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HomeMy WebLinkAbout1326A (7) v;ORKERS'COti'FEhSATIC!J DECLARATION ��°^�.3 +°"'+ APPLICATION FOR ELECTRICAL PERMIT ff�� I h+reby e!'�rm Ih;t I h.�oe a C^rti!i:;te cf ccns�nt Io s^:f insu�e, «"�Cf;G � � a ccit�5catr,ot�Yr.rkor5'Comprq�,�!�n In=,.irzn:e,er a crrt!ir.d COUNTY OF LOS ANGELES BUILD�NG AND SAFETY cbpy therrof(SoC 3900,L:.h.C.) �`��"Y<<�� CCmp�ny FOR Af'�LICAYi TO FILL IN J;::1 � J /� � � ❑ .Ce!b!iCA[_p s Mrp6 lurn?5h!id. [ACH �JO. p�G �.CCRCSS 4'4 / :7�Ge C.��E . "Y� Y Nr•.v Rc54!on:i;!I f11A^5.8 Poo�s � Cer!i'ied ccpy ig fieA w:;h Ihe eaunty bdL''ng inspec!ion 1 R 2-F,:^!i�y,Sq.FL S — S LOCA.ITY� a,�.�y� <�� . dzc��!ment. . 1d:i�i-f-Ti�y S�.ft. — ::nra[:sr �,.�/ � �+ , CRCStiST. / ••/!Y 1, � .YG�D D.'ta A,^.,^'cact � R•'s'C�r.!i'I 5•.rimr��nq Poc's C.::°N CH �j` FIn..11:nl.+= �C../`//�r�i t� CERTI=ICATE OF E%LMPTIO.`�FRO'.1\YQF2KEfiS' •%' 1 � •a•� COA+PENSATfO.'71�5URA'JCE �����^�5�ReC_Li.;".1 QS'.'+.— ,'� �'1( ppCP[55� (Thla 6sctbn need nol be compkled II the work irnolved 6y the F�r<t 20 �v '`'y 4' � �'� Tclal�Jn.� Aai.•ion��l CITY � TaL Ho. permit la lor one hundred dollars(S 700)or less.) ' I[crfiFy thFit in!M{wr�nrm^.ntC of IM vmrk lor whi�h IhiS perm!! �'LF.'�C14 CK �� � is isbued.I Sh]'I no[err,lo• m %��fRI�:.VT (' ���nf"S��III.'!�V T.�lIMI 50'S IO becaT^.SL'L`;,�10 Ihp�'dpfk^f3 Cenpert�.^.• �.^:vs. Lir,h!im3 Fi�!ures firs!2� ACDRGSS --- /, Ad�iNcml Y Tc!�I No.�� CITY ` Tel.�J�.� i�D,�TI�����c�ic^'. . f�iL-+-. . N TO AP?LICANT: If, a'tcr . r. firrd App''.��res t'r,POvcr 1 H? PU;'.9f r M / �//� �,i9 Cf'rt:.i^.'!(' 01 LT���Ir �Nli Ex^"1`v�1J'1.YC:J S�R:���^CCTC`.:�7=C�!0 11:^IYC.'YCIS CCf.^.,^,FO,a!ir,n R,^;�.+_ Np,.!^r_ DS'/. _ ar��Cn!fi (/ prrn•isiors ol iha,Lehor Cod.^,ypu rcu5t ICr�';;v.!h CCT,^.''1�•ri:h suCh Ovr.n,.._ Dry=r_ P/.ld._ ADCR[SS �J� �y(/Gf�� ryrorisc-s o�tF.�,P^rmR sh,q h.�d^C^n^d rr�rFetl. To� _fAU _ 17H._ L J L!C[CiED CO�JTRACTCRS�ECLMA71CiJ HocJ— Fan _ O!hor_ ��TY� � �'7��- f��'�J `7�� I hcr=ny;:!�;rm t!�,t I�m IicF�^,.M un4.�.prrni=�an5 cl Chap!^�f3 uCEr;SEC�� ( � �n 7000)cl Di�.is�cn 3 cl. C+�.:s�ar�s aM Gsp. — lioem Air Co•el. _ !`Q, Z G+.ac � coT^�,•nd w�tn 5ocn., ,a., rcc rv��-rn � � 'L C o Pf��nc5:n'15 C0�!�'...'.M!'FJ I�.(!'1..^,i5 in 1�'I fcrC^�rA C'1�^CI. [75SR�;T 1.�. f�OCES!'.ED[iv ��r�nra,,,,•,,s x uM„�;,;-.,�ES I6 � �7 �Y � �i:r.R Ty,�c I!P,K1'!.K!'.1.cr K\�:�R Q Liccr:se Ni!mhcr JU�rz•z' L�c.Gl��s G� U�!a 1 Ir�l. FI'!AL �.+ ���y� ri O�.rr 1!D 101n�1. CATE � � L(r�J�c../F��,..,__��3��7 VAIIDATION Ccr.!rzNc OO ❑ O:^•10 tn 50 hr.l. FI":AL I.n r.n.����.v�p,cpc. 0:.�..c0!�1Q0 I^.�. gy W 4 BRP.C.Inr(61c.p,gpq O�+C!100 � Q„� . N g�n�;�,..,c.sM !•CC S P,....�a..-.�o- , ~ "V ► Z °°�" o-20o n�n.u�:•:,�r,co v S�;n,!•�rn 201-1C00 Amp.Usdcr GCO V ❑ � O�.^r�r,no nnp er Over fC0 V Ercm;!io�lor Req,�^ii�!.[�ocl. � :i:t �2b S�^JGL[F.",'!'LY Terp.Pevr.+r Pe�c 8 A,^.^ur!an��ccs ' I'C••r C:\'!:CR��JILCER CECLAR�TO'J gi��w�lh O�e Or"^^h Ci•e:r: I ( r I hrmDY 2'frm f��t I 2^�e.!fm�t Ircro In�Ce�V:+tt^:s Ucn�sc L^..i � ' � • 1��]J 1r,r!:.n f,;!r.,.:^�rr��nn(^n�io�7031 5.Rus:rr.cs,.n�1 prp•..c��pns !."C'bnil i�;n E3nnch C�rni's , _ _ CeC^Y - e � .il��/J i; ❑ �•.SC.C^^!��.•5$C^!1^J��.^.f9 O O.}���7 7 �.?4 Cwnc�0�th�pro;,rrty,w•'I Co Ihc woih:n7 I!ie<iruclum. � is rw;t in!^rc!ed er e!Ic•etl I;,r s.^.'e(Sectbn 7044,P.cs'ness Q'h=r�Son Co�ye!•�Fre Scl�n;y.de)_ ► a�tl Pr'r,ssCnS C0�^I. � CCNSTRUGTIC'J LE�JC"dG AGEHCY I hcreby,^.'lirm Ih,-:t Ux•e is a con.=.!ructivn IonC�ng n�rncy for Ih= • perfermarre Cf Ihg�vork loi wlvch ih�s P"'�il is issu=d ISec.3097. FERR�IT PEF: (Sub-To'ip �,S'. • C:v.C.1. FLAN GH[CK!NG fE[ . . Lesdcr's NaTr. � P[R!!IT ISSU�":G FEE f U LenCer's A.d•ess I e=�lily tf�,.t I h^•m rend this..pp'ic2!iq�,�s!a!e Ih:t the.hove TOTS�FFE �S•7S I inform+tion is corrr.ct.I.^.�•cc lo com,^,'y x•i!h.�I Ca.inty c•di�ances a�d 5!�fC la•n5 rf�a!^.•in�Elec!rital wi.inp,+nd h^�nhy authrni±e rcpresrnl�tives cf lhis Ceu�ty t�en'er upo�th^^bo�r.-m^nlioned � - � � ' prc.�rr t i'ISpCC!i^ :rtpp5P4. SEE REVERSE FOR EXPLANATORY LANGUAGE /�a�"'1q %��_ . � � _�m•ttce Datr. _;' �_ "— ��_" ._...'___;� ".�._" ._. ._.... .�... ' . .' . ' ' ; . - . ; . . � I � � � ' 1 . . � . � � � • ' •, � . • . . ' '' s C �.) � - C � � . . . �, r -. f'I C J' L.: I'; "� . . • ' ' < _7 �: �� � �., '.�' ' . 1 . C) ` `� n L. � � . � • . . -• 3: U � � . �- ' ' _ ' �: L) y �l 1' ;� . . - � r� �� �� f^ �� h !-; ' . . � C' • ' , ' __�—.— — _... , ._ .. . ._ � -��--- :.. � r. , , ti• . f,. n; � � � I ^ — — — -- • i _:% . � ;'1. . �i • , . =�j; . . '�C'I. ' i i ' . 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