The URL can be used to link to this page

Home My WebLink About1164 DIAMOND BAR BLVD (12) WORKERS'COMPENSATIONDECLARATION '76A663 ,o,a, APPLICATION FOR ELECTRICAL PERMIT _ � I hereby affirm tha�I have a certificate of consent to self CE-806G i�svre,or a cerifficate of Workers'Compensoiion Insuronce, COUNTY OF LOS ANGELES � BUILDING AND SAFETY or a certified copy thereof(Sec.3800,Lab.C.) I P❑olicy No. Compony � FOR ARIICAIi�TO Fllt IN� ppDRESS �/ � � y/ � Cerlified copy is hereby furnished. New Residen�iol Bldgs.8 Pools EnCH NO. FEE 1 8�-Famil Ft. E — E LOCAIITY Certified copy is tiled wi�h ihe county building tnspac- Y.59• lion deportmeM. � Mvhi-famity$q.Ft. — NEaREsr (( . ResideMiol Swimming Pools CRO555T. Dote �� " A�pplimnt � . OwNER OR FIRM NAME CERTIfICATE Of EXEMPTION FROM WORKERS' Outlets:Rec_Light_Sw._ �'�� COMPENSATION INSURANCE � /+�DRESS Thit��ctton n��d not b�com lefed if ths work Inrolved 6 first 40 � � P Y Total No. Addilional � CITY.� Tel.No. fhs parmh it fer ene hundr�d dollan(5100)or less.) I certify that in the performante of the work�for which this PLAN CHECK APGLICANT parmi�is issued,I shall not employ ony person in any manner � so as to become z�6ject to ihe Workers'Compensation Lows. Lighting Fixtures First 70 ADDRE55 Toial No. Additional � � CITY � Tel.No. ,si Date Applitant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, ofler moking this Cerlificate of APR,�CANT Exemption, you should become subject lo Ihe Workers' Range_Heoter_D.W._ � Compensotion provisions of the lobor Code,yoo most forih- . Oven�_Dryer _W.M.—� ADDRESS � witfi comply with such_provisions or this permil sholl be Top �FAU —W.H.— deemed revoked. � �-. � � QTY - � Tel.No. � LICENSED CONTRACTORS DECLARATION Hood _Fon _Orher— : - Disp. _Room Air Cond. — I�CENSE OR /G!� ��ass.C� I hereby affirm thal I am licensed under provisions of Chopler 9 RFG.NUMBER O ' (commencing wi�h Sec�ion 7000)oi Divislon 3 01�he Business power ApparaWs 8 Large Appliances . DISTRICT NO. PROCESSED BY } i ond Professions Code,ond my license is in full force and eNect � � - - y ��r � � r y�s Size 8 Type HP.KW,KVA,or KVAR � � I �icense Number 0 Lit.Class / l� Up to 1 Incl. FINAL ` - �rrJLi'L*� Over 1�o IO lncl. DATE S / VALIDATION � � Confrodo ��e�� Over 10 fo 50 Ind. . � V FINAL I am eMemp under Sec. Over 50 ta 100 Inc. BY W B.&P.C.for rhis reason ' ( Services,swbd�nnccs Po�eiboo�d5 �� . �3 0 Z 8 A . ? Dafe: 0-200 Amp.Under 600 V ► � ��:� � • •2 � Signoture � 101-1000 Amp.Under 600 V � �� , -- ❑ Over 1000 Amp.or O�er 600 V I • •2 5.5� E�emption for Reg.Moim.Elect. SINGIE FAMIIY Temp,Power Pole&Appvrtenonces ,�\' '2�5��_'' HOME OWNER•BUIIDER DECtARATION 5�g�w��h One Branth Circuil O�3 O$'B�l I hereby offirm thot I om e.empt from the Confrac�or's License .. Addtional Sign Bronch Circuits � Law fcr fh>felloving recsen(Se:ticn 7031.5,Bosincss ond . � Professions Code): ❑ 1,as owner of the property,will do Ihe work ond the Misc.Conduits 8 Conduclors � - - � slr�c�u�e is not intended or affe�ed for sale(SeUion Other(See Comp�ate Fee Schedule)_ ► 704d,Business and Professionz Code). . CONSTRUCTION LENDING AGENCY - . I hereby affirm that the�e is a constrvt�ion lending agenty for - the periormonce of Ihe work for whith ihis permit is issoed PERMIT FEE � � (Sub-To�ol) �5 Q77 - � _ . -. . (Sec.3097.Civ.C.�. �. - . . �fj�� P4MF�1l�RfN9ffE. . . � ,Q (� . . . . lender's Name (L/1L � - PERMIT ISSUING FEE . . �`j U tender's Address � � � � �' � I ceriiiy ihol I have reod this opplication and state Ihat the TOTAI FEE above inform ion is corr I agree�o tomply wiih all Coony . . � ordinanc d Sta�e I s egolo�ing Eleclrical wiring,and , _ .,. � � , . hereb u�horize�epr eni iives o(�his County�o en�er opon � - . the ave-m ti ne pro erfy for inspettion purposes. � SEE REVERSE FOR EXPIANATORY LANGUAGE .,,�--�� . gn re }Perminee b Dote . � _...------- _. � - 'r' � . . .- i ', ' � ` , • .� i_ � �: � ' � � ', `� � . ' , �- , - . , � :� • . :. • t � ' , i ' _" ti-�. ' ' � � . � . . ., . � , � � _ , r ' � � ' � _ . � .' '. ,X � o � � _. p Z �. $ C x � � ''p .. S u' $ "° • , r � rD.. �1 �j � �l O � m .O ' , . �+' O Ci' Z � A .G . `� . O�i '70 '� p O � . _ �J =n ,N., . � o 0 � p �.. � t ' d . . . .. O �� rl � . � .. � O' �. �' � ' y ' . I� C '. , . T ' / ' ,' ,' . 1 . t ` � ' ,p O � C (� S _. ' � ann3c �-� � oo ' n �.1�� m O O C � � m � a'0 �'` Q +� -=a� Q h O1 G CT , . �'./_. �- .O W N •p � . 'E � Q p O + � .Q N � N N �< �;� 0 3 30 �"`-� ; a �.�'tti� ��'�_, a a a ' �p � Q '•O =�p W� F� =yC❑u� O tl-� p.•i0 �m �.D.7 � � .0 . - ' . O 4 S�° 3 G� < q S C ^� .A w�� p�.�..q�` •'D K 4' 'o O� � , � � � 'o .�c! " ff° p-3a'.N �`a � o��'c� ° �=n�3 � � s m . � -. � n . m L�O � � ° `�� N ° ' o a.�-"'� � � c_'.N �a � , � � �' ��oa ,�...�ro nO.. � C.� '^- -- . � . . p ' ;.O - _ �o o p ^ m v c� �K q y � o C � � � �, c '3v �oc. ovo�, � o, o o� o o*'allo NN o3 Q � ie p. < �-a�a'o N � m K3� n � �� ca£,x .b . � n � °i< £ ° o-oo �n.o °.00 � `''nN�Q ,.^.v� 3 � a cn �y os" g � '4 . � � ' °.anw ^ a .. iy C� N ''� s op- o ° 3 � 90 ' j �n ;.so7p =^°voov �uD�O so 3 °`m �< ° - A �.cro N � .+ o ° 3 `D ' sm � a '" o 0 L v � � �� o"'�o � a 3'� � w.o o'"�� "- ' 3 � - . r . ' C��4 T N — � M S -'��G - , .a �.c o � o u c� f. ° « a �`-�o� a c`-• ° a m � . N Tp �v�a � C�o-s 3-c o o N -, a a ° .�, ; x � � `w < on.oa.oQ �oo3N � u�� o � = o ; ' �o'a «� o .� � ° v ..,�� } 0 3 � •a� y� �. � � N < ^ , S•-p• --�p � < �n O C'� ^ 7 p n � `� O � 0 3 � �3 N QN 3 0� '� • ° 53a m ° oT° T s c .'£ w.� � , . ; � �nv � a..,o ' o To �n�s '.,°�c+ o,�.o :;s o \ , _ �:� ` � � s�Q N �,a o � ? Q ^ Q,p � a Q s�N N . . _, �" -' O V O 0.'6 ' O 6' � �'m � .. . O LL � „�„ Q. p�O `p' �. N S<D , . , . , � i �3 tC O� � p n Q �_. � w 2 Q p O T`C U. . - �� 4,..