HomeMy WebLinkAbout1155 SOUTH DIAMOND BAR BLVD (94) vvVKKtRS'COMPENSATiONDECLARATION �6A663 i0%et APPLlCA710N F�R ELECTRlCAL PERMIT �
I hereby affvm lhar I hove a certificore of<onsen��o self CE�BO6G
insu�e,or o cernf'icate of Workers'Compensar�on�nsurance, COUNYY OF LOS ANGECES BUILDING AND SAFETY �
or o cerlified copy thereoF(Sec 3800,Lob.C.j � -
Paolicy No. Compony FOR APPIICANi TO Flll IN JOB
Cerfi{ied copy is here6y fUmiShed. New Resideniio)81dcJ5.8 Paois EACH NO. FEE ADDRESS �
� Cerrified copy is fiiled with me mumy 6uilding inspec- 1&2-Fomily,Sq.Ft s — $ �OCAIITY �� �
NEAREST
fion deporrment. Mu��i-family Sq.Ft. I CR0.55 ST. �
/,.�r �' • � .��J Residentioi5wimmingPools OWNEROR
Darel—�APPlican� q,cXl•p.�J
FIRM NAME a
CERTIFICATE OF EXEMPTION FROM WORKERS' OuNe{s:Rec�LigMl,Sw..�_� � �'��
COMPENSATION INSURANCE ADORESS '
F�rsf 20
(This section naed not be wmpie}ed 1i the work involved 6y Totol No. Addiiional CITY Tel.Na. f d_f
the�larmit is for one hund�ed dollan(f100)or�BSS.� GLAN CHECK
1 cenify rhat in the performonce�of the work for which th�s APpUCANT ���� %[.nl
permi�is issued,�sha�l na�employ any person in any manner
so as ro 6ecome subject to fhe Workers'Compe�saflon Lows. Lighring Fizfures Firsf 20 A�ORESS �#-. r �f-1
Totaf No. Additio�al CITY I.No.+� '3
Dote � � " i° "� �
NOTICE 70 APPLICANT: li, after making rhis Cenificate of Fixed Appliances Mot Over i HP qppM��pM
Exemption, you should become subjecf �0 1he Workers' Range�Hearer—D.W._. ���
Compensormn provisions of rhe Labor Code,you mos�fo�th- Oven _Dryer _W.M._ � ADDRE55
with mmply with such provislons or this permit shall be Top —FAU _W.H,—
deemed revoked. Hood —Fan �Other_ CITY Tel.No.
LICENSED CONTRACTORS DECLARATION LICENSE OR
Disp. �.Room Air Cond. — REG.NUMBER ��� Class.�L
I hereby affirm rhar I am licensed onder provisions of Chapter 9 Q,
(mmmencing wifh Se<rion 7000)of Drvision 3 of the Business pawe�Apporarus 8 Lorge Applionces D15TRICT NO. � PROCESSED BY O
and Piofessions Code,ond my license is in full force and eHect Q
� /�� Size&Type HP,KW,KVA,or KVAR �
License Number���C�� Lic Cfass "��-L_ Up to 1 Ind. FINAL �
r,...� �/„� Over 1 to t0lncl. DATE `�„� VALIDATION U.
"'onrrocror�J�.��l�— Da�e �'���-�� Over IO to 50 1nd. L•J
O FINAL
I om exempt under Seo Over 50 to 100 Inc. BY a
8.&P.C.for ihis reason Over 10� Z
�. ►
Dafe� Services,Sw6d.,MCC&Panelboards
0-200 Amp.Under 600 V
Signeture 201-1000 Amp.Under 600 V
� Exemption for Reg.Moim.Ele<t Over 1000 Amp.ar Over 600 V
SINGLE FAMILY Temp.Power Pole&Appur�enances z�3 g,3 p
HOME OWNER-6UILDER DECIARATION Siqn wi�h One Branch Circulr
I hereby affirm thar I om exemp�6om ihe Controcror's License Additionol Sign Bronch Circui�s '(}a s s o��
Law for the following reason(Sect�on 7031.5, 8usiness and '
P ofessions Code): f 1 a�2�5(�
❑ I,as owne�oi�he prop rty,will do the work and the Miu.Conduils&Canductore s
st ucrure is no��niended or offered for sale(Section O�her j5ee Compiefe Fee Schedule)_ , �a e Q 5,,r7��
7044,8usiness and Professions Code). a� 2�,�8 7
CONSTRUCTION LENDING AGENCY
I hereby offirm ihat there is a construcrion lending agency far
ihe performonce of Ihe work for which rhis permit rs issved PERMIT FEE (Sub-Total) �
(Sec.3097,Cio.C.).
PLAN CHECKING FEE
lender's Name
PERMI7 ISSUING FEE �d
lender's Address
�certi{y rhoi I have read rhis applimtion ond shote�hot the TOTAL FEE . ���
above informarion is correct I aqree�o comply with all Caunty
ordinonces and State laws reg�lasing Electri<ol w ing,and
hereby autho��ze represenraiives oP rhis County ro en�er upon
the above-memioned p.operty for inspection purposes. . �.
I SEE REVERSE FOR EXPLANATORY LANGUAGE .,, .. �- �
r✓� � /�-�� j�.�2 71"/
y�� naro�e of�rree oare� . � . . . � � _
. _w_._._ . .__._ _____. ,__e_ r—; .. :,
. , r,s:.
.
�:..: _.:.._.- . _ ._..... . _..,;_______...._.; ��
. , r . . ,., . _ .. ... :1.5�5
.� ' ...�- . . '.:: ' . .:.. _. ..., c.ty
""':__.. . ._._.__ --.,.__._ .. _..__ .. ...._....._ ,,r .: , . . . , -
. . , . ' . .9.a,.; .. . .�. . ..3 .Gt].::
.,.•
r _
.. ._.... ................ . ._.�._.." '_'__�......_". '-'i "�:e-.-.
_ .._. . ._ r ..:� .. .3...-,.)¢`i-
. .... :'.' , �.a`� . . � ` ' _.� ;f-::.,: �< ... � ' . . . r1efF:
�._.. ...._.. ,_ "_'"" ._.....o—._.� _ -..,..._ . .
_ -
. . . ,.. - .�.C+).` ,....w. .c .,. � JYd�c
, _ ., ; . ..� v�,i,s.
.. .. _..... _.-._' ". ._...."_�'_ .__. ,.._. .___.__ . . _._...__.� s�<-. ' : -.-< ;-.._< . . . "La,r
, , � , .'�) . , . � ' ..,. _ ..� . ._... .�
, . . � - . . _ ...._.. _...._. . __.."".: y' y . hc
""' - " . . �... .. . .Y.'; �:�E,� c G;iF:.
., .
' � . ' .. . ' �....
,. . . . . � . .. � � ..., . : .
,._.. ....-. _. ,.."'...... .:..... . :." .: .. "„
... ...... .. . .. ..., . . ._ _ .. . ...._. ...�.., ,>", �,.if�'�f.Yrfr!
___._.. ..._'___ _...,._..u..._ _...._.V.._._. _ ___._� .____."._.___.._.__ _' __..__._...�....__.._...�................._._....._,._._ .T . � , .
. , a .._ . <. ._.�.. �!11;_CP,"dt;�
�.,� r.;v� '_ __.._ .s:.•Y4:/-'SiOF'Jy^I.-'y
`_ .__ "__,.�_..._....._..... ... ...�_...._ ... ."__.............._. .. ... ...,.., ......._..._ .�_.. ...__._�._.. _........._..._,...... r., . .r�.
- - . f n.. . ._,_, �.f - .�_�N.�,p�tr� ..1.�^L
. . . .i`.YC.'.S� )��J,^ ., i C.t�;�:•i=.�;i...:,1he
.�.... ... .._..........,......._�.:._..._. ....... ._ __...._.._...,.,_._ .._..._.. . . ..,__. . ................._.. ,..___•__. _.._., ..__.�...._...
r . .. . ) .. CA�... ......
... ..�..v�.�_.-...:._�....._. _..__... . .................. .. . .......�..._...........__._.,...,—...._,.,__....__...."'__........_..,...._..._............._..�..._.._._.
^ �.:.:_ . __._. .__._.._�..... ._"__'_"._ _ _ . . .___ _ .
. ..:" _ __.._. _ � ._..... __._'_. "_ .'. "_•___�__. _.. ,_..,__ _,.�......,..-.....��.._
I R __