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HomeMy WebLinkAbout1155 DIAMOND BAR BLVD (2) �..-'' _._. �_:_., ...,_ .. � ����.� WORKERS'COMPEN�ATION DECLARAiION �-���� ���� �6A663 10'81 pppL1eA710N�FO�R ELECTFt�CXC[�;'P�RdV11T � � I hereby off�rm thef I ho e a certificale of conse t to self CEBObG : insure,or a certificate of Wo kers'Compensahon� suro�ce: COUNTY OF LOS�ANGS`LE$� � BUILDING AND SAFETY a o cert f ed copy thereof(Sec 3800,Lab C) � � ' +.�.,:�� -1 . ..-..._�,.... __. .Y. . .. . . ... P❑oliry Na.� 1i i°TompanySTi4TL��A�YP_P1��7� ...... FOR APPLICANT TO Flll IN... .. .,.- __. JOB �. Cerrified copy is hereby furnished.%�v:2�1`/«%Y!N ew Residemial Bldgs.$Pools EACH NO. FEE ADDRE55 // /t/ j/ � Certified copy is filed wi�h rhe county 6uildmg inspeo- 1&2-family,Sq.R. $ — 3 LOCALITY rion deportment. Mu�b-fomily Sq.F1. — NEAREST CRO55 5T. � Date ApplicaN Residentipl Swimming Pools . OWNER OR .. .:.:.,z .., �.. ....:.- . .- FIRM NAMF ... ,. CERTIFICATE OF EXEMPTION FROM WORKERS' I MAiI Ou�lets:Rec_Liqht_Sw.� COMPENSATiON INSURANCE nDDRESS ., ihis section need not 6e com I t d if the work invaived 6 first 20 � P e a Y Total No. Addi+iono! CITY Tel.No j 6S7 +he permif is far one hundred dollars(5100)or less.) - - I ceriif ihot in the erforman<e of�he work for which this PtANCHECK Y P � APPLICANT permif is issued,I shpll not emplay pny person in any monner so as lo become subiect to 1he Workers'Compensation 4aws. LigMing Fixtures � First 20 ADDRESS h� � Additional � Totai No. . . I CI7Y Tel.No. Dafe Applicant - Fixed Appliances Not Over I HP PERMIT NOTICE TO APPLICANT: If, ofter making ihis Cerfi{imte of APP��C.ANT ' ExempGon, you shouid become subjeU to the Workers' Ronge_Heoter�D.W._ �- . � ��•�."-^-°."•-`.`"""`""'""" "•'•"'""g Compensafion provisions of ihe la6or Code,you mus�for�h- Oven �Dryer �.W.M.— ADDRESS . .,._._....._..._,..,:..,:�.:.._::.,-:.�a. with comply with such provisions or this permit sholl be Top _FqU —W.H.— ❑TY Tel.No. deemed�e�oked. ,,,, Hood _Fon _Ofher— � ^��-'+'�^ LICENSED CONTRACYOfFS d�C111`R'�Ti�J����� � uCENSE OR I hereby affirm thot I om licensed under provisions of Chapter 9 Disp. _Room Air Cond. — REG-NUMBER � aJ ` wCloss.0 (rommendng wdh Section 7000)of�ivision 3 of 7he Business DISTRICT NO. PROCES BY � � and Professions Code,and my litense is�m full torce ond effect. Power Apporofus&Large Appiipnces � p /� `l Size&Type HP,KW,KVA,or KVAR , �� � CJ liwnse Number r7`����9 Lia Class �7� .�p ta I Ind FINAL O.L . .Over 1 to 101od. DATE YALIDATION � Comroc�or����`Li7�s/C�Ste �' �y�7 Over 10 to 50 Incl. �� ����� V O� � FINAL Lu �am exempt unde�Sec Over 50 to 700 Inc BY O.; Over 100 U3 8.8P.C.for fhis reoson - �-���---.•, G -�+Date: $ervices,Swbd.,MCC&Panelboards , � 0-Z00 Amp.Under 600 V Signoture 201-1000 Amp.Under 600 V Q � � " -- � Over 16J0 Amp.or Ove�500 V Exemption for Reg.Maint Elect. SINGLE FAMILY , . . ., Temp.Power Pole&Appurtendnces HOME OWNER-BU!LDER DECLARATION Sign with One Branch Circuit I hereby affirm ihot I om exempt from the Contrac�or's License Addirional Sign 8ronch Circuits Low fo�fhe following reason �Section 7031.5.Business pnd � Professions Code): ❑ �,os owner of�he property,wili do the work and+he Misc.Conduits 8 Conductors l, � structure is not intended or offered for sole ($ection Ofher($ee Complete fee Schedule)_ � � / U �7 1 ra�� 7044,Business and Professions Code1. -� --•,"-� ,•�---,,, L ! c ,_.. ...... �:_..., �• n m a i" CONS7RUCTION LENDING�AG�NCY ��"��� � ��'"�"�"' ��"' �f� � I hereby affirm rhar�here is a construc�ion lending agenry for � a •2 5.5 G ihe performance of rhe wo:k for which this permit is issued PERMIT FEE (Sub-Toial) (Sec.3097,Civ.C.j. o c z GLAN CHECKING FEE� � - � k�S'��� Lender's t�ame .. . __..,....._.,....__..»r..,� 0 A;�1 '-8 7 PERM�T ISSUING PEE C� Lender's Address �� ��-�--��---�����--�-•�-•�m�--.� I certify ihot I have reod this applicoiion and stote that ihe TOTAL FEE � ,�� ,� a��� .__.. _..._ ..., .,.,... above informafion is correct.I aqree ro comply with oli County ordlnances ond S�are laws reguloting Eleciriml wiring, and hereby authorize represen�alives of this County to enter upon . ..._..,.,.......�_.-> the above-mentioned o ert for ins ection P� P Y P PurpoSes. ..:.:..MwF.:,...a.....:..:....�::::_.,-..�.,.._.�.,t�.w...:.:.,..._.....:;._.... 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