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HomeMy WebLinkAbout0978A (5) i _ }, ___��„�,�N �6A663 ,o,e� qppLICATION FOR ELECTRICA4 PERMtT �1 m�naf i have a certiticate of cOnsent to self inswe, CE-806G or a ceriifMate ol Wsrkers'Gompensation Insumnce,or a certified COUNTY OF LOS ANGELES 60fl BUILDING AND SAFETY u copy themof(Sec.3800.Lab.CJ Porcy No.10037682_ �omparry STATE FI�� FOR APPLICANT TO FllL IN .�OB � ❑ .Certifictl eopy is hereby furnished. - .EACH NO. FEE . AODRESS. ZL4Z$9 BRECKE , � New Res�dential B�dgs.&Pools �ocnurv. DIAMOND BAR TR 42571 � Certitietl copy is (iled with ihe county b�iidin9 Inspec�ion �8 2•Famity,C�.Fi. ��+�F � —� deFart t. Multi-family Sq.Ft. — Neanest . l� �p E & D ELECIRIC INC. caosssr. Da�e '-t"�� ,�.L'npplicant Residential$wimming Poois ' � �N�A�q � M,J. BROCK & SONS INC. . FIR1.1 NAMG a CEfl71FICAiE OF EXE6"PTION FROM WOflKERS' Outlets Ree_Li��!_.Sw.— .�' `� �`�a'� COMPENSATION WSUFiANCE � � � •��noDRess P.O. BOX 3SO (Thif section ne&tl not 6e com0�etetl U tM work Involved by the First 20 � perGnll Is(or one hundretl doilars(5100)o+�ees.) Total No. Additional pi,pN CNECK �REt� Tei.No.SZJ�8�.70 I ceitify that in the performance of Ibe work for which Ihis permit '. �� APPUCAM � � � is ISsucd,�shall not empicy any per5on�n any manner so as to � . become subject to the TJorkers'.Compensation Laws . L�ghtirg Fixtures First 20 ADDRESS � � Additional ,._.�/�• Applicant Total Na. • CITY - � Tel.No. ,ICE TO APPLIGANT: If, aRer making ihis Certiticate o( Fixed Appliances Not Over 1 HP pEqMit � & D ELECTRSC INC. Ranqe_HCatef D.bV. _ APP���M Exemption,you should become subject to the VJorkers'Compensation . provisions ot tne Labor Codc,you must forihv+ith comply w�m such Oven_.Orver_W.bt� AOORESS 319 PSC ARTFIUR k�AY�E 1 prwisions or�nis permit snall be deemea revokea. . rop �FAu _,w.H._ ��Ty - UPLAND � iel.No.�94�-2131 UCENSED CONTRAC70R5 DECLARATION Hood_Fen _Other_ �..I hereby affirm that.l am licensed untler provisions of Chapter 9 . . Oisp. _.Room Air Cond. �� 1JGENSEOR [,22589 �azs� (Gommencing with Section?000}of Division 3 of the 0usiness and �EG.NUAtSER C-1.� Professions Cotle,and my license is in full force and effect. poyre�Apparatus&Large Appiiances . DISTRfCT NO. t PROCESSED BY Size 8 Type HP,KVI,KVA,or KVAR - F Q �'1 � �icense Number��G$J uc.ci�ss—C-��� � � up co 1 Incl. - FINAL � y � E & D ELECTRI CI�iCr.�p_�_�n`}-__ over�to t0�nU. oArE . ^ p VALIDA710N � COMractor � ��o Ovei 10 to 50 Incf. FINAL U ❑ I am exempt untler Sec. Over 50 to 100 Inc. _ 8Y JJ/�-� � . . . W B.&P.C.for this reason Over 100 �" '�—� � Services,Swbd.,MCG 8 PanelboaMs- � � - � - � - Date: 0-200 Amp.Urder 600 V Si9nature '207-1000 Amp.Under 600 V � - --� '- � ❑ � � � Over 7000 Amp.or Over 600 V Exemption for Reg.Mainc Eloct. ��"�� � ' ' �'SINGLE FAMILY ' Temp,Power Pole&Appurtenarxes ��9 7�_$a , HOME OWNER-BIJILDER DECLARATION g{gn wi}h One Branch Circu�t �• .• •a 2 1 nereby aHirm Ihat I am exempt from the Contractor's Lkense Law qdditional Sign Branch Cirwits_ � ior ihe following reason(Section 7031.5,Business and Profess�ons � - � � � } � Cooe): � • � 1 �9 Z u � Mlsc.�Conduits 8 Conductors� � � - I,as ovmcr of the property,will tlo the vrork and ihe structure U 8 21t—8 7 is not iNended or oltemtl lor sale(Section 7044,Business Other(5ee Complete Fee Schedule)_ � and Professions Cotle). • CONSTi7UGT10N LENDMG AGENCY - � � - �� ���� - � hereby affirm that ihere is a conshuction lending agency for the ;rformarice al the vrork fo�wh�ch this permit is issued(Sec.3097, � PERMIT FEE � � - (Sub 7ota1) ).0`�j �44 � - � �- � v.C.). - PLAN CHECKING PEE �� . - �� - �� - nder's Name 1� 50 PERMIT ISSUWG FEE _ . . . - - ider's Aadress 'rtily Ihat I have�ead lhis application and state that the 8bove TOTAL FEE �.15.9ri . . . .. . _ .. . . . rmation is correct.I agree to compy with E�I COuny ordinances State laws regNytlng Electrical wiring,.and here6y authorize , _ , . __ _ . . _ . . esental��es o}this Coumy to enler uAon tho above-menGoned � �r1 f "spection pur oses. SEE REVERSE FOH EXPLANATOflY LANGUAGE ? � c�--lg�� _ _ xure of e Date i �-.. ....... _.. . r . ... �.... "� . , . �f _ . ; �, � . . ... . .. . I_I Y'i . .. .. � _.,. —. ,_, ., ___ _ .� .—---. _---. .. .____ _...._ _ _._.._ .... _Y_.______ ! , wsPt'Gt0�+5_ �. .� ' -.'�: '�01NNEA-BUILDER DEGLARATION�', � ,.. ^,^ r^ �. � APPROVAIS ;- -OATE-..-� . .. SIGNATURE - -- ��. .__� .— -�� .� .. l. ... .. . . .. . . . � . ; � -.;. . ,� � � � � �.�.,- - -���� -- --- _ ' ' - ' '' I M_rcby a«�um iMf 1 am exemA�from the Contrac!ois License TEMP.P05NER POLE � � � � � � . ,._ . .. _^ - . ,,:. .-'.. ;,,, .. . . ' ..__ _ _. ____ '�' ' . - . '� � . .� � 1 ;.� .l.avr lor.the fofmwing reason(SecNon 7037 5,Busi.acss 2ntl ..�_. , .ROUGH C,ONOUIT���.�, ;-- .._ ._,_. ___ ..�� . .. . .� :. . '-� ��� � � 'i � to erons Coticl:Any city w counry vihrch re4urres a pc�mir '- ---- . � . . � �Vucl,allcr,hnpion;.dcmolrsh,or repnir any sfn,e2re,Prror � � � � � �� to ifsYssuance.also requbes the�ophcvnt f�r such permii la�!e __.._� ._.. ._ . .. ,lMlRMG �� 6�;� d ("' - . , . � a siyrted sf3!ement(Yu!�c rs Gcensed pursuaM to theWa•isiwu � ___ . __.. ....�_. . ...___. _ �� �- � � ��� � � : of the Cmhactor's Lkense Law(Chap�er 9 fcommenci�g with - . FIXTIIRES � �- � - �-- � - �.�Seetion 7000)ol DivMrm'9�o!the Busrness ond Protesrons ..� �.- .. ._. _. _ ._ ._— �. ' '_ ' . - ��-�--I"���--"�-- -P01h'ER AUTHOflIZEO�:�-� " . :, CodeJ or'fhf hc�is'�exempf fhcrcLrom and!he basis S^r!he ' , . � aneg.M ezempfia�. Any�violation q!Section 7031.5�Lry orry .. . . ._.. -..--- "-'' U7WTY CO.-NOTIFIED �. � . � .. � ... ..... .:, .F.,. . � � apPlieant Yor�e Permrt 5ub�'ects fhe app�icanf to'a'ci�Y penatty ----- ---- �FINAL—-- --��-E��y(CY Oit/'YOItt � ' 01 not moie Inan livc hunored tlolLirs fS500).� ; .-...._...__._' _.� �..._.. ... .NOTES__.. . . . , . ; . ,• �.. '. - ❑1.as owner of fhe property wil!do the work.and�he . . :l f` � ., . ., � . ��� . �. . ` � ���� � .� , -structure is not Intended or oflered for saie. - - . '� � , ' ..i . � , ' . , .... . . � (Sec.7044.&rsirnss arn7 Prof�ssions Coda Thc CoaVa,._,s ..�. I..- .. .. . ,.. . . ,. � . , , - _.. �Liccnse Law Cpes�not aq>IY to ad owner of ProPcrty ivho 6u:lds . ..�" � � . ....� . � .�.. ." � �� , �":.a improves fherern,�anC who�Cocs such v:ork himsclf�✓ideo' ._._.._ .. . .. . :.... ... .... . ... ...: � � � , , , t8af soeA nnprovemenls am nof 7nfentlrtl or�off_ned fa�sale.1l, _.... _..:_. _ . . . .. . .. �� . : . ; _ . �' _ _.:. '. I ..:. . -. . . , o! , - ' . � , .. .. . . . .. ,. r . 'h tl tl n�bu�d o uiN'o'vc!�o!he Pu'Pos c of�snhc)P rnnn93ffiat �) i ,, . ' � . . ... �. , . ... � �.. .- .._.. _ . .___., .. . ,�- .. ._._. -. . .. .._. .. .. .. ... . .. . .. .. - ... . 1. . �, , ... _ . . _ .. .. . , ._��, , ' . . .. i-' r.r..,.� .. � .___ __. �'� - _: 'q am exempt�uncler 5ec. 1'�� ��. . . _ . . , . _. _ , . _ _. .._. , , �: .::.- � . _.. i :_� ... .. .. .... _ . ' _ ._ . _ __.. ._ . . .. ;� . . , �--� -B E P.G lor this reason '-�� � . j. . - _. . . ..._. ._. . . . . . _ � ..__ Date. . ___. .._._ . . _.. � .. � . . � , . .. Owner -._ , , � � i �. . . � ,. .; -�. � . . : . , , . , ... . . . . . _ , . . _. _. ._,. _.. � � . � . . . „ �� � . � � i � . . � . . � . . . '. . � .. _ . . ___ . . . , . . . . . �. . .. .. . . ,. . , _ . . .!_ _. _ _ .._. . .. _. ., � ,. , . .. ,, _.. . � . "� . �..�. . . ' ` � . � ... --- - -- --.._ .. _ . . .. .. „ . � . . . ,� .. . . . . c_ --- _' __..__ . _---..._ _ ._ -- �--_ , __ � ; �_ ' _ _. ._ . _. ._ _ — — — ___— _ .__ __ ___ ,� '�' . '�� ,i- . . . �