Loading...
HomeMy WebLinkAbout1620A �, . . N� �� ` WORKERS'COMPENSATIOW�ECIARATlON GE�-BQ6G��_g� APPLICAT`�.ON ��OR ElECTRICAL PERMiT a( � �I�ereby aHirm that I have o�certifim�e of mnsent to self _. msu�e, or a certificate o#Workers'Compensation Insurance, COUNYY OF LOS ANGtIE$ . BUILDING AND SAFETY oio c�errt�if,piead copy�hereof�Sec.3800,l C.} V�o'�Icy'F�d O S ' � Compony ►OR APPUCAM TO Fl��IN J09 Certified co y is hereb fumished. EnCH NO. FEE �+�DRE55 �'�.� p Y New Residential Bldgs.B Pools � 1 8 2-Fomii FI. f = S LOCALITY D\pI�+.F^� Cerlified copy is filed with�he couNy bvilding inspeo- Y•�� f2� tion department. Mul1i-lomily Sq.FL CROSS ST. p �� Doia ��SLY_A 1lcant 6 Residentiai Swimming Pools OWNER OR Q�� PP FIRM NAME �� `3V� CERTIFICATE OF EXEMPT N FROM ORKERS' Ootlers:Rec__tight_Sw._ ��� , COMPENSATtON INSURANCE ADORE55 Fi�s�2b (Tlyt soclion naad not bo complafad if Iho work involvQd by Totot No. Additional CIiY ,� Tel.No.7l�(pZ .� Ih�pannif i�for ona hundrod dollars(;100}or lo�s.) PIAN C ECK I cerfify �hai in the perFo/monce of the work fo�which�his _ . - nvPLICANt permit is �asued,I sholl rtot employ ony perwe in any manner soas to become subject fo the Workers'Compensation taws. 1i91�ting FixWres firs�20 ADORE55 Totol No. p�������� CITY Tel.No. Dak opplicant Fixed Appliances Not Over 1 HP � NOTICE 1'O APPLICANT: If, ofler making this Certificate of �pP�ti�UNi Exemption, you should become so6ject �o the Wo�kers' Ranqe_Heater D.W.� � - � _Dryer W.M.— ADARE55 ' � Compensvtion provisions of the Cobor Code you must forih- Oven _ _ _ _ . .- - - - with comply �aeitb.such provn oru a this permit ahap be iop _FqU W-H•---._� _ - �- -��""- - - "' '�� - - --- —_.__ - . " - . deemed revoked- .-- - -.� --�—�---..- - - - `- CITY- Tel.No. � MopA _fan _Other_ - 1lCEN5E6 CONiRACTORS DECLARATION ucENSE OR p 1 hereby ofFirm thot I am licensed under prov�sions of Chap�e�9 �'�� —Room Air Cond. — REG.NUMBfR � ��Ou•!� r (commeneing with Ssttion�T006}of Division 3 of the Business power Apporatus 8 large Appliances DISTRICT NO. PROCESSED BV (L � and Professians Code,and my license is in full Porce and effect. Size 6 Type MP,KW,KYA,or KVAR C� � license N�mber �9 3�� Lic.Closs� Up�o i IncL FINAL 4^ � � i�� C1_ ` Ovor t to 10 fntl. OA� � �� - VALIDATIOH � �s � Controctor�� C�i�"�`°'�'�a�e �'� Over 10 fo 50 Incl. V 4 ❑ FlNAL W � t am exempt under Sec. Over 50 io 100 Inc. BY � � B.BP.C.for tbis reoson ��e��� z 4 Services,Swbd.,MCC 8 Panelboards � � ' �O�°' 0-2(10 Amp.Under 600 V : Signature '` 201.1000 Amp.Unde�606 V � . O . . Over 1000 Amp.ar Ove�600 V z 1 b t 0 p � : EFempt�on for Reg.Maint. lect. ' SIIVGLE FAMILY Temp.Power Po1e 8 Appurlenonces � � �� � � � �2 � ! HOME OWNER-BUILDER DECIARATtON Sign with One Branth Circuit � a e 2 rJ.�Cj ' 1 bere6y affirm ibaf I am exampt from the Contmctor'a Lice�se qddilional Sign Branch Circuits '�� �pw,{«�}�e following reason (Section 703 1.5, Business an d �,,,,�, � � Vrofessions COde): . a.��5..:.,� � ❑ 1,os owner of the properry,will do Ihe work and the Misc.ConduiR 8 Canducrora � structure iy not intended or offered for sale(Seclion Other�See Complete Fee Schedu�e)_ � ��'���R� � 7Q4d, B�siness and Professions Code). CONSTRUCTION LENOING AGENCY 1 hereby affirm that there is a wnshuction lending agency for �he performonce of rhe work fo�which this permil is iuued PERMIT FEE (Su6-Toial) /�� �Sec.3097,Civ.C.). PLAN CHECKING fEE Lendei s Name PERMIT ISSUING FEE IO lende�'s Address �� I cenify ihat I hove reod ihis application and sto�e tha�the TOTAL FEE obove informa�ion ia corred.1 ogree ro comply with all Counly ordioonces and Stme lows regoloting Electricol wiring,and hereby authwize representa�ives of this County to enter�pon the above-menfioned properfy for inspection purposes. SEE REYERSE POR EXPLANATORY LANGUAGE /� G� 9-Y�._ ! �gnaWr er ee Date I ` \` ` m„o '` , l \ � . r�° ° ��° `� � � 1 � ; , -� � ,. � � � �.� ', . -� � mMd a t � N c '+'.¢N O � a "' O� � ` a ` v�. m o Q v�° � °v fl-o N n sa.r,ei ,c g, OY -yro-am � � o o.o� dwE = D � ` ` '` r t o s u� c s ; .r_ o s a i ,n , \ r '`��-y po `^ ° c,°'�s' o„ � Y�"� c; y d� a.o 1' t � ` �,. v o 3 E 4�: o ¢ �c u ` v+ 3.o o > o �,, ` � � 1 � °r =� - �� ro t' n p ro c °v°_p° c�°.� � c �, , � 0 c c � �N-� E r E �?.°�. :.-o v u E o �.or � � o O y o u o o G p u � m v. o c ,�� c-4 p.� , .\j ; r . Z, s o o �"�°i y�.�c� � . � .-� a y.m N= o i s `, c • � p t "'-' }°"""" ,�Pcn m �,E � � � A-@ �v cs ,- 4s , � ` y� � c .��'+ ° o y'= c � E a p 9 0-�o-n.t J� � •1 \ rd o .; f m .c � w.. o p y N t�o• �,. m • �, ,�,o c; o�E c o.. � . 4 c a�a.� m-cy o'3 7c v -�v' �^. ` �� � �.� b �o c a+ -c, N p ro -a r� o f �y �, LLj �. a�ai�-:a y�,v�n �y� �, s.�°c�o ir.�-a N"��• '' � ` ` 7 C. �O v,-6 O _ �,, f3 x �a i a-a �-� o = E c G � � n.t'-d.. .. iu�" � �' �\ c. G �` � ° � ��r o m°.'y a G.� �u�� a �a �. � c� ;� a. :.j � ?c x �; o a o v V" �c t1��a b .�, cr am �-�3 G�;d.:�ro �y-. q,. �� O 1 ' �-� ", Yi v' .u-��6 w N 0 9i 7.:?O r 6 �^ . �i � aL 4 d' ': r d � .`i— W o m G u�, d_;�,' ,"��, - �� =•.�2,° a n _ a�, �{; t 1 °; s a �'° �-� �,<�.+=U r°`n'" ?c '&`_ �,, o � a , ` � UL?�� �•�^' 'O 4-i�I C� O,r�-�p ,a�"� � �i1 a *.� � S �C � fl � 7 .�: @ ., afe. U P q' 6 ?i 7i 4�y n w y��u �U r q O m"' {O yv� ., (7 "� ° N �,;�� � c p �� T � � � � m C G � O D i^�. ((\\ =� a C � � Q v` � � �. E} C n �y a �',U `m a, � � '� r. t `.'. a, f ; ; y � � � ��� . ,.r ; �, ` � \ �, \ � . ' � � � � . � \ `, , . � � : , � � � � � � � , �a � � � �, ti � ', � '� �,, ;, i \ � `�� � ..� � � , � ;� \ � .� �, � '' \ � \ �� � � 1 � �, �, '' - � � ` � , �, `, � � t � %� � �� '� ', , '� `� ; ` ` ` l\ 1 1 � ��. � � 1 � � . � '�, �,� � � � � � � � � � � � `t � � � ` \ �` 1 l , i t l�iV` �)' t "`y � 1 �\ �t `;` � !` t . � , i � �..., j; �c, �y`•. 11 \����� ,� ,t; � , � ' t , '` � �; i��c\ ''�' ��;\ vf� � � `` `\ ��C��,\ � � ` � � �'a � ' 't } �� � I 1 4i , � �F �1 4': 3 1 , '�� � �i i ` 1 � `�v it y � \ F t �� �3V"� �\ �t` � 1 � � � � �� �\ �Q\'�'�` � �\ � �1 �, } `` , � ` 3 1 . O �!\ � i i � \ � � � � � � . '� � �, � �, � � `� � �, � � � � � � � �;�" ��, � ; .� , � �� , � , � � ` _ a"�� ` _ i � ` ' `� ! � � � , \�it:l� r�. a{ ` , � (\ � � F\ ��!�'� � +�a j$� E yt � \.� �` �� ` � �`i t` .\ � D�.� y+. � �) = F J�� t `� � � t � �7C'� � W�, ��j � �,� :�j �- 4� n � � i �� ` � � � ` i i � � J� �U` ,� r 7 ��"'�� 1 � 11 � � �\ 4, � ,t n r,: p � �''_ '+�y�,,.�c",__"'� . � 1. �, � i '"� �„ � a��-'`� � � 1 ` \ `� � � � t \ ` �"�= '� - �\ � �'� '' \ � � �� � Z �� � � w ` ,. �, s ;� � � � � , � � � � � � , � ; . � � . l �/�// . ' �i ����'`. . . �- , ��.,�-