Loading...
HomeMy WebLinkAbout0951A _ , �,��, �� � , l':O4KERS'CO'SFENSATION DECLl�RATION �tA�� �o�e� APPLICATION FOR ELECTRICAL PERMIT ' `,F'� � 1 hr.reby ofLrm ihnt I hnvr. o tcrlifica�r. oI mnsent m self �F"n�' insure,or o r=riiFicnie of`lJor4ers'Compnnso��on Insi�mnce, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a cei�i(ied copy thnreof�nSeb?600,L}n-b.C.) � Poli�y No���•npony�/� � O � FOi AYYLIUNT i0 FILL IN JOB � Cerli(ied cepy is hereby furnished. Nr.w Resid�n�iol 61dqs.8 Pools Fa.CM 1.'O. �FE ACDPESS IV (L�O�� � S — 5 LO:ALITY J Cenified copy is filed wirh ihe couniy buildin�inspec- 1 8 2-Family,Sq.FL I A —� NEAPlST /' � tion�lrperimcnt. ['� 1.Aulii�fomily 5�.FI. C�O55 ST. (�- I � S/g�r, �P y�( /�'�y� Residenliol Swimminq Pools O'f11.ER OR Dafc_( A Iic�nl�L�r`-"� � fIA•.1NAME E �R CERTIFICATE OF ExEMPT10N FROM WORKERS' Ou�le�s:Rec_L�ght_Sw._ � ' ` ' �'�'��� n ��f COVPENSATION INSURANCE ACDRESS J ' l. f�/ D� / Thi�s�clion n�ad not bs com I�tod if the work fnvolved 6 First 20 � p Y Tc�nl No. Additional CITY ��am p�Q ��Tel.No.&'G�•.� D th�parmit fs for ono hundred dollon(SI00)or I�ss.) I cnrlil 'hnl in Ihe e�fermnncr of Ihe werk for which this P�nN�MECK Y � AP�ICANT �ermil is issue�l,I sh�ll net employ ony rr.rson in any manner so as�o F.ecnmr suhirct io itie Workers'Compensa�ion Laws. L�qh��n9 Fi�lurrs First 20 ADDRE55 To�al No. Addi�ional CITY Tr.l.No. Da'e nP{����a^� Fi.ed Appl�on<es No�Ove�1 hiP pEqy,i� NOTICE TO AFPLICANT: If, of�er mnking Ihis Cerlificare oF APM��4NT y� �EG - -- ErPmption, yo� should F.Pceme subjec� io �he Workers' Ra^9e_Hea�er D.YJ._. Comnertso�ion provis�o�s of Ihe(nbor Code,ynu mus�fonh- Ovon ,Drye. �y�r.p.1._ ACCRE55 j��Lc � E � wl�h comply ith such pro�isions or ihis permil shall 6r. Top _FAU —V�.H.� CITY _� Tel.No. deemed reveked. Hoad _Fnn _Othr.r_ �� �r� . LICEN�D CO'dTRACTORS DECLA4ATION LiCF\:E OW I hereby a!firm ihot I o�n licensed under provisions oi Chaptar 9 Disp. �Room Air Cond. _ rrEG.tvu.�nBFR� Q •� Class. � � (t�mmen;inq wiih Secr�on 7000)el D�v�sion 3 of Ihe Business paM,P�qnrnrotu5 8 lerge Applionces DISTRICT NO. PROCESSED BY O and Profess�ons Cw.'e,ond my Gcense rs in full force ond eHeci. D C � //� Sire.8 TyFe FiP,KW,KVA,or KVAR V License Number / J Lic.Class� FINAL � / Up to 1 Incl. !.�^��S � �G���/ ('L��C �/l�/�� Over 1 to 10 Incl. DATf� � ypLIDATION W Conhncror Y�JO Date p�er 10 io 50 Incl. � F"�rrnr� �- I am exempt under Sec. Over SO to 100 Inc. BY U) 6.8P.C.icr this rcason ��n��� z Servicr.s,Sw6d.,M,CC 8 Panelbonrds � ,._G G a 1 :� �n�': 0-200 Amp.Under 600 V � 519nature 701•1000 Amp.Under 600 V ,_ e e e e� ❑ Over 1000 Amp.cr Over 6pp V E.emp�ion io.Rep.Main�.EI=c�. � • • � �,�Q S�NGIE FAM1l!LY Temp.Powe�Polp 8 App�rrerances • + F�O.".+E ONJNfR�BUILDE4 DECLARATION � ° � •� ��' Siqn wiih One B•anch C�rcuii I h�re6y ef(irri Ihcl I om ezempl frem ttie Contreclor"s license ������anol$i n Branch Circuils ' ����� ��7 �aw{cr�he followin�reason(Section 7031.5, Business and 9 Profess�ons Code): ❑ I,os owner ef 1he.property,will do the work ond thr. M�sc.ConAuits 8 Conduc�ors strucrure �s not imended or offr,red(or saie(Sect�on O'her(See Complete Fee Schedule�_ � ► 7044,Business and PrefPssions Code). CONSTRUCTION LENDIhG AGENCY I hereby a((irm ihaf Ihere.is o cons�ruction I�nding agency for ��e perlormanc�ef th?wo�k for which�his permir is issued pERM.IT FCE (Sub•Totol) `a (Sac.9097.Civ.C.). PLAN CHECKING FEE \lender's Nome PERMIT ISSUING FEE Lendr.r's Address �erhfy ihat I have rend Ihis npplico�ion and s�o'e ihot the TOTAL FEE `•e iniarmoiien is correct.I ag•ee io comoly w�th nil County '�tes and S�n�c I�ws rrc�uln�ing El�clrical wiring,and •u�horir reArr,sentatives of fhis Couniy io en�er upon men onr.d properry for inspeuion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE � � � \•P�e �Dn'� , , ; j � 1 � ', �. . �� � � .. � " _. '. - � . 1 � . � . . " � ��� �. � - . , � � I + � � - . I � ' . � � J . . - . ' I ; ` '�,. �` .. - �� - • - � _ IrI� - � � +- '' ��-, . I I 'C _^ T '` '�^..r .n . I ' � ' ' v T - • -- � L L���� � �. i ' 1 j . C7 x ;,, c: ; I , I � ` 1 — \� �; 7 Cl a;' — Y � �G �" 1 l't; i •I � " � n =, c� !�' T.. ;� �t. ` � - . i n � � U C '` �C c. �, U . , 1 ' 'I �1 Lf •' . ` '' (1 � c CT c � �. � � ; � , , � `;� ;` �� � ,, :� � � `/ �� '•• �l• i-1 � ;/i .. � � I . � �.� � _l_!---1---�- � � ; j . ; -1-- , � _1._ ► , 1 � , � � . ;� �; I �,; z; : ,. . ; ; , � , ,..: , � �. �. l � I i �j ' 1 _► - � - � , . , . � . I . . I � ' � I ; + �- �� � I ! . l I ; � '';� . l `_" - 1 , ; , �. � � �� I ��I'�_ -�. rtIL. .1 I . I � 1 ' . � � . '! 1 � . .I , � � � � ' 1 . . � ' -.v v�n�r, t,., r:�- - I , � n v _ ,. � �� c� n � _ .. � ;�:.: U o CT�' C � O �- _ p - ' �7 � V' :! .0 i '1 "' (` 7' f G '1 4f ' 'I l C fJ � �� Il � 'Il '" !� (: 3 • O �, I p, . � � Ci_N J' [: ' `"' �n � _ N'.� N o, r-_ 2 3 a�o j ;. . N 'v,-rn_ n � � « . < ; . r -. _ ., � •._.c;.^ ���: L) p �� n �� S� , r- _.. c ' ` n ' c; `'' � E• c �.�_ri..a-c c yc'� o a n s: c (1 x �y�- _ CL� R N w r. fl ln r�"c p.'C C^•? � � _� � �I l 7 i �.� i i �� C h�' `��.'.�f� 7 �'�;�'r C Z s"; � Zl ,' . ' ' � r T f• �' O r��„ �n � .. =�4' .� C n �� 3 � �. �, •i � . I I � _ � 1 � :, -_n ^ � 1 ..,� �•-:: '� n� r = °: °r :_; 1 c- �; f �; � y : M i� �' iy^ � � O� o � �'o � �: � I `.. a ° =° a:'� u" - � P ^ o �' `' rn `•oN C . . ' I . . �� - � = i N N U Ll i �= �^ ' ° `o �? w � c .'< � :i N c r. aN � � �- I N L'• C C � G'� 7 =1-: 'b. c `�7 ��, -� n n- C7 I � .ii ,�j..'�n_y y, O V�'� .ni.D; C i.J^N ?-= C 2; ^ 7J � I I i I ',�O �- °'U u" �^ �C :i �,^i]n i �_C+.�.�C] j- C� ;� c: c !c ��M � � � T� '� 3 � ^ ).� '� tl � I I I f. =-� C ..:,� n � K j'C U ' ' 7 4 O �.TJ � '"� .�1 7 �r p ' p' e r 1: v.� �S C. I � I .1 4� � j } _'. � � . } C. .. t r'',M1 N, 'V 7'� _ r 7 +) ;. I :J V, � b �' � nC�- D .n• . � •< _ •� • i ' °�n ° �_`,-. a' L° cn? ;i�� � o� ii�'yov, � A a�n< <�[�S I � u c ' � F � � , �, � � o ' „ 3 ° ° � c " "L '�wio�+�� � -,' �� ? a' �.; y� .. �_ � � � c w�� : � ° c �� . . � � ' ` `�t' o��: c_°.c � � ' �-����-^� N � i; � � y = y� V \ . T m L �` C 1J fl n ' -' !n ,'- �a N " C�n `� �y� �� � =� � <i � P � � :; r-u °•o 0 0 $w o / asay I �-� - � v � � _ r, a�� �. A . � o � � � _ , -.; •ouipio a _� � c n a v o � � �-�4 ? � J .. .�o�p �T o �� �..� p .. � �� 1 . � . .\