HomeMy WebLinkAbout1164 DIAMOND BAR BLVD (2) --_ , . �...-
���onK,:as•co„rsxsn-r�oNOFc�nxwnoN �sAs63 APPLICATION FOR ELECTRICAL PERMIT {�
- CE-8D6G f2-80)
I hereby a(firm that I have a certificate of consent to selt COUNTY OF LOS ANGELES BUILDING AND SAPETY. LJ
insure,or a certificate of Warkers'Compensation Insuronce,or . .
a certified copy thereot(Sec.3800,Lab.CJ ' �
6�Company�<<-U�(�Q`SSd�• FOR APPLICANT TO FILL IN qDDRESSf�� �'��20�� ��� aLVL7,
I Policy No. EACH NO. FEE � .
New Residential Bidgs.&Pools D!�µO�� �
� Certified copy is hereby furnished. - 1&2-Family,Sq.Ft. 5 — S LOCALITV �
Multi-family Sq.Ft. — NEARE57
� Certitied copy is filed�vith the caunty building inspection � CROSS ST �(2/S.(V 1� L��G•
department. . Residential Swimming POo15 OWNER OR
� �OV� G��I �[� FIRMNAME �"�� S�t�✓tIS
DateS'"� ApP��cant E��•��NG• Outlets:RecT Light�Sw. � MAIL
F��sc zo ADDFESS 1(�00 DO✓F S7�
CIiRTIFICATE OF EKEM1IPTION FROh1 WORKERS' Total No.� AddiUona� � CITVN�(f� ��.-�, Tel No.'rj��gll I �,
CO�IPENSA710N INSURANCE . � p�qnl CHeC a
� APPLICANT�UTJ-I«a5T ��C• /�C.r• O
(This section need not be completed if ihe work involveJ Li hting Fixtures First�20
by the permit is for one hundred dollars (5100)or IesaJ 9 r� � AooRessaQa7 j,Q�(fAJ� S�'", Q
Additional �
Total No._SL cirv5' �Illfs, �j$(�3/3/ f—
I certify[hat in the performance of the work inr�vhich this f�(J�, 7el No.
Fixed Appliances Not Over 1 HP V
permit is issued,I shall not employ any person in any manner � vERM1T ���� � .
so'as to become subject to the IVorkers'Compensation L:+ws. � Range_Heater_D.W._ APPLICAN7 d
� . Oven _Dryer_W.M._ ADORE5S !/ �
Dale Applicant � Top _FAU _W.H.,_ , CI7V �! Tel No.�� �
� Hood_Fan _Other_
NOTICE TO APPLICANT:If,after making this Certifitate of Disp. _Room Air Cond� LICENSE OR e C�O
Ezemption, you should become subjett to the \Vnrkers' REG.NUMBEF i3403��e�,
Compensation pr�visinns of the Labor Code,you must forth• Power Apparatus&Large ApplianCes DISTRICT NO. PFOCESSED BV
wilh tomply with such provisions or this permit shali he Size&Type HP,KW,KVA,ar KVAR ` -
deemed revoked. , ' Up to 1 Incl. . `O .
FINAL
LICL•'NSGU CONTRACTORS DLCL,�RATION Over 1 to 101nc1. DATE �J /b �/ VALIDATION
, . Over 10 to 50 Incl. � .
I hereby etfirm that I�m licensed under prrn•isions of Chapter Over 50 to 100 Inc. F�Y A� . ,
9(cammencing with Section 7000)of Division 3 of the Busi• Over 100 .,� '
ness and ProCessiom Code,and my Ilcense is in full force and - . -
effect. 2 2 � � Services � � � �
License Numbe ��/ �J Lic.Class GJ/" �D-200 Amp.Under 600 V � � � . .
201-1000 Amp.Under 600 V �
�w� ��� 'J�—�e�'� Over 1000 Am or Over 600 V ' '
Coniractor G��;�T Date P• � �
HOM14E OWNGR•DUILUER ULCLARATION Temp.Power Pole&Appurtenances - � �
I herehy atfirm that 1 am exempt Cmm the Contractor's Sign with One Branch Circuit -
License Law for the follo�ving reason (Sec�ion 7031.5,Husl• Addition>_I Sgn Br2nch Circuits .
ness and F'rofessions Code): . � . .
Misc.Conduits&Conductors � �
� 1, as owner of the property,will do the work and the pther ISee Complete Fee Schedulel— .
structure Is not Intended or offered for sale (Section � - . � �
7044,Husiness and Professions Code). . ' .
CONSTRUCTION LENDINC A(;ENCY . ��
1 hereby aftirm ihat there is a consiruction lending agency - . �
for the performance uf the work for which this permit is PERMIT FEE (Su6•Totall �
issued(Sec.3097,Civ.C.). � . � -
Lrnder's Name PLAN CHECKING FEE IOne-Fourth Permit Fee) ' . �7 6 6 4 A
Lender's Address . PERMIT ISSUING FEE �'� ��� � �2
` I • •33�70
I tertity that 1 have read[his appiication and state that the TOTAL FEE ' -
above information is correct.I agree to comply with all CouNy - � •3�7 O U
ordinances and State la�vs regulating F.lectrical wiring, and - ' ' '���� .
hereby authmize reprexenta' s nf this unty to enter upon . �
the above�nentioned prop r�y or in ec purposes. SGti'RHVF RSG FOR EXPLANATORY LANGUAGE � 0�1 2�s$��
� � S-/�'FII
Signatu e of 'ermitt e Uate . �
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