HomeMy WebLinkAbout1155 SOUTH DIAMOND BAR BLVD (2) . ���virt�v5A710N DECLARAiION �oaeo3 io�ei AP�tiCATION FOR ELECTRICAL PERMlT '`�j
affirm iha+I have a certificme of mnsent to self C68o5G
o cerflficate af Workers'Compensaron Insurance. COUNTY OF LOS ANGELES BUILDING AND SAFETY �g
ora cer�ie�c�o.�y�th.(e��eo�ec 3800.Lab.C.) . , � �
P❑o11ryN � -" mpany.S�7?"�G;a.(/�� FORAPPLI[ANi70FILLIN DDRE55 ��JS !�)/97t2ce✓� �/'- gL(� �
Certlfied<opy is hereby fumished. New Residentiql Bldgs.&Pools EACH NO. FEE
� Certified<opy is filed with rhe county building inspec- �&2-Family,Sq.ft _ 5 — g LOCALITY -
tion depprtment. � � Multi-fomily Sq.Fr. _ 'NEAREST
CROSS ST. (�
Residenriai Swimming Poo�s OWNER OR
Date Appli<ant F!RM NAME �� �=g
� CERTIFICATE Of EXEMPTION FROM WORKERS' ,v�qu S
Ou�lets;Rec�lighf,Sw._
� '�COMPENSATION WSURANCE firs�20 ADDRE55 -
(This secfion nead nof be complated if�he work involved by Total No. Addiilonal CITY Tel.No. r.� _Z�
fhe permit-is for one hundred dol�ars(5700)or less.) p�AN CHECK
I cerfity thaf in 1he performonce of ihe work for which rhis I APPLIUNT ' ^- �"]Z . L Si -f�/�
permit is issued,1 shail nm employ any person in pny monner ^
so os to become subjeci to ihe Workers'Compenso�ion Laws. ll9h�ing Fixiu.es First 20 A�DRESS�y�,�s p 2 ry �/
� � � Total No. Additional
GTV . Tel.No. � f._
Da�e opplicpn! Fixed Applionces Not Over i HP I PERMIT �?, �
-NOTICE TO APPIICANT: If, afre�making �his Certificafe ef APPLICAN7
Exempiion, you should become subject ta ihe Workers' Ronge_Heoter_D.W. _ - � ���
Campensarion provisions of rhe Lpbor Code,you mus7 forth- Ove� —Dryer �W.M..� AD�RE55
wiih comply with su<h provisians or this permit sholi be Top —FAU _W.H.— �
deemed revoked. CITY Tei.No.
- LICENSED CONTRACTORS DECLARAiION Haad —Fan _Orher�
I hereby affirm thar I am licensed under provisions of Chppter 9 Disp. —Room Air Cond. � REGNNUMOER ��]�� Z/ Class. (�
(commencing with Secfion 7000)of Division 3 of rhe 8usiness poN,er Appprotus 8 Lorge Applioncas DISTRICT NO. FROCESSE�BV �
ond Professians Code,ond my license is in full force and effeai. a
- �> � Size&Type H9,KW,KVA,or KVAk f} �
License Num6er `y?���� Lic Closs C' i� 11p fe 1 Incl. FINAL V
Cantracror�¢�''�--���� Oare S`�S�'�`7 ��e�1 to 10 Ind. 0.4TE �.-�y�_Cl� %Vp�IDATION �
❑ Over 10 to 50 Ind. �� t-
I am exem i under Sea FINAL
p Over 50 to 100 inc. BY ` V
W
B.&P.C.tor this reasan Over 700 _ y�j
� � Services,Swbd.,MCC&Pvne�6oards � �
�Ofe' 0-200 Amp.Under 600 V
Signarore 201-1000 Amp.Under 600 V
� �" � � Over 1000 Amp.or Over 600 V
Exemption for Reg.Moinf.Ele<t.
SINGIE FAMILY iemp.Power Pole 8 Appurfenonces
HOME OWNER-BWIDER�ECLARATION Sic�n w�fh One BroRch Circ�if - -
I hereby affirm rhat 1 am exempt from the Confractor's License
Low for Ihe following ieason(Sedion 7031.5,Busi�ess and Addirional Sign Bronch Gircuits
Professions Code):
❑ I,os owner of the property,will do the work and!he Misc.Conduits&Conducrors
shocture is not intended or offered for sole(Section Orher(See Complere Fee Schedule)_ � ,_,t5�,�,4 A
70a4,8usiness ond Professions Code).
CONSTRUCTION IENDMG AGENCY ;q d c m c s�
I hereby aff"irm rhaf there is a construc�ion lending agency for .
the performance of rhe work for which this permir is issued PERMI7 FEE (Sub-Ta!all � `� '����G
(Sec.3097,Qv.C.1.
PLAN CHECKING FEE �' ' "���v<s-'
Lender's Nome _ r�y G�4�7
PERMIT ISSUING FEE '��;
Lender's Address �
I certify rhaf I nave reod this applicatio�a�d srate thar the T�TA�FEE � j ,
a6ove information is orrect.1 ogree to comply with all County
ordinonces ond Slote laws regu�ating Electricai wlrinq,dnd
hereby aothorize representotives af this Co�my io en+er upon
the�ve-meniioned properiy for inspect on purooses. , -- -
SEE REVERSE POR EXPLAhAiORY LANGUAGE ���� �'�" -'� �- �
� ,. .. .,-.., �-
......__, . ,....... .
-Zo-r2-�.i �. �S/S":3-�
�Signature o4 Permit e Date . � �� � �-" ' . - -
- �� OWN£R-Bt11LDEl2DECLARRTION
� . � APPROVALS DRTE 51GNATUkE
TEMP.POWER PQLE I hcrehy affirm tha!I um azompr frcm the Comrector�s
� Licensa taw far fhe fal!ow�ing �� n (Sec;ion 70J1.5,
UNDERSLA6 WORK 8usiness artd Profes>ions Co��):Any city or county v✓htch
reqvires a permif io mnsiruct,aifar,improva.demo•'!sn,
ROUGH CONbUIT or rapolr any strUct�re,prior ta its Issuonce, also re-
' W IR1NG qulres 46a oppficant for;pch permif te file a signad sfare�
FIXTUkES �nent tnat he is licensed parsuar,t'a ihe provisions oi!he
Contraciors Licens�Lovv(Chapier 9(commanc"rny wiiii
� �" - � POWER Al1THORiZEp Section 7000J ai Division 3 of the 5us�ness ond Profas�
s7ons Cvde)or fhtrt he is exempf Vhe:efrom ard the bcsis
� UTILItY CO.NOTIFIE� {�r iFe aI(eged oxemptiart. Ar,y violation of Sectian
. ���A� � c7 703L5 by any oppiiconi for a permN suojects 1he appli-
Gnfea ort_Sroxf cartf to u tivii penaliy af not mare ihcn five hundred
�- ' NOTES dollars(550QJ.:
❑I,as awner ot fne property wii't do ihe w�ark,and
� � � � ?he sirucfure is not"mtended or offered for sale.
(Sec 70M,Susiness and Professions Code: 7he Coniro<�
tor's ticense!aw doe�nv4 appfy fo an owner of properfy
. wha 6uflds or fmpraves thereon, cnd wRo does such
work himself provided thof such Improvements are not
� � , in;ended or offored;or sols.If,nowever,1he bui!ding or
� imorovamenf is so(d within onc yea of rompletiort,fhc
awner-butfder�at!!have the burden of uroving thai Fe did
not build or improve for!he purpose of sale.)
- I am exempt�rder Sec. ,
B 8 P.C.for this reason
Da'e ,
pwner ___