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HomeMy WebLinkAbout1292A (6) WORKERS'COMPENSATIONDECIARATION 76A663 ,o�a, -'APPLICATION FOR ELECTRICAL PERMIT - � I hereby affirm thot I hove a cerlifimle of consent ro self �E-�� . � insu�e,or a ce�rFlmte of Wo�kers'Compensoron Inwrance, COUNTY OF LOS ANGELE$ BUILDING AND SAFETY or rtif' copy thereof(Sec.3800,tab.C.� �� � � . Company ���� FORA►►UCANTTO FlLIIN ' JOB . �/� � Ceifi4ied copy�s hereby furnis ed. New Residentiol Bldgs.&fti�� EACH� N0. FEE AODRE55 r ' � Certi ied copy is filed with the[ounty 6uilding inspec- 1 8 2-Family,Sq.Ft.�� 5 = E LOCAUTY I' 1 enf. .r�MM�ff///✓ Mulli•fomily Sq.Ft. NEAREST �/�//ry,y�.�`�' Residentiol Swimming Pools . OWNER OR Date Appliwnl—,�I�I . . FIRM NAME . CERTIFICATE OF EKEMPT�ON FROM WORKERS' Oullets:Ret_li9ht_Sw._ �`'�`�� � � COMPENSATION INSURANCE � ADDRE55 Thi�s�c�lon n��d no1 b�com la•d if th�worfc involvd 6 First 20 ( P Y Tolal No. Addifionol CIT •� Tel,No.� � th�p�rmit Is for on�hondr�d dollors(f100)er I�aaJ I certify ihat in�he performance of the work for which this APPIICANTK permit is issued,I 3holl not employ any person in any manner . . so ps to become subject 10 the Workers'Compensotion Lows. Lighling iixtures Firsl 20 ADDRE55 � Total No. Addiiional ��TY : Tel.No. , �� opplicont Fixed Appliantes Not Over 1 HP . vERMii � tV�fICE TO APPLICANT: H, ofter making lhis Certificate of APPLICANT �F ry �� Exemption, you should become subject to the Workers' Range_Heater_D.W._ �Compensatfon provisions of the Labar Code,you must forth- Oven _Dryer _W.M._ ADDRE55 � with wmply with such provisions or ihis permit shall be Top _FAU —W.H.— deemed revoked. Haod _Fan _Other_ CITY � Tel.No UCENSED CONTRACTORS DKLARATION � � uCENSe OR � � Disp. _Room Air Cand. — REG.NUMBER � I hereby atfirm Ihat I om licensed under provisians of Chapler 9 � C��S� � a, (commencing with Section 7000)of Division 3 of Ihe Business power Apporp�us 8 Large Applionces DISTRICT NO. J PR ESSED BY O and Professions Code,ond my license is in full force and effect. Vv V ���/} Size 8 Type HP,KW,KVA,or KVAR License Number_�Lic Class�!_1� FINAL I LC �v/�_ ��p�p�� Up to 1 Ind. pATE p co���o�foG�LZ���- _P1Q�� Over i ia io i�d. l:t y/� VALIDATION � Da�e Over 10 to SO Ind. W ❑ FINAL a I om exempi�nder Sec, Over 50 fo 100 Inc. BY N 8.8P.C.for this reason Over 100 Z Dote: - Services,Swbd.,MCC 8 Panetboards , ', 0-200 Amp.Under 600 V �, . 5gnature 201-1000 Amp.Under 600 V � ❑ Over 1000 Amp.or Over 600 V � Exemption for Reg.Maint.Elect. ��` SINGIE FAMILY Temp.Power Pole 8 Appurlenantes . � ' . " HOME OWNER-BUILDER DECLARATION Sign wilh One Branch Circuit � '�, I hereby offirm thot I om exemp�from ihe ConlroUor i license qdditionol Sign Branch Circuits . `� 2 9.2 R � Low for 1he fallawing reason(Section 7031.5, Business and � - Professions Code): � . _ �, �f e e o . i 2 , ❑ I,as owner of the property,will do the work ond the Mist.Conduits 8 Conduclors . � structure is not intended or�oifered for sale (Settion Ofher(See.Complete Fee Schedule)_ . ��O =6�b 8 6 7044,Business ond Professions Code). ► '. d� e 6��i b� � CON57RUCTION LENDING AGENCY �� I hereby affirm thar ihere is a construction lending ogency for � . ��2 5�'8 6 , ihe performonce of the work{or whith this permit is issued PERMIT FEE � (Su6Total) , (Sec 3097,Civ.C.). ' '. � � PLAN CHECKING FEE � � � � � Lender i Name - �� � PERMIT ISSUING FEE �� � � � � lender's Address . � , ' I tenily thof 1 hove reod this oppiica�ion and s�ate ihat 1he � TOTAL FEE � � / � o6ove information is correct I agree to comply with oll Covnfy � � ord�nances and Stare lows regulaung Electriml wiring,and � � - hereby authorize represenlatives of Ihis Counly to enter�pon ' . - th above-menti ed propert for inspection pur oses. SEE REVERSE FOR EXPLANATORY LANGUAGE �:';�,.�-o�-71'I�- �' � � Signoture of Permitlee Date � , . �, . � " F .,... ... .., � �:,.., . ,,.. _ , ,, . � ' � � � .. .. .. _ .. ..-'_ . � i, . . ., ._.1 i� ��. ...� . .� .. �. . � . . � ,. . ,,� �. . � �� ., :. �,. � - ,yeFROVvt�s --nATe _ N _ __ ._ _--• OyJN�R BUILDEf:OE�LA ATION� � �. -� ` J. v . -SICNATURE � - � ; � �� - �1- � , TEMi'.�OVJ„J7pOLE,�� �.--- � '-�-� � I hereby off m�hor I om exempt fro flie Co tractor's ... �. ... .. �)-`. . J �. �-t. - , .. --.. .._..__. . ....'_'I . ._ _ ! , �,.: ; . �, Lrcenso :aw for.tha,following rea;un (Secbon�TO,�.�5. . . .___.. UhtlERStFH�VC2K. .� . . C 7 d � ' { ; � � � � '- . _.___ __� ; - � - us ness an Pr ess ons Godo:Any citynr c Ny whkh :. ....�-- ...�-- - -�--�'-..... ROUGH C�N7U1T--,. '___..:_ _._._�._ _-_....____' ,� . , .,,.... .�...'. : � ��. �rsqvlres,a�p�fm1!to SonslruU Jal�er firnrovF��emolish. ' � V11�21NG`� ��' '''�- � - �� �j ' ��? , '�' orraphtr oriy�sfruelure,'prlor to Ifs lifua'nce,\dfso rc� '. �- '- -- ��:-"�� - -- �"�� _ � ` ; rqutreslhooppl�mntforauchpermlHofiloastgnedstolo- -. �� .- - •:lX1URF5'-�• �� �� - I � - -� ��� �-�'�- � � � -� montthafF.olslkensedpursuar.t.fo�hoprovlslonsoliho .' ,�,� -. .., . .. ', ' . .'. .....-. _....--- � •.Coauactor's Clcertse Low Ch❑ fer 9(rommencin �wHh .. �dflER�ALTNrJRi2FD--'' - ' � '.''��1 �.i --- --. . ' � - i ' Sectior 7000j ef,Divls�on:J a/�6e 8uslness rnd Pro/e:� ._._ _._.�. ._.__._ ._. ... _. . ..._.. . � � � i , ,.i. nlons Codc)or fbof ho Is exempt Iherofrom and the basls UTILfTY CO,NOTIFI.D.�.��__: j •, i ' . ,1or�fhu�aflegod exemptlort.•Any vlolation o! SorUon . __..- - -- �---_._ (� . c7 � .. t FINA: .__._..� Giiter�on��Yion7`-"..`�-�---`� .�.�.., ', ..'. . �''�� : �:.T037.5.6y any opp(lcant.for o permit eubjetts thn app17- ,-__ - - -__ / �- :':�.:, ,. _.... , 1 cant to a dvl pen^(ty ol nct more thon fivu hundcnd . ., ,��' NOTES � .-_ � � � �� ._.. _ ..' �':' � �, do!Ic - ____ ..__ __. _ . . ...._ '� , �, I I - rs 5500): ..._ � � �`�.,�' � � � .� ` .. ' . � ,.. � - . ..��.�� a a.vner ot ths property will do thc va.k....�d � . .,he stroduro�u�not imendc�d er offered for sale.� � �\,�,\ � �_ .� ��,,\ . -.�%-' ��,:.,' � i ; ' ._. �. t'. .:__ . . ._.. . , (Ser.704<.Cus�nessandProfessionsCodr:. 7heCon!rvo _ . ' _ � �,_- 1_ ' ' !1 ! d t ., _� , , \� -� � ' ""� - �- rs cemn ew oos no a p y fo an ownerof propert �, ! �:.-' � _� � '-j � ��.�� ` ;' � , _'_ ..-�..�_... ,.; ��..- - �who 6u7fds or�lmprovocilhoreon, cn;l who does�such ..�' •..,. . - ---�._ _�; . � � �, , -----........ .--. .. �..._ . provldAd fhot such�lmprovrmenls are rto� � ' . ' ' �''' .'. _ .._. ..:. � - � -...--�-�'j-- . . .�_ . .. . .._' . . . .�'Intended ar'olferod/nr sale,�If,hawevnr.��he bWld�og or ...: . ...,_.. ____ .. .. _._ , .. _ �'� ...�'lmprovement Is sofd wi7hln ono ycar�ol complelion,Ihe . ' - - � � _ � � '''ownerbuildcr w(lt hcve fhe 6urdrp o{proving ifia�ho did � � 5�"' �{ � � �no��tvtfd or 7mprave�{or fhg-du'rpo��o!sala.J \ � � �; � , ... � . ,. � - - ..... . :. .. - .. . . � � � . , . . ._ , . �, � �_�.: _.... _._..__ . . __....__. �.. .�. _._. . _ � . . ... . . ._. _ .___ _ . �1Lam�exeniptuodcr5eq._ � � --- - . . ; , . - ._ . -�— --......._. _ ._ . , , � _,,, ... , � , •'. : ; � . .`` � .. ,. . . 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