HomeMy WebLinkAbout1155 SOUTH DIAMOND BAR BLVD (140) -- ------- --_
_____�— . . _.__.. ......�:... k..,...,.. ,�.,. ... .... .. ... . ... ..::. . � - . '.z"_.�....r:-�-":v."w.'ttl:L:R.n�.i4::"^w.v 4"�.Y:..::.�a.3fi�-�......�w':'Srn"r.'?.t.`?Ox se.:...��'-�.�
� �NORKERS'COMPENSATION DECLARATION 76A663 i0;8� . App�`ICATION FOR ELECTRICAL PERMIT �{.�
1 hereby affirm rhot i have a certificote of consent,to_self CE-806�
._ . .. ., . . ... ._ . _ .. . .. . . ...
p COUNTY OF lOS ANGELES BUILDING AND SAFETY `��
lnsore,or o certifimle of Workers'Com ensafion Insuronce,
� or o certified copy ihereof(Sec.3800,Lab.C.) - � � �
P❑alicy No.�^.�.�. • .��ompany 3""f�d��'�I^'l.'%+�+�.�. FOR APPLICANT TO FILL IN JOB .
Certifled copy is fiereby fomished. New Resideniial Bldgs.&Pools EACH NO. FEE ADDRESS ' /< t;,+
� Ceriified mpy is filed with the munty building inspeo � 8 2-Family,$q.FL E _ � LOCALITY
tlon department. Muhi-fomily Sq,ft. NEAREST
� �,£-� Residentiol Swimming Pools CRO55 ST.
� Date �:` �'%• Applimnr +'4 r�`"` !7bCt`a.t �i=:� � OWNER OR 'jq
I FIRMNAME t�f'�y"�. `� '�F '�-.�":/�f
RTIFI ATE OF EXEMPTION FROM WORKERS' MAII '
COMPENSATION INSURANCE " � Outlets:Rec_Light_Sw._
A�DRE55 r`�: '�
' This secTion need no1 ba com leted if the work involved b First 20
� P Y Totol No. Additionol GTY Tel.No.
' 1he permif is for one hundred dollars(;100)or less.) PLAN CHECK
. I certify ihaf in the performance of the work for which this qpp���qryT
, permit is issued,I shpll not employ ony pe�son in any manner
. so as�o bemme su6ject to the Workers'Compensation Lows. L�ghting Fixtures First 20 ADDRESS
� To�al Na. Addirional CITY Tel.No.
Do1e App�iwni Fized Appliances Not Over 1 HP PERMR
' NOTICE TO APPLICANT: If, after moking this Certificate of APPLICAN7 ;'.4±•• - �1:.
, � Ezemption, you sho�ld become su6jeU fo fhe Workers' Range—Heo+er_D.W. _ , " �`
� Compensa�ion provisions of 1he Labor Code,yau must forih- Oven _Dryer —W.M.— I ADDRESS � , ,� , _
with comply with such provisions or ihis permit sholl be Top _FAU —W.H.—
daemed revoked. i CITY � Tel.No�•�c T .� � a
Hood _Fan _Other_
LICENSED CONTRACTORS DECLARATION " �ICENSE OR � O
I hereby affirm that I om licensed under provisions of Chopter 9 Dlsp. —Boom Air Cond. — REG.NUMBER "'��'-`"' ��°%�� �- �- Sa
- (commenring wuh Sectlon 70001 of Division 3 of the Business Power Apporotus&Large Appliantes DISTRICT NO. 7ROCESSED 6Y �
and Professions Code,and my license is in full force and effect.
` Size 8 Type HP,KW,KVA,or KVAR � �'+-
Li<ense Numbe�'� �� �''j'"�� Lia Qloss i--�`>'� �'� Up to 1 Ind. FINAL �"
�M � DATE �
/ Over 1 to 10 Incl. _ VALIDATlON �
Con}raclor�'�f�'�ii�i.'^_v'�<-+ wtp'atp ' Over101o501nd.
. ❑ .f�-^' :e%,"� FINAL O
I om exempt under Sec Over 50 fo 100 Inc BY
B.&P.C.for this reason Over�00 . W
i Services,Sw6d.,MCC 8 Panelboards ► �'
Date: 0-200 Amp.Under 600 V
� Signoture 201-1000 Amp.Under 600 V ,;:i:r wr�
❑ Over 1000 Amp.or Over 500 V �
Exemption for Reg.MainL Elect. e��y�.s;s�a'
SINGLE FAMILY Temp.Power Pole 8 Appurtenances_ ; ,y,�; � �
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuil '� � '�"
I here6y affirm that I am exempt from the Coniractor's License qddirional S�gn Branch Circui�s �.��,A:s,��:�r�s.
Law for rhe following reason(Se<tion 7031.5, Business and " ^..
Professions CodeJ: � _
� Misc Conduits&Conductors '�"``""'�"��-
I,as owner of rhe properry, �II do the work and rhe
' structure is not iniended or offered for sale (Secrion Other(See Compiete Fee Schedulej_ �
' 7044,Business and Professions Code).
� CONSTRUC71pN LENDING AGENCY �
� I hereby offirm that there is a construclion lending agency for
. the performance of the work for which this permit is issued PERMIT FEE (Sub-To�al)
, lSec 3097,Civ.C.J.
, � �y,.-� PLAN CHECKING FEE
� Lender's Name
. ,.r'� f,y" PERMIT ISSUING FEE
Lender's Address f 'A -'`
� I cerFfy that I have read this application ond sta�e that ihe TOTAL FEE
� above informalion is correct.I ogree�o comply with oll Co�niy � "'� -
ordinonces and S�ate lows regulaling Electrical wiring, ond
� hereby authorize representotives of ihis County to enter upon
the abqve-mentioned pro erry for Inspectioq urposes. �
-, r ��,, SEE REVERSE FOR EXPLANATORY.LANGUAGE
;f j �i�+�'�''r� �"..�=t r,6'`r,;,� x's��',-'',i�.t;.
Signa�ure of P mittee Da,