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HomeMy WebLinkAbout0561A (4) � WORKERS'COMPENSATIONDECLARATION CEA�,'��i8� qpp��CAT10N FOR ELECTRICAL PERMIT � Z �✓ �n � I hereby�af(irm tho�I have a ceriifico�e o(consent to sell �7� �insure,or a cerrHimte of Workers'Compensation Insurance, TY�F�Q$/�(y GEL � BllILDING AND SAFETY �f - or o ceril(i�dSopXlhereof(Sec.380D,lob.C.) Tract ��Q� l.Ot �fZ1 Y�an � U L 1� uU POoI1tyNo. nS2�_Qn �Ompany V'Jausau TI1S. lORA►►II[ANTiOfl(GIN JOB Ceriified copy is hereby fumished. New Residential Bldgs.8 Pools EACH NO. FEE . ADDRe55 � Cerrilied copy is liled with the coumy build�ng inspet- �g 2-Family,Sq.F1. ��SR s — a �O�A��TY Diarrond Bar Hi 11 s lion deparlmenl. Multi-(amily Sq.FI. — NEARESi � oo+e 7-25-86 Grev Hill Electric ResidentioiSwimmingPoois cRossst. . Applicpn � RRMNAME Hrarelea California, Inc. . CERTIFICATE Of EXEMPTION FROM WORKERS' Oude�s:Rec__light_Sw._ " Mn�t COMPENSA710N INSURANCE � First 2p A�DRE55 3151 Ai rw� Ave. Su i te N (TFfs�.cfion n••d no�6•compl.�•d if th•work Involv�d by Toral No. Add�tional GITY (�AStd �53 Tel.No.$5� 1��1 th�p�rmit i�for onv hundnd dollors(f I00)or I�as.) I certify thot in ihe performance of the work for which this P�AN CHECK � ermil is issued,I shall nof em lo an APPLICANT p p y y person in ony monner �� hlin Fiztures First 20 so as to 6ecome sv6jecf to the Workers'Compensation Lows. 9 9 A�DRESS � Total No. Additionol CITY Tel.No. Dat^_ spplicon� Fiaed Applionces No�Over 1 HV N E TO AFPLICANT: if, aher making this Certificate of GERMIT E ,tion, you should bemme subject ro the Workers' Range_Heater_D.W._ aaPUCqr7i Grey Hi 11 Electrc, If1C. Compensotion provisions of Ihe labor Code,you musl fo�lh- Oven _Dryer _W.M.— ADDRESS 6760-B Central Ave. � wi�h comp�y wirh such provisions or �his permi� shall be Top _FAU _W.H.� deemedrevoked. CITY Riverside rai.No. 354 8900 LICENSED CONTRACTORS DEGLARATION Nood _Fan _pihe�_ Disp. _Room Air Gond. _ uCENse Oa Class. I hereby offirm tha�1 am Ilcensed under provisions of Chap�er 9 . aEG.NUn�eER 316579 C-1� (commencing with Section 7000)oi Division 3 of fhe Business power Apparot�s 8 Large Applionces � DISTRICT NO. PROCESSEO BY �- and Pmfessions Code,and my license is in lull force ond effect. � O Size 8 Type HP,KW,KVA,or KVAR v U ticense Number 316579 ���,Class C-10 � Up to 1 IncL FINAL Grey Hi 1 1 Date C-1� Over 1 to 101nt1. DATE ` O Comroc�or Z•38-�� YALIDATION ❑ Over 10 ro 50 Ind. FINAL W I om enemp�under Sec Over 50 fo 100 Inc. BY � � B.BP.C.!or lhis reoson Over 100 � z Date: Services,Swbd.,MCC&Panelboords � ► � . 0-100 Amp.Undar 600 V ` � Signcrure �Ol-1000 Amp.Vnder 600 V ❑ Over 1000 Amp.or Ovar 60p V �,C rJ b� a Exemption for Reg.Moinl,Elecf. SINGLE FAMILY Temp.Power Pole 8 Appurienances �' • • ' �2 HOME OWNER-6UILDER DECLARATION Slgn with One Bronch ClrcoN T � ��)by offirm thor I om exempt from the Controtfor's License qdditionol S�gn Branch Circui�s � ' 8�g� l�w for the following reoson(Sec�ion 7031.5, Business ond Professions Code): • e.c�j�,E�� ❑ 1,as owner of the properiy,will do�he work and the Misc.Conduits 8 Conductors -� struclure is not in�ended or ollered for sale(Section Other(See Complete Fee Schedule)_. ► 0 fi 1 3—8 6 7044,Business and Professions Code). CONSTRUCiION IEN�ING AGENCY . - 1 hereby affirm Ihat there is a mnslruction lending ogency for , 7he perlormonce of ihe work io�whicb this permi�is issued pERMIT FEE (Sub-Total} 75 38 (Sec.3097.Civ.C.). PIAN CHECKING FEE � � Lender's Nome � � PERMIT ISSUING fEE 1 O SO � Lender's Address 1 certify thal 1 have reod ihis opplitoiion and s�ore thet fhe TOTAL FEE a6ove informo�ion is correct.I ogree lo comply wilh pII Counry ordinances and 9ate laws regvlalinq Elecfricol wiring,and � . . hereby au�horize represen�a�ives of fhis Coomy to en�er upon , the o�e-menico ed p�operty ior Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE � 7-25-86 5�,7nature ef ermittee Dare . .. ,_.. . ..,., , , _ _.. , , , ... : , . . ; ; : _ , ._.. . . .. 'rt _... __._.. .N ; naaeoyo.�s_: '.__nnre - -Sicr:�ru�� - --- _ ' . $"�'z�; : OWNEP-�UI1DEl:DECLARATlO . . _.. _ .._ , � -�-"-�. .. "..�... .��� -TEl,1P.POVlER FOIE. . ...) � -- .- -' ---. . �. ' . .. . .'. ' . eby ci�irm��hat I am�exemp+Srom the Contractor's �� � � ' " ' � ' ��, � .,- � . cPnso Low to:.t6o 4ollewin reoson (Sect�on 7031:5. I . -... ._.. ..__ - UNDEFSlA36•J6RK __. ' .____.. . ..__..__ .. ; �� g , � � .__ ,, -_ , �� � EuslnessandProfesslensCode)�Anydtyorcounrywhrch � ROUGH CON'JU1T .- ( , � - ��.��. �.: ' � .roqufres o pvrm�t lo construcf,offer,l�nurave,demofish. ._... . .... . .��. �. �,•� �� �.�-. . _. . ... -.�. . . . . I � �.'crropo/rony�siruUwo,-Prforfolfz�lsivanco. nfsaro- 1 . ..- . . .--.�.-..:. . LVIniNG --- �� "' - . �U'Z��(f�, ' � qulrvstncoppllcontfor�u:hperm�ffoflleaxignedsfale� � � � ' •� . .'.�' FlMURES.�....�__. .�-- � G�_ � � ' ' -� � ���-��- - � - �� � ment Ihat hr is Iironsed purwart!fo ihe prov&rons ol fhe . . -� " _ � �Cantroctorb Clcem.e Low(Chapfor.9(commenctng�wiih � ' �� ' � r '� ' � '�� � Sectiar.7000�o���lvlsion�of-tfie f,ux�nass rnd Profes- � • . . � PONlEF AUTHGRIZE� _._ ��230�..6- � - - -�- �- --- -�� , .. � � � ' � s�ons Codo)or fFat hc Is exempt Ihcrrfrvm ondthe basis ' � UTILITY CO.NO71FlE�� � ��3i y� ' I`�,�, � � �. . (or.iho allegod exvmptlon..Any�v�olo�ion ol SacNon " . .. �� � F!'dAt .�.��l �- .�rorii.•`_.. ._..._. ' ...:.. . � ..,. .7C31.5 6y any applican}for a permlt aubjocfs Ihn applF .' � _ . _ . n e�on ' ccnl fo a^!v(f�ena(t f nof more t6an fivo fiundred , ._ . ._ . . _ . _. ._ . - . vores � __ , , , d�rron�ssoo�.:� Y� t .� -.�. . -�.. . . . .......... _ , ,. . . � . ' .� -�.. .. :❑I as nwner af th�propeny wl�l do the war"��d - � � .,the structuro is not inter.dod cr offered for sale. - - � ' � �. � , . ., , . . . . ' , ..(Sac�Od4,3uslness and Frolnssions Code:�Tbe Contrac- � �" �� � �� for's Ucrnao Lcw doe:nof appfy fo on owner of preperfy ' ._ . . ._ ., . . - . �� . � . i . , . who 6utld3 or'improvot iboreon, ond who does such �'__ ._. ... ._ ......_... . .';.. .• _ _.:_ . . . : , ; -- .' �'�- . . �.'": � . work F�hns�ff prov(dr.d fFaf such�improvameMs ore noe . . . ��. �. ,. ,_._ .._..__�__ .�, .._.. -._ ,. � . . � .... .. �, � ,.inlend�d or offored for sole.If,howevnr.the bWlding or ..:... .... .. � ��... .... ...:._: �. ....� :..�' .�_� �' � � . . imprcvement Is told withtn ona yra�of compl3tion:Ih� � ' � - � � � •�ownor-buifdcr will have Ihe burden af provinp Ihot he d!d � ' ' � not Eutld or Impravc for fFc purpos^of sa(e.) ' i �:'; ' _�. ._..: . '._... __ �. , : .,.� . ._. ._ � __. .__._ . _�. _... . ' 1 am ezempt under Sec. , _ .. • '� I . .. . ��. '. I ' ' , ., � - -.... . . .. .. . . . . . i - , ,, ,. ..._. .-'-..._.. . .---..____� . .,. . _ � --�-- . . . , .. .....�._ . _ . ._-_ _. . _ . . . - __. . � _B.EP.C,_f�r this reason � , ,. . . � ; . ,'.. - . . . . . .. . � ..___Dnfe. _.. � � � � , Owner �. .. . . . . .. . �