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1180 S DIAMOND BAR (4)
r .l.. . WOKK,-.,ts'COYIPENSATIONUF:Ci,ARATION � �Esa6�;�2.$0, APPLICATION F�R ELECTRICAL PERMIT t hereby vfflrm that I ha�e a cert�Picate of consent tc�se�f `µ COUNTY OF LOS ANGELES BUILOING AND SAFETY � insure,or a certificate of Workers'Cnmpensation lnsurance or ';� . � . - . . � . a cert�tied copy tUereof(Sec.3800,L b.C.) ^���,, � - � � � �. - I1GQ f?j� ��� }�_�,,.,,� �FOR APPLICANT TO FILL IN �pg � Yoitcy No. Company EACH NO. FEE ADORESS r �� �� Nr,w Residential Bldgs.&Pools . �.-� Certified cu v is hereh furnished. $ — $ LOCALITV �� � . p- Y 7&2-Family,Sy.Ft. �i• - Multi-family Sq.Ft. NEAREST Oertified cnpy iy filed with tlie county building inspectinn �3 � CROSS ST .� dep tinp nt. ��--��^^���//, -7 �,' ResidenYial Sw�mming Poo7s OWNER OR " - ��-��/�����) ��-^'(�/�T'�1 •' FIRM NAME �. �Date��� l APplica��t '✓«t✓ EUGeia_ _ - ' . F — � Uutlets-ReC.,_Light_Sw.� MAII �� �� First 20 ADDRE55 CEH71F1CATE OF EXtiN1YTION NROM WORY,7?R9' ��Tnial Na__ AddViiona! - CI7Y ��,.�;�„� ��.Tel No. y.. � . COMPr.NSA7'ION iNSURANCH -� � ' �� PLAN CHECK � �- � � i. APPLICANT_ lOi :"." ,ei•�--' .q , % (Tl�is section nced not Ae completed if [he wuzk involved Li htin Fixtures First 20 V � � by the permit is for one imndred dotlars (S100) or Iess) ;� :`� �g Arld�nona� aooaess - �Jr.'-L.r � „�� � ����� � �'� Total No. � � � ]ecrt�fy thkit in the pedormance of tlie work�for which tl is .'6 Fixed Appiiances Not Dver 1 HP. '� CITY ������Tel N��. ��p�.� permiL ic issued,I shall not emptny any persan in any man�er �@ . -- . . �.�� .�so as to become subject to the Workers'CumPenaation Lx��s. � Range_Heater_D.W,_ ; APP�I ANT __ �-•;_ Oven _Dryer_W.M,_ ? AOORESS � �„�,,,,.,�,^. -z � � .Top� _F�AU —W.H .— �� . ........—. .Uatc Applican[ _ R CITY Tel No. � Hood_�Fan _�Other_ __ _ �NOTICE TO AI'PI,ICANT:If,xfter making this Certiticatc of :Disp. _Room Air.Cond� g LiCENSE OR � �. � Ezemptinn; you shuuld hecome sUbject t�> the Workers' � � � �; flEG NUMBER .Class ���Compensation prnvisinns o{the Labor C1ode,you most forth- � Power Apparetus&Large Appliances e DISTRICT NO. PFtOCESSEo BY . 'lvith complV v.ti[h such provisions or this permit sltall be �� - � J � deemed revoked. Size&Type HP,KW,KVA,or KVAR - d ��,�/� � Up to 7 Incl. . - ` � _ Y/�'�'�'��'� Dver 9�to 101nC1. FINAL - � LICENSI±D CONTRACTOftS DF:C:.ARATION OATE C'�.�' � �J VALI�ATION Over 7,0 to 50 JncL �3 2! - t hcreby affirin that I.im licensed under pruvisions of Chapter � Over 50 to 1�00 Inc. FINAL BY ��9 (commencing�a�ith Section 7000)nf Uivision 3 of the Busi- �� — Over 700 � � �7.t_�• � ��ness and Prnfescians Code,and my licensc is in 1'ull fnree and . � � - - �.effect. - Services �. License Number_._f�L11�" Lic.(9ass �"! S "t'� ��,:� 0-200 Amp.Under 600 V ,� .. � 201-1000 Amp,Under 600 V � - � Con.ractcr�__ ��'�ute ���7 � Ovcr t00Q Amp.or Over 600'V j �����;� ' � . HOME OWNk.R BUILUER DECLAIZA'1'ON �!Temp.Power Pole&Appurtenances � �m �, e�e e� �� . �Sign wtth One Branch Circuit `� �"'�7z-` � �11 .t h h Fo�m rhat 7 nm rxemot from thc Conti,icmrs �: �� �� � �µ License I.aw for[he tbllowing reason(Sectiun 703t.5,Busi "u,li�G�a'$'-yn �...�,,,,.c .. � _. —. .___1 � c °;,G U �C . , ness and Prafessions Cude): � :a � a 4 ,S Q.� Misc Condwts&Cnnductors } �� 3, as nwner nf the pr�perty,wil1 Jo�he work and the Other(See Complete Fea,Schedule)—.% a��,_8,� � � , structure is nut intended or offrred for sflle (Section 1044,Susiness nnd Professions Code). — —� ' �� CONSI'ItUCT10N 1.h:NDING AC3EN<:Y � � � I�hereby aff'irm that thete is a construction lending ugency � � ��� fpr, the performnnce ot'[he work for which this permit is � pERMIT FEE (Sub-Total) " issued(Sec.3097,Civ.C.).. � ) . . , LtmdeNs Narne — - P�AN CHECKfNG FEE (One-Fourxh Permit Fee) � � Lender's Address . - '. pERMiT ISSU7NG FEE � � � � � I certity thai t h,rve read thes Jpplicutinn and stute t6at the . 70TAL FEE - [�� �� �abuve inforination is correct.I ugree to comply with all Coitnty -- . . � � � . ordinancec and State laws regula[ing lileMrical wiring, und . � hereby authoriac representu[ives of this County to cntur upon . � the.i(@ 1ove-mentioned pr�o7perty for ins eMio�purpusex. 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