Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
1884A (11)
� � �NORKERS`COMP[NSFITION DECLARATION 76A663 70/81 n nne IP�ATIP1�! CP1Cf CI C1"�TPft/�A 1 1'1r1"111NIT � �` I Yi�re6y.�ffirrn thal I have a certrficate of�consent to self insure, �E-a���; eti���i`vF±i ivi� i vi� ��C'v i i5i"vi-�� ��nivii i � � ar a cert�ficata of V'Jorkers'Compensation Insurznce,or a certified COUNTY OF LOS ANGELES BUILDWG AND SAFETY ' ,opy thereof(r;ec.3&OO.La6.C.) r Fc!icj No._ Ca�Gany FC�AFFLICA�T 70 FILL tN JCB a. E ❑ Certified copy is hereby turnished. EACH NO. FEE ADORESS � ��� f q(,�e1�Or .P� ' New Residential Bldgs.3 Pools p �..� ;Certified-copy is filed with.the.county building inspection i&2-Family,Sq.Ft. $ — S . LOCALITY . �i1 yy � �. - deparfinent � - � Nlulfi-family Sq.Ft. — � NEAReST /`� i �� Hesidential 5wimminq Pools -Cnoss sT lRfS7�7�U$I�f {4. . Daie Applica�t j OUJNER OR �Q�k `Q�� 'FIPh4 NAtSE 6i � -CERTIFI�AfE OP XHN?TION FFiOM WOf�KERS' �� � k� MAIL y� Outlets:Rec Light Sw.— �� � )� � � COMPENoAIIJNIPlSURANCE '� � � �� �DRESS C�� � dG (!,f�'fr Vd (This,section need not be compietetl if the work involved..by the '���''" First 20 ��permibis torone�hondred dollars($400)or less.) -� Totzl No.� Additional _ __ �' � CITY ���,;�� ��� Tel.No. ��C,j-���G , 1 cerfiry that in the�.performance-:oPthe work for which�this��permit _ PLnN GHEGK . :is�issued 1 shall not empby any person in.any mannerso as to �'} nPPUCnn.ii - -become su0�e,to�ihe Workers"Compensalion Laws � - LightinA Pixtures First 20 � +�-�AODRESS � { Additional c lotsl No.� �GITY Tel.No. ➢at� �9�.j +T� A{u�t ait r��iF�fl :- . � NOT{CE TO R.P�ICA'J7 lf a e�s Certiticate af Fixed APPliances Not Over 1 HP P�Fmin ,�e � -Exemption,yo�shoul�i bacome siib�ect t6�the Workers Lompensation Range_ Heater_ D'vV � �P�'�"�rANT 1_,:'Czr�`�'�- .�provisions of?he Lahor Cr,de.you must forthvaith comply�sfith such Oven— Dryer_ W.M._ � ADDRESS ���J��� �g 1L(?.��' �7�-- . ��� provis:on cr+n pnri�f Y�fl�e i am c+revek_d Tcp — FAU � W.FI._ -;y �p LI�ENSE�COIdTRA�'TO`? OG�LAHAIION . - ���Y �JJi•�(�pc;y,ui� ,�F(7 Tel.No. t�Jy,���('�i � �. Hcod Fan .__ Otner_ �� j�y � ! i here�; a firm h:t� 3m! e-�sed der;pTomsions;of�Chap[cr 9. �, � Room Air Cond. — -1'��� ' it��,.� � uCEIvSE OR Class. - ) -.(cammenan�vritfi�Se ricn �(�U)�of�Div�sion 3 oP tha Business and n� � FEG.NUMBEF �Protessers Co1c a�:d my license'�s in=ull forqF an�e,iect &` I GI97RICT NO. Pa�C'cSS�D BY, Pov��er Apparatus d Large Appli�nces ! - . y � - - Sizc&Type HP,KW,KVH,or KUAR i i�# ��C � Lir,ense Number Lla Class tJp to 1 IncL ! FiNA � U € Over 1 to t0lncl. i DATE� VALIDATION � - ��T� ` -Gontractor___ Date __Over 70 to 501nc1. i ' � � ! .❑ �am 2xempt tlntleY SeC. _ Over 50 to tU01na � ; f=INAL`� V � —. - �— ._-�--__._. SV . � . � 8.&P.C.for this reason Over�00 �� � � � �`�'-"�a�� �. � �r,p v' Services,Swbd,MCG&P�nelboar�y,s �� � _ ._. Date: ".__.._._ 0-200 Amp.Un Jar 600� �._ ��. � �•. � Sic�nature 201-1000 kmp.il iJer 600 V _ _ �� _ ❑ 6ver iGOC Amp.or�Over"000 V � Exeniption for Rec�.Maint.Elect. � — I �_. SWGLE FAMILY _ ?emp.Pawer Paie&A�purtenances HCME OV`I1�kR-3UIL;ER�ECLARATION Sign with One 6ranch Circuit �1 hereby affinn ihal I drn ezempt from the Contractors�icense Law� � for the following reason(Seeiion 7037.5,Business and Profesaions� Additlonat Sign Branch Girr,uits , Code). I � . �. ��.?'�'�. �{ �'� I.as ownar of the properiy,will do the vaork and the structure Misc Conduits&Conductors I � is not intended or oftered(or sale(Sec!ion 7044,Busriess� Oiner(See Complete Fee Sched�de)_ �t e � � �"-� � and protcssions codc�. � I � �F•6`7�: � �--- � CONSiRUCTION�ENDING�,GGNCY ` _ � I fiereby ef`irm tna??here is a constr�ction lending eyenr.y for Yha, � �' ��� � ��-- performnncs of ihe��ror:<`:or which:his permit is issued(Sec.3097; p�RMIT FEE (Sub-Totaq - - Civ.C.). . - � U�4���.:-,w;.il j �� PLAN CHEGKWG FEE - � Lender's Narrs . �� � � - PERMIT ISSUWG FEE � i Lender's Address � � � I certif9 that I have read this appiication and state that the above TOTAL FEE . �� ' information is corrcct.I agree to coroply veith all Cnunty ordinances and State Izws regulaling Electrical wirin9, and hereby authorize- representatives ot this County to entcr upon thc above-mentioned . _. property for inspection-piirposes. ( SEE REVERSE FOR EXPLANATORY LANGUAGE � . �� �� Gc�� � ���� � /"�ignalure of Permittee ate / ..w .. ..-. , � . .._ ....-..;�q.: I ; � j � � � j �., ���,�� j � - _ n � ' � � � � ( ( ` ('�,�e�-3 , � � �� '2. �; ' � r �'� r g � � ( , ' I � � ��— �? '� �� � � � , i i I � � � j 9 ' � �. � !`' � � �� � � I �� � '� a�; � ' ; , � € I [ � j I ` ( ' .,� �� i r � � i I � p i � � � i � , ,. � � � � , � ' I � � � _ ,. j � � f � , � � � " � � ' 1, ' i � � � � ,,' , �� � � � � � I i � � � � I � , � . ` � � � � � , � ! I _ �-�-�t� �� i 3�✓�.s. ; ';ii I� 1 ; � � : ! � , �� " r )j C. 'i7 "h 4� i �3 s . . � � ! # ` 1 �,, �� � . �E �� r 2 '�k �� f€.� �� . . � i � � � ! � � � � n� ? j �xj � � �.� � ' C-t � m � � F � � � � ! 9 9 � -� � � � � � ..i7 �� � - � � . I i f � 1 � � � � � � �- '� � � '. ! � � �f ' I 3[ j( � , ' � � � � � � � � {✓ �` � '� ` �� . I I I � € € � � i � � �� � 1 � � � ... i J�� � �., � � j _> i r i 3 `C+ . ., � � � j � ! ' � � I I '3i j � i i � � � � ' � �� � � � i � � � � . � � t , ; [ ( 3 i : ; � [ � ; � I .I � [ . � ( _ �� i E �� ; I � ' I 3 _ ' ( � . - > > p' ( � , � , i :'. f 3 � . _Y� .�_� _I � [ � j � � � � j � 4 � 6 y � i . E^s I�'` ;�:[ 3 — . � � � 3 I I � . � . ! � � � � � � ��� 5 � � �� . � ;j . � € 4 ' t . ! � j I j ' � � � E ���,I�.. � ` � �: ` � � ! ! j � j ` ' } � :��a�, � j � 3 ; �; ; � ��. . � : ' 3 � R€ . � � � i € � I I _ � ` � j ' � � ` !� ' � E ; � � � € . {{ $ .. ; ' � i ' 3 . E� � � t ���. I ' ' E � � I , � � . � . . .... i � > ' ' E � � � _c E � j �~� � [ � � � �� F i ' �,. ' � � _ �_ { ; , ; ; � I � I � r � � E : : � ; ; � � �� i � j , I � � ! � � ; � � ; � i ` "` � � ' i� �`� ! � ,�.� . 7 ' � �i �� ( I � ` ; .� ; ; � ' � ��;� 3 € � � � ( � � � � ' � � �� 3 7 . I � ' . 3 .. . � E �i ��{{� � ' � € 1��� . � � �3 ' � � � � i � t � � 1 3 �� 3 i � €1�-i.�i � '� � � � l ` .. � , [ � � � � � i ���'` � � � � I - �� �t � -} i � . �_ � , � ; � � � � �� � � �� , _ �___� ��_��.��_.� � � ' 3 ,� � i � � � � � ` I ° � � � � � � � � , ; � � i ; _ , i , � : � � ; ` � 1 � s ; � ! i � � � � f � � 3 � � � � � � � €k � ; i E ;� [ : � � � € E � � �� � �� � � 4 . , , - -� � € ] ' ° € � E � � � €j t ( �� � f � .. . " � ... . , ' € t� � � � � ( 3 1 E � € € .. � � � ._� 1 � { � 1 � , � � ' 1 I ! � � . _ . 4 � j � ��� - 1 �. ( � � � � � � , _ ( � � 1 � � � � � . � _. _ _e ...,.._,. 3 � ` ' ' , � , , , ; I � _ � I � � � � E ' � i � � 1 � 9 , � o i , i � � � e_ � �, � ;" cr �, �'ry,� „ i"� � � � �, � `� � — -.. � m � a .a c: � ' r c ,; n . ��� . c� c • ��,u, c r � � � x, :3 c � � U � re `' _� c � ro w . G c _ � j ,7 ,� �' � r � � v a; s� ° �' -.�r, � n o c i k -� � a � { C� � � � � . . � ' � � `�'� ": ( ..�',- � ^ M C� K ..� l"1... � ',�"`. °1. � Vj • ,`. '� --,. S)i- -,� � � � � � a � � � 3 � �„3 r . . . ... . . ' . � �, C'tij � � (" O �J �.�. ^ . `� . � r . lJ ,.. . . . - . 3 �-'. �. ..� ' . . . � �.. C S C�A � G� � =. � � Cu � t` '3. ,� �* C) `h ti K � . " ' �.� �.T.'c ,:� @ 5[j � .�j ^' �j � . '�'"J � _� L"J l „` ,M '`h' ... � :.� (�n `C Ce � rn n tu � ."�i Q� vs `�.. `h � � " £� `� a -. , "F� G fi ' � C ,-�� , '"�1 •� C . � . . -. - �,:� � �,ti n. � � � � �, � � � �, ri : '� X C,� � „ . - . _ � � �, `J � � b a p � t�'S r Z'- I'-^ G, t C'`� ., 7 !"' € `1 cJ � Q K` V> �� .si C7 € ' ..:: �D ' � U ry t` � � ` Z'' O �'� 7'Cl _ ' _ . � ', : ° ,� �., � t, m � s R^ w a �' c� � -.. :.G . � ' - . . . � � € '� _ z➢ CJ �' � .7 - 'S' 4>l � ' '3 � �J "t..,'" � � ^�'" Ct �.;/ i € � '�. zD .7 t'S c � _ E�J'tts _ 'J�.• '� c' �� � -` FP i - � i �_ "r"y . t; 'r ' �,.ry, `".,' � n ? :5 a ' i ._.�5 �Y�-.. "E f'� � � C� ,.t ; - . ' c"j . � � � � � (3 C" � R .�` CJ. Q � . .�.. Cs C. � �' � W Ci -+^, � � � ' l( C' e J '�� a : w � n � � C°i �"—�'{ ... . � '. .. . . _ � ` � I t m p c� 7 � r Q a' C�, .�.- c7 .� � � r' ? . .. . ._ .. � i , � " � � c � r c� � , r �o c� "� ? _ . . � 1 j . p c . � � .�" � U� � � ... .� s .P ,r. {{ .0 ^� , . .. .. . ., . . � � _. � 4 Te , � � � � � „ ..� c^ e' � 'r`a c1 ,'� �' C' i ui � �.. r � t; a , . ... � ' ,. 4 ... ...� , � ., 4 ... n� ,,. ''s "� _ , j j C': `) � � '� t: 'I. C3 I