Loading...
HomeMy WebLinkAbout1398A (7) , WORKERS'COMPENSA710NOECLARATION 7en663 +o�e+ qppLICATION FOR ELECTRICAL PERMIT {�� I hereby affirm that I have a certificate of consent to self insure, �68o8G or a certificate ot Workers'Compensafan Insurance,or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY u copy therenol(Se�c.+3�8-�00,Lab.C.) PoIiCy No����3�7Df7�OmPdny N FOR APPLICANT 70 FILL IN DDRESS S. �/VJ✓� / . ❑ Certitied ropy is hereby furnished. jN • New Residential Bldgs.8 Poo}�/��{/' EACH NO. FEE 0 � Certifietl copy Is filed with the counry building inspection 1 8 2-Family,Sq.Ft_LSQ`.2� 5 ' = S LOCALITY /e � - 5,� art nt. ,/� Multi-family Sq.Ft. NehaEsi � �rA_ 3 L. �- /� �n_ Residentiat Swimming Pools caOss SL L�f�L., Oate Applicant_f7�YTI 11�r�d-"-K.. � , Owr�E�i on A' . � . FIRM NAM /�' � CERTIFlCATE OF EXEMP710N FROM WORKERS' , qrt�ets:Rec—L'ght—Sw._ ��� - COMPENSATION INSURANCE . ' , nooaES �O�� "' �ThIs seetbn need not 6e oomp�eted if the work involvetl by the First 20 permit la for one hundred dollare($100)or less.) Total No. Additional CITY Jr/� � �a Tel.N�'.. •,x I certify that in the performance of the work�for whiCh this p2rmit I'V N CHECK is is3Ued,I shall not employ any person in any manner so fls to APPLICAN7 � — become subjett to the Worke�s'Compensation Laws. L'ghtinq Fixtures First 20 ADDRESS � ' - - � Additional � � To[al No. CITY �� Tel.No. Date Applicant fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: �F, a(ler making this Certificate of PERMiT ���i �/�,�� � _ E-=mption,you should 6xome subject to the Workers'Compensatbn Range_ Heater_ D.W. APPLtCnM / (/ . �.ions of the Labor Cotle,you mvst forthwith comply with such Oven_ Dryer_ W.M._ A�DRESS .Q �� �p,_dsions or this permit shall be deemed revoked. Top _ FAU _ W.H._ ��Ty ��l � 7ei.Na �// � LICENSED CONTRACTORS DECLARA710N - Hood_Fan _ Other_ /"'� �G7�� I hereby affirm that I am ficensed under prwisions of Chapter 9 _ Disp. —Room Air Cond. _ uCErvSE oH • � ��_/y� � (commencing with Section 7000�of�ivision 3 of the Business ard AEG.NUMBER z• Pr0}e55i0n5 COdC,arM my IiCBn50 i5 Ifl}ull 10fCB 8nd etfeLt. DISTRICT NO. OC D � Power Apparxtus 8 Large Appliances L�ense Number ��27 Lia Class �-V Size 8 TypeUp to iVl cl.a or KVAR FINAL `� �- - - ,��-�'y";} ��,/ q7 Over 1 to t0lncl. DATE !� � �ConiraclorN'�`����r Y�V Date • v � - �'�V y VALIDATION 0 . � Over 10 to 50 Incl. FINAL ❑ I am exempt under Sec. Over 50 to 100 Inc. By W B&P.C.1or this reason Over 100 � N� Services,Swbd.,MCC 8 Panelboards - � � . Z � � � Date: 0-200 Amp.Under 600 V � Signature 201-1000 Amp.Under 600 V � . .. c�1 3 9 8 A ❑ � - - - � Over 1000 Amp.or Over 600 V ' Exemption for Reg.Maint.Elect. �� � � •L� �' SINGLE FAMILY� � Tem Power Pole 8 � ° �7�8 2 p. AppuAenances HOME OWNEF-BUILDER DECLARATION � Sign with One Branch Circuit �� � � � �9•���'�`��' I hereby alfirm tha[I am exemp[Irom ihe Contractor's License Ww f� -'+,e following reason ISection 7031.5,Business and Professions - Addi!ionat Sign Branch Circuits . ^ '���� � `F � � �� \ �� ❑ I,as owner ot ihe property,will do ihe wo�k and the structure Mise.Conduits 8 CorMuctors � � � � � � . is not intended or offered for saie(Section 7044,Business aher(See Complete Fea Schedule)_ �� and Piofessions Cods). ' - � � , - - � -� � \ CONSTRUCTION LENDING AGENCY � _ \•mby affirm that thera is a construction lending agency for ihe kmance W the work for which this permit is issued(Sec.3097, . PERMR FEE � - -�- -- -� -- (Sub-Total)� ��. PLAN CHECKING FEE �Name PERMIT ISSUING FEE � �tldress � - � � � � nt I have read this applieation and state that the above TOTAL FEE �� �is correct.I agree to comply with all Cwnty o�dinanees � - � � � �aws regulating Electrical wiring,and here6y authorize �es of this County to enter upon the above-mentioned ' � - � � � � �� - inspection purposes. � �� SEE REVERSE FOR EXPLANATORY LANGUAGE .�.�/�.�� ,f Permittee Date `. ' -. , .. �. 1. 1 •�t . �� ...- � / ' � �� � �� . . ! ' ' , ' - ` _ . � • � �� .�, . I� . . ' �.. . 1� . �� � . . . • . � �" ' ', ,_. ' ` " " i " ^ . _ , _ ' : .�J . . . .�.. �_ � � � - ' � � �- � �. . . •,� . ' . ' . y ., - _ � , '� �, �' C !1 . , � G .p '-n� L' p � �. - . ._ � • ' � �i y '^ =1 U X 77 G � ;9 '� �t ' �� O Z � C 'Z �� p .b� y . ' , _ i ' i.N � � � m � � � � ,v�. . . N .. O. .p , '' �• O � .: p � A � . . _ ' �' ° � Q �trl� �: �-�. �, , � p O =i � r . . . . . � �? 'F �tt . . _ ``' '.' . � � . . � � ' ' • . , , . , � W O , � . ' � . I_ v � p _ " � rn ti '� � �� 1' � :` � ,, . 1 { �;' ,1 , , ^ NN �� � . 'i ` •i1 � •, '' . _ co,,., , � /, ' � � , C� _ m� ' t , ; ; ' � , '' . • . i _ ,. . �i ' . .. ' . , . � . .. ;l _. . , . . . . . . . . �4 ' �' ' . � i � , ` ,l i . , � ; .. - , � ; . . , - _ _ - .. , , ' _„ . � _ h N p s.i o^'�s^� � c�u . "" � � ��Q. .� � � m _.. . ' `C, � �_� pR, _� f,�i � �� Q�_� Aq.�'� ���.`•I . � (5 fl� N ,.,�-C. O3� Q� V� UI � � � � . , � � � po �,� /.', QR � �� r.o�D -R Q�`' oc� " �;�,n o��l � t� m � �'i p �. � ? W � � ,�Y...'ti.' O � � -.In � A� w �,3p� O� � y.-^�• N O � Z � . �. , . . � . � . � r 3� �.��O C N LS 7 O` �� 7 n O g ~� �w G �, . . .. Q �. 'J• . o C� ., agQL.`� �7 �(`� N � � �.y" �' � �� g" � 3 G . ,J . ' . S 7 4` C��a O N �O�7 N••C % � S ' (D 'L�,N K Q (��J�t0 C � W � � N a�G O (7 I_ " .�, m � � goy ���'aQmatr' O� ��v'_�'s`� 5 � 9 [s1• �� . . . N ',� ^ ,4 Q��j �t, •� �o � `�`�G � � �� Q � �' _ �c, ,'' � a o0 0 �,, 9 0�� � $'c���.n'3 ��3 m . � c. ' - . . S': � < Q � N to c� O -�-.� �. Q�� n' . a " '• � -`� �� o �p .�� � .�-o �,�� .,� r-. , , . ' ' ' � � �Q� � Y � �v+�� �' �L° = � wc� �, �'m �� �k nv=o� ���� �a�s2 7 -O�� --+ y . . : ''� �aQR���000�V?�', c, o��.� y' w O- . .- �'' � Z ,,~�`� (n � � O ?�j 3 �y � w� �� � ��.�� v' . � _ " . _ � � S.t,'' 3 } � o � y� � � mr . _ . -. c o �`�iN'� F s 'v+N.� ?g3 �� �.� � (a� p� I�f . ! ' ' _. � `� � Q 3 7 si ''ppp„�G O�'� L".O� fl• 7 N � • ,� . ' ' . - � ' �`K ��r n • �' w `� � Qj N Q 3'n(9 . . . . T : p N � h X Cj ~Q,� 5 .�� . '/� . . . ' ' ' G �..� Oj W .�---- -- � - ' �`. . - ' ', �2:a !.-��� � V.� , ... -- � ��'