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HomeMy WebLinkAbout1553A (9) � ,n.,�.� �r �.,�,�_ �� � � ,� � !�fa-3 d �%�rn�G'�ceJ `�rv ���� APPLp�d►T(O�V �f� �L I�L PERMIT . . �� ' WORKERS'COh�IP�'F1�A710N DECLARA710T1� �6a663 io/81, ,. ` -I hereby affirm thot I have a ceriifimfe of consenf to self CE-8 6G y� . . , . � - ,,. insure,or o certif'mte�of Workers'Compensation Insurance,Q�� QU�§°^Q���NG� � � �� 8 ILDIN�o/�N�_SQ�T�(� "-�� ��.. �a certified copy thereof 5ec.3860r,lotb C.) /��� -- L�� ,,,,_ _ _-... _ ..�,.� s�'�S .._.,. :..�� ����om anyS.��^"s�-+ . , _, FONAPPLICApf'�Tb��itl IN_�-�.. ..., -.-�- ,� �DDRE55�� ��iR Ce iified copy is�he eby fumished New Res�denfial 8ldgs PRols EA�H. .NO FEE` . . . . . ...._.__ �.__ ... .,. ���/fl� �5.� � — g/C� ... LOCAU7�4� �� Certlfied copy Is 4'led witn�he county�buildmg mspeo- � 1&2-Fomlfy,�Sq.ft . �- . - � __ .._ _� � . Muhi-fomil FL �— --NEAREST . . t on deRartmen�. �Y 59 .. _ ': . CROSS ST - '- � + .'/�� ' ' Res denhaV Swimming Poois OWNea�S � � ; , Date���Appliconi�� �_J�-�� .. . �� . � � FIRMNAh . � _ - " CERTIFICA,1`E'�-F'EX�`N!�`l l'�C��R�JF� � O�tlets:Rec -�L ght+Sw�_ MAYL . ' ... - ' COMPENSATION MSURANCE"- �� - . ADDRESS�_t._Q. ' - ti . ' �' First 20 -(This secfion need nof be completed i the work mvolved by Total No. .�-Additional - � QTY Tel.N�,.�� ,J,� +.�.�fhe�permifisiorone�`hundreddallors(�100)or�less.)� - � �-��� - � � �� .PiANct+EtK� ��-�"� . . -- - � �-� -�`I certify ihat n ihe performon2e��of ihe work�#oF whicF this � . . � � � .. . APPLIGANT :_.�,z_.- .-_ „�-. - - -�-'�� -.-pe�mil is issued,I sholl not employ any person in ony��mtfriner--�' .. � �. � -�so as to became�subjetl to the Workers'Compensation,laws. :. ��9hting Fixtures� . Firsf 20�� ADDRESS . _ � _ .., ....,._ �,... . . �, �,_ , , . ,:: -Add�tional . .. . - . . � . �- . �Total No.� - � . -- - -��-� . CITY Tel.No. . . . .,_�_�.-�,...�,.� .,.F. _. .Date �� - .....ApPlicont� - •�_ ----�_�-""" Fized Appliances Noi Over 1 HP �- � . - .... y�..-.- .. :'NOTICE TO�P"�LIC�'N(? Il',�a�fer making ihis Cerifrmte.of PERMI7 � `T/�� ��` .Exempl�on, you shouJd become sub�ect In the Workers' �Range_Heater_D.VJ._ . APP��CAN:---+-�' .. _. . {ompensation pro�isions of the lobo Code,you must forth Oven _Diyer —W M— I I - ..ADDRESS ��"'�y^'�" --w�th�comply rth svch provisfo�s or th�s permit shall 6e - 7pp _FAU --�A�H._- CIT Tel.No. _� w -�-deemed reyoked . . � � -�' � � , wss�.�r.-��� �Hood ,�F&n _Ofheo-.� - - - . - ;:-LICFNSEO Cd1VTR��I�i'��L�A7�N � � � � LICENSE R � � , . -- -D�sp _::Room Air Cond. — ' REG.NU�BF. �' L„ . las���s � 'I hereby affi m thoi I am I censed under provis ons of Chapter 9 . � . - �� -(mmmeneing wrth Section 7000;of D ision 3 of ihe Business _��. power Appocmus 8 Large Appliances . � DISTRICT NO.-� PR SSED Y. �� �� nd Protessions Code,and my license s n full force and.effed . - . ,, � d ��� �� � � � � Size 8 Type�HF;KW,KVA,or KY.4R� � � ��` V L cense Number `` � �'�� L�c.Class �� - � PINAL . .. . :Up 10 1 Incl. ' �n 1 "�������� -.Over 1 to-i0'Incl -� DATE �F- e� VALIDATION, _ o �:�Controct ���L o� S �� -0ver70to561nd �� . . . : FINAL �- ���.`�5•�� U � I om exempt under Sec - -.Over 50 to 106 fnc - . . gY .. . m a � -�ver100� ��e a�a� */1 8&P:C for ihis reaso � �� � � - - � "�Date. M� Serv'ces,Sw6d.,MCC B�Panelboords � � �. , � � � � '",�""�""'�'�""' ":"„' _.0-200�Amp.Under 600 V . .. 7 a i 1 � � ,. � Si natore - �� - ""��=� 201 IOW�Amp Undedb00V _. � � x. -_ .:.z .,.:_..� ..._ .. _.. .'.a 9-.: -� � . Over 1000 AmP.or Over 600 V . -m s '��.i S't,�;7�� �� • Exemption for Reg Ma�ni.Elect , .. �.5�. ! �7'"��- � ' -51NGLE FAN}I�Y � µ�� �� �� Temp Power Pole&Appurtenances""' . . - . 'HQAAE`tJWNER BUILDEK���C�LARA�fi'�5�������� _Sign w rh One Bronch Grcuit . , . � l hereby�affirm rhoi I pm enempt from the Confracto s license,..� qdditional Sign 8rancli CirN fs . .-�. . -� Law for the following reason"(Secf on 7031:5,Business�ond _ � _ � � . �- � � - � Professions Code): � � �- � .� -� - - . - ❑ I,as owner of the� o ert � Misc Condu tS-&Conductors .. � . . .. _.. ._. .. � �Sr p y,w�ll do�he work ond.ihe� 'Ofhe�(See Comple+e Fee.5chedu�e)_ � siruct re �s not in�en.ded or oHered tor sale (Section�� �. . . . . 7044,BusineSs.ahd Professions Code).-- . . . . -� CONSTR�CffON LENb=11JG A�ENCY �. � - - - � - - - 1 hereby fiff'rm that fhere is a construd on lending dgency for . ' . __ ---�- �� - �. .. � SecP3097mC v C f ihe work.for wh�ch this permrt�s issued _ � pERMIT FEE �` � ���� (S 6 To(al) - �- �� � ( } . _ .F��.� �-.�. . . . . -,.a _ . .�.:.. -:: ;.. , _;�... '. -:. ::: PLAN CHECKING�EE.'�_.,tl.'•.�� ��.. -� Lender's Name ��� .�-�>"` . . - `.�:-""` � - . . PERMI71S�501�+7G�FEE" -� � .- �_ �Fl . . _ . .. . - ". Lender's Address � � � .mee""""".""` . ... ... . .._�:--__ ...._. _.. . ,-�. _ ..__ lOTAL FEE' i certify thar I hove read ihis oppl cphon pnd stafe ihpt�ihe. .. �, � ` �� ✓� � � . �� above information istorrEct.I agreeto comply w th oll Coun�y� - . .. . � - � � -" - " -: - . � --' ���. -�� - - �ordmances and State lows regulonng Electriwl wrring, ond ._. _ .:�_.. '.. -: -- " ' _ , .. . � �hereby author¢e representofwes of th�s County rp enter upb� ' �� � ., � - -� --� � ' ���- -.�the above-menhoned property forrnspection purposas � ' - ���Y� � � � . . � ��- SEE REVER5E Ff31t E7�V�l�l�fi�1�G�E���y . �,.✓�i-� L���� ��/�t"�3w : S�gnalure.of Pe m tiee Dote . � � - ; - .�_, �_ . . . � y, ^� �:L_-''S- `��zz��'a_"'��':` a . x;e-} ��_ �*+��''"��f'����:a�t�..fi�:t=�'�." = .�z✓.: ti_ - ,.Y� .Fi�.��s-�� . . � . . . � ��:. � ' . . �. . � .-_'. .. ' �- .:: �`� . .�..--�- OV�INER-6l�iL�ER DECLARATION , _._. �.: "" . DAlE ... � . � . .. -.- : . __.. APPROVALS SIGNATORE - � -- -_ I.hereby affirm ihot I am exempt rom the C .racto%s _ � -.: . � TEMP..POWER POLE--- . �'_ ..� - �.� . . . . . _ License taw for ;he foH�wing reason.l5ecton_7C31.b, . - � - � �--��-� � - ��- - Susiness and Profassions Code):�AnY city u co�n4y which ___. _,.. ..--:, . - �� � � UNDERSLAB�NORK � req¢ires a permit 10 cons4ruct,alten improve,.demclish.. ._. .- .- ,_.. .�_a � . .... . - - - . . . or repair any stNsiure,prio�;0 1fs rssuaice, also rE-. � '--- - . - ROUGHCONDUIT � _ - � � qu7resiheapplicanfforauchpermittofiieaslgnedstate- � . _ .< .. .. .. . . "�-. - � 1NIRING �� - - -- � - -. - ment t6af he ts(fcensedpursuant to fhe-provisions of the . � ' � �., ... .._,._� � � - . - �CenPrqctor's license Law�(CRapter 9(commencing wlfh �-- � '� ,PIXTURES- __ . - ,. . . _ - . � - � Section 7000)of Divigion 3 of the Bosiness ond_Pr�leS- � --. ... .. ._ .. _� .. . . . ._ ... .._� . - ^ ��- � ' POVJER AUTHORIZED��- - - slons Code)or that he s exempt;he;efirom a d t6e basis � � � -� - � - - �- � -� for the alleged ex_mption. A.ry�vtalation ot 5_<fron � .. . - .. . - UTILITY.GO.NO7IFIED:` ,y � - . . . � . 703i.5 hy any�pplicant for a permii subjec4s tha app!i- . __._�,._...w,......� ___ c7 -� {� cant to a oivil persalty of no!mare.fnan fiye hundred , . .�... .__ FINAL �_.Gnfvi an tmn� � yy.. . _..,��,-„,_ dolfars(SSCO).: . . .� .. . - __ � _. ._�. ;.�, _._ - - - � �-� NOTES�'- � � �- ` -� '�- - . ��1,as awner of ihe property vtill do..the work,ond ____ , - - .._ :. .. ,- , .... _ . . . ihe structure is not!ntended or offered tor sale. � --•- ". ' .- -� ,; „,v.� ,y� �s,;4,�.,.* , �?` y� ;= %(Sec.7C44,Buslne5s and Profassions Cod=: Fhe Controc- , ..-._ ._ .--..: .„-.'.-..;-,. .},,,.-�_.:. .,._....�.�-;:. _.._�:. � '-;v� ,`<„,..�,..., -: .-,._ _F >::-. ..tor's Li'c�nsm Lcw does no4 apply to an��owner of prope�ty . ...� � � � ' . __.:. , „,-;::n,�,.,_,,,�, .�;_��. _�_� �. ,._ �w6o buflds or lmprove's thereon, and who doss.such � � � - ... . ��- '- - provements are not.. _ . . ._.:_ ' ',,,:_ ,,.^:.: _,mc._ -..::, ._._: ...: .� ;; -- . work himself rovidad shof su � .,. ^ . -_ " - ch im . .- `.`� . � .�` ` � __,_ ,,,-.,...�. .�:, „�,-,.:y �.. Intsnded ar of ered tor sala.lf,haweve�,Phe bui_{dirg o: __ :�mpj.6Ve�e�}i�iolcf wifnin-one yeaFef completion,the � - �� .,g �.-.-- � �. ownar-bulfder wlif_fiave 9he�urden af nroving that he did _ _ -r.. --^•"". 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