provlded�fhvf such�lmprovemenfs are nof � ,"� ' � . ...r ,•. � . .� �.: ---; -- '- ....-.-- --'- �� . � � - � . .•inrended or offernd fe�sale.N,however.fhe building or ' ' � ` ` �-�� � ��� �� � � ' � � � �-�Improvc,r,enf!s sold'witbin ono yeor cf complc�fon,fho . , � , � j , - ' 'owner-buifdc^'will hevc fhe 6urdan of proving lhcl hci dld � ' - ' ':no¢.6ul;d or lmprovc 1or fha pvrposc of salo.) . . • _ � -.. .. . �� .. . , ` �� .-� ' ' . — _-__"� . _� _S. . .. . . . � . � � . . � . � . .__._____..-. __'__.._ `•.• __- _. ... _. .._ .._ ' " ' -- - .. .. - .Iart�exemPt�nderSoc.. .. . �'�.., : � ' . . _'_ __.._ .. _._. . ` . ` ` . - , , ,, . . .,.;.___. ---- �----.._.._� .�., ,,, ��, .._� _..__. . , -... . . � . .... , , , , , � _ . (��' ,. ._.. -,..__ . .__-- -- -_ . ._._6$.P.C.for this rooson ' . � .. - . _. . .. . .,. .. _ �., . . _ . -- �--- ----. .._ _ - ------'- -._..__.._ ., , � � . . ., ...�. �..� . .�, . � . —.. . _. ... _---' _ .. ..i .. . - '� : . ...__Da�e _......___.. _.. .. _... . ' ' . ' Owner ..'. , , � . . �� ' _ . . . . .� . . , . ,.—. _. .-__... ...,._.____I . .. ... . .. . �: . ., , . ' 1 '- � , � .,.�,,.. . >� . . _:. . . , . • ,. ,- ...._----_ �. . . . , . . . ,,,�- �:�.. , ., .. , .. r—I .. . . . . __ . . .. . , . _ . . , . ,. . ,- ,.. - ' 4_'_'.'.._ ._. �..... �. '__"'__'______�._._"_" """"_�._.._. . . .. „ ' . . _�. . . �. . . �, '1��...__... , . . ..... . . �. .. .. ... . � ... . . - .. . . � . . ..`._' ' � .. . ., � , . � . _ . ;:, . ' . _.__'... _ ... . .... ... .. .... .. �, . .., . . � i ., �. -' . .. , .... .. ._ . ...,........ .,. .._ . , . \ . -ti (�f` .�1. , . .�` - .