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Home My WebLink About1155 SOUTH DIAMOND BAR BLVD (90) MPENSATIONDECLARATION� 76A663 IOiel APPI,ICATI�N�FO� �ELECTI�(CAL��PERMIT I h have a cerf�f-cafe of mnsenf ro self �E-OotG � ��s�� r e ot workers'Cor.�pensation��s��a�ce, COUNTY O�LO§RNGEIES BUILDING AND SAFETY or a certrfied copy�herecf�Sec 3800,La6 C; ' . "�',_: -" �" " '- ..'. .. .:��M.+#TaF,�.x�. '..-_..�- - ,..rr ..:,�A..v..�..- . , '..: .. � Poli[y No. Company . .., .iOR APPLlCANTTb�FILI_M ._ _ JOB 1 l .,,, �, � . � Certified copy is he�eby'urnished. New Residenlial 8idgs.&°ools �ACH i NO fEE w ADORE55 { � Certified topy is filed with the county building insper 1 8 2-Family,Sq.Ft. E = g LOCALITY tion depariment. Multi-fomily$q.FI. NEAREST' ReaideM�ol Swimm!ng Pools CROSS ST.- � � OWNER OR l � Da1e Applicani .:,. -�-. q / FIRM NAME O CERTIFICATk�OF�EXEMPTION�PRQAA�WORKERb'� � �LightLSw..1Q_ I MAIL � N Ouflels:Rec ADDRE55 COMPENSATION INSURANCE r`� V �47� ��q First 20 (Thfs secHon need nof he complafad if fhe work involved by iotol No.�LL qdditionol "L' s7 CITY� � � iel.No. _ ihe permit is for one hundred dollars(SI00)or feas.) p�qN cHECK I cenify!ha!in the performance ofi�he work for which ihls qPPLICANT ,. . ..... ......,...y...w..�.,.:._.......,.__;;p_wa permit is issued,I shall no�employ ony person in ony manrrer� �� hrin Flxtures First 20 �ADDRES$- so os to become subject�o rhe Workers'Compensqiio LawS. 9 9 _,;,,.�;,,;,;,;,,,;,�„F_,� Addlrional -- �-j�ro'�� ry Totai No.�_ CITY Tel.No. �Date ( Applicant ��-- Fized Applion<es No�Over 1 HP PERMiT NOiIC TO APPLICANL If, afrer making this Certifimte of , APPLICANT Exemption, you should become subjecr to the Workers' Range_Healer_D.W.— � Compensotion provisions of the Labor Code,you must forth- Oven _Dryer _W.M.— ADDRES$�� , wnh comply with such provisions or ihis permit shall be iop _FAU —W.H._ deemed revoked ._...._,,,-..,;,.,. � � �- Hoad _ CITY �(}. p �� Tel.No��j� LICENSED�CONTf�ACTORS DECIARAiION � —Fan Other_ LICENSE OR i hereby affirm that�am licensed under provisions bf Chapter 9 Disp. _Room Alr Cond. — kEG.nIUMBER . ,�„�Class. _ (tommencing with Section 700D)of Division 3 of the Business DISiRICT NO. PROCESSED BY �' Power Apparotus&Large Applionces and Professions Code.and_my license is in f�ll force ond eftec�. /Q � Size 8 Type HP,KW,KVA,or KVAR . L License Number ��!g �2 r Lic Class � Up to 1 IncL FINAL CL � ...Over 1�0 101nd. DATE ��'� VALIDATION � Contractor k1.� ."rJl`�/YN�3TDme��-� Over 70 fo 501ncL FINAL W ❑ I om exempt under Sec. - Over 50 to�00 Inc, � BY � N ... .,._...._.,..... B.&P.0 for rhis reason ,,,,,,...,�.„ Over 10p � --�� -��Dote: Services,Sw6d.,MCC&Panelboards � 0-200 Amp.Under 600 V Signature s=�: 201-1000 Amp.Under 600 V Over 7000 Amp.or Over 600 V � Exemplion for Reg.Maint.EIecL �[t C��Q k SINGLE FAMILY Temp.Power Pole$Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit {;�c a �^ 0 2 I hereby ofFirm that I om exempt from fhe ConNoctor's License Additionol Sign 8ronch Circuits o e Law for the folfowing reoson �Secflon 7031.5, Buslness ond ) �%�.C� P�essions Code): . Misc Conduits&Conductors '�4 L.�C`� I,os owner oi Ihe properry,will do the wo�k ond the struc�ure is not iniended or offered for sale (Sedion O�her(See Complele Fee Schedulel� ► � � �v_�7 704a,Business and Professions Code). CONSTRUCTION LENDING AGENCY�� - I hereby aff�rm thot rhere is o construction lending ogency for � - the performonce of the work for which this permit is issued PERMIT FEE� (Sub-ioiol) �j 'l} (Sec.3097,Civ.tj. . , . PLAN CHECKING FEE� iender's Nome . . - � �� - PERMIT ISSUING FEE �v �� Lender'sAddress ._ ..__ _.......,.,_.:..:.�-:.s,.::,, . �� v� I certify that I have read this opplication and slole 1ha/the TOTAL FEE .. �,�;,�_�� .. .. ......... .:.....,,.�.,:..,.a above informmion is corcecc I ogree�o comply wirh all County ardinances and Sra1e laws regulating Elec7rical w ing,ond ir hereby authonze represen�arives oP this CouMy to enrer upon . -� �� the above-ment oned p� erry for inspec��on purposes. � � ._. .... ....... . .. . ..... � SEE REVfRSE FOI�EXPLAMAiORY tANGUAGE �gn-� �rm-tlee ate . . . .»:��.. . : ._ .�.. , . . . , �. � ..,...� ..,.•: . ... , .. ...___ . _... ..._.�,.. _.., „ j ... . _ .,�, ' l, . . ... 'f� . �'i��. ; ._ . _ ..; ,,..� . 3:' Z�i� - ' - . _x.. . ..` . . : ..C,. . ... . _ : n , - _..,.,_. . __�.�_.�I _ ....._-__._ ,�_ ....�..._...._. _. .... _.. - ' _ � . . . , .. . � ,, . . ._ ' .. .. 't.. .. '..Y: - - . . .�:, -'C ' � . .. �- '"_"_"' ,_. 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