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HomeMy WebLinkAboutNo Permit Number . �: ,:.: .:. , _ . - �WORKERS'COMPENSATION DECLARATf6N-�� ��� �76A663��10/el ..AppLICe�TIOid FOR �LIECTRI�i���-��1�1�`��� � �v`�� I hereby affirm that I have a cerhficate of consent lo self � CE-806G �nsure,or a cernficate of Workers'Compensation Insurance, COUNTY OF LOS RIVGELES BUILDING AND SAFETY ora tertified copy thereaf(Sec.3800,�La6.C.1 � . . . . . ... ... ........ AD�RESS YI+Ot u�i34 � 2. : ..: � ,� . ...:. .>.� . �P❑ollcy No C'19(1097�'Y'ompony rjJa '�� �:�.��� . . .. ..: � FOR APPLICAN7 TO FRL IN .... ....... JOB . Cerl f ed copy is hereby f rn shed. New Residential Bldgs.&Pools E/+CH NO. FEE � O Z]_ Ld�t � Cerrified copy�s filed with the county building inspec- 1&2-Family,Sq.Ft. '2(1_?_d- � — $ �ocaurv Tg.#35742— - tian depanment. Multi-family Sq.Ft. — NEAREST � CROSS 5T. Dqte� 8�$ 83, Applicant��C° MCG2e EleC'�riG Residentiol Swimming Pools OWNER OR . Fierr�Na�nfl�'! J Brock & Sons '��� CERTIFICATE OF EXEMPTION FROfat WORKERS' . OuHets:Rec_Light_Sw._� ' -'v'A�� � � � -' . � - COMPENSATION INSURANCE "���-�-� nDDRESS 1698 �Greenbriar�Ln. $�224 � -(This section need nof be compleTed�if�the work�involved 6y First 20 �fhe permif is for one hundred dollars(510��or less.) Total No. 4 Additionol CITY BX•ed Tel.Na.SZ9—$1�]O I cenif thal in the erformonce of+he work for which this PLAN CHEGK � Y P APPLICANi petmit is issued,I sholl not employ any person in ony manner so as to become subjec�fo�he Workers'Compensation Laws. Lighiing Fixtures Firsi 20 ADORESS� � � � - � ��- " Total No. 1 Additional . � CITY Tel.No. � ��-Dote � Appliconf � ��- - Fixed Appliances Not Over 1 HP PEHMIT � �TICE TO APPLICANTi�If,��after m6king th s Certificate�of APPUCANT��C�� McGee E7 .. ri c Tn npt on you-should become subject to ihe Workers' Range_Heater_D.W. — � . . �ppnsa�ion prorisions of ihe Labor Code,you must fonh- Oven _Dryer W.M.— ADDRESS �wifh comply wifh such provisions or this permit sholl be Top —FAU �-W.H.— • � �deemed revoked. � QN pOIROri3 Tet.N�627-093f._,. � � � IICENSE�CON7RACiOR$:�6ECLARAt10N"" " � "' Hoad —Fan _Other_. � Disp. _Room Air Cond. — 3 5 LICENSE OR C�1� I hereby affirm Ihat I am licensed under provi5 ons of Chapler 9 REG.NUMBER 153�7$ Clpss. .(�ommencing with Seciian 700p)of Dwision 3 of the Business Power A g pp DISTRICT NO. PROCE ED BY and_Professions Code aod my I cense s in full{orce and effect. PParatus 8 Ldr e A liances � � �- � �� ..� ��� �� . Size&Type H?,KW,KVA,or KVAR� tJ License Number �53378 Lic Class C_—_l�fl � - V � � Up to 1 Ind. FINAL co�r,o��or Electrieal oare8/8/83 o�e�1 to 10Ind, �ATE ���j��� VhC1DATION � . - .Over 10 to 50 Incl. FINAL � � ❑ I am exempf under Sec�. Over 50 to 100 Inc. BY .�.�-j�� a B.BP.C.for�his reason � Over 100 � � � - � - � Date �� � � � Services,Swbd,MCC S Panelboards � m � . � � . 0-200 Amp.Under 600 V . � Signoture � � 201-1000 Amp.Under fi00 V � a � � �� � � � � � ,� �_ . _ Over 1000 Amp.or Over h00 V Ezemp�ion for Reg.Ma N.Elect.� . . ,.. ... .. ,. �, �.. , �r; � . SINGLE FAMILY��-�� � ���� Temp.Power,Pole 8 Appurtenpnces � � � HOME OWNER-BUIL�ER DECLARATION��-� Sign with One Branch Circuit � ;"^�re6y affirm that I am exempt from�the Co tractor's License � � �for the following reason (Seciion 7031.5, Business ond Additional Sign 8ranch Circoits � �� , ., ,. . , Professions Code): � ❑. I,as owner of the property,will do ihe work and ihe Misa Conduits&Conduc�ors ' ' � s�rudure is not infended or offered for saie(Sec)ion Other(See Complete Fee ScMedule)— � . . i C :�7 7044,�BuSiness and�Professions�Code) - � CONSTRUCTfONLENDING�AG�N�Y������������ ��'� ������� I here6y affirm iho7 there is a consiruction lending agenry for the performonce of the work.for which ihis permit is issued PERMIT fEE (Sub-Tota�j 1 (Sec 3097;Cio:C.} ����-��� ��- � � � � � .. � . . PLAN GHECKING PEE Lender's Nome � - � � � 10 5 � � � � � � . � � �� �. PERMiT ISSUINGPEE Lender's Add�ess� � � � � � -�f certify rho�l�hove read this application ond stote thot ihe TOTAL FEE 13g.1 �above informa�ion iscortect.�agree to<omply wlfh oll Covnty , ordinances and S�ate laws regulating Electriml wiring,and . hereby.uth ize representotives of ihis County fo eMer upon � � � -� ��-�-��� � � � - �� �- � � fhe a ve- ' � for inspection purposes.�� � � � - -� -� � � � � .- -� � - � � � � 4f� �-- SEE REVERSE FOR EXPLANATORY LANGUAGE� . . . � �/ 8/8/83 S — _ _ : nSfure f rm�iree Daie . � . . . ... _ ,.:.... .......,.._.. � ,.. . .� �..,, .,,... , � .,,. ... , _ _ , O BU T � N1NER !LDER 6�-GLARATIOPd,,, . _ -- APPROVALS DATE $IGNATURE � - �TEMP.POWER POLE - . � I heroby affirm iha�I arn e e pt from ihe COnhqC9Dr�5 � •.- - �� � .eason [5 c4ion.703i 5; . , , ,,,;,,,,,, ,,_. � - � � �� , - License,icw for the follb�ving UNDERSLAB WORK - - � 8usiness and Professfons.Codel:P,ny city or mun4y whiih .. - .. . . . . reqyires a permif fo_consiruct,a!fer,imprpve,�dernolish, ROUGH,CONDliIT_� � � � � � -�or�-�reliotr nny struc7Ure,�prior fo its issuonce; also re- ���- - � ��� . sNIRING � r•-'�.�`-� quires the applicen�for sush oermif to fife a signed stote- „ . - ment Shot 6e is llcensed pvrsudnt to iF,e pro�isions of fhe :... ...�.�.��: � ^��.�.�. FIXTURES . .�� . � .-.. .. . �Cont�actor's llcensolaw(Chapter 4(commendng w'rth � ,. --� . � �-�.�•--�� -��� . . � - �� � � Secilon 7000)ol Division 3 of the Business ond proios- � " � � � POWER AUYHORiZED __1 slans Code)or that he Is exempf therefrcm ard the Sasi: UTILI7Y CO.NOTIFIED� . � . . � � � `� . . . � for tbe alleged exemo3ion. Any violafion o9 SecPion � - � FINAL Y' c7 ' � � �703i.5 by any appficanf-for a permif sobjects the appli- . �nfev on..Yiant � cant Po e civtl penaf4�/o!not more fhan five hundred . . ...... � ., .. . :�.,..: __._ .,..._._ .��_,_,., .,,. ..do(larx($S00).: � - - � � NO7ES - � . � � . .❑I,as owner of ifia proparty will do the work,and �. ' . . :.�� .;. :: .. _..,,, , �.,.: . .,�-. - . , . ... . �- �- - - � the s7ucture is not.intended or otFered for sale. -. .� .. .. ... ..:>.. .. ._ «........ .. ........_....� �:�:,,.. _..�.. ,:.y-. +:f.,'a,+-c::��2'i b"-:,.,,m u.a:�:,c�f�'-,..:x..�.�Sec.704d,8usiness'�dndProfes.ionsCods: iheCon��. .- ..;._."^ "- . � . �� � � ��� � � --- ��- ����� ^ � � � � -- for's License Law does no4 appl�fo ar owner o£properfy , """ ' ���°��,�"�"�-"��=�w6o 6uflds ar improves fhereon, and wAo does such .,. _ .,._.. .. .. _ .��.... ......__.-�,....y.�..,M....,...,:.. ,..,��x..: :,:�:w�w�n . -..,. �� .�..: - . .. . . � . .. . _,.... : �. . . . . ,,,,�, . � work himself provlded,'F�a1 such ir,.provemen!s are not -.-.' � .._ .. ... ,...,. _,.,.,.�,_.a.. . . ....:..:..:... ...:.,.�:,,. �...�..:..,.,. ,. .,,..,,;..-, ..,�..,...,,, .,. .,.:•^.�;�z-`:�.:�sintended or�o£fered for sale.lf,�however,the buildrng or :,.,.� . _ ,.. �.._ ._.... � . . . .. � � � . - . . . � � �improvemenl�is sold wi4hin one year of mm.p7ation,the . . . -. . ... ....._........_.._....,_M,....._.._......�,......:...:., -..--.=.a»w.s.u�.s.,-�-:: . . - �"'�. `-"'"' . .,.4..'. �^�r-5ullder wRl have the barden ol proving that he did � . . ...... .. ._ . . . . .. .: . . . �... nof.build or 7mprove lor 1he.,purpose of sale.) ,..�.........�..,,....�..., _ .. . .. ...,.., . . ,,..: . � . ...._. ..._....__.,... ..:., .k,..-..;,..,.,-�x,:;,..-..,�.��..�w.:w�w�,:cu�«�..�.::t�.�....�..-N�.....�<. ,.:,....�'.�s;e�x.....-.:«.�,�.:u».:.-..�.....�,:.r..,,.,::.::�..:.s:.........�,«,.�w» � . � �� . � - � -� �. � . < � .. �� ;am ezem f under Szc. . ...._. . ....�... ...::, ,_�...,�,.�a..::.^s�:i„x^� �,�«s.:..,. .,.::�....,:.��3c.�'m��.�cm.�an�scn�tY_ '., , ... ..���.yl � �„^;� o.w,......a r .....o.._ � , 6&P C for ihis eason ��¢ . 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