The URL can be used to link to this page

Home My WebLink About0909A WORKERS'COMPENSAT[ON DECLARATION 76A663 ppp��CATlON FOR ELECTRlCAL PERfi�IT CE�B�fiG 12�80) � I heteby at�rm that I ha�e a cettificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY i inaure,ur a certificate of Workers'Compensation Insurance,or i a certi�ed copy thereoP(Sec.3800.LaD.CJ ' � FOR APPLICANT TO FILL IN �pg ��/]�� Policy No. Company . AODRESS ��+J New Residential Bldgs.&Poois �ACN NO. fEE � Certified copy is hereby furnished. 1&2-Fami{y,5q.Ft. $ — $ LOCALITV ��,�„�� CertiCied co y g� p Multi•famity Sq.Ft. N AHEST py is filed with the count 6uildin ms ection Residential Swimroing Pools CROSS ST department. OWNER OR ,_`� PIRM NAM ��{�� Date Applicant Dutlets:Rec,_Light_Sw._ ADDRESS � 1o�'�W KS First 20 CERTIFICATE OF EXEMPTION FROM l4'ORKHRS' Total No. Additional CITY Tel No. y COMPENSATtONINSURANCE ` a PLAN C O (This section need not be compteted if the work involved APPLICANF V by the permit is for one hundred dollus ($100)or less.) Lighting Fixtures First 20 qDDRESS Total No. Additional O I rertify that in th performan of the rk for which lhis Fixed ApD�Fances Not Over t HP GTY Tsi No. U permit�iseued,I hall nof emp oy any pers n in any mannet PERMiT so as to become ubject the kers'Co pensat�on Laws. Fange_Heatei D.W._ APPIICANT � a Oven _Dryer,W.M.� ADORES5 y j Date plica ` � 7oP —FAU _W.H._ �� , Z 3 Hood—Fan _Other— CI7Y Tel Na �� NOTICE TO PPL{CANT:If, fter making this CertiPcate of Oisp. _Room Air Cond._ LICEN3E O !� /J �+y, � Exempti n, you should 6ecome subject to the Workers' REG.NUMBER �i7�lass VJ � Compensation provisions ot the Labor Code,you must forth- ppwer Apparatus&Large Appiiances OISTRICT NO. PROCESS�p BY with compty with such provisions or this permit sNall be deemeQ revoked. Size&Type HP,KW,KVA,ar KVAR f Q ��X Up to 1 InCI. FIMAL . Ov¢r 7 to 70 InCI. DATE LICENSF:ll CONTRACTORS DECLARAT[ON Over 10 to 5�Incl. � 3 VALI�AT�ON [h FINAL � Y affirm that I am licensed under provisions of Chapter Over 50 to 700 Inc. gY .:� 9 (com enc with Section 7000)of Divislon 3 of the Busi- Over 700 us and�Y�rofes ns Code,and my license is in fuii force and � effect. ,. Services � Licen m r � Lic.Class 3 � a200 Amp.Under 600 V 201-1000 Amp.Under 600 V h ct Date Over 1000 Amp.or Over 600 V HOME OWNER-BU[LDER DECL RA ION Temp.Power Pole&Appurtenances `�4�S H � [ h e r e 6 y a t f i r m t h a t I a m e x e m p t f r o m t b e C o n t r a c t o r's Sign with One Braneh Circuit �y• • • � •� License Law for the following reason (Section 7031.5, Busi- AdditionaY Sign Branch Circuits ness and Professions Code): � " ��C � Misc.Conduits&Canductars fI � I, 2s owner nf the property,will do the work and the Otber(See Complete Fee Schedulel— ` � ��'`S'�� ' 1 structure is not intendeJ or offered for sale (Section � 7p44,Business and Professions Code). � C;G(�-81 � CONSTRUCTION LENDING A(3tiNCY I hereby aftirm that there is a construction lending agency . (or ihe Petformance of the work f�r which this permit is pERMIT PEE (Sub-Total) issue d(S ec.3 0 9?,Civ.C J. i - Lender's Neme PLAN CHECKING FEE (One-Pourth Permit Fee) I � Lender's Address PERMIT ISSUING FEE i E certify that {have read this application and state that the TOTAI.FEE �� above information is correct.[agree to comply with ail County , I ordinances and State laws regutating Electrical wiring, and , . �hereby authoriae representatives of this County to enter upon , "the above-mentioned property for inapection purposes. SEE'REVERSE FOR EJCPLANATORY LANGUAGE � Signature of Permiltee Date J I ` o c a c �,... r � `�y H o,'�c m ' . ' . . y V1 � V w � 4 Z � b C fi O � [� �� . . . , a Q � oo r.� o� �R �� `� C� '�'O a, i� �� ° ��,o n.e � o c o o � 3� � � ��`'� z ❑ fio'- � Or'�,�"� �,•- +. � 3 E. o303•� y, �, O �° :� .. g�o�� a� ^ ,; _ �ti ao c o ^' � � �,�'` 'g � 3'h-r � .. r�. = ��,,,vv ° aE� ° vo- C� E`a,tl o 4'�sq-4b� ° .o�C� ` o u"�`fi,=� C C T. c'• -�'O rn,,� ai C..�'. �'C �., j'a h oi�r„ O ' � ,� " ;Q N a'y ^' � o� �e ' �c 4,'��„ ° ~'3'� V a� •. r c,� c o, �.... h � .`ne �'a . Q � C b v � ��F C h,s � C a> `�''�o > 'ti`�^- o'�i'c c� ^. , a y 3` p �y � C�V ��•� , p�� a�y•='� � T . y - o V] t O'n ci a = W �^ � .. �n �s �'� r F� �O ¢yt7't� cy�-.¢ri�b G'�l � A `' ° � �,~ � o'ho °",� ,F,, c o `ry"c � °'ts � = � ^ m u m c'� 4 ° O ri.y.c°� `u.. c � o '� °i 3 � ' � �` Y � n d e, � o,s o��"�`' d v C•� n,� '�^'C y c," C' ,«C. W E p� � 4� v� 3,.`',a o�, n,� � �� s? � r °o; v V . 'S. _ +. � `h ��no 'w �s �'y, r �� ti a� `� w � y C°r .a 0 ,, � a z :� ; n � o : z b °a� � � —rr�; 3 i� C e a;� C"' y F O �`� y �y o.� �p a, h O 'C �c.: ��'�, >.� .,. ec� � a, � °� n � ? a� c s-r o `b.� E °:�° �,e�: o a e�ia,ay �— � CI O F � °: ' �' a ti 'r c; C s . , � � " Y O'�.[;� � :3 Z'.�O'a a .�,.�7.� a�, •• ti � O'h`'� .'.-�c: 3'C`o �, C�t"' L�i`� 4H ca • o Q � � I � � ' � i i I � � � I ' � I � � � � ; � � ; , I � � ; � I `�W i ' � ; � o ' � � ' � I I � ; I �Q , , � , : , � � �� « I � I i , i � ! i ! � � i � � � j '� � ! € i I � ` i I I - I � i I' I W� ; , � : �: . � I � ! I� � � ! Q ; � � �� . . , , j , � ° � ; ' ., � �I_ f ; i � i i i i . ; f � ' � � � _�...-�-_- • � -':-- ;- i-�-', ;�,; j. � � � ; ; i ; ' ' � � ; �� N ° �' � ` I � I ' � � � i I � � � o� � - i j � ,_ � . � � � I ' � , � i ! a , � s � � I . � � � o ' i I � ; � i � ; ; >• w ro Z � ,._ �' � , ; • I i . 0.� 3 a� � ,� i • �: R�1 ; ` i I I ! � ' ' � !• � �� (� J I U � LLL ' '. : U �Y � e ; € I � . � � �. d �i = C7� n- � 4r } � U] � ' .. � � � , , � � � I . a i W C'i o �I Y o 4 Z p�• � I I i i ; �-- �' CL ti a � i u. � Z,,��+ , � i � i I I � I i . �J �-- T � I ! I I � �. � I , ' � � � � � � � � � . � . �� _ � , , � I l � � i I . . � - ?j .. , i ; , ; � i ' i � ' � . A` , ; � � ; � , - - � i I �. � ' ; � � I I I � , � _ � ,�.�� j ; � ' ' � 1 i � j � . a : I � � I i I , � I