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HomeMy WebLinkAboutNo Permit Number (5) WORKERS'COMPENSATIONDECLARATION 76.4663 10/el qpp��CATION FOR ELECTRICAL PERMIT � I hereby offirm ihat I hove a ceriifico�e of consenr lo self CE-eo6G insure,or a certiiicote of Workers'Compensation Insuronce, COUNTY OF LOS ANGElES Blll`p IyG AND SAFETY or a cenified copy thereo((Set.3800,Lab.C.) Bld 4i31 B-1 O�y No.054336 Comppny WaU58U FOR A►►IICANT TO Fllt IN JOB Cerli(ied copy is here6y f�rnished. New Residentiol Bldgs.8 Pools EACH NO. FEE ADDRESS 2Q]25 (�-� E. Crest Lane � Certified copy is filed with the couniy building inspec- 1 8 2-Fcmily,Sq.Ft. a — S LOCALITY _ �ion department. Multi-family Sq.Ft. �1SZ�V . 4 — NEAREST q 2$-$7 Berner Electric, I C.Residential5wimmingPools , Cr+o555r. DatA� Applicani ' OwNEROk F�ann N�The •William L on Com an CERTIFICA7E OF EXEMPTION fROM WORKERS' mni� � COMPENSATION INSURANCE O�Ilets:Rec_Light_Sw.__ ADDRE55 P (Th4��Nlon n��d nof 6�compl�l�d H 1h�work imolved by� Firzl 20 , tA�p�rmh{s ier en�bundr�d doilors(f100)or I�ss.) Toial No. Additional ��TY Pl W ort Beach CQeI.No_ 533-3600 1 te�tify ihoi in Ihe performonce af the work for which this aPPLCANT� � pe�mit is issued,I shall not employ any person in any manner - so as to be[ome subjecl to ihe Wa�keri Compenwlion LCws. LigMing Fixtures First 40 ADDRE55 Tofol No. Additional , Da�e epP�;�a�� QTY � Tel.No. . NOTICE TO APPLICANT: If, oher making this CeH�ficote of Fized Appiiances Not Over 1 HP pErimit Exemplion, yo� should become subject �o Ihe Workeri Range_Heater_D.W._ APPI�CaM Berner Electric, Inc. Compensation provisions of�he lobor Code,yo�mus�for�h- Ovan _Dryar _W.M.._ ADDRESS 75 East Grand Blvd. flh comply wilh such provisfons or fhis permft sholl be Top _FAU —W.N,_ deemed revoked. � Hood _Fan _Other_ CITY n � CA 91719 Te�.No.734-3171 LICENSED CONTRACiORS OECLARATION iICENSE OR Disp. _Room Air Cond. — Class. 1 hereby offirm t4�of I om licensed unds�p�ovisio�s of Chapter 9 REG.NUMBER L{HS3ZZ C�� (commencing with Section 7000�of Division 3 of ihe Business DISTRICT NO. PROCESSED BY p}.,' and Professions Code,and m license is tn full torce and eHect. Power Apparotus 8 Large Appliances /� w�,�, ��wJ Y C�O Size 8 Type HP,KW,KVA,or KVAR ' o�- !'` W U license Number �LHS'J�L2 ���.eia�s uP�o i i�d. FiNni � Berner EZeC. 9-2$-$7 Ove�1 to IO Ind. DATE "'I 1 �Q �J VALIDATON � Controcror Dme Over 10 l0 50 Ind. .���t �� U ❑ 1 om exempt under Sec. Over SO to 100 Int. BY A� �+ - n: B.BP.0(or this reason �°B��� .v`� Z po�e. � Services,Swbd.,MCG 8 Panelboards � . 0-200 Amp.Under 600 V �, . Signalore 201-1000 Amp.Under 600 V � ❑ Over 1000 Amp.or Over 600 V . Exemplion for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole 8 Appurlenonces �'� - HOME OWNER-BUILDER DECLARATION S;gn with One Bronch Circuit ��. 1'� P�H A I here6y offirm ihat I am exempt from the Contracbr's License pdditionat Si n Branch Circoiis ' �2 Law for the following reoson(Secfion 7031.5,Business and 9 . �• • ��+ Profassions Code�: - � ❑ I,as owner of 1he properiy,will do the work and the M:sc.Conduits 8 Conducbrs � � • 1 9 1,U 6 strudure is nm inlended or offered for sale(Section Oihe�(See Complate Fee Schedule)._ , . � 7044,Business and Professions Code). � • 1 91,46� CONSTRUCTION LENDING AGENCY � I Q� b-S I I hereby offirm fhat there is o ronstrucfion lendinq agency for the performonce of the work for which Ihis permi�Is issued � VERMIT FEE � (S�b-To�al) (Sec.3'J97,Civ;C.). PLAN CHECKING FEE � � Lender's Nome ' � PERMIT ISSUING FEE �� 5� Lender's Address � I certify lhot 1 have reod lhis opplicalion ond state tho�the TOTAL FEE � � �, a6ove informalion is mrrecf.I agree to comply with all Coumy , �ardinances and 9ote lows reguloting Eleciricol wiring,ond - � hereby aathorize represeMatives ot this CouMy to enror upon � ihe above•meniioned properiy for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ' �l��,r�,���r.,�.�n� 9 Lb F37 $(gnotu�e of Perminee � Da1e '. � l. . . ' . . .. � '� . ' . � . . . . . . ... � .. . i.. •. ' . . .. � . ..-.__ _. ...._.__.. .. '.. ,� -- r� � ..; . .. . _..__ _ �.._.._. � �.��OWNER-BUILDER DECLARATION . .� _ APAROVALS DATE� �SICNATU:E-� � - ' � - � � � � � ...-�...�'--- .����� -'I-.'..�.. l'Eh�9:GOVJER i'O.E. . .... � � .. �.. -�-� - . . .. .. .-.� .. � . ' - ...' " I hembY offirm?har I om'oaempf from iho�Contractor's � �', , �. . �. � . licenso Law for.the follawing�rcoson (Sec�ion j031.5, . . _. .. . ..._ _ . . !��'-'� ��-'--- �-'----" UNpEF5CA6W0^nK-�--� -� � ' � ' � Buslnessar.d➢ro(oss7onsGodeJ:Anyclfyorrourttywhlcb � � �- - - ROUGH CONDUIT � 1��, � ��. �'- .�requPes a pormit to consMocL oher,Improve,demolish. .____._..__..._ .. . ,,.. .�. , i . � _` � � - � ' �.�.- or rcpolr any struclure;prlor fo ils fstuonce, olso re- .___�_�._ :--�....., '.'.'�.-.'_�.-.. WIRING'.'..'--. . �� , , - qulrosfhsapplicenf(orauthpermffbflleaxlgnedstafa �. ' � " � � � � - � � mon��hat hels licnnoedparsvan�to fheproNslons o/eha '.. _. .- _.-. ...� FIRTU�ES�.' .' � � Contracf�r't Cfcense Low,(Chapter.9,(commencing wleh � � �' � � Se<fion 7000 (.DlWsfon�3 0(fhe Business and Profes� ' _. . . '� �.. : FC'.';ER AUTH021ZED ._. . .�. _.. ._ .' . .... . .. . �.� _ . . � � . j o - �- , sions CodoJ ar fhat he!s exempt fhere/rom and Ihe basis ______ UTIL(TY CO.NOTIFIED � �� � for tho.ob.^p3d azomptlon. Any�vlolation ol Socf+on _ c7 -- - ._ . . .._ � . � FlNA: ' ���ifcr-�on",3ronl . . . . . �.. . . ' . '. ' ; . 7031.5 by any oppheont!or a perm7f su6(eUs fhe oppll- - �--�----� �- - ---- , _. ' . canf}o o clvl(pena(Py of nof more Ihon flvo hundred Nores dorran(ssoo).: ___ , _ __. _ _ _ , __ � � � � � - �- �� . .. .,l.��,as owner af Ihe.property will do Jhe work,ond .._ .. . - � .tho�strucruro is not intended or offered far sale. � . � ' , � � � � � .. � . (Snt.704(,Euslnass and Profoaslons Code: Thr Contrat- � �� tor's ifconse Cow doos nol oppf y lo on ownor ol proper�y ...� , �� , , . � who bv!!da o�'Improves ihereon, ond who does s�cb - - - � � �� � - � " � � wo.-k hlmseff provfdod thot such�fmprovemenis are net ..... .. . . . , , � � � � -�-� �- �� � - � � --- �� , mfrnded or ollervd!or aale.ll,�fiowever,iho 6ullding or .. . . .:.'.' _�."___.._"'_. .. ......:..� : � . �. ..�. .-...... � � ' - �lmprovemant 1;sold wlfh(n onc year ol complellon.Yhe - ' ' . '" � � � ' ' �.`ownervbullder wIB have IM1e bu�don o/p�ovfng fha�6e did - - � ' -' ` � ' � noi butld orlmprarc for thc purposo ol solo.J , � :.,� --�-- _ .. _.. .. . . � � � . .---..._ ... . ... � .. .� . . - .. _ ' I am oxempt under Sec. . _.-. . . . � . . ._....__. . . .. ___ __. . � . � � .. -- _. .. . ' . , . . ._. _..- _ . . . . _ . . .._.B.&P.C.fcr this reasor- �� � . .. _ _ . .... . . . -:. .. ;.� . - � _�aio- .. . � � � Owner '' � ' � . , . . � _ . _ . _ .. _, t . . . . , -���: . - � . . ,, , ,. � . , � . � . � _... , . . . _ . . . .., . � . , ,.. , . . � � '�