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HomeMy WebLinkAbout1286A � WORKERS'COMPENSATION DECIARATION ��� �0.81 qpp��CATiON FOR ELECTRICAL PERMIT � I hereby oifirm Ihot I hove a cer�ificate of consen�ro self CE-806G � �nwre,o�a ce�uNcare of Workers'Compensation Insu�once, COUNTY OF 40S ANGELES BUILpING AND SAFETY or a f' d c y Ihereof(Sea 3800,Lab./C,.) - ' 0����Company /�"V FOR AP�UCANT TO Flll IN ' JOB �� Cerlified co s hereb furnished. fACH NO. FEE AD�RE55 � Q /1�'!- . ,..�,/ PY� Y New Residen�iol Bldgs.&P �yT CertiFied copy is filed wilh ihe couny 6uilding inspec- 1 8 2-Family,Sq.Ft. s = S OGALITY �"'C lio par nt. Mulii-(omiiy Sq.Fr. t�ARESi �-. ����� Residential Swimming Pools OwN R OR Date App�icant fIRM NAME �, CERTIFICATE OF EXEMPTION FROM WORKERS' Ouflets:Ret_LigM_Sw._ N`°'�� 3 COMPENSATION WSURANCE � /�DIXtESS� . Thfs t�dfon n��d nof b�tom IN.d(f fh�wark invelv�d b First 20 � P y Totol No. CIT Tel.N . }h�p�rmit fs for on�hundr�d dollars(f100)or I��f.) Additionol ��� I cerlify Ihol in the performonce of the wo�k for which fh�s � q pii�NTK � � pe�mif is issved,I sholl not employ any person in any manaer so os�o become subiea to the Workeri Compensarion Laws. Ligh�ing Fixiures First 20 ADDRESS � Add�rional Tofal No. GITY 'Tel.No. �PP���°^� Fiaed Applionces Not Over 1 HP PERMIT N�riICE TO APPLICANT: If, aHer moking Ihis Certificate o( APp��GqNT l '� Exemption, you should become subjecf to Ihe Workers' Rpnge_Heoter_D.W.— Compensofion provisions oi the Labor Code,you m�si forth• Oven _Dryer _W.M._ ADDRESS / wilh comply with.such provisions or Ihis permi�sholl be Top _FAU —W.H.— deemed revoked. � Hood _Fan _Olher_ CITY � N Tel.No. .LICENSED CONTRACTORS DECLARATION uCeNSE I hereby affirm Ihot I am litensed onder provisiont of Chapler 9 Disp. _Room Air Cond. � REG.NUMBER ,� Class.�' !�, � (commencing wirh Setlion 7000)of Division 3 of�he Business power ApparoWs 8 Lerge Appliances DISTRICT NO. PROCESSED BY 0. and Professions Code,ond my license is in fufl farce and effect. � ' �� U �/}(�Q�, �1' Size$Type HP,KW.KVA,or KVAR License Number�lic•C�ass `�� FINAL � Up to 1 lad. '�/ � Over I ro 101nd. DAiE �'f./!f/�(p . VAIIDATION U . ConfraUor���l�/�Dote� Over 10 to 50 Incl. FINAL W ❑ 1 am exempf under Sec Over SO fo 100 Inc. BY � N B.BP.C.for this reason �Ve��� Z Da1e: � Services,�Swbd.,MCC 8 Panelboards , �. ,, � 0-200 Amp.Undei 600 V , � � Si9nature 201•1000 Amp.Under 600 V �. , ❑ � Over 7000 Amp,or Over 600 V � , Exempfion!or Reg.Moinf.Elecl. � SINGLE FAMILY Temp.Power Pole 8 Appurtenances � . � � ;���7 H G A I HOME OWNER-BUIL�ER DECLARATION Sign wilh One Branth Circuil � I hereby offirm thaf I am ezempt from Ihe Contmctor's License Additianol Sign B�anch Circuits � � � • t�• • • e �2 � Law for Ihe ioflowing reason(Seclion 7091.5,Business and �, . Professions Code); � � . � J o e T 3,Q� � ❑ I,as owner oi ihe proper�y,will do the work and Ihe Misc.Conduiis&Condoctors � •< . � � strodore is not inlended or offered for sole(Seclion Other�See Complete Fee Schedule)_ ► ° l a fl 2 c=i� 7044.Business and Professions Codej. � . ��,,�$�a 6 CONSTRUCTION LENDING AGENCY ' � I hereby af(irm that there is a construUion lending agency for n � . � 1he performonce of fhe work for which Ihis permit is issued PERMIT FEE � (Sub•Total) �� � (Sec.3097,Civ.C.). � � ' PIAN CHECKING FEE � ' � Lender's Name � /� � . �� PERMIT ISSUING FEE '� / ' - � lender's Address �� � � � . - � I ceriify rhaf I have read rhis opplicotion ond stare tha�rhe TOTAL FEE . . � ' � obove informa��on is correct.I agree b compiy with oll County �. . ordinances and S�o�e lows requlating Electricol wi�ing,and , • � � . hereby outhorize represenlafives of Ihis Cavnty fa eMer upon . - Ihe ove.mention d propert fo inspetlionQurp es. , � . � o � SEE REVERSE FOR EXPLANATORY LANGUAGE Signa�ure ef Permiilee Date � � .. . . . .���. . , . . . .. . . �`�[ , .. . . � . . _... ;; ,:.; � _ � .. . .� ...�'• .•AFP�?QVA25 .__DATE � - .. ._- -'-� ... . ... _ '` I .C ATION . , �_. . . , �OWN�R,BU LDER DE LAR � . �, . _ . , .. - - CICNATURF �__ -._ .__ . , . • . ` -�... TEP1P.�POVJEP.;PO.E, � -- � -- �' � t �� � -�" � � �1 h c6y aff-rm tha�I� .mpi f ihc Co t a�cr i , _ � . � ` . . .�, ..__. ��-- . _ _. ,. ' ._� . . . , ...Lmenw La.v..ior rhe 4ollawinq reoson (Secbon 7C31,5. �. �:,� . � �-�.- � � UNGERSLA6 1"lORK �, � '�. -I--� � I , ,;..� Bustness and Profes:lorts Cede):Any c1ty or co:�nfy wbich - '� - '--"-- �-..`. -..- F.OUGHCA;�DUIT-; � . .' :..c .. . �-.... , : - reqW rsopeFmlHccensiruct.aber,��T�prove; amolr.h. � ` �.�„ •. . �.��� .'..._.. '��;.. - _._...��--�' -. ..�.'o��rapalr-any sfruclurc.'prior fo�Ns fssuanca).also�w- '� -- . .-. . . --- WInING-�...,..',�- .. - �� ��. �, � ��.I� �. . „ qubosthocppHmnt/orsecbpermittoflloasignn.dsfafe� � �' - �;: ` � :, . -, . � � ���-�-�� � �'���� � - - � "' mnr�ffhclheis/Rensedpursuantfothcprooision.•,o/ihv � .-.__. . .- . � FIXTURES ' ..' --. ..� -�. ' �� _ 0. . � ' ..',',.Conirecfor's LL•ensa!ow(Cfiopeor 4!(commendnq wlrh ... . ._._.. __ `., �.. . `" _��}._-.�.. .__�.PO'Jr'ER AU7HORt'�ED,. -.-.. _..._.:_ ' '.'_ ' ' ' . '-....-_'.�. '. � Section 7000)of Oivizlon�l3 ef the OusMess end Proles. __ �� � ' �. ', �� - i _ .sions Codo)crlho/ho Is exempi therelrom and the 6osis ; _ _.____.. _ ___. _.._.__ UTIIIN CO.NOTIFIED._. � ' �, � � i . _,.{or iF.e:cflegod exemptlan.�hny vfalofian ol Suction FINAL ��_f R(ei�o J�ranf-,.......------��-� ,. ,�...� ,..��• �.....��. ��i ..'.703�.5 by cny epplicanf.lor o permk subjecls Ihe appl;. � — --- � -�-"- -"- - -� '-� --" " � � � � cant fo a clvil pentrL'y of not moro fhon(We hunrlced , . � � _ NOTES � �. �. ; �' ; . ""_'. � � do7fan(SS00).: � , . ' _ _ . , . � -�' �-- �� ��� . . . --... _ :�;i � � � ' � .. � . ��-,[]I da�owner of tho properry wil!do the wark;..nd �i�� .• , � ��•�..� ':t'�• �� � . 7hG s!rur,turo i��not intend�d or offered for salr. . . � `'.`��, �;�_�•� _, �. : � . ._.. . . .. ,_. . �. � . �.(Soa�76i;,6uslnasn ond Profosstons Code:� ihe Contrac- _ .� -, „, � ., . ' �`�--���� ' ' '��� � ' � � � ���� � � ror's lfcensc Low doos nof vppf y fo an owner of proporry �_. __. ._.,. - . . _ _._ . � '�, :,_- � _ � � , � • � � ' - • i ' .. ,.: � who buflds or�im rovos Ihoroon, and who doos such . . . ._ __ - �'" `' -- � ._.. . . .__ . P . . . work hlmsvl(provfdod tnat sucb fmprovemenfs are nof � `_ � -. .. __,_ � '....'..:..-�� _----.-.-.--.-� �--�-- -..... `. , . .. �"-. . . �..�.tnfendodarofferodlo�sale.If.however,�IhebWldingo � � �� �"~ � � � '� Improvemont 7s sold wifnin onc yeor a1 romple��on,tAc � - � ' � � J "ownorvbuilderwlllhavn.ihebcrdencfprovingihc�ReNid , ! ,��. r � . � : � � _�. . , . . .. . . .. �� `- � �� ' � ' �;net bulfd or lmprove foF fha purpo:s ol salc.).. . � ; . ' . `. ..�_._. __._�: ;�. � ___...__... . .�._. . . � . . � . .. � :_._. _.__., .. : \ . _ ' I om';oxempt under Sac, � `-� �` . , , , _. '. ' ...'_ _. : i ; .. :..: . �� �.� Y ..' . . . .r _ .-_. , . ,.. . . _. ..___._. _ ..._____: . . ..__.___'-__ .. - � -.--_ _.-_ - . � ._ .B&P.C.for this roason �- . i . � , .,�,.... __ .. . ..� . . . ----._. . � ._... .._._....__... 4 ^ � i _ _ ___' __. . . ._'- ..-.- - , ;� .. ..,:. .� .;. • -Dote � � . . . � �, � Owner . � , ,.. ,. � . � �_ � � . . .� . . � . � ---�--- _ __.. . _---- . . . . . . . , . ... .:�. : ,; . - _...... , � . , ' .. _ I , .. . . . . . --- .. _.___ .. . . . , .. ..... ,. ...�, .,.. . ,. , . .. . . . . . .._ . . . � - . � , . � ' - 1:.. .�.. .._ . �� . . .. „ . . , _ . , . _ . -'. ' --- . ;,... . . . � ... _---._..._ ... . ._ ._ _ _ _ _...� . . .. . ,� . , . . �—z . . , ' .� ._.. , ,. _ � � � . � . . . .. . . . . .. __ .. . . ._. . .r �.�- - l __ .