HomeMy WebLinkAbout1180 S DIAMOND BAR BLVD (17) - "�OMPENSATIONDECIARATION 76A663 �o,B, APPLICATION FOR ELECTRICAL PERMIT `
_! l r �ol I hove o cerlifimte of consent to self �E-� � i
� � ,ficale of Worke�s'Compensotion Insurance, • � ��
COUNTY OF LOS ANGELES BUILDING AND SAFETY �_�
� � o1p,,y ihereo�1((S c.3800 lob C.) - � .
�V�S Co�a?y �c � ..fOR APPUUM TO flLL�N A�ppRE55 (��0 s. IJl�d�� (i�t,c 9�vD .
` .tified copy is heraby furnished. New Residential Bldgs..8 Pools EnCH NO. FEE .
LJ
Certified topy is iiled wi�h the county building inspea 1 8 2•Family,$q.Ft. s — f IOCAIITY p�.(�tiJ �/,
rion deparrmenl. Mulli.family Sq.Ft. — NEaREST
-� � Residential Swimming Pools Cao555T. MC� �6'�Ai�� .
Da�e Applitant - . RMENAME SAf�wA '�'S��
CERTIFICATE Of EXEMPTION fROM WORKERS' � Outlets:Rac__Light_Sw._ ��� d0 -
COMPENSATION WSURANCE �-- ADDRE55 �� � S. rr M� 810R ��/
This��c8on nNd not 6s com I�bd if fh�work inrob�d 6 First 4(1 -
1
� P Y To�a!No. Additionol � CIN alA w�p $A Tel.No.�6(a ,�' •
fh�parmif is for on�hundrod dollan(5100)or lest.)
I terGfy ihot in�he performonce of the work for which this .. - nPaUC/+NT� � -�
permit is iss�ed,1 shall not employ ony person in ony monner ' ,
so as to become subjec�to the Workers'Compensa�ion�ows. Li9hting Fixtures pirst 20 ADDRESS - � ,
.. � Total No. Additionai
CITY Tel.No.
Dafe Appticanr � Fixed Appliances No�Over 1 HP PERMIT
N0710E TO APPL�CANT: If, oHer moking this Certificate�of A7aI.ICANT �V �.(� E�(,°GT/Z�C '
Ezemption, yo� should become svbject to the Workeri Ran9e_Heaier_D.W._
Compenwtion provisions of ine Lobor Cocle,you musf forfh- Oven _Drynr _W.M._ ADDRESS 6'G�� �' �^ll OU �
with comply 'th such provis�ons or this permft shoil be Top _FAU _W.H.—
deemed revoked. � - � C�TY�OR NG'rC � Tel.No.s '�QSQ
IICENSED CONTRARORS DECLARATION Hood _Fan _O�har_ '
� Disp. _Room Air Cond. — ���E�� y Class.
I heroby affirm lhot I om litensed under provisions of Chop�er 9 . ReG.Nun�eER ��/� C'(C�� ..
(commencing with Secr�on 7000)of Division 3 of�he Business DISTRICT NO. PROCE ED BY
ond Professions Code,and my license is in full force ond eifecl. "' P�`^'er ApporofVs 8 Lorge Applionces . , �
Size&Type HP,KW,KVA,or KVAR- J Q � On:�51. � Q
license Nomber��o -�iy Lic.Class�`Iv . . . Up to 1 Ind. FINAL .- . V .
Controdor�Va«T1' ��'e1QK Date �-� Over 1 to 10 fncl. DATE VAI�DATION Q .
—� Over 10 fo 50 Incl. FINAL �~,!
❑ I am enempt under Sec, Over 5010 IOO lnc. BY - W
a {
B.BP.C.for this reoson Over 100 Z
. pa�e, . Services,Swbd.,MCC 8 Panelboords � . ` yr/� - � •
0-2Q0 Amp.Under 600 V /} V 1�-7 �
Signarure Z01-7000 Amp.Under 600 V l� � Ll� �
DOver 1000 Amp.or Over 600 V � �
E.emplion for Reg.MainL EIecL � .
SINGIEFAMILY � �, Y '
Temp.Power Pole&Appurfenances `^ �
HOME OWNER-BUIIDER DECLARATION � �2 O�.6 A "
I hereby affirm tF.cl I am exempt from the Controtror'S Litense Sign with One Bronch Circuit�
Addifionol Sign Brcnch�Circui!t� � �}• •-•�• •.`Z..
law tor the following reason(Sec�ion 7031.5,Business and � �%�'� . ��� -
Professions Code): .
� � Mist.Conduifs R Conductors ,� • •�4 Cl 5 0.
I,os owner of the property,will do the work ond�he
srructure is not intended or offered for sole(Saction . O�her(See Complere Fee Schedule)_ , . • • •4 0.5 0�
7044,Business ond Professions Code). ' - � .
CONSTRUCTION IENDING AGENCY . ,O�J.O 7-H�l -
I hereby aifirm tho�there is o tonstruUion lending ogenty for �
Ihe performonte of the work for whith this pe�mit is issued PERMIT FEE � � � (Sub-Totol) � � . .
(Sec.3097,Civ.C.). - . . .
� � � PLAN CHECKING FEE� � � - � . . �
Lender's Name � -
PERMIT ISSUING FEE � Q �_ .
Lendar's Address �
I cerlify�ha1 I have read ihis opplication ond siate ihat the TOTAL FEE 1��s�
above informarion is correct.I aqree to comply with all Counry . . �
ordinonces and Siale laws reguloting Eledricol wiring,and �
hereby ob�horize representoiives of this Covnty to enier upon � � - � - �
rhe obove-mentio d property ior inspeU�on purposes. SEE REVERSE FOR EXPIANATORV LANGUAGE
6� 3-1--SY , _
Signvture o Permittee Da1e
� ._ ..
� ` ,
� .
^ ' " �',— '.
, � � , ,
' � . C � ,- .
. � T �� O p � �. .
, Z Z a O � 7o c M
� rD' -...�C � m � S cn � �ov
. . N
. . O 9 N � �p A A
O
� e � � � ,
O � ,c--+ �° � £�i+
- ..+ T m
-- - . �, N
! O p
_ , , �J - � .
n.
1
o v
� �
`FJ m
0
�
. Z
.� �
G •
�o
m
. ... .
. , .
. r
.. - " . .. . '. N N�C13 c �y � p o '
o° o
' � � 'ain�' �o� w � =� .�.'s a � c�i o �
. . ,,3 D 5 � 3,y � O - N ^p^ss N'O q v� „� .
� ' . . 0 � O �j ro � �� �r,,.�C �N O Lr m p V C +�� p O O �
O Q � � . G'� K q?c^� s�..n.:In U`r` A ���.7'O �0 Q�t � O
' . . . 3 � � . .X Q.C 3 p N a'�" } m �^.O� '�f� a o �N�p 3 p � 3 Z
^ co - o m -, �o om .o;. `� ,� "o � _� � -- T r^
� ' ;� .-� tl� �.«O r N N s�,• �� 6.S�m n� C � m S O A
.. . . . � ' � 3 � u. D� ~ '� 3 b ^� O�V O ��� 3 " -` n � 4 � G .
p
. ' . � ? p ��Q.�� m �-3',�,,,. �7 � Q �O 0.N � N '^ �3. �'
af N � b � � �
.: . Q : � o� �•N ?m '�a� �.o�� �^'nN,9o^ �-m�m p
'N
p c� �.7-o T 000- � fl - 3 =-0o m "' o .. 3 �^
. • a '� T m � m �'.� N o � °. -o ro �'` o D o�° �
. . . �'0 O'O .—..C p� H p O O 7 q.,�� � ...�„�4 P ...
' � . � n.Q T='3� � to� � 3� � m.o� p '" ^_ � 3 D
' ' � ''O ry K O • � N � '�E �' C �N O =N 3�G .�{
� " O � o Z7 � � �0.S j.G ��O O O� O C p 0 � Q � .
' - " " ' < 'o„on."^a acr- 3N3o N � c � 2 z.
. '�'o,�'° O,�' < fQ ° o ��o` '^. 3 : ., moofi .
' � O (1 ^ �D � � m ...Q 3 � p m e:(:1 @ C > 7 .
� ' ,1 W � O � s p m � � O 4-��.� p O n �G V Q
° wv a.� q°.m f ?o a+�v� « �—O f w^
. N p O N O O _S O
. . • ' Y 7'�,C O� O ie' � Q n t7'O � O v� ii cn
_. ' S; ?ON� » O 0.roONNT�QOSS. N
. . � � � � ^ � p .Q , �'7
. . �7'O O ��C' � _
�� � .