HomeMy WebLinkAbout1155 SOUTH DIAMOND BAR BLVD (131) _.; ....� ...
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WORKERS'COViPENSA;TION DECLARATION�� zo-oow oaw a,a� ' ., °•"',A�';� ,�- , , � . � ''` - - „ - �
I hereby affirm ihat I have a ce�tifiwfe of consent�o self cEeo�� /�PPLICA1�Ib�V�x-��OR.ELECT�tICAI P�F�MIfi��, , . .. ',;
nsure,or �ernFlcate of Workers'Compe�sation Ins�rance, COUNTY OF LOS ANGELES DEPT.OF PUBLIC WOR�I(5 "
or a cert fi d mp th eaf(Sec.3800,L b.C.) �. .. �-�.,M s"�v'.'� � t ,�
T9 _ � ; ,.�,� �. " �';�i.�1
Pol cy No��� ���tj ompany -.� ..FOR^APpLICANT'TO Fltl IN JOB /��.r! � Y? ��,. )•�.� .�
�Cenified<opy is hereby fumishe-d����^ New ReSidenfipl Bidgs.&Paols EACH NO. FEE ADDRESS 9' !lT
�Cenifled copy is flled with the coont ilding Inspec- 1&2-Family,Sq.Ff. . $ — 8 LOCALITY _ ' I
iion department.-� . , Muhi-family Sq.Ft. — nlEnReST _
.
Dat���� � � Residentiol Swimming Pools -
�r"����" A IIcaM � ` _ �r°� � . . OWNERSOR r y,
PP ,,b Cd'�IS FIRM NAME W
��Q CERTIFICA"fE�OF'EXEfv1P'fIGIS"�FF2bl�i'WbRI�E�'������ � p�tlets:Rec�i��gni_sw._ "'a'�
i ; ;j L COMPENSATION INSURANCE� . ',����� a�DRESS a-o r�"l!'J
First 20
� (This secfion need nof 6e complefed if fhe work fnvolved by ., CITY Tel.No. --
thi�permie is for one hundred dollars(5100)or less.) Totol No. �1,�-Additional �1.`�� -� . -�a, �w„�
I certify rhot in the performdnce of ihe work for which ihis le�� APPUCAN7K �d" �
permit Is�ssued,1 shall not employ any person in pny manner ^
Sv'S;os to become sub��ect io the Workers'Compensotion Lows. �ighting Fixlures Firsf 20 ADDRESS �a �
-- Addi�ionol
Totol No. � CITY �,_ Tel.N . 3
Date Applicont �� ' Fixed Appliances Not Over 1 HP pERMIT ' p
NOTICE TO APPLICANL�If, ofter making fhis Certifimte of qpPUCATION ��.�,� L7.J
Exemption, you should 6ecome subject to the Workers' Ronge— Heater_D.W. � ,
Compensation provisions of the Labor Code,you must forth- Oven — Dryer _.W.M.� ADDRE55 �«,y
with comply with sucn provisions or ihis permit shall be Top -- FAU —W.H.— . 0
deemed revoked. �
Hood — Fon —Other— CITY �g�iel.No.�` �a �
I hereb affirm thdt I om licensed under ovisio � P�
LICENSED CONTRACTORS DECLARATt0�1�������� uceNSe Oa -
y pr ' ns of Chapter 9 Dis Room Alr Cond. � Class.
REG.NUMBER I,r�,3 -I Q
(commencing with Sec+�on 7000)of Division 3 of the B�siness Power Apparofus&Large Appliqnces DISTRICT NO. PROCESSED�8Y � Y
and Professions Code,and my license is in full torce and effect � ('1, ��1 O
V Size&Type HP,KW,KVA,or KVAR v (`
License N mber����.'1 ,Lic Classp `- � Up to 1 Incl. FINAL U
�-�'y��t��_ / + �l Over 1 �0 10 Ind. DATE - __���� VALIDATION �
CoMroc�o��Y��" -�7��iY.rl-r'2'r Date
❑ �-Over 10 to 50 ind. FI AL V
I pm exempt under Sec. Over 50 to 100 inc. BY w
B.BP.C.for this reason - Over 100 a
. �� � Servlces,Swbd.,MCC 8 Panelboards , Z
D Yte:_ �'� 0-200 Amp.Under 600 V —
Signature � �"� � 201-1000 Amp.Under 600 V
� Exempfion for Reg.Maint Elecf. Over 1000 Amp.or Over 60p V
SINGLE FAMfLY � „ ... � Temp.Power Pole 8 Appurtenances
HOME OWNER-BUILDER�ECLARAT1bN� Sign wifh One Brpnch Cirwif
I hereby afiirm fhot I om exempt from Ihe Conhracior's Lltense Additionpi Si Brpnch Circuits
Law for ihe following reason (Section 7031.5, Bus�ness and 9^
Professions Code):
❑I, as owner of ihe property, will do the work ond fhe Misc.Conduifs 8 Conductors
strudure is not intended ar offered for sale(Sechon 7044, ��her($ee Complete Fee Schedule}_
B�siness and Pro£essions Code). , ��j��,�,�A,
CONSTROCTION LENDING AGENCY "
I hereby affirm ihot rhere is d cons�ruaion lending ogency for " ��"���"�" � " "��'""
the performance of fhe wo�k for which this permit is issued PERMIT FEE (Sub-Total� � � �-���'r'
(Sec.3097,Civ.C.).
PLAN CHECKING FEE
Lender's Name -- .. . ' .,"�_ __....:.;.:::....::,., �
- PERMIT-ISSUING FEE �� �j r, u c,S;.;�(�
Lender's Address .. ".. ". .`..". .""'.""" �� TOTAL FEE I Q� , '""��3
I ceriify ihat I have read this applica�ion and state lhaf_iheyTM�
above information rs rorrect.I agree to comply with all Counry
ordinonce nd Sta�e laws reguloting Elecfrical wiring,ond �ry �^J
hereby lhqrize representafives of ihis Counfy fo enier upon 5 f L .. .
fhe a ve p5enlioned pro ery for� s ect;on purpose � ��.���w•-- ' �� � �
.. ..y... . ......-,. ..... .
, , . SEE REVERSE FOR�XPL�S��GUAGE
" " f. ��..� � r�s
� -,'�_.
. Signaiure of ermi ee ' ❑te ; �'��w
� ,. �. :,....p...:....: . . .
��.APPROVALS Y � DATE—�_�r�NSPECTOR�s � OWiveFt•BUlLi7eRDEs:Ir�f�dTION
si�Narus�=
TEMP.P06NEF POLE � .
i nsr¢by a3Pirm thac i am exempt tram ihe Contrector's
UNDERSLAB�ICRK � � LlcenseLawforthefnilowingeesson(Section703}.S.Business
,ROUGHCONbUIT� � � ��- . -anrlPro/essronaCotleS.Anyci,�orcounPywnichreqalresapermir
��� d°"":___�__._,..s�____� .te consirucf,alfer,%mprave.demohsh,or rapalr any stmctura.
� ' � � (nlIRING � � � N.�_� � •� priorioitsissuance,afsc!equi!estheapplicantforsuci�permrtro
-- R . � . . � (i!e a signed statement fiYat hre is IicettseJ pmsuanf�o fhe provi-
FlXTURES � sioos of tY,e Cartractor's Licens�law(Chspter 9(eommancing
- i ppWE�—p qU7ypq�Z�p �i--.- ��� wiih SscYlon 7G0[}J of Divis(on 3 of Pha 8usiness and P�o��sslons
� CodeJ a tfla'1 he is exempf;n&rBfrOm and tire baSis for fneL^:f2gBtl
USiLfTYCO.NOTIFiED � �_W � axemAtiun.;inyv+wationo(Seo[icn7�'37.5byanyappGca;:tora
..�.-_.i_.s..a....d...._...n.
Fi'NAL r �" Ae�m�t subjeo?s iiie apA�rcarrt!c s civil psna7ty ut r,at mu�inar.
Geafer ars}roxf fivehundieddatiarsj$5�1(1}�
NOTES
� �1,a.awn�r ai ihs}seapBr[y wPii 9a ihe w�ek�sng
._ _..._.__ ._... ._„_.�,....._._..__„_�._.,..._..___�..,.����..:e.�.._.,� ihe slnicture ie nof infentietS or�f�erad fac sale.
.____.r..._____ ..._._-_.._.
...:,.. , , . ....�......
� � � � . .--- ..... . . , . iSec.70d4:8uslnass anU�roiessiurrs Cutie' me�on�ractor's
�_� - _ � � � - .�._....._ "Lioensalawdcesncfappiytoar.00v,aeratproperfywhoCa[idsar
� � � ��- � _ . _ _. Jmprovas Phareon,and vahc 6css�;ch work himsell provldstl fhaf
O1 - - - - ......�_� �,,,,,,,,,�„�,�__ . �_.,.;,,;�_ svch rmpvovement��a:e rat fiiendeel or oitera�for Saie. !t,
� � ' " '- • � � �- �---- � - � hawever,the Awlding ar Jmproi�ernent is sold wiPhin ona year o0
..___...._ ......,.,.d____�.�.,,_...,..:..._......_.............�.�..,.._.�_._W_. � �...." ..,_. -'..aompletion.#heuwnei•DaiidSr�rvillhavethebutdenotprovingihai
. ---�--- , . . . . . . - - he tlitl no[buitU cr+mR�ve tor the purpose o4 sak.)
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