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HomeMy WebLinkAbout1625A WORKERS'COMPENSATIONDECLARATION 76/6b7 10/el APPLICATION �FOR ELECTRICAL �PERMIT � � I hereby afFirm that I have a certificole of consent to self CE-B05G insure,or a certificote o!Workeri Compensation Insurance, COUNTY�F LOS ANGELES BUILDINCs AND SAFETY or a cerfified topy thereof(Sec.3800,lab.C.) - . P�olicy No. Campany FOR/VPI.ICAN7 TO Fltt IN qppRE� D V� Certified copy is hereby furnished. New Residentiai Bldgs.&Pools EACH NO. FEE � Cerlified copy is filed wiih fhe counly building inspec• 1 8 2-Fomily,Sq.FI. E — S � LOCALITY � tion deparlmeM. Mulii-family Sq.FL — NEAREST Residentiol5wimmingPools � GR055Si. Date Applicont .� �RM N ME R � l�v T�R� CERTIFICATE OF EXEMGTION FROM WORKERS' Outlers:Rec__Light__Sw.__ �DRESS (D V COMPENSATION INSURANCE Firit 20 (Thls s�ctien nNd eo�h�compbNd if fh�work inrolwd by Tmal No. Addi�ional � CITY Tel.No. tha p�rmil Is{or ov hundnd dollan(SI00)or I�si.) ` I certi(y Ihat in the performance of the work for which this qppNjCq�K permit is issoed,I sholl nor employ any person in ony manner . ' , so as to becoma subject 10 the Workeri Compansption lows. Lighting Fixlures First 20 ADDRE55 � Total No. Addifional � Oo�e '—��� pplimn� CITY Tel.No. � NOTICE TO APPLICANT: If, afler makin this Cerfifimte of Fized Appliantas Nol Over 1 HP pEgµ�T , Ezemp�ion, you should become subject to Ihe Workers' Ra�9e_Hea�er�O.W,._ , . A��CNNT � !V . Compensotion provisions of the Lobor Code,you must forlh• Oven _Dryer _W.M.�. ADDRE55 '.3�� QD�GG� '� wiih comply with.s�ch proviiions or �his permir shall be Top _fAU _W.H.— . deemed revoked. Hood �Fan _Other_ CITY p� Tel.No.�I� , UCENSED CONTRACTORS DECLARATION � LiCENSF OR �herahy affirm tha�I am licensed vnder provisions of Chapler 9 Disp. _Room Air Cond. -- REG.NU+�BER Cloas. G 4'„f� r; (commencing with Section 7000)af Division 3 of ihe Busines5 Power Apparafus 8 Lorge Appliances DISTRICT NO. . PROCESSED BY d and Profassions Code,and my license is in full force ond effect � � O a�a33 8 GL�� Size&Typa HP,KW,KVA,or KVAR C� License Nu ber lit.Cbss FINAL LL' Up to 1 Incl. . 9'R.$Gi Over 1 to IOlncl. DATE yA IDATION � Contract ate T Over 10 to 50 Incl. OFINAL W I am exemp�under Sec. Over 50 to 100 Inc. BY 0..� Over 100 � B.BP.C.(or this reoson Z pa1e: Services,Swbd.,MCC 8 Panelboords , 0-200 Amp.Under 600 V . Signature 201-1000 Amp.Under 600 V � ❑ Over 1000 Amp.or Over 600 V . . Exemption for Reg.MaiM.EIecL - SINGIE FAMIIY Temp.Power pole 8 Appurtenancas �1 6 2 5 A � HOME OWNER-BUIIDER DECLARATION Sign with One Bronch Cirtoif � - � I hereby affirm fha�I am exempt fram ihe Cantrattor's License qdditionol Sign Bronch Cirwi�s �� � � � �� � Law for 1he following reason(Section 7031.5,Business and � Professions Code): . , � ,...2.�r.5 O . � Misc.Conduits&Condoctors . I,os owner of�he property,will do�he work ond Ihe . x � strucwre is not intended or offered for sale(Section Oiher(See.Comple�e Fee Schedule)_ ► � • • �2�5�e�. - 7044,6usiness and Professions Code). � fl4,D4-86 • CONSTRUCfION LENDING AGENCY � - 1 hereby affirm thot there is o construction lending agency for � the performonce of the wark ior which this permif is issued � PERMIT FEE � - � (Sub-Totol) ��� � (Sec.3097,Civ.C.). � PLAN CHECKING FEE � � � � � � � lender's Name � PERMIT ISSUING FEE � JV � tender a Address . _S� � I certify ihat I hme reod�hfs opplication and state ihai the � TOTAI FEE � ' above information is correc�.I agree to comply wilh all County ordinances ond Slale lows regulating Electrical wiring,and . . . � - hereby nothorize representatives of this County to enler upon � e above•mentioned property for inspection purpases. SEE REVERSE FOR EXPLANATORY LANGUAGE /a.�, - 4-4 �� 9gnalu e of ine. �� ate � � '". ,. .. .�.i . . .. . . � '�. . � .. ' � . .. . I'. . . �. . , , . .. . ... . . � , . . . ... ,, ... ., .. � - , . .. . � . . . .. . . ._ .. . ' . . .... .- . ..... .. . i.'.. . :� .l.r .,.. i� . .... . . i. .. ... . .�, � �..., . .. � . � � . . .... ... __... __.... _ � _.__ . _._ ._SIC TURE� ._'" ....._ � . . L C RA ION � ; � APPRpVAlS _ __DASe ° ��v ..__ .. ..,_.._. ______ __ ._ON,�NER B DER DE CA._. .. . _ T � �� � �-�� 1EMP.POIYEF POIt, 'NF ' � �' '� harc6y cff rm har am cxempr from ihe Cont a�cr's . , •, . ..._. '�� . .. �. l�censc tow forrrholFoiiowing r�aon cUon- OJl.S. � - --- --`�- '��" UNDERSlAB-�NiORK= '.�"_���� �� ���, . � ��-���- � . .< . �. .�- � �Bus/nessandProlesstonsCodeJ�Anycltyrorcounfywh7ch � �-- .. .� .., -- � � � -- �----' ROUGH CO!�DtIIT �-�� � � : � ' "'. ���•n���� �� •� -� - reqvl es a pe�mlf}c cons uu,ober,/mprovn,demelish, - --�-. _--. P }P � �� ,•�. � - '; � � ������ ���^ ; -- �or-re a/r ony slrudurc, ricr to Ils ISSUORCR, OI50�� - r -=.-�_� � �.>..•-. •�� -.'- WIF,ING... ' .-. .. � I _ • qufreslhoappllcanticrsvchpermll/al7lpaslgnadsfofc- ' ��' " �i ..�:-' �� FlXTU2ES� .�. �...- .-. ' � �.�: �__ •��..�::_-... ..� �.�.�, thct he!s 1ltensad pursuartf to fhc provlslan:ol tho men! --- �-�-� - � � --�-- ---�--- ---- ��""- ' - r Conlroctotf Llcenso!aw(Cfiapfer 9;(commencing�wl�h i...._. _ _—-...__.. .:_.� ` ":FOWER AUTHORIZEO'. ' .,.-_�._._.--- ....:..__._.._..� ,. ., .•, _.. _._ ,.�.�..-'�:. �, ° OCO)o/ ess end Proles� Secfion 7 Civls/on�3�ol fbe��usln � �� . � „ alons Code)cr that ho/s exrmpt there(rom onJ iho basis s__-.—___._.._.__ ..._. . UTIIITY CO.NOTIFIEd`_'- -. ' t � � .ior 1F.e alfe ed,uxem Ilcn.•An � ' ._, .,...��i :.... ,�- .- �,�..� .. 703f.5 6y an¢a licont for o crmlt su6 octs the oc"li i FINAL : . ...--`� : ..._,..__.__ I ..', � y pen � I d e _.__._._._____ . _ --- -- ----.�Rlrron rorl" 1 � � ._. , , can!lo o tivN afty of ne more}han livo.hun d ; �' � NOTES , •,- � . ; � ...... � .. . .:dolfars�5500). �: ; � . .. �. � '� '_} . .. ..__ _.. __ - . _. .. - ' .. ;.,. � �. . . , . �. . , . . .[f I,�as owner oi�iho proper�y will do ihe work;and - •` �- �'' '' � �+he�struU�ro is nct intendad or offored for sole. ., � � . -' , ,�.. ,. -.,,_. � i ; , ,. - . . f5ec.70d4,6uslnessondPro(esslonsCode: .TbeConMac � � - � - � � - �. :fors Llcrnic Low doer not apply lo on owner ol proper�y • . . -.. .. ..� _ .. . __. . . �. ..,,, � . . . .�..•, • r `.. ' � �, , �i. i ' . .,.:,',. . ,. - . who 6uflds or�lm�vos fhereon, ond who does such -�- - -�-'�'- � �`" � ��" - � ' 1 ' � � �- � �� ' woric h)mselF provl nd�fhal sucb�7mproJemenfs are no! , �i.,•�. ;. �� .�� . : ,.. ._.�_. .. .._'_.,__.___..._i — .. . . . . ._. .�. , iroended or o/ferad for sale.!f,however.�the 6ullding or . �.:. ,... ._ .__ _.-_..... .:. ... .. _ _. .�..._. ... , . ' , . lmprovcment is scld wilhfn one yoar ct complefion.fhr i I ' I . � ; "�ownor-6✓1lderwill have fhe burden al prbving tfiot he did . � i —'.nnt 6vlld or impro�c lor,}hc pu�pcse:o/sofo.) , .\ � . � . . . , : ... : ;._-. __ _.. ._.. __. �.. .., . ... . _ . . .._.,-... ' '_._. _.'__ _....__ ; ' . 1 om exnmpt under�ec. , � , - _ ---� ' , • _ .-. . ; �.. . . � `. �...___ .:.--- _ --- . -� ._ B&P.C.for-this rcoson .. ._ .. . ,... . . _ _ ._ . _. ____. , . . � i � �:�. . ��..,, .- . . ;.._. __-__..- '_.._. . '... ..__pato_ .. _ . .__. . � �� . ' � i � Owner . . . � -- -, __.—. .--. .. . . . �'• � t � . . . ' ._ ,. , . , . . ' . . j � . .... ; _..,, . . .. .. , � _ s_ ._ . _._.. . . _�. _.. _ . .. .. .. . � �--- � , � , . . �. �----__ . .. , . . , .,._,,.,.. .; �---'-.__--`� � .._ .. . � ... , �.�� . ....... . ___._ ._.. .. ____.. _ ..... - , . . ,..i� � ; . . . , . . . . . _.._._ ...._ .. .. .... „_.. ... ._... _ ... ; . - . . ` ����. 1 . . ...._.. . � .. . . � ... ...�1.i. -... ` .. � ..