Loading...
HomeMy WebLinkAbout0831A (4) WORKERS'COb1PENSATIONDECLARATION � 76n663 APPLICATION FOR �ELECTRICAL PERMIT � � y� � CE-806G(2�80) I` , 1 hereby attirm that 1 ha.e d certiticate ot consent to self COUNTY OF lOS ANGELES BUILDING AND SAFETY U insure,or a certiflcete of Workers'Compensation Insurance,or� � � � a certified copy fhereof(See.3800,Lati.C.) � Wp81-b2494 Freemotn Indemnity FORAPPLICANTTOFILI.IN• J09B�(�O - II�t �jG - D $� n Center Policy No. Company EACH NO. FEE , ADOHE:S' 9 3� 8Z� New Residential Bldgs.&Poois - ❑ CertiGed coDY is hereby furnished. � � 1&2Family,Sq.Ft, $ — a LOCALITY TR#41305 - Di amond Bar �.Certifed co ' Multi•family Sq.Ft. � — A py is filed with ihe county building inspection , Residential Swimming Pools CROSS S7 departrPent.� � � OIWFiMNA E Presley Co. � Date 11 ZO 81Applicant C MC�,P2 E�2CtP1 C Outlets:Ree.�Light 6 sw.� -_ ,60 . 9 5. 0 AooAEss. 4600�Campus D1'. � - F��n zo CERTIFiCATE OF EXGMPTION FROM WORKCRS' Total No. 9 Additional c�Tv Newport Bch, Ca T.�No.540-0500. - } � � - ..COMPENSATtON WSURANCE- � . � a � � - � � , � , . PLAN CHECK � (This section need not be completed if the work u1vOlvCd AVPLICANT V _ Lighting Fixtures First 20 �� - by the petmit ls for one hund[ed doilara(f100)or less.) ADOFEss � � Total No. .� Additional � I certity that In ihe pertormance ot the work for which this Fixed Appliances Not Over 1 HP � CITY Tel No. U permit is issued,I shall not empioy any person In any manner PERMIT . W ' so as to become subject to the Worke�s'Compenaatton Laws. Range_Heater D.W._ APPLICanIT o. . . . � . . . . �OVan _Dryef-_W.M._ . . - ADDRESS . Z Date Applicant � Top _FAU _W.H._ . . d7Y Tei No.� � Hood_Fan _Other_ -- - NOTICE TO APPLICANT:If,after making thts Ceitiflcate oP Disp. _Room Air Cond._ LICENSE oR C-lo . ExempNon, you should become suAject to�the Workers' REG.NUMBEq 153378 Class . Compensation provisioni of fhe Labor Code,you must forth• Power Apparetus&Large Appliances � DISTflICT NO. . PROCESSED BY with comply with such provisions or this permit shall be Size&Type HP,KW,KVA,or KVAR ' �deemed revoked. . � . ' �Q . �Ct.u-«� � .. ' Upto t lncl. . . . . . FINAL� ' � Over 1 to t0lnci, oATE '/ VALIDAT�ON � LICENSED CONTRACTORS DECLARATiON ' Over 10 to 50 Incl. Y a 1 here6y affirm that I am licensed under provisions of Chapter . . Over 50 to 100 Inc. FINAL � . - � BY 9 (commencing with Section 7000)of Division 3 of the 8usi- Over 100 ness and Rotessions.Code,and my Iicense is in full force and � � . � � effect. Services . - - � •153378 C-lO 0-200 Amp.Under 600 V Lic n¢ Number� Lic.CJass � � � � � �Lf� MC ee E�i c, 111C. • 2014000 Amp.Under 600 V � � � ec r Cnntractor_�� Date 11%91l/Rl� Over 1000 Amp.or Over600 V � . � . � HOME OwNER•BUILDER DL•CLARA7[ON� - � Temp.Power Pote&Appurtenances . .� � �. . 1 heretiy affirm ihat I am ezempt trom ihe ContractoPs Sign with One Branth Circuit - � " � � . �� ' - - � License Law�for the foltowing reason(Section 7031.5,Husi- Additional Sign Brench Cireuits . , : ness and Professions Code): . � -?Q�2 j,� F� Mise.Conduits&Condactars - � 1,as owntr of the property.will do the work and the Other(See Complete Fee Scbedulel� �,!e . •2 - . structure is not intended or offered for sale (Section - - . 7oa4,Susines�and Protesaions Code). � . , CONSTRUCTION LGNDING AOL•NCY . ��O ° � 3..�i O� . I hereby atfirm that there is a construction Iending agency ' � � " - -� � - � _ � for the performance of the work for which this permit is pERMIT FEE (Sub•Totall 5, Q . e `? µC�U � issued(Sec.3097,Civ.CJ. _ � � -. � . � LendePs Name � �PLAN CHECKING FEE fOne•Fourth Permit Fee) � - � �•�v_�`•� . Lender's Address PERMIT ISSUING FEE � � � � 1 certify that I have read this appiication and stete thet the TOTAL FEE � 13. � above intormation is corfect.T agree to comply wiih ail County � ordinances and State lawre regulating Electrical widng, and - - hereby authorixe represenlatives of thia County to enter upon � . - ' ' � . ' . � the a6ove-mentloned property for tnspecNon purposes. SEF.'REVERSE FOR EXPLANATORY LANGUAGE . � �ig_natur�mittee � D� . . . . . .� . . � . . � ,w,. _. ` , ! `�-' _i , 1_ . , • - i i _li ; � .� �� '• ��. , ; . ` ' �`, �. . ; . . . � • ��, � t` ' -1 '�, ' ;4; t ' • . '_j : .. ;t ; : , _ �� ,• �, �t . I .. _ , - ,� _ �, - �- a�. . � � '. 1�� � :z �' Z' m �_� - _ _ , z .� � o x �, o � � _D. �. � m _ ' � D �:--1. m- C ,Z; � �. .o. ;9: � m !' { 73. y'. � u� p, .� i . i- � tn m. . C� r,. � o ' . . • i'.. O �- N O m' �- D ' � �� Z =.. � � `z v r" : k , .. o p C O O�. N .. � � -1 77 r" - ' , m N: . T m - ` . �m - ' � O' �.. ' ti, , - � ? !D ' • " -i . . - _ - � -- "�� 1 m '- . . . .. 4` --. - - _ - � , . �+ , ' ,, . .�+' . , x .{ - Zm . . . �r(, _ t _ t4 ,�.� -i-1 . _ r_ . �. _ i CO _ - mN . i • _ � i _ ' .. . .1 _ R , i _ < . . , - " <' _ . . .. . � 1 ' �,- `_ , . " .1 ' ' . 4 _` ' ' I ` . . - , ,:_ . � - '� . . � - - . :., _ • - - _�. ' J t `. ;: -, ' .� _ - � , � i .. . ,. . . :_ • � . ..,n a n �`cy.C7 r:.r -� . -' ' . . � �Wn�oa M ra . , .. , . .. . , ' ,r,���«o.� N O O � C _' n '� r. _ � .n C p =�i n .yo.� .��n� "�' �'C,'� � .N 'F � . �O � _ , ' _. ' . �`-y:�.� R �'�"l� � '� �I�� � O~`^ t�^..l0 v��A �n � .[`^�G' G . � _ . � oa� �'o � �h-o�~c.� � � p � � �� � � � f M [zi'1 _ _ - '- � C 'p� .� ..i �C .:_p 'o h z C.- ' ' . � � - ^ �� a ' ip r. O L.G Wy. ^� �D`„O O'�.+.v ^.n y .. �-� - . � ,O � U P° � �,o� ?.° „ ...o� bN'° oo ^ o'��.-.. roca ��o3 p ' ' - � •s �C r+ �i :.. _." ^. = � _ o ....a -- ...o �:`° y Q =:.a ,�, �.� C � , `'_' , ` � ._ . . .. .io C� N �5 s= �'' �� «'O .�. j' n 3 "N'•f�-'c� o '° h �' ,r [" ^ . . ' -S � .mv G� N, ,p", $ o-,,, �o ov� 7 �p w � . , � .. � . • ' ,.. : ... p., ,� . ...p O p`=�Q'� u. � .V�" q n o� i �.n H �+ G?� „��'7 . , . ' , n e» io � � 4 a � A 7 •µ.•_Q O `.`� 2Z. O n m -- ^ � ry ., • .. ' _ . ' . . ' G G �� ��,o aa,�',f°�-oc i„: (� o �..'� ° �� � l7 '. . . - . , ' - � _ "' rG, , `A.a.^ � c:v� � �o ° . �.b.=c,a'^'�� i�o°� �c: _(�"� - _ ' � . � -_ i ^ o =.�-�co� o �' =n;�=or;,.� :' �, ..,� .., :t�' - " � � " Q •-., y °�° �•<'n.o ; � �a Y� o •' Y - . . . � . ._ ' - ; � �' �L"O � q.. c � �f-� cbw�°,� a.- o�t � n . � - � , _ .- �i� �a �vHF:' `eTiy"`�10.va � v,= rl . . - . . , - � �� eo ��% n ro� ✓P'=.`c o n 'M io _ ..� . � . . . - . . _. � .. • � ^C[ �. n � ��ia 0 . I=p IKO.'^�'.�. � �+ i�,Y� O n O .. , � . . ; . - . �.oti�:.''C`.�,,� ^ "o �� ;yc =_:' �., pM � -� Q ; . .. � " - ' � � � to y ...� � •'.��._ .. O�C �'� n . G N� n �v � . , . , � , . .. . ; � .,.'� O'C7 0. . 'F.. � C C eo w 5 .r b O ��,,,:, - . .. � , -� . ' - - ..� . '. �'o � O <.O'� ' O �� 't73k��+.� p~3�C � ",C.�. �_ � - - � - ' - -- . . ' . io . -�.� �,o:. n� 7c.� �.m �? y: ��_�n` ,^� io,� i„N. �. . . �, . � - ' . . � .. . . . - i � n l.io �� O. 7� n :'.�^ � �O m II . ' . -_ , . , + - . ��Q�q ��� G .. . . . . •. _ . . � . � . . � �� � � � . , .. .. . � �_—� �•, .—'