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HomeMy WebLinkAbout1155 SOUTH DIAMOND BAR BLVD (120) • �"WORKERS�COMPENSAiION DECLARATlON - �6A663 �a:e� � APPlICATtON���ORJ�LLE��'�ICAL-P��Mi`��rz��' � � I hereoy afs rm hhat I have a certlfimte of consenl!o self C6806G a i .... ..... . .. .. . ... . . n_ i�sure,or a�e��f�are or wo�ke�s Compensaf�o���s�raoce, COUNTY OF LOS ANG`EL'�S' BUILDING AND SAFETY /1P or a cerFfied copy'hereof(Sec 3800,Lab.C.) FARtiSERSIi�C GRP _ . _ ...,�.. , _......._.:_.,.-.,� .::•.:- ,.., _ .. :,..._,. . .._.. P❑ol cV N�fl l f1��,1 S �J[flid<<lany . FOR APPLICANT TO FILL IN........ ... ..... JOB 1155 DI��OND B.� BL� Cer�fied<opy is hereby furnished. New Residenfiol Bidgs.&Pools EACH NO FEE ADDRE55 '� Cerr fied copy is filed w th�he munry building inspeo 1 8 2-Family,Sq.Ft. � � — S LOCALIiY DIAT�IOTdD $AR tion deparimenL Mulii-family Sq.FI. — NEAREST BROZ^�`7 ELECTRIC Res�de�tial Sw�mm+�g Pools cRosssT.^vRAND BLV� - Date TT*ry �S2 �ClA1�,p�ican! OWNER OR � a��—����—�=l'"'^ i FI2M NAME n- CERTIFICATE OF��XEMPTION FR01N GVbRKER5'� d, MAIL OuNe�s:Rec�,Q_Lighl{},L_Sv✓��_I 2C w �-rj �� COMPENSATION INSURANCE - �� ��75 /+DDReSS This sedion need nof be com leted if}he work involved b First 20 � � P r Totol No.106 qddaional � I � 3 �0 QTY. iel.No. the permit is for one hundred dollars(5700)or less.) ' - � �-��-�- -�-�-^�� �certi ihof in ihe erformonce of the work for which this PIAN CHECK iv p APPLICANT �TIN: JOHPISOPI permit is issued,I sholl not employ any person in ony monne� $.75 Q � ]_5 �n so�as fo become subjecf to the Workers'Compensafion laws. Lighting Fixtures first 20 Q ADDRESS T , � Total No. Additionol • ��_._ ��Tv DIPS.40T.dD �A:R CA. re�.r�o�11+ 598 65 6 �ale AppllcaM Fixed Applionces Not Over 1 HP PERMIT �- NOTICE TO APPLICANT: If, ofter making lhis Certifimfe of APPIICANi (' Exemption, you should become subject to the Workers' Range—Hepfer_D.W. � Compensatian provisions of the Lobor Code,you must forth- Oven _Dryer —W.M.� ' A��RESS with comply with such provisions or this permit sholl be Top _FAU W.H._ deemed revoked. .3 w�-F•�� 3 � 12 �� CIiY Tel,N 'LICENSED CONiRACT6R5 DECLARA1fON �-� � -' Hood _Fan _.Other_ I ^ -R 1 �.E1 �619 2k5 19 5 LICENSE OR I hereby affirm�hot I am licensed under provisions of Chapter 9 Disp. _Room Air Cond. — REG.NUMBER 23�2�3 Class.C�-� � (mmmencing with Section 70001 of Division 3 of the Business � DISTRICT NO. PROCESSED BV Q. Power Apporotus&Large Applionces and Professlons Code,and my Ilcense is In full force and effect. �� � C1� Size 8�ivne HP,KW,KVA,or KVAR ��.QQ r� � .ZQ �� � 1u;Y License Nomber`�0?03 Lia Class Up to 1 Incl. FINAL . 0 ��� Over 1 to 10 Incl. DATE 7� ;/ VALIDATION !— Contracror _ __Date, � Over 10 to 50 Ind. � l �� U ❑ FINAL�„ � I am exempt under Sec Over 50+0 100 Inc BY Over IOD N B.&P.C.for this reoson � Date: Services,Swbd.,MCC 8 Panelboards �.15� 2 � 3�.� ► 0-200 Amp.Under 600 V Signarure 201-1000 Amp.Under 600 V �;p�� � � ❑ Over 1D00 Amp.or Over 600 V o o e Exemption for Reg.Moint.Elect. fy e .c�� 51NG�E FAMItiY � � � Tamp.Power Pole&Appurtenonces �,S HOME OWNER-BUI:DER DECLARA71bN�� Sign with One Bronch Circuit � a 1 9 ..•�l I hereby affirm ihot I om ezempt from the Conirador's license Addiiionpl Slgn Branch Circuiis o a � ��y^,�(j� Law for the follawing reason (SeUion 7031.5, Business and Professions Code): ❑ I,os owner of rhe o r �If do the work ond ihe Misc.Conduits&Conductors � 2.�I J"'�t5 6 pr per y, Olher See Com leie Fee Schedulel_ strudure is not intended ar offered for sale (Section � p , 7044,Business and Professions Codel. CONSTRUCTION LENDING�AG�EN�Y ��� � I hereby affirm fhot lhere is a mnslruction lending ogency for the performance of the work for which this permir is issued PERMIT FEE (Sub-Total; �18(�,QQ (Sec 3097,Civ.C.1. -� PLAN CHECKING FEE � Lender's Nome - PERMIT ISSUING FEE � ZO• 5O Lender's Address .- I certify fhat I have read lhis opplication and s�ate�hot Ihe� TOTAL PEE ❑bove information is correct.I agree to comply with all Co�nry ordinances.pnd S�ote laws reguloting Elecrrical w ing,and ir hereby hor ze represeq tat-ves of ih�s Coumy fo enter upon ihe a'v?mentio i,pidperty for nspect�on purpases. . -� �� �- � � -�--- �-�� � "' � -�� - i - SEE REVERSE FOR EXPL/INATORV LANG'LYAG� `�' E � "� F�e ��:,�..� DEC 11,1986 .._...__,�_. . M�..... �.�.,.... ,., . ..<..,, .. ... . _.. . �.._ ,... • w.�<,�.,.._�._.,.. �,..v:. .,.....:,...�_...., _._..,�.�. . _.._....,.....�.__.,.... .,,..... 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