Loading...
HomeMy WebLinkAbout0877A (4) 1 �� WORKERS'COMPENSAnON DECLARAnON 7BA663 10/81 ` ���r �I he�by af.firm[hat I have a certificate e,cronsent ro self��5��e. °E.808G APPLICATION FOR ELECTRICAL PERMIT �� or a certificate of Workers Compensation Insurance,or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec 3800.La6.C.) � Pplicy No: �'�� � - CqfiiParty FOR AVPLICANT TO FlLL IN.. - . J09 .. .❑ .Certified copy is hereby furnished.� New Residential Bldgs.&Pools - �EAGH NO. _ �E_ AooaESS ��Z��(./J(Y �� 1&2-Famil Ft. � — S LOCAUTYp �� � y� � � Certif�ed copy is filed with the county twiklirg inspection Y•�L � � . depaflment, - � '' ' ' � � . MUlti-family Sq.Fl. — NEAREST . caoss sr. {=I N p l�'i2 Da[e � Appiicant � � � � �� � Residential Swimming Pools � � � OWrvER Ort r1-�� -. ..� . . .._ FlRM NAHtE. (l� !L� CERTiFICATE OF E7(EMPTiON FROM WORKERS' � L � '�J� "�' � Mni� � - � COMPENSATiON INSURANCE . , - � . ��e[s:Rec L'ght Sw.— .��_', . , r aooaEss��- �- /O'/�4�= (Thls seetbn need not be compieted if the work Invdved by the Iz Frst 20 � permft le for one hundred ddlare(5100)or IeasJ Total No.� Additional -- � CRY . ___. _..�. Tel.No. �certify that in the performance of the work for vfilch this permit � - . . . Pllw cHECK � API'LICANT is issued,I shall rrot empby arry person in arry manner so as to _ hecome sublect to the Workers'Comp atio Laws. Ll9hting Fixtures First 20 -�- - �ADDRESS -��- . � Additionat �Date�-����7 Applicant Total No. ' CRY-- r-���� �� ,-- TeI.No. NOl10E TO APPLICANT: If, after aki g is.Certif'�cate � Flzed Appliances Not Over i HP PERMIT � Exemption,you shoutd become subject to the Workers'Compe tbn . Range_Heater_DW. _ ����`�'�T �I L L � L�=�rsn provisions of the Labor Code,you must lorthwith comply with such Oven_Dryer_W.M._ � ADDRESS 2�L(,Vy�P,J�W(r N� 1`�✓ �provisions or this Rermit shail be deemed revoked.. _ Top �_FAU _W.H._. . _. ; � LICENSED CONTFiACTORS DECLARAiION . Hood—Fan _Other_ � � CRY� - ��QQTeI:No.�(/_�sj �I hereby_aHirm that I am I'�censed under provisions of Chapler 9 . ..Disp.--Room Alr Cond. _- . . _. uceNSE a . ��. ' ��commencing with Section�7000)of Division 3 of the Business arid - REG.NUnaeER'" " Pfofessions Code,ard my liCenSe is in full(orce ard effect p�r Apparatus 8 Large Appliances D�S7RICT NO. PROCESSED BY _ � . ..,d _ �' __ o Size&Type HP,KW,KVA,or KVAR � License Number� Lic.Class �� -�- � ��� �Up to 1 Incl. - - -� • - � � FlNAL � � - - - - - � V . �... . . . Over 7 to 10 IncL � DA� VpU�AT10N � �� Contracror ..... .. � �ate� . . . � pver 10 to 50 IncL .. . . - ... � �.�. � . FlNAI - ' �� ; ❑_ I am exempt under Sec. . . Over 50 to 100 Inc. ._ BY ...._.. -.. ..- . . .- .. . � .y,� - � 08P.C.for this reason O�e�10D . � � _ _ " Services.SWbd.�MCC 8 PanelboarBs_ .. . .... .._ . � - ..__.___._ ._ . _. . . .... .__.__. Z . __..___ . .. ....Date: .. . _ 0-200 Amp.Urder 600 V � � Signature �--��201-1000�AmP:UrMer G00 V.. ' ... ._. . .. _ . .. .... ......... _.._.._.__.._ . .. .. _. . .�❑ . ... .. . .. . .. Oaer 1000 AmP.ar Wer 600 V . .__.. . . R O 8 7.7 A Ezempl'ron for Reg.MAint.Elect. - � � � � --- - -�--�---- ---� -- �- �- � SINGLE FAMILY � � ._ _Temp.Power Pole 8 Appurtenances �' � ��� i 2 ... . _ . . . .. _._ .. .. � HOME OWNER-BUILpER�ECIARATION Sign with One Brarich Circu@ I hereby affirm that I am exempt from the Contrecta's License Law � • •2 J�.5� lor the(ollowirg reason(Sedion 7031.5,Business and Professions � -Additwnai Sign Branch Circuits___ . .. .... .. _ . .. . . _ _. . CodeJ: .. �-��2��J�� Misc:Conduits 8 Conductors� - - � �� �-� �� - � - � � - � �-�--- I,as owner of the p'operty,witl do the work aM the structure O�� G"s 7 � is not intended or otfered for saie ISection 7044,Business . . Other(See Compiete Fee Schedule)_ , � . _ . .. . . .. --. . . . .. . . .. . . . . . . anG Proressons Code). -��- � - -` -��"� ' - ' f CONSTR�CTIONLEN�INGAGENCY ` � �� ---��- --- --�� -�-� �� - ---- � � I here6y affirm that there Is a construdion lendirg agency for the � /� peAormanCe of the work tor which this permit is issUed(SeC.3097, � �pERMR FEE- �-� �'- �- - '--� � -1�6-Total) � � -� •� -- -� -� --�--- - � --�- -- -�� " � Civ.C.). _. PLAN CHECKING FEE _ - _ . . . . . .. _- . -. .. .. ._.__.. . . . . � _ .._-_-.._.. .--_.__.. . Lender's Name ' � ' � . PERMIT ISSUWG FEE. . . � . . . . ._�� � . .. . __.. _.. ._ _ . . . .._ lender's Address _ .j�\ I certify thai I have read ihis appl'�cation and s[ate that[he above TOTAL FEE _ ._ _ , oGJ��ti U , ' � intormation is correct I � - . agree to compiy with all County ordinances � .� �and State i�ws regulatirg Electrical wirirg,and hemby authorize __ .._ __ , . , � � . �oreseMatives of this County to enter upo the abare-mentioned -� - � � - - � � - � - � - �� - � ��-- � �� ' � ra' 'dty for in ection uiposes. 0�� -�� �-�- �� � SEE REVERSE FOR EXCLANATORY LANGUAGE �. --. . . ... .__ . . .. . �: '� _ � S� ture � er � Date � . . • ]• �-i���--r r .,r'� - 1��...�_.v...'/.J � _ .,.. �_'-.f'��. ___ '_ "' �. �..�.., v...�. �.��. �.�a�',� - i. : � , I^~� I!, I ��� ! �I !1 � a'i ' . . _. . �i � i y ��� • I I �' �rr!' 1 ,Z.c�... � ! i• � � I ' � � ' �, ; - � :;. ;._ '�� ! : � ( ^.� I , ,.^, . � i, , �z. j � . ij � a..... w �., �i: �� � � I I � � Nf _ ♦ � � i� - ' 1 � iL � � � � I�� � ,' �.i t "�4 ' _ � � 'f t" � i� i . � I � - I� I� ��,7!"\ f 1�h_�-! i �' �` : � �� � '- � i - i ��, I . ; ; L; . Ii � . � i : � �; � l�r, � i ''__ _ ._ i.. .� � � I`� � I � �) .� `�1 I I� �` f � �, - � I , _. 1�. . ; I � I 1•. t � : �,` �_ �L � ` �. •. I I t ;'^ �_. o z � �O T ��' O � m t - i�? � I ! � � m � � m c z "� m � ; �r: { � U I �� ;�' - � � �< �,7J D. G�� 2 '� .'O f �' m � I1 �✓ � ;I. { 'C� `D tn' p D ;O m __ t . a O c � ( � .. -i I 'W L�' Z � I . •m I - ` O - I �i I ( - '-- ~\�� i ,� � I� i C '�O� i��� <' r._ ; �`,, j". _ i . � _�-„ m j ; � � O• '� � ' i ' i ' f r" v " � .., 1 I ' , i I ' ,��.,, v ' � S� 'I � . , , . �- --. - - -- - -- -- - --� - ,. .. � . : , ; I : , � i . _.._ 1 ' � J ! l ; � ' I � � � , . _ � o • r - - -- . . , _ . - - - -- - -- - - ' I - ` � ,' j i i � � ; ; � � � 1' � � ,' , - ; , . , t , , , ; . , , � ; . , , � � 0� � , ; I m , .. � � � i ; , , i i � ' , � �t � � z . � I _ '_ � - - - -• - - - " { , ' -. - - - _ , - � � :� � �. -� --- I j ; - - - � - - --- � - I� �- � � - , tncZn � c� . -. i i ' ! � � . , ' I I � I ; zrn ' � � ' � I ` I � '� , � I �� i s � :, = i ! I � . , ; -..i c�p � ._ � �- - - - _ __ _ -- — -- - I ` _ ;_ mN �. , . 3 i i _ � � ' �� � � ' s: �"� � i I - . I. ': :. '�; I , ' j '.', 1 � ! � I ; ' �_ , } � i , _ � � = !- _ � _ : ` � _ � I I� � - . � � '- � � � ' �. �� - �� . � � � � . � � i _ l . . �� t . �- . -. . , ' P � �. _ _. � . .. . _ " ' ' _ '_ -._ .. ._ �__....__ _.. .,,._..__.. ._._.. ... .-___�-,.v.._._..i ,. -. _ �'.� �'i ' , j . ' _ , I � I � �, ' _ " //�, / , _, _. _ � .' . i^; � � � -✓ �. O O' I ' I � �I �!n � � Q.A� typ I i � �� � (�(��v 0 p O�� �. �"�. . : I .. _. . �. � (D i �. � 3 ', '.Q� � � 3 f� l'�� � t0 ��1 ���Q, �n O �D � ` . '. m � �p 'o: m m �� m,�';';Q~ �' `�i � �' t� L�i � o Q � � � � - _i i , _ ' n � 3 �� � ?� � o'N' 'Q ,,, � Qo � � � M � ',• - - I �. �� �.� �c 3 � i' m: Q 3 �� d � �fD � I /''� - _ i � _ _ - ' " - m v� �� `�i/o:� �� o � �� �' �0 3 � _ �/ � I _ � I S � �nn � a `�'J �' y �->>��� � � oR-� H� �°o � � .. L` i. �, I N ,.� -i.�j 5�.3 � T[1 ^ � y ' � .G'. �. / ; . . , "� , ��fp f� -� CJ Ini O a = - m __ . v� �' � 'b > 0 ��� � � /}�' . - i . � � : � ' i o ' �p �.a �4 , 2 �`a'���c� �`�,A:� 7 c,� � m �� Q7 - , 4 , C7 � O 7' Q CS � N d fp . � 7 mnT3�' F � cc ,�,` � ru - �n c ' I� ' � � � � .' � , (� i �'`C �7 p .� (j � G, � �fn �''�� � !p' � _ , � , _ - ' ��.��.Q a o o � o Q y Q � � o R � ; r� $2 � =Q g in m , - i � . - -' ; '�-� ���'�i a �. a � � m o m C)y � � � � ,. 21 - , _ _ a � � � y F o'� � ? ¢ � c 3` � � .1� - ' , i . _ � �' .. �� �.,a C � � �,Vl� y� � � � � (m') ' ��1 . � � .. , - �� Q�'$ � � � ��a o � �' � �� �� �o� � _ ; � oc.¢ �.om .00 �� � �0� $ _ � �� . � � $ '�` � � ,� �,w � . -- � ` - , - ` - ' J ,'�� � � ? m ~ �s yo� � � ��' �' $ ' � � . . q, ���i � o ��, � �'D ij �' o. Z - ' t . _ - ' � � Q; f � ',n•'c- , ` v'y'�n � � � N �y -_ ,_ � 4 � � v � ._ � ^ " _, �� �g �4 � �a ,.'�"�` $ �.'�`n g o� 1�-�' m-. '�r \- ; : - ��+ .. E� _� : -: _�. `° � � Q _ � � _� �� _ ,_ . . _ ' _ Q.,^, ¢ wvi ,�u `��� m � 5 � c'o'R3n � � , % / _':/ . �� '/ ��