Loading...
HomeMy WebLinkAboutNo Permit Number WORKERS'COMPENSATION DECLARATION 76A663 �Olet AppLICATION FOR ELECTRICAL PERMIT . � I I heretiy alfirm that I have a certificate ol consent to self insure, CE-906G or a certificate ot Workers'Compensatwn Insurance,or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY COpy thereof�Sec.3800,L2b.C.) � PolicyN��qO�B3�Company����T��pL �v� FORAPPUCANTTOFlLLIN ' "- - - .- �B � bq � SUV�1'� IJ��� � � EACH NO. -FEE Aooaess Certifred copy is hercby turnished. New Residential Bldgs.8 .�� . . � . . i d 2-FamilY,Sq.Ft.� S O _ `� LOCAU7 (�..�a S�(p'V �OT: cert�r�ed covv is filed with the cwnty building inspection NEAFEST �department. � � � a�..y)�� Multi-fzmily Sq.Ft. caoss si. ��` ' Date� 3o Applicant�� �01� Residentiat Swimming Pools . owNER oR flRM NAME�Ra��i� c-� . CERTIFICATE OF EXEMPTION FROM WORKERS' putlets:Rec—Light—Sw._ � � . , . . . . CAMPENSATIONMSURANCE,. �� �.. � �� - � - � - AODRESS 3� I � C �/ (Thic sec8on need not be compleled H tbe work involved by the First 20 • Tolal No. Additionat _ qTY �6� Tet.No.�`�-�DO permit Is fo�ona hundred dollars($100)or less.) . . . � . . . PLNa GHECK � I certify.thal in the pertormanca of the work for which this permit ��� - -��- �-- -�;- � �-- ppp��C.4N7-� � -��- - .is issued,I shall not employ any person in any manner so as to - _ � - � — hecome subject to the VJorkers Compensetion Lavrs. Lightirg Fictures First 20� -- - � ADDRESS� -� -- -��� . . .� � . ..,. .. AddiYronal ...,... Tel.No. .. . . .. , .. �. Total No. CITY .�. .... -_.. . __ � Date ' Applicant � Fixed Appliances NOt Over 1 HP pEaraiT �� NOTICE.TO-APPUCANT:.If,.alter.making�lhis Certifica[e of � ppp�iCnM � �� C�C�T��L Exemption,you shouid become subject to ihe Workers'CompensaCan Rarge_Heater_D.W. _ . _ . provisions of the La6or Code,you must fortfivrith compy with such Oven—Dryer_W.M._ ADDRESS�r� provisions or this permit shall be deemed revoked. . Top ,_FAU _ W.H._ . . L. I`6y 6 . �� � . CITY^� � 0 1�U�`- -�7e1.No.J � _LICENSED CON'fRACTOFS DECLARATION . Hood_Fan� _ Other_ � .I he2by atfirm ihat I am licensed under,provi5i0nS o1 Chapter 9 uCENSEOR p ��$ - -- Disp. —Ro0n1 Aif COnd. _ {�G.NUMBER'L �� 0 ' 6 (commenCing with Section 7000)01 Division 3 of[he 8usiness and � Protessions Code;and my license is in full torCe and effect: power ApparatUs&Large Appliances DISTAIGr NO. PROCESSED 9Y ._ . _ . .._ _ _ ._..__.__.___ _/'`. . . . . ....... � ,Ip p, Size&Type HP,KW,KV0.or!(VAR v a O�'� License Number `1 1�_�6 3 LiC.Class �-t 0 . . - . . ._� ..Up to 1 Incl. ....`. . . .--._".. _:. ." ." FlNAt-. .. .. . . ... . V � . ,,�� �q� Over 1 to 10 Incl. DATE ��/� yAUDATON � � Contractor.�Ff*���� .� - Date��L�L... . " .�..Over 10 to 50 Incl.. . .. . . . .. . .. .. . .� U �. ❑ � � . . RNAL . . I am exempt under Sec. Over 50 to t001nc. BY . _._ . . . .. y� ...-. -. . . - � Over 100 p+. B.&P.C.tor[his reason !n Services,Swbd.,MCC&Paneiboards -.. ..- . . ----. _. �. . .... . . . ... . ... . . � ... _.__.._.. .. ._. - .__..__ Date:..___..._ . 0-200 Amp.UrMer 600 V � s�9�a���e zo�-i000 nmv.u���soo v �j 1 g.3 A 1 -� �- -- - - - - - � Over_1000 Amp.or Over 600 V � ! ExemOtion for Re9.Maint.Elect. • - .- .. .---. - . . ... . _ ..- . . ... .�r 2�� ' e e e e e � --- �- '� SINGLE FAMILY � -��- - � Temp.Power Pole 8 Appudenances , . � HOME OWNER-BUIL�ER DECLARATION Sign with One Branch Cvcurt � •�-� 2-�-4 6 I hereby affirm that I am ezempt from ihe Contmc[ors License law p�ddional Sgn Branch Cvaits _ __ .._.__. . . .. . e.- tor the(oilowing reasOn(Section 7031.5,Bosiness and Prolessions - - - -�� o � C��1(�•,�_, . °odej: 0&26-8& ❑ -- �Misa CoMuits&Conductors .. . --- - -. .- - .. . .. . . I,as owner of ihe property,will do ihe wak and the structure Other�See Complete Fee Schedute)_ � � is not intended or oflered for sale(Sec[ion 7044,Business � . . . 2nti Protessions Code6 . � ... . . . .. .. _ _ ._ .. . _._. _.. ._. . . .. . . CONSTRUCTION LENDING AGENCY - � � - - - �-� � �� �-�-- - � �' - -�'-� � � I hereby affirm thaf there is a construction lerding agency for the � - performance of the work for which this permit is issuetl(Sec.3097, pERMR FEE � - �� --��- �� ��-- (�b•Totap S � -�- �------ - �� �� ��� - �- � � - - Civ.C.l. � . � ._ PLAN CHECKING FEE - -. ._ . .---- - .. _ . ._ . ...._ ... . . . - _ - . Lender's Name pERMR ISSUING FEE . ... _-._._._____. ...-�� cs - . .. . . . _ _. . _ . ... - - -..__. .._.. Lender's Address n�� L// I eertify that I have read this application and state that the above TOTAL FEE �� 7p _... , . . .. .. _ _ ...._._.. . __. . . . . _.._ _ _ .._. . . ..... _, . . _ . intormation is correct.I agree to comply with aIi County ordinances , � and State laws regulating Elechical wiring,ard hereby authorize _., . __ . . _____..____.. ... _. ._ ._ _ .. . . . ._ _. � . representatives of this CouMy to enter upon the above-mentioned - � prop ty for inspection purp es. _ SEE REVERSE FOR EXPLANATORY LANGUAGE .. _ .. . .__. ._. ._._ _ . . ._.. . . . . . �� a� Signature of Permittee D te � � � , . _ '!�� _.,..�fi_ r�__ . `---' / i i— - -�'—C 'I •I�i �I.. -,.• `1_...,v'-i_I'�-'^`r� � - i� � � , I I � � '� � � ' �: � _ �` i i�, i i� .� ; ; �:_ ' � � i, ' . _ � - " I I i � I � • f ' 1 � _ ' � �� ' l� ', i_ i � � r I i I. � ' -\i � .. t j �� i i� i i ! I = � _ - ' _� , I- -- - i-- -�., - �,1. I. I j i i- . �`. I ... i_ i �� C , . � . , t _ � ' . � , � , , 1 �� { 1�i i ' . . � , _ � Ll ,, � � �Z T C � T :� ..37 C --I : � ' � �� I,` -� m D C � � �! �C O '�y � � , I �: �' � � N i -�C � m � 2 � :� D t .__ � I �` ' � ' � C �r I O > O � ' � • � O � I � f-` �� '� -1 I, "� !'2 IA m I_. • � I � Z = � ' : 0 � ..31 � � �� � _- �; �e ' � i � � C D � `�( � ' i.'I'i i �1 N � � I � 7[) O � C ('.. + ' _j j � '. � _ .� � o p ; � m � -.': , . . :_ _"," _ � ._ _ ' � I � ' _j � + . , . _ _,.. . _ 1 : . . � - - � - - - -- - - - - - .. . . , , , � �i i �' - - - � i , , � i , � , � �, N . . _. _- -, - -- -- - - -- -- � o i � � � I I � � _ __ N' _ 1 � _ _ _ o � �_ � � � � � , I ; i ; 'r S1�\\ �1 � x� : � , � 1 � ,, � � I ! i � ��i \� � \�' i �m ! ..:.. � 4 ! �- , r . I i ,� i � � ' i 1 � I � �i _ , i s i •� ' � -1. .__�_ ._�_ ..'. � _,. _i_. ..._. i ' - --�_ . -�- ---- -- -- --- ----- �`�' - - -- - - � � ��` � --' � I - _ � {_ � ` ' ( i j I i � , � i , • � � � . � I . i . � � . . ., ' . - .'_�- - '. _- ._ ' - ' --- ' ----- - -- - - .� � � � � ' i � I j ! � � i ' �� . ., � i � � i i i I � � I Ztn � � ' . . � � , I ; ' ,' I � � �� , . I , . i . , ' i � `i -.'- .--� --' — .. .'-- '1.._ ..__. ._ -- -- - - - - - �� � i I � -- --- - -- -�- -- v' mN i I 1 I� � ` � � i - ' i � � �. _ j � � - � � � _ i • - I � , i i � _ . _ ,- �, � i; , i i � - . _ i i � f � � � ( i I� � _ _ - � � ... � � � C � � � c � i i' i� ' � i I i I � � _ � � ; , I -� - � � . - ' 1 - i i _ - � � � . I f _ � � , . . ;. �i_ �i i t . - i _ . ' ° t � . � - , . 1 . ' • . ' - -` . i 1 . - . . ' ' . • , ' . . � � _ - ; i ; : , : G.. 1` ` I i -- � O O i W = �- � �'o � $.r in`� o�' �i ��n o m g'o �� - jl: - . � - _� ! � .- � � tD� R' � ' � .-4�-m �' ��n cCi p �O � ii $ L�.ln o �� � i . ... _ � . _� � i 4 n �»� o ^:`��° � �:� `� m �3 � �$ � tQ�� y�.� o� j'- ., �� ' . i i I 0 �� S,r,� N� 3 y `�e A-" N N. �.(kp ' p�" �' � �-� 3 � . ��� � ' � i ' � tnU� � 4 '� y38,.�iOc°ii � m ,C, p� � �' � r. r• I . _ � I ; �- _ . ,Q C �'� $ � �, � � .Rg ? 4 � � �.`z� C'y . ` � I ' " . fn � �Q-� a � � a' � � � _� r� m �t�i.�.. o .. � c�i Z `_: - i _ .. � ' �`° �- :'a� � � � . ny4 '' �, n,� - m ' I N f� '.. ;�_ Q'.vi �' a ° � y�c �-< ��$�p `��e m 73 . - c: -i � � �,� o � �-4� O � 2 � ��� 3� � .=; _ I iu I I i = , . ".L�' � 1D �'c' � � ¢aa.� � m � ��„ a� ok c = �� ... ' I � � - _ _ � i � . ..� o o.o ��a r'd N �. _ pr r. � @ Q � �' 6 - . . ' Q o o m.- i � _ . ' . � -a ; m Q � =ao g' 3o� � o v., In .. - _ I , i L' q � �� � n m � o � �� .lii `�+; Q ��. 77 . i . � �� - � :. . � . i � . a � � Jcn.� ���p� � . � .��Z; � C' �� p� . � . �-� 1 : . .. , '_' � . , ! _ _ .. � ? � � � ��Q � � ��d ��� �' �:�'�� � � �.o � �� � - �: ,c� `� o 0 , . � . _ - I _ L o-�¢` o.�. � `� o o � � �, � Q -. �' � c� .. � ._ _ ._ . ._ _. _ � � �j' Q ? �`i 1 �` O V � � n ._ �.� � �� � ... . . ' � � O : : _ - ' _ � < <T'o.S �'3 a c3 ; c� � �,,�, � �� p, . . ^-,Q N �c , o ' �`;.' �� � �' o. 2 . : _�_ � - .. .. � . � .� -�'�.. �0 , . . - ` . ^ _ - _ o o Q � � ' F '5 cn � � n � � c m �'- - . �,� �go �, � `_.�� `D� g .:� �'', r _ �_ _ r_., I�, ` ro �'' " c a ' Q,� � �. °� �': '_ - �_. _ _ ��� c� Q. � g (� ..} : . _ � , - - - ' - L i_ CJ -: � � O: ci p - � �.�+�l N N �1'�J `C� N fn � � fJ i .Q fN7'