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HomeMy WebLinkAbout1155 SOUTH DIAMOND BAR BLVD (37) ._.... _ ..... WORKERS'COMPENSAT(ON DECLARATION �6A663 �o�ei qppE�CATIO�N ��OR ELEC1��tICAL��PERMIT �t I h=re�y aff'rm thaf have a certficate of consent•o self CE-e06G � ins�re,o•a ce+r f caie of workers'Compensaro���sora�ce, COUNTY OF LOS ANGELES BUILDING AND SAFET or a certified copy ihereof lSec 3800,Lab.C.1 -� ��.• ;-�� �' �'ias.� �v Y �,a �.,.:�.�:" �cy No. � Company _ p! . FOR qPPlICANT 70'FILI IN , „ JOB µ e Certified mpy Is herebv furnrshed, . New Res�denYal Bld9s &Pools EACH I No. FEE� /+DDRESS � Ceriified copy�s ffled with the counry bu�ld�ng inspec- ��2-Famiiy,Sq.Ft. 5 —I$ LOCAIIT� tion depanment. Multi-fomily Sq.Fc — NEAREST . � Residentiol Sw�mming Pools CROSS ST. „ -,,,„..... ......... Dafe .-.-, APPliconf . .... . OWNEROR .. ' FIRM NAME C �� CERTIFICATE OF-EkEhV�TION�fR67✓i WORKERS' Ourlets:Rec_Lighr_Sw._I MAIL � COMPEN5ATION YNSURANCE First 20 I ADORESS � "' � (This secfion need nof 6e complefed if fha work Involved by Tota�No. Additional CITY � p�`; � �'Z,Tel.No. the permir is 4or one hundred dollars(S100J or less.) . P�qN cHE�1C I certify iho7 in ihe performance of the work tor which this � � permii is issued,I shall noi employ any peison in ony monne� APPUCANf _ . ,....._.._--.w-.. �x,.,:.�..w�..::�a+�+w.•.+� so as to become subjeci ro�he Workers'Compensdtion Laws. Lighfing fixtures F7rs+20 AODRE55 „,,.„,,,_. �.. Additional . ._. _.__.........,.,...__,....,-. ��'�'S��pplimnl �� ioral No. � CITY Tel.No. .. Date ixed Appliances NorOver 1 HF PERMIT .. ��....._...,.....::..:...�:..-.....:.....,,...,�:.N,�.�....-;. NOTICE TO APPLItAN7: If, ofter m mg this Certiiimte of � qPp���qNT ��.�/fd �6/d¢" V"' Ci Exempfion, you should bemme'Su6'�ed io ihe Workers' Ronge_Heater_D.W. — Compensation provisions of the La6or Code,you must forth- Oven _.__Dryer —W.M.— ADDRESS ���� Qd�l�1,.���� - wi+h comply with such provis�ons or ihis perma sholl be Top _FAU _W.H.— ��LJ J deemed revoked. _ Hood _Fan _Other� CI7Y . � f L� Tel.No., � ' Cj LICENSED CONTRACTORS DECLAIFAiION-� LiCENSE OR ,1 I hereby affirm thot I am licensed under provisions of Chopter 9 Disp. _Room Air Cond. — REG NUMBER 7 � � Class:E`-j�i� } � (mmmencing wl�h Section 7p00)of Division 3 of the Business pawer Apparatus&Lorge Appliances ❑ISTRICT NO. PROCE D BY O and Profess�ions Code,and my license is in full force and effeci. ,.," (�e V /� Size&Type HP,KW,NVA,or KVAR � � �v�--�.L License Number ✓7��6� Lic Qlass �"-�"�� Up to 1 Ind. FINAI � C' DATE � �✓��}LL3 r,�/F�+nate �/�g ^'�!f Ove�1 to 10 Incl. VALIDATION � Controcror � Over 10 to 50 Ind. FINAL ❑ I am exempt under Sec. Over SD to 100 Inc. BY '� _, ... v� 8.8P.C.for this reason _. _ ._..,_, Over 100 ...._.....,._ ' ��ate_ Services,Swbd.,MCC&Ponelboards , � . . ...:.�,..,,. .._..... , 0-200 Amp.Under 600 V Signarure .-.....�.--:-: .-...�.::.:�,:='=�=:.:::•. 201-1000 Amp.Under 600 V ❑ Over 1000 Amp.or Over 600 V Ezemplion{or Reg.Mainf.Elen. SINGLE FAMILY• Temp.Power Pole&Appurtenances HOME OINNER-BUILDER DECLARATION Sign wirh One Branch Circuii f ,y ��j(a.��(,j.� . 1 here6y of4irm�hot I am enempi from ihe Controctor's License Additionol Sign 6ranch Cir<�its � �,! Law for the following reason(Sec�ion 7031.5. Business ond � N �� a m c m� Professians Code): �✓ � Misc.Conduits 8 Condu<tors 1,as owner of ihe property, �II do�he work ond the j �� � e '��5� shucture is not intended or offered for wle (Section Other�See Complere fee Schedule)_� � �, 7044,Business v�d Profess�ons Code). - --•���,' �� � eam25.5C� , . . .. . . .. ...._..,_._....�..ns.:�:... 't CON ST RUC T 1 0 N l E N DI N G A G EN C Y �-��"�" � � r 1 i 1,�C 5�8 6 I hereby ofFirm that�here is a constru<fion lending aqency for - � ihe performance of the work for which rhis permir is issued PERMIi FEE (Sub-7oro�) (Sec.3097,Civ.C.). , . „ . PLAN CHECKING FEE� Lender's Nome . PERMIT ISSVING FEE Lender'sAddress --. . . -...-,.,- . � :=.u-:.:.;::a 'I cerrify rhor I hove read�his dpplicaf on dnd s+o+e thd��he TOiAL FEE ,,:_�..�.� (� .... .<.....,h.,.� .,,...,. above information is correci.I a9ree ro comply with all Counry ordinances and Srote laws regulating Eledricol wiring,ond _ hereby au�horize representarives of this County to eMer upon �--� � ��� �' -�� _, ....... ...... .__.. . fhe above-mentioned properry for inspecrion p�rposes. . . .,.=-,w.�-,��•.'�^�^':��.""'��"" .�,,.,, ,..;.,..,.:.,_.�:,.....�.�. . 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