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E�R�R � SATION DECLARATIDN ��,�3 ,o,e� qpp��CATION �FOR ELECTRICAL PERMIT �
I hereby af[irm iho�I have a certificate of consenl�o self CE806G
i�su�e,o�a cerrifcote of Workers'Compensorion Insuronce, CpUNTY OF LOS ANGELES BUILDING AND SAFETY
or 6 certified copy ihereof�Sec.3800.Lab.C.)
��Y No C25854577�ompany �A FOR APMICANT TO FILL IN JOB �
Ceriified copy is hereby furnished. New Residenriol Bldgs.&Pools EACH NO. FEE A� E55
� Cer�ified copy is filed wi�h Ihe county building inspec- 1 8 4-Fomily,Sq.Ft. 131G E — E l0 LIN TR�4258 ia B3r
tion departmeni. Multi-{omily Sq.Ft. — NEARE
CRO55 ST.
8/20�86 °T" MCGee EleCti3 Residential Swimmin9 Pools
Da1e Applicant OWNER qR
FIRM NAME ��L', Anden
CERTIFIGATE Of EXEMPTION FROM WORKERS' QuNets:Rec_Light_$w._ ''�'��
COMPENSAiION INSURANCE ADDRE55 1074 Park View Dr.
(This ueflen m�d nof b�comploTed{f fh�work involwd b� FirSt 20
Total No. Addifionnl cirr Covina, Cs, ret.rv�67-9541
fh�parmit 4 for one hundr�d dellars(S1D0)or bas.) PIAN CHECK
1 cerlify ihat in the performonce of fhe work for which rhis AFttICAN7
permit is issued,I sholi no�empfoy any persan in any manner
so as ro become suble���o rha Workers'Compensation Laws. Lighting Fixt�res First 20 ADDRE55 �
To�al No. Addi7ional
QTY Tel.No.
t'~� Applimro Fixed Appliancas Not Over 1 HP PERMiT
l .CE TO APPLICRNT: if, ofter moking this Certificate of APPLICANT t"j�� cGee Electric Inc.
Exemption, you should become subjecf to Ihe Workers' Range_Heoter_D.W._.
Compensa�ion provisions of the Labor Coda,you mus�forfh- Oven _Dryer _W.M.� A�DRE55 R�0. &yX 1111
w��h comply with such provisions or Ihis�permlt shall 6e Top —FAU —W.H:-- S91—b�ibl
daemed revoked � - CITY Chino, 9�.�08. iel.No.
LICENSED CONTRACTORS DECLARATION Hood _fon _Other_
Disp. _Room Alr Cond. � uCENSE OR 490083 Class.C-10
I hereby affirm Ihof I pm lice�sed under provisions of Chnpter 9 REG.NUMBER
(commencing with Seciion 7000)of Division 3 of the Business power Apporatus&Large Appliances DISTRICT NO. PROCESSED BY R�..'
and Professions Code,ond my license is in full force and effect. ' O'
Size&Type HP,KW,KVA,or KVAR- l v U
License Number 490t183 ���.�iass C-10 Up to i Incl. FINAL �, �
Electrical 8/20/86 o�e.i ro 10 Incl. OATE g, y � yq��DAT10N v
Controttor �afe Over 10 to 50 Incl.
❑ I om exempi under$ec Over 50 fo 100 Inc. BY A� 4.
Over 100 N
B.BP.C,for this reoson Z
Date: Servites,Swbd.,MCC 8 Pane�boards ►
0-200 Amp.Under 600 V �
Signature 201•1000 Amp.Under h00 V
� Over 1000 Amp.or Over 600 V , �
Exemption for Reg.Moint.EIecL i� �J�.2 A �
, SINGLE FAMILY Temp.Pawar Pole 8 Appurtenances �
� HOME OWNER-BUIL�ER DECLARATION � Sign with One Bronch Circuit �' • ° e • •2
1 hereby offirm Ihat I om exempt from the Conirodor's License Addi�ional Sign Bronch Giicuiis
law for the foliowing reason(Section 7037.5,8usiness and 1�� •6 3 0 6
�ro4essions Code): �
❑ 1,as owner of Ihe property,will do the work and the Misc.Conduits&Conduc�ors •� ��J u..�i'b c=a
strucrure is not inlended or offered for sole(Section Other(See Complete Fee Schedole)_ . ,�
7044,Buslness and Professions Code).
Dz ?£�86
CONSTRUCTION LENDING AGENCY
I here6y affirm that fhere is o canslruciion lending agency for .
Ihe performonce of fhe work for which ihis permit is issued PERMIT FEE (Sub-Tmol�
(Sec.3097.Civ.C.).
PLAN CHECKING FEE �
Lender's Nome
PERMIT ISSUING FEE ].O. O
Lender's Address
I certify that I hove read this applimtion and stofe that the TOTAt FEE 06
obove infarmotian is correcr.I agree�o comply with all County
ordinonces and Sfale lows requlating Electricol wiring,and �
hereby au�horize represeNatives of ihis Counry to entar upon
ihe abPve-mention d properry for inspection purposas. SEE REVERSE FOR EXPLANATORV LANGUAGE
I � 8/26l86
Signo�ure of Permil ee Dale
'{J4���'! J,fr}�T� 1 i �� �� �"fJ`' /� `.� ��l�
y��._����� ��.�.� OWNER-RUlLDER�R
.. . . ._L_____ tSiG?JATEJ#� �
7fMF {,,.C�'°O e. �.. _ _ � I hsrzby affirm 5hah I om exempt from the Convoctor's
. � t -��-�--- �---- '�-�t�'� L�cense tdw{or ihe followmg YP.a5U0 (Secfon 7Q?I S,
Uh''CRS��. O_•K I, ^ � fius�ness an�Prafess7or�s Cods).Any cMy or co nty wHJch
RDUGh!C PdCUiT ��^� � �� Y� ..,,_ �.�equlreaYspermti to consiruct,aifer,imp�ovd,demofl h,
� �-.- �.� repclr any sfrudure,prror ro Bs Isiwnce�also a-
,'; Wi� '�1NG � ��Y__� �...? �V qWrei ifie opplEcorvf ior such parrnN to ltle a edgned stare-
' - �FlkFU2E � y� � I m..+nt tha!he ls lttensec�purivarti fo fhe pro�tsions o(ffie
�i.. .. �,-:_, � �. � �� �v _.._________7 C4nfractpr`s Llcensa Law(Chopter 9(comrtt�rtMrg wlth
� � � j fiU'.?lf.R AU7FiGR11.ED � � Saction 700G)af UNts(on 3 of the Business snd Profes-
� � � --=^==i�—. stons Codo)or that he Is exempi fhere#rom and fba basis
� �T�`������`J������ �c��-� far.thc� cttaged ext�mpiion. Rny violoHon ot 5ett+on
FINAi ^.'._.. C n€er nn _3mrt � � � 7C31.5 by rsny appftcont for a permit subjar.ia ihe aPplr-
, cant to a dv�i penalty o!noi more fhan Hve hundred
� NvTES daflars($540).: --
._ _, ., . . ❑I,cs owncr of the property wlll do�ha wor� �d
......_.....__._.�___.__..,..�_ _. the strutt�re is nof in�ettde�or of4ared fw sqte.
. � r�.r � � (Soc.-iC4i,8usinossondProfessiansCods� 7heConrrx-
�- �� ��- � ' .�____� tods G:ertvz Lawc'oes nei oppfy�o an ownn of propsrry
- ` � ` ��- � `� •� � - �-� � who bolPds or��mproves ihareon, and who does such
__._._.. __ .,�.�.� - �.- __�.�. work htmsetf pravfded thaf such�mprovements are nm
-�� � . �"� � �. tn�end�d or o!tered for sole.If,however,fhe hutFdirg or
_.__ .. _...�__�. _.._ iinprovamenf is said wifhin oae year af compfpfioo,tho
� � � owner-6vtlder w"N have�ha burden of proving that he did
� �., _..._,_._�_____._.V .._.._._,_...._._. � npt bia!!d or fmprove lor)he purpase o/sale.)
�.._ --- -..__.._.__.,__ ' _ .. . i cm'�exe}npt under Sec.::.�� .
--- �-- , _.---. - --.----.-. — 8&P,C..far this reason
r�______ ____. — _ 4ate ___________
4 . _ __�_ ___ _�_�.� --- Owr�r _
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