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HomeMy WebLinkAbout1469A (8) _._.._._ __ . ;_._.� , . . . _._._. _ WORKERS'COMPENSATIONDECIAHATiON ���3 �a�81 � .APPLICATION FOR ELECTRICAL PERMIT � � i6y affirm�hat I hove o cerfificote of ronsem to self �E'� �,or a ceniFlca�e of Workers'Compeasotion Insuraoca, . � COUNTY OF LOS ANGELES BUILDING AND$AFETY � eriified wpy�hereof(Sec.3800,Lob.C.) � . - ' I Na �Company � fOR AP►tICAM TO FIU IN ' 1�B� . � Certified copy is here6y furnished. � New Residential Bldgc.&Pools EACH NO. FEE ADDRE55- ��� .- �Cerfified copy is filed with Ihe couNy buildin9 inspec- 1&2-Fomily,Sq.F. f — f ���A��TY ��PrMO.v c� q � tion da orlment MuBi=fomily Sq.Ft. �A�`'� � '�� � P � Residantiol Swimming Pools O�R OR ' � '� Applicant � FIFMNAME �C NvJS� I CERTIFICATE OF EXEMPTION PROM WORKERS' � �I� i - COMPENSATION INSURANCE Ooders:Rec_Light_Sw._ pppREu �. rAn First p - i�etton nNd noe b�compb»d li/M wor .d bY � . CITY Tel.No. , irmif is for onv hundnd dolla (f100J �ss.) Totol No. Addirional f i t� 2 PL4N CHECK fy Ihot in Ihe pe<<vrmance o fh ww for-whic Ihis � APPLIGNT�� "' '�is issued,I shoil not employ ny ers n in ony anner - � - 'o bacome su6jecl to�he W r 'C taws. LigMing Fixiures First 2p ADDRESS� � � �� ', �� . � . . Addiuonal .. Sotal No. CITY Tel.No. � PP110 � Fixed Applionces Not Over I HP � pEgnuT �. E TO APPLI ANT: {f, ofr r maki g Ihis Certificale of qopUCANT� M�ef�c AYIi. ° iion, you should beco e subj ct �o the Workers' Range�Heater_D.W._ . � f msqlian provisions of the Lobor Code,you must forth• Oven�_Dryer _W.M._ ' � ADDRESS - � � r omply w�rh such provisions or this permit shall be Top _FAU —W.H.— _ CITY �pC MJ�` -� -Tel.No. fj- j �d revaked. � � � Hood _Fnn� _�Ofher_ � UCENSED CONTRACTORS DECLARATION - . uCENSE OR. i y offirm thal l am licensed under provisions of Chopler 9 Disp. _Room Air Cond. — REG.NUMeER Clau.- � � encing wiih Sec�ion 7000)of Division 3 of fhe Business DISTRICT NO. PROCE55 BY Gower Apporarua 8 large Applionces , Y � �fessions Cade,and my license is in iull forca and etfect. • , d I . - . Sixe 8 Type HP.KW,KVA,or KVAR� � O ' Q ��.Number Lic Class Up fa 1 Incl. F�NA� V , ' � . Over 1 fo 10 Ind.� DATE VALIDATION Q :tor Date Over 1010 50 Incl. fINAI� � V am exampl vnder Sec Over 50 to 100 Inc. BY . d . . Over 100 � � '� � t.8P.C.for Ihis raos n � 2 .- - � Servites,Swbd.,MCC 8 Panelboards � ► � -', � � -� " �� �-' � 0-200 Amp.Under 600 V . � :iqnalure 201-100D Amp.Under 600 V . ' . . � ' . Over 1000 AmP.or Over 60p V . : . . ... . .. _ . xemption for Reg. aint.Elect. � � � SWGIE FAMiLY � ' � Temp.Power Poie 8 Appurienonces . . . . . f HOME OWNER-BUII�ER DECIARATION� Sign wilh One Broncfi Circoit y atfirm ihat I am exempt from fhe Contracror's licanse . Additionol Sign Branch Circuiis � �� � . . i 1 4 b 9 A . I� . �the foliowing reoson(SeC�ion 703I.5,Business and , - � � �ons CodeJ: � � �• •`2 ' i � Misc.Candui�s 8 Canductan - � � ' ��� �� - ' - �� � �as owner of�he prope�y,will do the work ond the Ofher See Com le�e Fee Schedule � •�2�J.5 a �� Iruciure is not inlanded or offered For sole(Setfion � P �— . . __ _ _ . ��i Oaa,Bosiness aod Professlons Code). � •2�5�� � � CONSTRUCTION LENOING AGENCY � � - �. y offirm�ha�there is a construciion lending agency for � . O�Z� O'�8�l . (ormonce of the work for which this permit is issued PERMIT FEE� � � - (Sub-Toral) p - - � - � N7,Civ.C.). � .. j � � PLAN CHECKING FEE � � - � . � � � -- � � s Name � - � �. � ' , . PERMIT ISSUING FEE . . .. O , . . ._ . -. s Address � � �� '� �ihat 1 hove reod this apphmtion and sta�e tho�the TOTAL FEE . � �,j� , . .. .. , nformolion is rorratl.I aqree to compiy wi�h oll Counry _ , , � � ites an te laws regulating Eleclricol wring,and . . . . � . _ . . . . . .._ ' puthor'e r presentatives of fhis CouNy fo en1e�upon . - . � ive•m tio properry for inspection purpous. � - , � O !/ '. . SEE REVERSE FOR EXPIANATORY LANGUAGE � � � � - f�t� }E of Permirtee Dare . � �� 1 -_._.. .. .. � nPPROVaLS DATE '. � � � . . OWNER-6UIlDER DECLARA7ION _ .. . , �S�GNATU2E �- -� � - 2EMP.,POWER POLE - - �� --- � � � ' I hareby offirm thc�I om exempt from tho Contractor's � - - �� }icanse Law for.tha following roason (Sectton 70J1.5. � UNDERSLAB WORK � _ ' . _., � . . BusMess and Profeszlons Code):Any Nty or muntywhlch � ROUGH CONOUIT - - � - � � . requtres a permlf fo mrtstruct,alfer,Improve,domolfsh, .. _ . . , � or repolr ony afrodurc,p�lor fo Ifs Issuonce, afso rr � WIRING � , . ' qulrestFeapplleonHoraue6permlttoftleras�gnedsrofe- � �� � � -� - �FIXTURES �� � . . � . , - . ment thaf fia Is bconsedpursuanf lo fho provisions of the , � - . , " Controclori Gceme Law(Chopfer 9(commencing w7fh . -�� --�---- " POWER AUTHORIZEO �� - '�� � � ��� � � Secfion 7000J o(Divisfon 3 07 the 8uslness and Profes� sions Code)or thaf he�s exsmpJ Iherelrom cnd tbc bozis � �'- � -��-- � UTILfTY CO.NOTIFIED�- ' . � . for the alleged exempf�on. Any violat(an o( Soc�lor. --- - - --- FINAL - �' � � � � � � ' ' : �� 703I.5 by any oppflmnf for a pormif wbJous the appi6 rtfn�an ronf canf fo o cfvfl penafty ol nof more�fhan{lve hundrec NOTES � - . .- ... _.___dollan(SSQQ).: �. - • . � . � � � .�I,os owner o4 1he properry.wili do 1he work,anc - �� 1fia atructure Is no�in�ended or offined for solo. ' + ' �� � . " ' � �� � � � � .--. , -'�{Sec.7044,BuelnessondProfesslonsCodo� iheConfrac . � � � � " 'ror's llcense Law doas noi opply�a on owncr oi properry ' � _ - _ . .._- - _.. � , _ ., _ . who 6uflds or Improves fhereon,and w6o does sucl . - work h�mself proLlded tFaf such Improvemanls are no � � � - -' �- --�� -- �-- ��- �- � � Mfsndadoraifcredforsole.fLhowevvr,Ihe6ulldin2o � � � � � Improvemont Is sold wl�hln ono yoar o/compfeflon.ih� � _ � , _� � . - � - �ownerbulldorwillhave}hoburdenoiprovfngfha/hodi� . -- - � not bWld or Improvc(or the purposa of sale.J �. . � . �. . .. . .. . . , � . .�. . .. . I am exempt undcr Sec. . � B&P.C.for this reoson . ._ . .. _ _ . . . ..-�--- _Do�e .. .. � .. - � �� Owner � � " � � � ,�, � .. ..__' . _ . . � � �� , . . , . . - _ . . . . � . . . . 1 f � „ � — � � � � ,