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HomeMy WebLinkAbout1799A (10) WORKERS'COMPENSATIONDECLARA710N �6A663 � ppp���CATION` FOR ELECTRICAL PERMIT ,r� CESO6G(Z�S01 � I hereby affirm that�l have a certificate of consent to self COUNTYOF LOSANGELES ,_ '�`,, � " BUILDINGANDSAFETY tJ , insure,ar a ttrNficate o(Wockers'Compensation(nsurance,or � - . � . - n certilied copy thereof(Sec.3800,Lab.CJ ' � Polic Nof.LL(—"'�'Com en ��r'���� _�_ - -- _ _ _---- _ -_._�%_�_ >•. < . . -;` : : • . ` " , .Z_ :, :;r . , , _ ';,��-; � OWNER•BUILDGR DLCLARATION , �:, ; � - � � 1 hcreby afftm that(am ezemp[from�hc.Contcactor's ,_. ..."--. ._ .._._. _.__ . .__.. . r m ,r,-r��PROVALS � DATE �N5aEC7on•S . � - � License Law for the following rcasnn fSection 7031..5, ' .%Ci ,�.. `: • . .. � . - . � _- .-. sicNaruRe .. . .. . . . .. . �,..-.��. ��:rsiness'an8 A�ofessians CadeJ:�Any city-or ca4�iiy :; _�..._.._ . ..�. � � � . � � � - - TEMP.POVV[R POLE��- '-- � �"'" ' _ � � � , - - k'++t�h requims a permi� fo canstnrct, alrer, fn�prove, r__ _ _.__ ---- .. �.�. '. . , ; .... _ ,' . . demoli.�r,or re cir'an}�strtictitre,Prior to its�irauance. �ON�ERSLABLVORY, p F � - �� � � � a7so re urres U,e.app(icnnt far such,permit-to.file a � `'--��� � � ROUGH CONOUIT ; - ��� � �'-'� -- - - - �. �� � �'��`���" � ,, - siynerl stQtemertt Sha7 he is licerued pursuanf.fo�lhe ± � .I�`WiRING=��� � �' ' �: prorisions o`j�he,Contracfor's l.icente La�t�(Chepter 9 , .._. ._ ._ .- -- _ . . . , . � _......(mrnmeqcrrrg raifh Secrioii��000/�:bJ Drvision�3 af�the �. . �� ��� ..FIXTURES . ^C��. �� :-... � ... . -. -- ' � . �� � � �� � l3usinesi vrirl Professiw�s CodeJ or 7ha7 ire it exempi ' ,..__ ._ . __... , ' r f . p.r � �_ �� . - ,...� . • . �._.�_ . ... " ' .--.'-. :�..; . .fherefrom and ihe�Gasir for fke�dlleged exemption.Any - _ . _. _ . .. .p6p/EFiAUTHORt2[D . � . � l'Io1QttOnOJSCfliO/i7031:5bynnvapplicanfJorvperinit _ ��:�7n"�. �,?i'.^.' UTIllTY?GJ:No'TIRED - � ' subjec7s 7he applicanr to a rivt!penalry ojnot more thaR , "- ' � ' - ... .�jirehwidreddo(fars($SOOJ.: '� �� � � : �T�'�. � j.�_f=r'•kiNA�n' ����.�� ��ttr-d._.Wt.�2Mtt . � ' ' � .•. . ' O 1.as ou'ncr of Uic propert5'�sill do thc�rocA.and � "•^ . � � � - the structure is not intended oc offered for sale. - " N07ES �'��` �� � �� � i � � � . . � .. . /Sec. 7045, Rusrness dnd Profesaruir.r Code: The Con- ; c"'r' 1N p f,��y�+�,'( ��� ��,����� ���.� . . Iractor's Liceir.te Law does not apply fo are aw•rter of property who builds or impro��es tlrereon,nnd x�ho does � � ,�"; rT.- .;'[�jr?'l �.. C .'C� ' � � � - . � - �.i,.,. - - . . � � such work hirvuelf prorrded that sucir rrnprovements . i ; t.'c, . . ,`?,.'..` . , . . . . . . . . . - are not rntended or oJfered for�safe. If. However. Nre - � � - - � -� � -�-- - � . � . f . .Guilding or irnpro�'enrent it sold «�i7Hf�i one.year of � • . .�, �,, , , � � ��� , . ,�,,complerron, the�o}��rier-builder n�ill hmr tAe,burden ..�..`. .. . . . ::�-.' ' 4 I . � . � of Pro�•ing rhar !ic drd nor build or improce for�rhe II .. . . . . � ' • . ... . , . . -purpose ojsale.) . , r , ,. . . . . . . •, . _... , � � � � am ex n er 5ec. . , I empt« d ,..__ . .,, I � :. - ; .. ... .. , .; ..,, . __. ► - _ � B&F.C.for this reason __ _ - � __ -_ - - , ; ;__ _ ------ -_ _.. .__.. , . ; i . �: ��: , � .� : . . _ .I ' _.', . ',,,;,�. . .. . . D�tc -• . ., . ..i-. . . . . . _ . .__ _ . .. _ . , . . . , . . �. _.. .. . . .. .� . . � . - Owner . ;, � _ _ • — i , . � :.___ . . _, .._ _ , _ __ . _. i:. ' . . . ..., , ' � � . _ , , � .. , . . . . . . I. .._. - __ _. .. _ . _ __.. � . � ; I - , . . � �- - __ �� � -. ,