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HomeMy WebLinkAbout0966A (5) VlORKERS'COMPENSATIONOECLARAT�ON 16nB6a �Oie7 pppUCATiON FOR ELECTRICAL PERMIT � I hereby aflirm that 1 have a certiticate of consent to seti insure, ce-eos� or a cer,ificate of Workers'CompensaGon�nsurance,or a certif'�ed COUNTY OF LOS ANGELES S00 BUILdING AND SQFETY eopy thereot(jS���B��ab.C.) STATE FIJND Po�icy Na Comvanv Fort^rv�.�c°HT To flt�iN � 24248 BRECKENRIDGE LOT 25 ❑ CeRified copy is hereby furnished. EACH N0. � FEE ADCRE55 . . New Residential Bldgs.8 Pods � �Certified copy is filed with�ihe county buildirg Inspection �8 2-Family,Sq.Ft. '�991 S —3 �ocA�m -DIAMOND BAR TR 42571 dqp^Itynq�t. � . -- � 6lulti-tamily Sq.Ft. qo5sSS7. ' °�r pate��ADPi�cant F. &'D F.t.F.CTRTC TNC. Resitlent�al Sw�mm�ng Poois � ownen oa �•.� FipMNan� M.J. BROCK & SONS INC. CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Ree_Light—Sw._ � � MAiL � COMPENSATION INSURANCE - pDORESS -j' Q yThis aectlon naed not be comptetbtl H the woek Nwofvad 6y the First 20 �{•. Total No. Additiona� CITY. . $R�[{ .. Tel.No. � rmi�Is ror one hundred aw�ars(Stoo)w�ese.) � 529-8170 I certify Uat in!hC pe110rmance o1 the V�ofk fOf whiCh thi5 pClmif� PIAN CHECK is issued,1 shall twt employ any person in any manner so as fo � APPLICANi - become suhject[o the Workers'Compensatron Laws. l'ghting Fixtwes First 20 ADDR=_SS- �� � Total No. �tlitional _/'�, � � . CffY - � 7e1.No. P.pplicant Fixed Appliances Not Over t HP ,rce To APPLICANT: if, after making this cers��ate or PERMIT E & D ELECTRIC INC. Exemption,you shauld became subject to the Workers'Compensa[ion . Ran9c_Healer_D W. , A�'����'jT provisions of the Labor Codq you must torthwith comply with such Oven_Dryer_W.M._ ADDRESS 319 MC ARTHUR IdAY�l prrnisions or this permil shall Oe deemed revoketl. Top _FAU _.VJ.H._ � LICENSEO CONTFiACTOAS DECLARATION � . CRY UPLAND T��.r�o.94 G-2131 1�ereb effirm that i am licensed under P Hood—Fan _Other_ y proV15i0n5 01 CIW 12f 9 . OiSp. —ROOn1 Aif COnd. _ I�GENSE OR (eommencin9 with Sedion 7�00)of DiviS�on 3 of Ihe 8usiness and � . REG.NUMBEFl -�422589 - � ����ss�C— - Professions Cotle,and my liCensc is in futi force and effect. DiSTRiCT NO. FROCESSED Bv , Pnwer Apparetus 6 lar9e ApplianCeS .. : . , . . ` Size 8 Type HP,KW,KUA,or KVAR � � i Q 'p h Q� license Number �t22589 lic.CWss �—��1 Up to 7 Incl. � flNAL ` � O � ^7 Mer 1 to t01nc1. OATE �J � �Contractw '� E"& D�ELEC Date • ��r � pvcr 10 to 50 Incl. "��v ' VAiJDATION . . 0 � Fl n� ^ V I am exempl UnCer Sea Qver 50 to 100 Inc. . gy ' 8.8P.C.tor this reason Over 700 � - a N Scrvices,Swbd.,MCC 8 Parelboards ' , �� - � Date:� 0•200 Amp,Under 600 V � $ignaNrc �207-1000 Amp.Under 60D V � � � � � ��- - - � � � � - � � - Over t000 Amp.or Over 600 V � �A Eaemption(or Reg.Maint.Elect. � . �.� � SINGLE FAMILY � Temp.Power Paie 8 Appurtenances A HOME OWNER-BU�lOER OECLARATION Sign with One Branch Circuit �'���`�'G . 1 heiehy cf(irm ihat 1 am exempt Irom Ihe Contrador's License Law qdditbnai S�9n Branch Circuits � � fo�Ihe followin9 reason 1Seclion 7031.5,Business and Prafessions �� - -� - - f •}[�2,' (4 Codel: ❑ 1,as owner ot ihe pmperty,will tlo the work and the structure Misc.Conduits 8 Conductors � ' - � � S A��P.�Ll c=o �s not inteM?d or ollered for sale(Section 7044,6usiress Other(See Canplete Fee SChedu�e)_ U a / aiW Protessbns Cotle). , �� � � ��� - CONSTRUCTION IENDING AGENGY � � -� � - I he�eby alfirm that Ihere is a eonstruCtion lending a9ency tor the pertormance ot thc work(or which this permit is issuetl(Sec 30�37, pERMR FEE - � '(Sub-Total) 1$1 Q � � - � �� -� - Civ.GI. � PLAN CHECKING fEE �� - � � - � . , � Lentler's Name � PERMIT ISSUING FEE . . . . Lender's Atltlress � . I certify that 1 have read this epplication ard state that Ihe above � TOTAL FEE . . 1�12.].Q informalion Is correct.t agr¢g to comply wilh all County Ordnances antl State 4aws regulating Electrical wiring,and hereby aulhorixe . _ represenlatives of th{s County to enter upon the above-mentionCd . � �� � ' � � � _pre er �inspection pur0oses. ` � g � ' „/7 I�(��r^� - SEE REVERSE FOR EXPLANATORY lAN6UAGE � - . .. . . . f r�7 V � - _.___... P.m . oate � . � � .- - ,... ,... �., , , , ., r.� � , . . ; _. - , . ,_.. . � , _ .. ,._. -, -�;:�: ;_ . �- �,.:- ,_._.____.__.__ ...._ __ ._._____ __.__,_ ..._.__ . ____ �_... __ .�__ � �� �- � , �� �� triSPECiOR'S�, '�'� � -- --- .-�.OWNER-BUIL�ER�ECLARATION�"- �� �, . �� . . .., �-�APPROVALS '. : �-.. .DATE-... . : SIGNATURE '. .. . . ..... .. . "._. . ��� � - � � - '� � � � '�� � ' i hcreby al�lrm that I am exempt trom Ihe Conhactor's License � T�.MP.POWERPOLE �- �--�.--� ���- : . . . . .� . � '___ . ._._ ___ ._. �=--- � �� - . . . �� .. Law for the followirx�reason(Secfron 703J.5,&rsiness and � '� � . UN�[RSCA6 WOAK., . ____. . � -:.._.�.�___. .. ___... . .. .. t Ralcssions Codcl:Amy crty ar counry which requires a permit ' . . ROUGH COPlDUIT- �' �' , .� .... . - � . . . ' i ,. .. .to consWct.alter,lmprove,tlemolisl;olJe,a�ir any stlucNre.Pna. , �� � j' " --�(o fts lssuanee,alSO reGu;ms the applirarrt la sucn pennit fo>, ' ..__ ' '.•.�.'. .•`. �_.'_::___.. '�., ._ -.�_ � � . � . . � WIftING � �. : � ' ;_ �. . � . ; �s�g/k;d 513tcmL'nf'fh8;hC 15 liCenSCd pWSU(U�'I!0 the jNOvi5i0f1s �. ��.... .... . . '� . ..._ _'_. . . ; ._ _ _._.. ..�<_:... FIXTt1RES�...—___._- . � , i ollne Confraeta's�ticerse Law�(Cnr�fer 9(eommencmg wl:Jr _. ., ..-_ .. _ . _ . .. _ j ,i,�i . .; � , , � -"��•�Section 7000)of DivP,✓rn�3 d the Eusiness.and Rolessc:� ,_..._ _ _. .___._....,__.. -FOINER-AU7h10'12E0�:-.-, ' ..-. , ..-. .- .. _.. .���- ' . Ca1c1 a fhnf hc�io e•empl tl�erelrom'and Inc Gsu'f�'..:c ; � � � , � !.,.. alleged oxemptian.Any::violatian�ol Section 703J.5�by mry ,-��-�- -- - �- ---- -- --t3FILITY-CO.-NOTfFIEO-� � � • ' 1 . � � ' ..., , . + � appJicant for'3 pem�R�Sub(CGfs Ihe apP';Cant ftl a Cim7 peimlty . _ _ '___...__._ ._. . .FiNAL.__.._ __...:11�C:7'Cllt]'�YOl1l . . . � � f o(not more tban tive huriCred Uolfars l5500J: � ,. r„ . � ' , � � � ❑1,as ov+ner ot the O�oDcrty v+ill d�Ihe vrork,an�lhe �-- �--- - --� -� �� � .-s!ructure is nat intentletl or'oife�ed tor sa e_ _ ' _ _ " NOT,ES ._ �.. . , . , . , .; � ..-, ; ..._.__, ___ _ �_____._ ____ ."_ .... .- � . . �, .� .. � � . . , (Sec.�7044,Business nn0 Pra(essiau Cod^.r'The Conha�_..s { � Liccnse Law docs nof app7y to an awrrer ol propeny who buirds � . ..;.. �%.. , .. �..,. . � . . ... wrmproves t7>crcron.antl who i'oes sueh wak himsel!prwiHetl , . ! :._____.__ �.'..._ . , , _ . . . _ �.... ` � � �� � � �� � fhat s�h imFrovements ard not iritcr�etl w o1lcred(or sak.�l(, �.�_. . .�..�"_'_ _ _..__'_...'__. ._._ .__ �_; , ' _._ � ' ._. .. �. �:. : howevcr,�fhe bu)'ding or�irnp.roremen:is Sold wifMn onc YGzr ol i , ._ ...__. . .. . . .. ... ... . .. - . . , . ilder wiL have Ihe bu�den o1 proNng Inat 'CG�mpletiai,t11C oNlnC1-bu �'_. __: .. _.._.__..___.. __.__....._. _:.:._ ,� .; - � � . ' ..' , hc d;d naf builtl or Imprwe!w tbc purpose o!sale.) � . . !; . i .._ : ..,. � , . . � .. - i .... . � . ; , , ... - � '�( .:i ! i ; � I ; . . ._ . �.�: .�.s�.� .��, ..._ ., i • _.-. ._.. ' . . ..._ _...__ ._ ..._ ... _.__. . . ..: ,- , ; i,t.-�� n�: � ,, ..�, , � ��.,`, - . .. ., . . . _. __. . . __.._. _.._. � .. ...... _.. . 1 am exempt�under Sec. ,_. ._._..,_. .. .__-. . � , � .. � . . . . , . . . '..: i ...'... .� �. '�.',. .�_ __..._ . .. . . - ._.�__....__: ,- � '� - - -� � .._ . ._8&P.C.for this reason ; .. __ __ __ _ . .. ,. . , � -Date .. . � , � Owner .. � � �. � _ . f � � .. � _.. ___; .. . ._ i ., ' . .� .. ,. � � , .,- �. . � � . �' . � .. . ..__... —_-- ..:_.. . ._..___ . _ ... �, i _ . __.. _.._._ . _ . .__. . � . , , , � ��..,, . .' : .� . . . . . ._._. _ .__._�._..___. .__... ._.._._..__._ � ,. � . � � ..� ., , . . . � . ., i I"-'- . . .. . ,. . � . .. ... •� � . . . . . .. .. , . _...._. i . . j __;._.. _.; . .... � � _ .__..__ __ . _ . . _.��� . . . �.i . ,. ..� .. ._.._ �