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HomeMy WebLinkAbout0990A _ - - - ----, - ---. - - - ,°,�, APPLICATION F4R E[ECTF�lCAL PERMIT � � I he eby affirmP�at I hov(a ceni4imte of cansent to self � WORKERS COMPENSATION DEPLARATION .. . ��.. ,... .. . . . .. .' . a' . . . .. .. .. ,....�._ .."'- '...�,..._ . �:insure,or a ce tifimte of Workers'Com ensation Insuronce, COUNTY�OF LQS ANGELES � BUILDING,AND SAFETY � or a certified co thereof�Sec 3800,Lab.C.) � P❑ollcy No. � -Compdny FOR APPLICANT 70 FILL IN J08 � Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ADDRESS � � . . . � . -.. - �. . ..• ` 7 8 2-Fomil FL $ — $ LOCALITY � . Certified copy is�filed with ihe county building inspeo Y-S4� tion departmenL Mulii-family Sq.Pt. CRO55557. - - � ���a�e � ApplimN � - � � Residenfial Swimming Pools OWNER OR . _ . . . � 'fIRM NAME � � CERTIFICATE OF EXEMPTION,FROfv1 WORKER5; . � � ��-� '� ' � � MAfL ' ����"� � "�" ��"� " �" - � . � :� COMPENSATION INSURANCE�, .�� � �� Outlets:Rec^I.�gh�_Sw._ AD�RESS � � - Firs120 � �� ..,_.,... � ' ' ....�(Th�s secfion need.not be tompleted ii the work Involved�by To�a�No_� AddiYional CITY � Tel.No. �.fhe permiT is for one hundred dollors(5700)or(ess.) PLAN CHECK ' . .I certify�that in ihe performance of the work for which ihis � APPLICANT ",�.�permit is issued,I shall not employ any oerson in any manner � � � � - -�� � ' �-so as to be<ome subjed ro ihe Workers'Compensation Laws. Gghting Fixiwes Firs�20 ADORE55 � � � �- � Addi)ional � � � � � �. . . Tatal No.__ I CITY, Tel.No. � Date:. '.' .. � ApPlimnt � Fixed Appllances�Jot Over 1 HP PERMIT . - ". .. . ... � NOTICE�TD APPLICANL If, after making ihis Certifi<ate of APPLICANT � - � ' Exem�ption,��you should betome su6jecf to ihe Workers' Range_Heater_D.W, —. �� . . . Compensa�ion provisions of ihe iabor Code,you musl forth- Oven _Drye� —W.M.— I P.DDRES$ � " with comply w th such provisions or this permit sholf be Top �FAU —W.H.— . I I ' � � i ' � Hood Fon� _Other_ � CITY iel.Na. deemed revok�d. P ATION , , , —` � �� ' LICENSE OR � � �" "� " - "' �"�"� �"""" � LICENSED CONTRACTORS DECLAR �. I hereb affirm ihot I�om licensed under rovisions of Chaptei 9 Disp. �Raom Air Cond. —,., REG.NUMBER Class. } � � (commemcing wifh Secfion 70D0)of Division 3 of the Business DISTRICT NO. PROCESSED BY � f� Power Apparatos F:Large Applionces and Professions Cod.e,'and my license is in full force and effect � '� � . Size 8 Type HP,KW,KVA,or KVAR � ' � � - � , License�Number . „ Lic Class �_ Up fo 1 Incl. FINAL � � ' � Oyer 1 to 10 Incl. DATE f/,J� VALIDATION � - Controctor, Date_ , ,. Ov=r 10 to SD IncL FINAL. ��� � � „ ❑ I om exempt under Sec Ov�r 50 to 100 Ina gY � ' 8.&P;C.for ihis rea�on � .Ov�r 100 . , o �' � � � � � � - � Services.Swbd.,d1CC 8 Panelboards d" � ' DO�e'� � 0-200 Amp.tJnder 600 V � � . ' Signoture 201-1000 Amp L'nder 600 V � ❑ - � Over 1000 Amp,ar Over 60D V Exemption for Reg.Moint.Elect. . �, "SINGCE FAMILY' , Temp.Power Pole&Appur�enances HOME OWNER,BUIL�ER DECLARATION _. cign wifh One Branch Circuit � - ' ' "'��' � I hereby affirm�hotl om exempt from the Contiactor's License�� qdditionol Sign Br�n<h Circuits ���a':� - Ldw for the following reason (Sechion 7031.5, Business and � � - � �-� , Professions Code): ,'�❑ I,as owner of the property,will do the work and the Misc Conduits&Conductors � �' struqure is not iniended or offered for sale (Sec(ion Other(See Compl�=te Fee Schedule)_ � - 'L 7044,��Bueines3 and Piofess�ons�Code). ` � � � CONSTRUCYION�LEN�ING AGENCY - -'- �� '�`- � ' ' � I hereby affirm ihat�there is a cbnsrrucl�on lending agency tor _ the performance of the wark for which rhis perml�is issued PERMIT FEE (Su6-To1al) " " (Sec 3097,Civ.C.). � ' � . - � PLAN CHECKING FSE Lender's Name � - � �� PERMIT ISSUING Ff:E �:Lender's Adtlress � " I certify that I haJe read ihis applimtion and slate iha!tne TOTAL FEE abave information is correcJ.I ogree to comply with all County � � � � � ordinonces and Siote�aws reg�lating Eledriml wiring,and � `hereby authorize representatives of this Counfy'io en7e�upon"'" ' ' " ' ' � � " - � '� ' " � � ' � �` ihe above-mentioned properry for inspeciion purposea � � � � �,�� .:- .�_,. 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