Loading...
HomeMy WebLinkAboutNo Permit Number WORKERS'COMPENSATIONDECLAR4TION 78A863 ,o�a, , qppLICATION FOR ELECTRICAL PERMIT � {� � I here6y aflirm that I have a certificate of consent to seB insure, ce-eosG or a certiticate ot Workers'CompensaCan Insurance,or a certitied . COUNTY OF LOS ANGELES BUILDING AND SAFETY LJ copy thereof(Sec.3800.Lab.C.) PoIiCyN���I� �i��pmparry`��US�PIAL ��h � FORAPPLICANTTOFlLLM - � - DORESS �b SOU ���A ❑ 'Certilied copy is hereby tumished. .. , ,., , , . New Residential Bldgs.&Po�ol�.. /n - �CH N0. � FEE.. + 1 8 2•Family,Sq.Ft� g � — S � LOCALITY R�Y25 6-V LD�� 3 ��"Certified copy is filed�with the county lwilding ins ction , _ ��� . deparfm2nL � � -� f MUI�i-(dmily Sq.FL NEMEST, Residential Swimmin9 Pools - � � - � -� ptyraE oq Date 30 &� Applicant `$I�� -�:`C� FlRM NAME. �� � CEF7TIFICATE OF EXEMPTION FROM WORKERS': � Outlets:Rec—Light—Sw.— - � � MniL �� COMPENSATIONINSURANCE. � -, � --.--r �� � � �� 31SI l `' - ,. . _.. �- ADDRESS . (This sectlon need not be completed if the work Invoived by lhe First 20 permlt Is 1or one hundred dollars($100)or less.�-. :.. , Total No. Additional . � CRY ..bs�� 'C{` � r� el.No. S �l(b I certify.that in the performance of the vrork for which this permit � - - � �� - � � qp���MK�-�- �� — is issued,�l shall rwt employ any person in any manner�so as to � � � . — become subjec[to the Workers'Compensation Laws... . L'ghtirg Fixtures Frst 20�� � � � 'ADDRESS �- - - - , . . � Additionat - � � � � � � - Totai No. -CITY�' �---- � �� Tel.No. Dale ��-� --ApPlicant �-- ��� - - Fized Appliances Not Over 1 HP � pEqMii � �NOTICE.TO�APPLICANT: N, Iter-maki �this Certilicate ot , '� ( a ng nraucnrir � C- L��C��C Exempfion,you shwld become su6iect to the Workers'Compensation Ranga_Heater_ D.W. _ ,._ __ __ provistons ot tha Labor Cad-o,y�u mwt fortfr.u�th compFy w'Y,h such �O�.�n—Crycr_ N...,._ . � p���PF�s -O- p � .provisions or this permit shall be deemed revoked. . ., . ._.Top .—FAU _W.H.� . - . ... . - � CITY��I b � p TeI.No.S -6 (, . LICENSED CONTRACTORS DECLARATION. � - Hood— Fan _ Other_ I hereby.affirm that I am licensed uMer provistons of Chapter 9 . uceNseoft ci p , -- DiSp.'—Room Aif Cord. �_ ' - REG.NUMBER��� 1�O O p 3- ' � Clase.�+�U (commencing with Section 7000�of Division 3 of the Business and Professlons Code,and my ticense is in fuli force and effect.� Power Appamtus 8 L2rge Appliances. ._ D�STRiCT NO. _ PFtocesseo BY � �- _ _ __ ` /�� M O �qao�3 ���� Size&TypeHP,KW,KVA,orKVAR lV �,\�,Ol�� License Num6er L�.C1ass � �Up�to t Incl. �- � - � � � FlNAL ��(� � ' ...C�ECr'`(C/�/: � Over 1 to 10lncl..___ . DATE /,\_(�,—XA . VALIDATION.. . � �ContraEta � Date� . Over 70 to 501nc1. - C L �� �� � �� FlNAL ❑ I am exempt under Sec. - - . Over 50 to 100 Inc. _. gy � . . . . � 0.8P.C.for this reason Over 100 � _._ _ serv�e5,s,�roa.,nncc a r��iboa�ag � _ �1 1 5,9 A z �Date:�-��- " ��" 0-200 Amp.Under 600 V Signalure �...201--�1000 AmP.Under 600 V -"... _ . . . . .. . .-. .- - - . .. - #•� •-• •� -- . , .. .o�.i000 amo.o�ae�soo v .. I_• 1 1 2.1 II .. � Exemption for Reg.M2�nt.Elect -�� �- ���� ������� -������� -� - �� -� ��� ���-�� � ��� . ��- � � `� ��SINGLE FAMILY- �� � .. Temp.Pa.ver.Poie&Appurtenances , .._, .. � . • >.i 1 2.1 II� ___ _._ _ __. . HOME OWNER-Bl11LDER DECLARATION Sign with One Bra�h Circuit � I hereby affirm that I am exempt from tne Contractor's License Law ,qdd;tiona�S�qn eranch Cirwits— - - � d&2 6'8 8 for the fotlowing reason(Section 7031.5,BuSinesS and Professlons -� -"- - " "-" - �" - "- �"��---"'�- "------ - � - � - � - Code): , Misa CorxJuits&ConduMors . . . _ ". .. ...... . -. ..._. .�. . . ..... . ". . . .. ❑ �,as owner of the properry,wili do the work and�the structure O[her(See Complele Fee Scheduie)_ is not intended or offered for sale(Section 7044,6usiness . . .. . . . _ . and Professions�Code6 � CONSTRUCTION LENDMG AGENCY � - � ���--"- -� - """"� � �- �"�- '� I hereby alfirm that there is a construction lendirg agency for the � performance o1 Ihe yrork for which ihis permit is issued ISec.3097, � �pgRMIT FEE- " � --- �- -'� (�b-7otal) � �- -� � �- - -�-- - -- � -- � � � Civ.C.). � �PLAN CHECKING FEE -- � � � � - - -- -� � - �� � � � -� - - � � � Lender's Name PERMIT ISSUING FEE--�-�- � - � - �� �JD SO � �- � �- ��- � �� � � Lender's Address ' n ¢ I certify that I have read this application and state that the above -- .TOTAL FEE_ _ .._ ___ _�.__ . _._....__.. .. !�.d.<�p _....__.__...---_ . __.--- ---.___. ..--...._�------ - . information is correct.1 agree to comply with Atl County ofdinanCes and State laws regulating Electrical wiring,arxi hereby authorize , .., . _ _ . _ _ „ � representatives of this County lo enter upon the above•mentioned � - prope ty for irepecAtio�n purpo e. - SEE REVERSE FOR EXPLANATORY LANGUAGE� � � �- � � �-- - - � -- /'' ( �� Q� Signature of Permittee D te � . � :l r... -_�� .�r: � f-_._._.. .. c...:._ :.ti..'_ ��=�. � i-- -�-` -�� ��- -- _ _'._.al......`_� __i�.- - - - �-� ,.. J i ' i, ;+' - � I�� i ��- i_ I �'� . � � i: , I�. , I I 'I �l i i ' �, .1. � ' � i - � �, i � i I�. �� I `' !` � - ' 1 � i:_ j . f � � i`. i- �-- ' i _ - i , i�_ t . ' . _ - ! �± � �- _ � _ 1 I � � j' ' C'_-� IJ- . �t r i � � _ I � �� �'' 1 ' �- ! �.' � • I i � { � �I �y � i . � '• � ' -— �-- � ;' �'—; , � i I '-, .i i; �`� IZ � c �._-.T�. i,�� c i � - � -` , . � �, - c �� ��` Im � c � '� �i �°. o z - i , II ." ! '` ;— i cn �' -� m c z, .G) m �' ' c . ( i . '__ �- ', � � i < 77 'D L� .S � ` � . f ' ' j I O C N O � � � � e, . ; . . i q'� - I: I .� ' i -. W � ; i.. a.r ' � : � i ( , � Z S� i � p � 7m.7 O 1 ' , , ; ; ;j� _ � o .� ,� �� o .� � � ; � ' , I . •i I „ N '� � o cn , � I i i I i _ � o_ o i i � m i Y . -, -- - -, - - - - -,�� '-- --� - -- -� _- '-- - -- - �, --- ' - _ ,_ i (,'' , , . , . , � � � ., � . �� , . . � I � , � , , , � , , ; „ � _ � , , , i - • -- � .. - � -- -- � -. � � � --� - ,- -; -; - , - - - -- ° � � ;- �; D i � � r- , �! � � � � � i . i i �t, � ' ; ' ll m � , 1 _I , � I ( � � ._ � , � � i �i I � ' ' � - . � , ' - I �' �_ I 'I ; __ '_� '__ __ -_ -_ R '� _� i __ _; y ; ; . i � I i � r - -�- — - - - - - - - � � - - - - - - - - - - , - i - f � � � � j � I I � ' � � i � i �', i � zm j '� ti'r ; ; � i i -': �� ? ,.... � �- -- -- I - - -� - -� ' - --- -- -- -- - - - - � -' z�0 ' . � ! - � mN , � I � j -- ... ' ; j , __ I 'n � � - ' i .. , � j � - " ., - - , ' - -: : :: . i ; ' � " jr� _; �i, i I i � . t - .. • I .' _. .- �' . '� f� ' ., ' r "_ ,. ( . i i�' - " ' � !'' I i - � �J � i I iJ . � ' , � _ . " ', ' � S _ � I - � i ' i ; � (, '_ . ` - � ` � f • : � I , � .. _ ,: --. _ _ - i � � � - _ - _ , , . , .. � __ _.__ _. .� _. ' . . __ ._. _._ ._.__ ._._. _.._ _._. . -- --.._ __.. __._ _.__ �. __...-. ------- --.___�,��, ; _, � _ . I � � � ( � , ! � � � I �r �� _ . �� � I ` :' '� i`/ i•' ,. � p � i W , - �� � � ag $ r-�� o� r� fno r� gp ' � s� su -`° � q� ^' "�p � �� '• � � f � � U '�., , . . ' = N i (,y :_� �_' -q y 3 � ^ � � ` �(O' 1n <J � ,.-. � . � _ " - . ' - �^ '��j. : X . :' �a'�� �� � �W ❑3 � 4 � no. ��� � o� r�". _ ; ' I _ � I :co o'� �'� w� -Q o $.v ,,, c-c�' � �, ' ' . ,� ' .. � ' o � c � m � " � Aam " R 3d�, � � Si �'�' � � � " '" _ . � ' , . . , I "� v �y'- o m-� o� ;� � 3 'I� - = : ��1 � � = � - I � '-.7 ,✓ ,Q � >�� � �.� _ � ���r R�� ¢i � �o � O '_ � �_ �:�. N O_ �� � 4 -�n 1 � '" 3 �O y'; O.=' ' f � z � . - : - • � i m `-° r `�`� � � � � � .: a o � a,� m : ' _ � m ; � �r „ � ry o a a � �.� � �� 7J - ; . ' � �_ ' ' - � , � '' o I � -o. R'�' � � Q S' � �� � � � S�,-� � � � :p _. i - i � � ' ._ I � I i.. _co 4 � �,� �u n g 3 y w K C " ;�, i � - - ' i I I. . ' �� � o o��o n h m 3Z w ��' � Q'� � 3_ r r � . � � - . i, � . � � 30 � � �� � oS �,�,� Fp� o � �� m ; ' _ , .. _ i � . . _ - - _ -� � � � y ° � a � `D °�,� "��� g `� _ � 4 C' � � Q�� Q��c' � � . ,- � 'I _ -- ' .. � . . _ ;_ �. ..� m v�,�'Q ? � c)� �'Vi�. ?: � LS � ,� � � � � r - ' -- '�- � _ , . � � - _ i� '�� �o � °�'q �°$. � oo� �� �� g� oWo � ' f, , � � _ � � � � y. ��OV�'� � C'�' 7 (n � -�-�. . 1��� _ L . . '_ - ' _� '. " �� � ,�� 0 � �j,� � ; � d w �y � O-�.N� ` n �� ., • �. �. - � . . • � � `S ti.c � o , ci � �a_� � �`�' o Z. " - , � ` �. y. - _ " _ ,- _ �_ -._ f 1� � �g o � � a �� Q��g €�,� � -. : ' � �n g �;S �.' m i • � ` - � -- -. _ �' .. 1—� � - - -� q � �.� =' � � �� � � -� 3 �_• . �' �r:4 44i tn N `[ `C W v� ? vi f`u � �- � N .