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HomeMy WebLinkAbout1753A �.�_�Y.._..�_�...�,_._�wb..�..�_��.,..A.:F.��_� .�:__._._..���..w,.�,,.._._:.��__.._....�... .._.��_.m�.��� :. �.:.�.._ ���:��:� ��,� ,.:� ..� . . .. , . ..,.... W'ORKhRS C01kPENSAT]Oh D�C[.AR4T10?� 76A663 APPlICATION �F�R ELECTRlCAL PERMIT � CE-806G l2$01 . .. .. , . �. .. .,,. _ ,. , . _. . ... . v ., .. ... . _ ... . I hereby a£firm that I have a certificate of cons•ent to setf COUNT. OF LOS ANGELES BUILDING AND SAFETY insure,or a certifica[e nf�;`orkers'CompensaYion Insuranc2,or � -. � � . ` a certified co �thereof(Sec.3800.Lab.C.)"'�°""�*4�!`+i��.m���+xaw+e+�as..., ���a�+�.x�n-z:w-a+�u-�u..�a�w�w.fin4..��ew:�..».,,.:a....`:.�,4a::» row;..�,...-.. ,.,,.u... .,._ ._. . �.. -. .. 01-39-37 Rl11LiTf! F 99UC FOR APPLICANT TO FILL IN J06 c� NolicyNo. Company -�� �-�-�-- - � EACH NO. FEE ADDRES�I�?O. R1S1T1�T 5�+=�-X' �T'. New Residential Bldgs.&Pools � � Certified copy is hereby furnished. 1&2-Family,Sq.Ft. — Dl:.+mond 13�:r $ S LOCALITV „ ,.Y Multi-family Sq.Ft. � — NEAREST Certified�copy is filed«�i[h t county building insp ction CF3.pSS ST `,. .. ._.. . Residential Swimming Pools OYVNER OR J'� i .�epar[ment. � . ' FIRM NAM�._ T r. PICC`c.�)Q Datz��v�Applicant �'v Outlets:Rec,._Light_Sw._ '"�?�� e ......... ...._..�..........,_.. . .. Fir5t20 A�DRESSmn,.•«��,�.,........,..... ............ . ,CERTIFICATE OF'EXE[.4PT[OLV�FRObi WOIiKERS' Total No. Adtiitional CITV • - -'� N G; ..... . . _. . _� � � CO�PENS�ATION IVSliRA!�CE PLAN CHECK � a (This section need no[ be completed if the woik involved ???LICANT.....,.,.,....,,,. . ...... by the pexmit is for one hundxed dollazs (5100) or lessJ L�ghting Fixwres First 20 ADDRESS � Additional �_.,.._._._....._.._�..._...._... .. � Totai No. ��Ty Tel No. � I certify that in the performance of the H�ork fur which.this Fixed Appliances Not Over 7 HP � "������^•�• ^^�"---�� b" permit is issued,I shall no?emploi�eny pers•on in any manner PERMIT U so as to become subject to the R'orkers�Compensation Lxw-s. Renge_HeatBl_D.W._ APPLICANT ,'�n.'AOTfl(r.S 4Y'OV- � OVen _Dryer_W.h9._ ADDRE55�2/OO rx�;t2'C�.eTl �3r'OV e � .,.:,�..,..,.�,.._..,_....,......._... .. _W.H._ . �. L :_ .., Da[e .App]icant.-.�_._.___.._. _.. TOP —cAU CITv `:r%��il^CZBi1. �:Y'OV(3,eihl ..].6D Hood_�an —Other_ � NOTICE TO AYPLICANT:If,after making this Certificate of Disp. _Room Air Cond._ RECG.NSU�vI EF 35551i.z Ciass SC"�- Exempiion, you should become subject to the Workers' Compensation provisions of[he Labor Code,you mus[forth- power Apparatus&Large Appliances DISTRICT NO. PROCESSED BY �vith comply with such provisions or this permit shall be �Size&�Type HP,KW,KVA.or KVAR J deemed revoked. !� - �``��� Up to 1 Incl. FINAL � Over 7 to 10 Incl. DATE �LICENSEUCONTRACTORSDECL.4AATION � 3—Z<�- �7 VALIDATION Over 1D to 50 Incl. I he�}by affirm that I am licensed under pto�isions of Chapter Over 50 To 100 Inc. eY AL 9 (ci,,,�lmencing with Section 7000)ofDivision 3 of the Busi- Over 100 � ^� ness and Professions Code,and mp ficense is in full forcc and � /� ��'�'�'�'�� effect. Services � � c�, � 0-200 Amp.Under 600 V License Nu P,���—�i�r'c.Class___�?-� Zp7-1000 Amp.Under 600 V Contract ����iK1 "�� "" � Over 1000 Amp.or Over 600 V � HOY1E 044NER-BU[LD R DHCLARATION Temp.Power Pole&Appurtenances I hereby aff'um that I am exempt from the Contractor's Siyn with One Branch Circuit z� ��``�"�� License Law for the foitowing ressson (Section 7031.5, F3usi- pdditional Sign Branch Circuits ���.e r �2 ness and Professions Code): s Misc.Conduits&Conductors J s a 7'j,5 Q � I, as owner of[he property,will do the wotk and Che Other(See Complete Fee Schedule)— � structure is no[ in[ended or offered fur sale (Seciion , �. a I �.��� 7044,Business and Yrofessions Code). -- CONSTRLCTION LE1U[NG AGILNCY �� ���� �" " � � �J.� - '2 I hereby vfiirm that there is a construc[ion lendin€'sgency � , for [he performance of [he �vork foc which [his penni[ �s pERMIT FEE (5ub-Tota1) issued(Sec.3097,Cia.C Lenders Name �' PLAN CHECKING FEE (Dne-Fourth Permit Fee) � Lender's Address � � PERMIT ISSVING FEE I certify tliat I have read this application and s[ate[hx[the TOTAL FEE �1 ' above information is cortect.1 agree to comply with all County ^����`"-��������� "�����������-� � ��-� - ' � ordinances and State laws regulating ELectrical�viring, and . � � � hereby uthori e represen[a[iv s of this County to enter upon - � � the ab men ion d propert for inspection purpo es. � �'�� SBE�RIVERSE FOR bXPLANATURY LANGUAGE ��iL� � 7 ��_ � Signature of Yermittee Dxte � � � ..^""YueP�}e.qw,^-i,..��^^,rte,.,...,;�,..,.:.;..,,tp�gs'n9spAl.. .,_..xa- A,:w���.^s.�.-.,a.,.;,,,. ....� _. . .�.. . ¢...., . ... .r. ,. , .. . . ,... . . . . , . . . ._ .. . � ... � �.�_n.._.,c� . . . , - ' � a a.s a � . . ....,..A�Ll.M'VR.. . . 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