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1122 DIAMOND BAR (9)
_ _ _ _ "'°a"F:RS'�°"'P�ns^T`°N°F:".^`t"T`°N '6A663 ARPLICATION FOR ELECTRICAL P:ERMiT � � � CEE06G(2-801 �� -� � i hereby affirm that i-have a certificate of consenf to setr � �� .COUNTY OF LOS ANGELES � � � . BU�ILDING AND.SAFETY ' � insure,or u certificute oi Workers'Cumpensutio�[nsurunce,or.�� � � � � � �a cereiFied copy thereof(Sec.3800,I.xb.C:) � � ^''� . � I �Policy No. �Comp�riy _ FOR APPLICANT TO EACH N NO. FEE AD�RESS �� Idu'�'��y�,�. � - New Residential Bldgs.&Pools � . '� Certified copy is herehy furnish A. 1&2-Family,Sy.Ft. $ — � LOCAUTY�._ � Muiti-family Sq.Ft. — NEAREST ,�Certified�opY is filed wi the county bu ing inspectiun��:� CRO55 ST de�artment. �. Residential Swimming Pools OWNER OR e: FIRM NAME Date�pplic it �: Outlets:Rec.�Liyht_Sw._ MAIL ��•�.�_ ,., �'"' �,L,t�.,. . . � . � First 20 ADDRESS '� CLRTII�ICATL OP P:XLM1IPTION FROM WORKERS' Total No._ _._ Additional CITY . ��,�'y, el No.� -__`��5 COMPI�.NSATION INSUNANCk: � — .1. . . LANCHECK �. (Tliis section need not be completed if th� work involved�����' a PLICANT � by the permit is foi one tiundred dollazs (5100) ux IesF.).�,�:� Ligh[ing Fixtures First 20 q RESS ' � � � Total No. Additional � � 1 curtify thu[ in�thc performance of tlie work for which this '� Fixed ApplianCes Not Over 1 HP CIT Tel No. fl permi[is issueJ,(shull not employ finy person in anv manncr PE RMIT � � —� ' U � so as to Uecome subject to[he orl<ers'Cnmpensution Laws. Range_Heater_D.W. APPLICANT �.�r�'Q.��S �.a� . UJ - - OVen _DrVe�—W.M. — ADDRESS �2^�JF' �.. �.(.y'�...Qsy.b .sA � � �Dafe � Appiica� . . Top _FAU. W.H.. .. � -- .-_ y' /2-�~ � . CITY �} � Tel No' Hood �Fan Other —�M-.q,�.i�+.�. �� NO'f1CL 1'O ANYLII'AN'I':1t,after makmg this Certif'icate uf Disp _Room Air Cond. LICENSE OR 1� . b'.xemption, you �shnuld becnme subject to the Workers' REG.NUMBER .l��"s��Class -'�(V Compensatior�rov�sions ot thc Labor Code,you inust Pbrth �:: power Apparatus&Large Appliances DISTFICT NO. P�R�CESSED BV` with cnmply with such provisions or this permit shatl be �� � " ` deemsd revoked. Size&Type HP,KW,KVA,or KVAR �'� � �� �Up to�t-Incl. FINAL Over 1 to 10 Incl. DATE /�J ' LICENSED CONTRACTORS DECLARATION Over 1D to 50 fncl. �C✓ � ��' VALI DATION , ��I hereby affirm that I am licensed under provisions of Chaptcr Over 5D to 1D0 In0. FINAL � . �.9 (cummencing with Section 7000)of lliaision 3 of the Busi- ' -0ver 100 BY � ness and 1'rofessions.Code,nnd my licenxe is in�full force and . � '� '� r��-� � � ��effect. � ��.- Services � Licens ber` � ���ic.O1ass C ��t� .0-200 Amp.�Under 600 V - _ 201-1D00 Amp.Under 600 V� �Cr truct /bate ���� �^�7 ` Over 1000 Amp.or Over 600 V . . HpMk'.OWNti:It-BUILUI.iH UI�:CI,ARA'1'10N ��.Temp.Power Pole&Appurtenances hereby xffinn thut 1 um exempt frum the.ContrUc�or's �' Sign�with One Branch Circuit .R S;��.9 A ��� .�. ta.�,.��..�i c�,g.�.,��.r;.����.� . .icensc Law Por the folli�wing reason (Sec[ion 7031.5, Busi- - . � � ��exs and Professions Code}: � �i���e.o r •`� , " �Misc.Conduits&Cnnductors � - �7 I, as owner of[he property,�vill do the wurk�md the ��i Other(See Complete Fee Schedulei— I�� •�U 5� . structure is not intended or offered for sale (Section � . 7044,Business and Professions Code). — --- 'm f0 0��'.v.J Q� '. CONSTRUCTIUN LL•'ND1NG AUh:NCY � � Iiereb�Y �t�firm tlut d)ere is ,i construc[ion iending agency t Q�� ,;,8,� ��. . �r the performance of the work for whiuh thu pecmit is ` � . sucd(Sec.3Uy7,Civ.C.). ': PERMIT FEE (Sub-Total) � ender's Name . �: pLAN CHECKING FEE 10ne-Fourth Permii Fee) . � : ender's Address ��-. pERMiT ISSUING FEE {� � . certify t have read This application und state that the '�� TOTAL FEE � �� uve in nnotio i i.correct-1 ngree to cnmply with all Couoty . . dina •es and tate la�vs regulating F,lectrical wiring; and '. � rel authotip'e reptesen[n[ivea of tliis County to enter upon . � � nve-meittiuned prop y fy�inspection purposes. SEE�REVERSE F7R EXPI,ANA'CORY I,ANGUAGE � ' , r�-�--�� ign ire f Ycrmittee llute � _ / y . , , . � ; .. , � 4 � ,r � � � �\ � _ -. . �. � ; � ; � \ � y{, � \ V \\ .<� �: t 4� t E\} \ � \ "� t ` sy� � � . \ j i �' . ^�' , . . . ��. � :,.., s f s '` 1 a ,,:..�--'";�- l-� : ..-a� li S "'� 1t' fn y � �•, - \ � � \ t , :.---� �. � � �a. � � r.,'b� ;o � . �, � � s� `' �� ` w � ''' � '' � . � ` -�-�'�,\x� �fl ?+ i"� >'� ' .. ` � ' ` ` , \ t '� � 1 � � � -c� a `� ��` �1 �, -c �-a �t � � � �� " "' 1� � ! ��� � . 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