Loading...
HomeMy WebLinkAbout0906A � ..:.., „� . . . ...,r,..: ' ..�. ,wFrR..:<'drx. -m,;..:1 �' P .,..: ..._.. . ,, .,;;eWx�x, . .r.. . . . _ ...... . . ,.',wtoa.;., s _. ..,._. � : , ..,. .,._ ...:.._ ... - _ `WORKERS COMPENSATION DECLARATION 7tiA663 t0 el � � � � � � I t��r�h,,,;(f.�ryn„thqt l„�q e,a-.��st�ti.Ga�.e,.o{.consep.r,rq,self....,,CEseo6G. , ���',�,I�A��Q�[� Fi7R._.ELECTRICAL..PERMI'� � _,. sure,o�a certticare of 1No.ke�s CompensationJnsura ce COUNTY OP LOS ANGELES _. BUIL�ING AND SAFETY or a�ertified copy ihe eof(Sec.360Q .C 1 �- �- .-�-- . - - -. .. , . �.. . ..._ _� ... _ .-,. -....., � .. _ , _ . PolicY � �y FOR APPLICANT TO IFI[L IN JOB . . . � ADDRESS Certified copy is h re�furnished ' New Resident al Bldgs.8 Pools EACH NO. FEE 1 �Certified wpy is filed with the w bu Iding insper 1 8 2-Fomily,Sq.F!. S — 5 LOCALITY �.tid tion de a 1 eni. (``� Multi-family Sq.Ft. — NEAREST '" � � � � �{ Q � CRC55 5T. DatA" � (3 � ' Residentiol Swimming Pools _ .,._, . . . pplicqnt OWNER OR FIRM NAME C� . .-., - CERTIFICATE OF,pXEMPTION FROM WORKERS' OuNets:Rec_Light_Sw._ � MAIi . COMPENSATION INSURANCE nooRess ,(Thjs seclion need nof be complefed if the work involved 6y First 20 the pqrmif,is For ot+a.hundred dollars(S100J or less.) �To�pl.No, Additional ��TY TeL No. I<ertify;hat in the perf.ormonce of 1he work for whi<h ihis PLAN CHECK � � ""� '� � �permit is issued,I sholl nof employ any person in any manner APPUCANT so as fo become subject to the Workers'Compensation Lpws. �ignting Fixfures First 20 ADDRESS � Total No. pdditional .. .__ . ,. ..._ CITV .Tel.No. Dare Applicant Fixed Appliances Not Over I HP NOTICE TO APPLICANT: If, after making this Cerrificote of �T` � Exemption, you,should become su6ject to the Workers' Range_Heater_D.W.— '�[J� Compensation provisions.of ihe Labor Code,you must forth- Oven _Dryer W.M.— � ADDRE N�_ with comply w-�h such provisions or this permii shall be Top _FqU �W.H.— deemed re�oked. Hood _Fan _Other_ I CITY Tel. .7�.. — ,IICEN$ED CONiRACTORS DECLARATION IiCENSE OR I hereb affirm fhatJ am licensed under Disp., �Roo.m Air Cond. — l�� Clo . y provisions oF Chapter 9 REC�.NUMBER (mmmencing with Seclion 7000)of Division 3 of fhe Business pawer Apppratus&Lorge Appliances DISTRICT NO. PROCESSED and Professions Cod license is iq full force and effect. y ����S�Q /= V?! Sire 8 Type HP,KW,KVA,or KVAR I ! � a', � �.�,`' � License N�mber ULic loss`•-�{3l� ' � '��/'� Up to 1 Incl. � fINAL� 1 6�j .. Conir tor D?et"�VV ��� Over 1 to 10 Ind. DATE � � � �. .. � a� ,. YAIIDATION � ❑ , Over 1D to 50 Ind. � I om exempt under_Sec. �-3u^—"�,Q FINAL /` � � . Over 50!0 100 Inc. gy / �,�/'� �----'^ .. .._., ..,,,.„B,,,&P C,..foF„ihis re.pson Over 1C0 V 4._ � Services,Swbd.,MCC 8 Pqnelboards � . .. _, �� ,.........,�,..,.,.„.....,..._..... _._.. ...... Da1e: 0-200 Amp.Under 600 V . ' . Signajure 201-1000 Amp.Under 600 V - ' ' �.. � ❑ Over 1 C00 Amp,or Ove�500 V Exemp7ion for Reg.Maint Elect. SINGLE FAMILY Si nPwit Wer Pole&Appurtenances ,,,, ,.,. , ,HOME OWNER-BUILDER DECLARATION Add'rlo n One Sronch Circuit ' � � - I hereby affirm that I pm exempt from the Coniroctar's License g . Law for.ihe following reason(Sec�ion 7031.5, Business and al Sigr.Bcanch Ci�cuits . . . _ P�ofessions Code): � .;C.y���f' ❑ I,os owner of the y, Misc Cpnduiis&ConduUors � � propert will do the work and the Other $ee Com lete fee Schedulel— "' " ° `� ''� ,,sjructure,is.nqt,in)ended or otfered for sale (Section ( p , � ������ �� 7044,Business ond Professions Code). � � a C i ��J .,CONSTRUCTION LENDING AGENCY � I hereby affirm.)hqt there is a construction lending agency for . . .. . a 2�`�;:�.c'� � ihe perfprmppce o.f ihe wock for which ihis permit is issued PERMiT FEE (Sub-Totall �;4�( C._�� (Sec.309L Civ.C.). � PLAN CHECKING FEE � � . ....,.LEL'de,r�.>�Am.�, � � � . � ' . PERMIT ISSUING FEE .. ..:lec�d,et';�4,dSlress � . . .. . .. I certify that I have read ihis applicalion and state ihat Ihe TOTAL FEE `� � Qu^ . � � , � ...., . fi� .. . . .. above information is correct.I agree to comply with all County�a�^�a^-��„�� •_. m �.,. ,•_ .... - � - ordinances and State lows regolating Electrical wiring, ond � � � � � � � � hereby auth �ze representatives,of ihis County lo enter upon � �� �� �- ���� ' � � � the abq e-� ed properfy for inspect' n purposes.' � � � � � '`_J/� � �� � , ..w ,_�.,,.���.,R�J/�BS�F,.QR.E7CPlApIAJORY LANGUAGE. —i.� Signature of Permiflee .. __ ..Dafe -.� . , . � . , . ... ...,,... -..�.„..��..wan.xz,wadwana:.a*x,4:a..a�..:,:t... .,:, . .,::. .,.,::.: . ., . ',x ..*x't� .§ ... ,:;.;- - . . . .. ... .,.. .. . . , � ,.,_,.......,.�,Y:..�.ww»=�:��.-'..w;.aa;5:.:Y.ue- ''.d,"t'w'�""`.�r'�'- ' . .. . , . ..» , . .. ....,.....�:. � ....,._. ..:., , .,,-....:. ...,.,,..,.....,..,,«.v.,�.�..- .,...-�.-,a<s.a':t,.;_s.s.. ._ � � ,.�,r,..� ���„.. � . � ;�M,,, . , ,� .,..,h....,. a. ,-iu.,. ...... ...,.,_._ . � .. .,. ., .....,.,�..e,..-.�. . . .....> :,.».. ...,,..... .,..<>.�,s;a;^w�Y`..h`�`:�'" ....,..,-....,. .-,-....,,:..........,..,,.�M.,,o. �.�4�cr-°+ar_.',:. . . . � .._..-, _.....�Y.-,:-...,. .�,.v ,_�.w.::r �� :�,_.:....:r.:^-_r::..�' ....,. .,.. ......._.._ . a:....., ._. �.x e`"'.�"-....�.;";�r,.�.,"�,r'+�nr?�_...._ ,.o- e.s"�: ..� . � . .. .... ....,........,...�.«�.�,�t.,.,,..�,n.ww;�,:�.:.:.�w...a:s..:��:ssra�° . ... , .�,n �°�'a=:,, .. . .. . .:........ a ..., ... a. . ..,�-r �.,. . . �� ..,rr n�:,�:t;a.zWr�wa.a+ca�<7�.�r-u.:.�nt+.:' .�'st';-,,�.;;,:,... . _" . ............ .�.......w....--..a--e...,�«..-+=N2lIMp '' - . .. ..... . ....�..,...._............:..�.v..'o.,.uw,�.. .. - '.,Jn.:«'.:4.'..r "�' ' , e. x• i�. ..... . .�: . . ,�.`kk. - .r,°.�.s - ..,....... »..,..........-�..�.4.�. alod ,.�.�;:>z .,�,u,r-�'f� a�ps: {, . . . ,. . ,..., . .., ...:... . ��,�� . ... ,..,. ...., � '�w+�>w.�.�..Pm.�.-_.... .. . .��ve r . . .... ..........,...,.........._...,...-.....�...�..,.. - .� ..,......,.__.__.v.._.,..,..,..�,�.... _ ,- ( ._._...,....__..-:., uosoa�siy��o}'J'd d 9 . _. .._,........_�......_.�,,�,k<.,�s,..<.�-.h,..,.._.,. Lya�,;�# ;��, �,, . , . `" 6 l�,lnb �i . . . ..�ag aapun adwaxa wo.� . . .. . ..... ,,.... „�..- -w.w �+� i �s �..es ! � , .. . �t�,7 c �.� (�a;4s;o osod�nd ay��o;eno.+dwi Ja p�inq Sou .... . .._ . . . _ ....,. .._.._._ . .. ,,......., .>_�_T. .. ........ . . • p�p ay;oya 6uinoad�o uap�.nq ayi anoy�t!.e��p�1nq•�eurino ' -� ayd'uorje�dwm¢o�ca/auo u�u,{im plos s�;uawanoadwi . .. . ......... .......,..Ww.�....,�.mr,........�,:,�,�....,.i�......o..+,.:.,,.._,;:a.,:�,�wnr'�&'atixsucu: , .'1 j , •�• Jo 6uip��nq sy�'�ana+noy'}r'a�os�03 pz�a;�o�o pepua�ui l � �ou a��s�uawano�dwi y�ns{oyb papino�d}�eswiy xJom . .,..... .. „.. .,..._..................,.�,�.,,...,.��..,......,..�..,..�.w�.�.�;Mb�...-.,M%�nw c- �� ' ' , y�ns saop oym puo 'uoaaay� sanotdw(�o sp��nq oyra , � . ,..:o-,.n«.,mnw.»„u:<e:;e�.z-.�-s,,.^a-N4.,�,.-..AF..:n�t-..ai�s�S'�''.+�.=. � . . .... .........-,... d�lado�d yo.�aumo uo o�A�Cda�au saop Mo7 asua�r�s�of '�--�-- '��-' �`""..'^•-.""""' ""•' -oo�;uo�ay1 :apo)suo�ssejad puu ssau(snB'b60L��5� � � �a�os ao}pa�a�}o�o papua3ur you si a�n��n�is ayl ...............,..,...._,.<.u,,,.,.�..-...,...w,..��.,......��a. .. .. .... - . . . .._ . _.:.. .�."�; *+."5':�",�:'-e� . puo'��om�4�oo�pm A;�adoid ayl}o�aumo/sc'�1 L; S310N � anr um�e�ow ou O!I+DUB(I Ih 3 O O{}U6J �— I ' �LDO.F`"�aYn'"'i's�ii '� '�'��'��--"�•�y��� ..1�5�1 BdDj�O� pa:�un4 f � � } ! I, f -.Iddo ay�s}salqns�+w�ad a�o/.�uw��ddo.tao,iq S'1E01 d� �..-._,... uoie��S 3o ue:tn�o�n 4uy uoijdwaxa pebepo ayj �o� 431dIlON'O�Alllilfl s:5cq ay{puc wo1}a�ay�fdwaxa s+ey}ny1�o(apo�.suois 43ZI80Hlflb'2i3MOd -saro��pvn ssau�sng ayd}e E ua�s�n�p}o(p00L�°1PaS � y�1ro Supuawwoa)E.+aydayJ)m47 asus�p seoAo�Fm) 5321f11X1d� aq��o ruo�s�no�d ayd oy ivansJnd pasua��f s�aq;ny;auew -afu�spau6isoalr;o{4icu��dy�ns�o�;ua»fddoay{se�rnb --,J�„ `JP'�a�M, -e�os�o 'e�unnssi s;�od�o�.rd'a.m�an�{s dup»�e�10 tIf74N07 H�JfIOb •qsqowap'ano�dw!va6�n'yon�:suw o;+iw.red 4 sel!Abar -. u,�+ym/�?uno��o dl!��ll y:(apoJ suoisseyo�d puo ssau�sng � � �IaOM 9M52J3ON� 'S"ICOL �al.�dS) u s irno��oi ayt �o} �'+�o� asuso�� 3lOd M�MOd'�W31 0 oei 6u s�os�p�tuo7 3y:wo.q�dwaxa wo�toy�wii}}o,(qa�ey ', . . .. . . ..... 32if11VN`JInS� � 31V4 stvnoae v .� .. n�oi�vadi�aa aaaiine-a3n�nno_ - _ ._._._.�_._.�,.. �;.,.� ��, ..�.::� ,..:,: