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HomeMy WebLinkAbout1192A ���.:..�'.' �.,��� :tiu�:...r.'�;.,��3e,:�ci:,iJ .:�,. ��.':w�.::�..� .�....:.:r.:� r,.^�.�:.. .��.,w,�.y^:,. .e. �.. o,_...�. ...... . ..... . ..� ... . . ._. . . .. . ,: . 6�0$JSFK�2$�Oh7PENSATIOV llECLARACiO'� 76A663 �I� t' `}$� ��$06��2 aa� ��.�..�,�..�:�!,,,��..f,F4?,�.��.�CT.R.(CAL PERMIT 1I ..., �.�::�. v�.<aan4aY,a�?xacn'YlaiPni:-�r�}�'�.".`u aiaw:.�,��rar�rts.2i�.. ...ti''�F+*.� !I [ hereby 2,f,fjcm.�bat A haxe,a..certificate,of consent to seie ,yw n, ,, ,. C,fOU�VT.Y,QF LQSANGELES BUILDING AND SAPETY �a insure,or a certiFicace of Vlorkers'Compensation Insu'ra�ice,oi- ��{ ��a�� � � �. �.� � � ' . � . �,�a cer[ifiepd/c/opy thereof�Sec.380�]0,Lab.C.) ' 0�"""' � �' � � - ��,�� ��; , � -� ' ✓�!/C G�� ��f7���� - /�� � v. ,.FOR APP�ICANT�TO FILI.IN JOB ��`I � �I Yolicy No. Companq��-��,�-�-�"�! � EACH NO. FEE /+DDRESS L$ING,.S?%��- New Fesidential Bldgs.&Pools �Certified copy is hereby furnished. .1&ZFamily,Sq.Ft. � — S '�OCALITY /�j �p ❑ Multi-family Sq.Ft. — NEAREST"' ��`N Ceaified copy is filed with the counEy building inspection CROSS ST [7L Re ide.p$al Swimming Pools de artment. / / � � !`. ,i� OWNER OR ; p �C7 `��J�� �?�P' ,Y,�j:. FIRY1 NAME E /� L J ...Date �'��� �PP�iFaRt �'t' OuNets:Rea_Light�Sw._ A�DRESS ' �1�� IC! N� �"� � First 20 , ...__..._ . . ...,,_ „CEF�"CI.EIC�T�QP;EXE�1k7[OY FRphI WORKFRS' Total No. Addltional aTY ai N 5'6}�.-g�� CO�t}?�A'YSATIQN INSURAIYCE � -� --�•- PLAN CHECK ^ APPLI.CANT (T�f�Ki �, OL�S � (Tl�,{�„se�tiqn_need no[ be completed„if.,th.e,_wo:k involved - - � �� - O Lighting Fixtures First 20 qDDRESS by the p,�;�i�t.,is�or.,one.hundred.dollazs (5100) or less.) Add cional �5 c�lN SE7TF{ � Total�o. .. : ..,.,�_,,._...... _ . . . . . . Fixed Appliances Not Over 1 HP CITv �-`� Tel No. C7 � 1 certify tha[in the perfqlfFl}anse.of..tbe work for which this �jl.wijA �N�4 � �'� � permit i5 issued,I shall not employ ony person in an.•rr�anner PERMIT /� so as_.So become subject,to[he Wvrkers'Compensation Laws. Range�.Heater�D.W._ APPLICANT /C+�. �t9s�t!l,�il6 W, Oven ,_Uryer_W.M._ ADDRESS s � p.Ns-;�� Da[e A licant ... —_W.H..— ..:.... .....-_.. . . . . . ..<.;,..;..-.. . . ... ..PP.. __ . . ToP. ....-t—..FAU CITY Tel No. I_LIFj J C � Hood.—.Fan _Oxher_ PW7N �NA �� , _[Y,OT[Ck_:TQ_APYLICANT:If,aftex making th'vs Certificate of pisp. _Ropm.Ai[Cond._ LICENSE oFt `'J"" " � � ? Ezemption, yoq.shQuld.become subjzc[ tu the N'orkeis' REG.NUMBERT���� Class e—�.J Compensation prqvisions.oF lhe Labor Code,you must furth- Power ApparBtus&Large Appliances DISTRICT NO. PROCESS'E D BY with comply with such provisions or [his permit shal] be SiZe&7ype HP,KW,KVA,or KVAR J /� r p/�J�� ,deemed revoked. � ( � /7.S-� ""--� � Up to 1 Incl. ... FINAL . ,,..,__„_,LIGF;..'YS�A.CONTRACiORS DECLARATION � �`er 7 to 101ncL �qTE �� ` S-�� VALIDATION � - .,,......�._ Over 10 to 50 Incl. �' �'- ' 1 1]ere6y_a,[[irm;ha;1 am licensed under provisions of Chaptet ,,,,, _., , Oyer 50 to 500 Inc. By'4/�� 9 (commencing with,Section 7000)of.D'L�ision_3 of the Busi• Over 100 (�' '�(/1+.2�� �_-� _ngss and,$4fessions Code,and m5 license is in ful)force and ,._. ,_ . . „ �effect. Services . 8�=ct��! �_J!_?� 0-200 Amp.Under 600 V � � .,�„�„c�ens�;Y,.�u„m„�5.,,�.,_,�, ..-�,�„[,ic,,,Class - ' �/ 201-1000 Amp.Under 600 V , Coneractor�.L. Gt>ttlAYS D'a�e, I�%�S a Over 1000 Amp.or Over 600 V � � . ,� , µ,,,,,F,j,Qy„t�0}gJ�ER;BUI�.DER.DECLARATFON Temp.Power,Pole&Appurtenances , I hereby affirm that I am exempt,from,the Contoactor's Sign with.One,Branch Circuit ;�'{ � 9:�{�, � License.La�r�tor the foifpkdng reason (5ection 7031.5,Busi- Addltional Sign BCanch Circuits ' c o a ,n,@ss,and,ProfesSions Code): �� �2 Misc...�qnduits&Aonducmrs ; o a G$,�[1 � I, as owner of the property�,w}IJ.,do,the work and the Other ISee i,omplete Fee Schedulel— � �p,,..,stryc„Sur�,�i,s�.#n°�„j����ded._07._Off�ced..fur.sale (Section � a��.V Cy` , . 7044,Business and Professions Cotle). - - . ' -__'__.__...CONS71tUCT10tY LENDING AQENCY ..- - �i As G 1.C�4°'B G f hereby„n,ffi;m..Shat,,.[.here.is a cons[ruction lending agencr for the per�pJ,pi,��c�,„u,f..the work for which Ihis permit is pERMIT FEE (Sub-Total) � � issued(Sec.309'1,Ci��.C.). ,.,m Lgg'?e,�-y,ag{e_._,__-�,- PLLqN CH�CKING FEE IOne-Fomth Permit Feel � .,.Lender's e?.ddce�., ,_ _ PEFI,MiT 1SSUING PEE S � 1 certify thut I have read this appAtC.ation and ata[e tha[the I TOTAL FEE � $ J� � . � � ,_aU,o,v„e in(ormallon is correct.I agree to comR�Yµ'Ath all Countr . ...-� .� � ��.-�---�-��� � � � �� � � ' - otQinances.aqd State laws regula[ing Electricxl wiring, and � . . � hereby authorize represeIItatives of this County to enter�upon � - � � the abo�e-mentioned property for inspection purposes. - ���������f;�kL,d.��y�.,ORX L¢NGUAGE � :..,,.:.sn�xlkwm++�uroa�r-:�^.sC"F�P?�•nwvs�co!'m:mraw;,r+S.s � . . � aC.emwfe.-...ars. � � f . . . .. . � . . . . � . y+' `�`£2 ignature of Permittee'�������` , �.Dete � � � � � � - . � , � � � _ _ __ .�.._____._._..__.___,.. ___�__.._ • : < _ ......._..____� a - --��--.------- — -- —=��-•-..— ----�--�-- .. -- ----- ---- . 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