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HomeMy WebLinkAbout1392A _. _ � . : ,� � �,.��,,.�,.����.� . ., � ,... ,�.�.,. ._�, .�M � ._...�. , v� _: ._ : .�. � �.� �.��, - �� y. _:... ...�. .,�.� WORKER5'CO��1Y�.TiS,�IT�NDE`CLARATIOt� 76A663 �APPLIC�iTIC�N F.OR ECECT�tI,C.i�1r `F��RMIT . � . CE�BO6G�f2�$�)��� i hereb� af£�rrr� ihat I ha•e.x.certificate of consent to setf COUNTY OF LOSANC'iEC�`S� ' u BUILDING ANDSAFEI'Y -� � in5ure,or a�Certificate of�Yorkers'Compensation InSurance,or , ,,_,..... ...-:..� ;. ���;=�+-� `-',+� � �""�� '•�a.#:�1-F�.. a certified copl'thereof(Sec.3800,Lab.C.) � � - " �"�� �� � �'�"'� �"`��¢� � F ��� . .._._ .. ..... .. . . „ . .« . - . ....- .. .. .'... . . - .. . . FOP APPLICA(VT TO FILL IIJ . . . . JOB ..YolicY ro. _. Company.. . ..._ . . . . . . ... w�, N.<�.-�..._ -...�.,,.� . .....;.;,��.�..,... ADDRESS ...... .....::.: ' ❑, � .. . . . � - ;... �. . . . New Residential Bldgs.&Pools EACH No FEE� . CertificJ copy is hereby furnished. 1&2-Family,Sq.Ft - $ — 5 LOCALiTY _ . . , ,. .:... _ . ....:..�; .... _,__..... � ... . Q� � � "'� � � �� � Multi-family$q.�t.� NEAREST CertiPied copY is filed with[he counq•buiLding inspeciion CROSS ST department. . Residential Swimming Pools oWNeR R � ' . ��� FIfiM'NAME Date Applicant -�-�- � - Outlets:Rec.��igh[�S�n�._�t_ �' MAIL . - ' � � �� � First 2O �' AODRES$ CI:RT[FiCATE OF FA��f1�I"I�[v'�'�'R01�1�OR�Ct�K5'� � Total No.. // � Additional CITY Tel No. Z COMPEYSAYION�iN5UR4N:E � -� }� PLAN CK (This section need not be completed iY the wo:k invotved � �APP��cANT� . .__..,.` F`. .� ,. � p Lighting Fixtures First 20 `� ADDRESS � U by the permit is for one hundred dollars (5100) or less.) / Additional '� ''� � ��" � � Totai No._I_ . .�...��.. . . I certiFy that i�the performance of[he work for which this Fixed Appliances Not Over 1 HP GTV J Tel No; O ....,... �,�.r��v.,r.ax�f 'a� � permit is issued,I shall no[rmpiop any parson in uny manner PERMIT � U ao as to become subjact to ihe SVorkers' ,ompensation La.��s Range_Heater_D.W." APaLICAN____ T �.���r�,[�1.fl � a - . "- � � Oven _Dryer�W.M.` ApDRESS �. � . ' Top _.FAU �Vd�H._ �"' "�"` Dat�lj/.l���/Applican[ � � CITV �el No. � `� / —�%�� Hood r Fan _Other_ "� �y..�. NOTiCE TO APPLiCANT!�?f,after making this Certifir ot Disp. _Room Air Cond._. I LICENSE R � Gxemption, you shouid 6ecome subject to the lk' rkecs' REG.NUMBER .,.,,.Class ... Compensa�ior.�provisions of the Labor Code,you must forth- power Apparetus&Large Appliances DISTRIGYNO. PROCES D BV�� wit6 comply with such provisions or this permit shal] be c{ie&TYPe HP,KVJ,KVA,or�KVAR /!1 deamed rzvoked. ` /(-' a�r�'�'L'�'� . . . UP to 7 Incl. �- ,...:,.,...:�-... a�. ._ ... ___ FINAL . ,-:::.......;,c: Ovef 1 to 701nC1. DATE LICEN5ED CONTRXCTO�t�S DECLARATTO�v � . Over 10 to 50 Incl. �� � �� VALIDATION . I hereby affirm that T am]icensed under provi5ions of Chapter OveY 50 to 700 Inc. FINAL 9 (commencing with Sec[ion 70D0)of Dil�ision 3 qf the Nusi- Over 100 BY �ness and Professions Code,and my license is in full force and ��. ��� effect. Services � License Yumber � . Lic.Ctass _ _. 0-200 Amp.Under 600 V - � � 201-1000 Amp.Under 600 V Contractor ,� Date Over 100D Amp,or Over 600 V ��HO�SE 0ti41�ER-�BC.TLllER DI CLAI2AT101� �� � Temp.Power Pole&Appurtenances' �_'j J 9,2�i t hereby affirm that I am ezempt f'rom the Contructor's Sign with One Branch Circuix �• q o e 9� License Law for the fol[owing reason (Section 7031.5, Busi- Additional Sign Branch CiYcuits ness and YroPessions Code): � � o - � � ' Misc.Conduits&Conduciors 6 � $'7 n � I, as owner of the propzrty.witl do �he srork and the piher(See Complete Fee Schedule�— e n c � 5,7�x s[ructure ii not intended oc offered for sale (Section � 7044,`Business and P ofessinns Code). �'��� ��,LL CONSTRYiC1'101J LL�h'ti�iNG AGP.I�CY � � �1.2�'—c�'2 S hereby affirm [hut [here is a consvuction lendang a�ency - - for the performflnce of the �i�ork for which this prrmit �s p�RM1T PEE ISub-Toia�) issued(Sec.309`7.Cir C.).� �• Lender'sName "'�""... .."':`.''�-�. PLANCHECI<ING�EE'`���ne-FA.��'�. :.��~��W � aurt�Permit Eee) Lender's Address � pERM1T I$SU(�1G F`EE"-�' ;.��� � -� �� � ., .. ... �.............. 4 1 certify that I hxve read [his np}�tication and state thal the TOTAL FEE �y �1(� above information is correct.I aq_ree to iomply�vitl�ail Cnunty - . � - '— ordlnances and State la�vs regulating F_techical .viring, and . - � � hercby author''e reDresenta[ices of fhis County Co enter upon � � ` � :� �.:: ���� � .:.� . ��� .. ... .. . . ..:.,.__ .. .... � �...'.- .-..-:. _ the aboce-m onzd property for in ection purposes. � "�'`' ' � � �� � � �� � ' ���� -� SE�REVERS�'.`T'�OR FXPtiAAATORY LANGUAGE . ignatuxe of Permittee te . �-.... + „v1-��''�� 4�� .....;...... ..:... � .�W-.���.h+i+a�.",�wa�.�� ����ar,-3.�w-.:,:.a� -.�-��*9: ,�w�pr�"'�""��.. .... . ,..:. N.,,m2._.. , , ,.�-,wr .�.� �� w++ .. �v-e .,,,, �,; ;'s 'c. . .w: ' � .... ,� .... .». � . . . ...-._._.:..,,.. :.'� _. ...... . ».�..i..a..,w,,.,� �� ' _.. - -- -�-� � . , . ; . v.,���d:��-t��.�t�x�ri�4�scLA�;�.f3;. . :h- eby a[#errn li:at i zm��eempt ffram:iie Contrac[oi's � � � aPPROV�aLS� � OAYE . � �v��'EC��GR�S�j _ � � �� . e. erce La«• Fos eize fuitowing reason/5ecrioa; 70�7.5 . ; . � �� � � SIGNATURF� � . � :1._�.�..a ,..r-- .� ."-';r -- .. . � R�:.neas �nd Prr.;essu �dej: Arzy Giry �r caa:n:y . . � T�tiiF �cwectao�t�_ . ._ _, ' . . . ;.. �. . � whi re4�izs a gernrrr t cr, strdcr, alrer. imGrovr. o n. _ - . .. .. _.. . . . n e � -e�ohsn,„� repair cny stnccSure,pr:,� •a its dssaan.re. UNJ RSLAB WOR!:. � � '. � . . . -�--- . -. . . • . . -.� ' - � . a5� e�{uFre rha aLUpicn+� far aueh perrnrt ro ;i7c c �. �,.:.. , .. ` . .. .���O�CN G�ivu�Tf .! : � � � � J.._ r�nEa icret-ar,t�ih4f�ka t lice.nsed pur,set�ri: tu .>h.e _-t. I yt:�"`" . . . �. , i�rvi .�sv;��— � ��f r . ���'',J. : t,o.(ei�ns L� rf,e £'ora.rector's;cer s !cw(Cha�rer 9 • T. ' -j . - . . •.�ir'ri Sec��u i0�ti/ of Ile a�o r�;1he . 'correr�+rcrr„ � r � , e3 ? . . , _ '�:�I?���u��`5�;. . .. � � .,�"i.. , . ts!uiraes.> arr� ,fhofeeseu.r. L:xze; or�t;zat.he rs zcn�nps . . .., --�-_--.-._.. . �. •_.. .'.;:... . .. ---� .. _. �. .�--�. ._. n.ie)rom.a7d ttee hasr fcr�.'e�alle e�exe>rr wn 4r<,; , , �.=C3dE�AUTH.'� �I��D�-. : � ' . . � . % ITt . �rnla w�o� ec�ort 70?I�6y anv applicunt fora ye;;•rit , . UT��i�v co.tvo7i iEo� ' � � �� � � � suG�e�ts�:t anptr�attr to a rvsl n:naltv of no!mure tav3: . �--- ----j . . . f ee hiiri�r..r! ��Il�ra'f✓,sstl�;•.. . . t�i�n� .�.:t y%ah Cr,sc.�3tavs4 _.__�.. ,- . ... - - �'„�L , c wftex o�;7.�praperry,�.i!!da ahe wor?..and . �ores — .. , , .. � � __ , �st,':ciur is not ir iercie3 qr qiic:ec;fcr sa!e. .:, . . 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