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HomeMy WebLinkAboutNo Permit Number (5) vRtitrtS COMPENSA710N DECIARATION ��,�3 �o�e, qpp��CAT10N FOR ELECTRKAL PERMIT � I hereby of(irm Ihat I hove a cerlifimle of conseN lo seli �E'�� insure,or o cerrifitore ot Workers'Compensa�ion��so.ance, COUNTY OF LOS ANGELES BUILDIMG AND SAFETY or a certified copy Ihereoi(Sec.3800,Lab.C.) ��Y No. 054336 �amPo�Y Wausau FOII A►Pl1CANT i0 Rll IN �oe Cerliiied copy�s hereby furnizhed. New Residenf�a�61dgs.8 Pools EACH NO. FEE /�DDRESS 20735 A-D E. Crest Lane � Cerlified copy is filed wi�h the wonry bvilding insper 1 8 4-Fpmily,Sq.FL = — E LOCAi1TY TR�i43718-2 tion deparfinenr. Multi-lomily Sq.Fl. � — �8 NEAREST 9_78_A7 Residen�ial Swimminq Pools CRO55 5T. Do�e Applimnf eerner Electria l ORMNAMf The William l on Com an CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec_Light,Sw._ ��� COMPENSATION INSURANCE ADDftESS �9 COT orate Plaza (TAIs��crion n..d no�S�sompbe�d H th�work Inrolwd 6y First 20 , tA�pnmif L for on�hundr�d dollan(SI00)or bss.J Toral No. pddinonol ��tY NEW ort Beach,CA Tai.No.g33-3600 �I certify thof in ihe per/ormonce o/the work tor which Ihis . q pNCANT�� �permil is issued,I shall nol empioy ony person in any manner so as to become subjetl ta ihe Workers'Compansation Laws. Lighling Fixlures First 20 A�DRE55 - iotal No. Additional Do�e� 4ppliwnt CITY Tel.No. 'NOtICE TO APPIICANT: If,afror moking this Ce�tificate of Fixed Appliances Nor Over 1 HP vERrnii Exemption, you shauld become subject io the Workers' Range_Hea�er�D.W.._ nPatICANT 9erner Electric If1C. Compenso+ion provisions ot 1he Labor Code,you musr forlh- Oven _Dryer �W.M,_ ADDRESS]S EBSt GI'8fld BZVCj. with comply w'i�h such provisions or this permi�sholl he iop �FAU �W.N.— deemed revoked. � Hood _Fan _Orher_ ��TY Corona CA 91719 ra�.N�. 734-3171 UCENSED CONTRACTORS DECIARATION ���N�� C�O I heroby affom tho+I om liaensed undar provisions of Chopter 9 Ofsp. �Room Air Cond. _-. REG.NUn+BFp A853 Clou. (commencing wi�h Section 7000)oF Division 3 0l the Buvness pawe�Apparafus 8 Large Appiionces DISTRICT NO. PROCESSED BY a' ond Profeuions Code,and my license is in foll force ond aHect. �1 . �� U . Siza 8 Type HP,KW,KVA,or KVA2� d" License Number 4a5322 Lic,Gbss C�� �UP�o����� FINAI � ContrucwrBerner Elec. pa�e 9-28-87 �ver 1 io IO lnd. DA7E .�q ov? yALIDATION U b ❑ Over 10 to 56 Incl. I om exemp�under Sac. - Over SO to 100 Inc. BY A�f� .�, d B.BP.C.for this reoson Over 100 v Vv Z Dote: Ser�icez,Swbd.,MCC 8 Ponelboards . 0-400 Amp,Under 6pO V Signature NJl-1000 Amp.Under 600 V ❑ Over 1000 Amp.or Over d0p y Exemplion for Reg.MaiN.Elect. SINGLE FAMILY Temp.Power Pole 8 Appurtenantes HOME OWNER-8U0.DER DECLARATION Siqn with One Bronch Qrcuif I hereby affirm thoi 1 om exemp�from the ConnaUor's License Addnional S19n Bronch t�rcu��s ��P Q O Fl law for�he 4ollowing reason(Section 7031.5,Business ond Professions Code)� �• • . • •2 ❑ I,as owner o�the property,will do fhe work and the Misc.Conduits R Conductors atrucfu�e is nol inlended or oHered for sale($ec�ion Other(See Complele Fee Sthedule)_ 1 • 1 9 L 4 6 JOA4,Bosiness and Professions Code). , � � � 9�4(7�� CONSTRUCTION LENDING AGENCY I hereby alfirm�ho�there is o convrucfion lending agency(o� �Q 1 6—8 7 the perfo�monce of Ihe work to�which Ihis permir is issaed PERMIT FEE (Sub-ToralJ ($ec.3097,Civ.C.). � PIAN CHECKING FEE � Lender's Nome � � PERMIT ISSUIIJG FEE Lender i Address - I cerlify that I have read Ihis applica�ion and stoie thot the TOTAI FEE 191 46 � obove inlormaHon is co.recL I agree to comply wi�h oll Couny ordinanres and Sfote laws reguloting Elecrrito�wiring,ond �-� hereby puthorize represeNafives o(Ihis Cou��y�o enrer opon � Ihe obove-mentioned property for inspac�ion purposes. / SEE REVERSE FOR EXPLANATORY LANGUAGE `���.�tCti`��nr�, ��-8-87 �S�gnatvre of Perminee �are , � _ .. .... . � - , � � _ ��_ �AFcaOva,GS � � OATe _ - �OWNER BUILDER QECLARATION � . SIGNATUFE - " � � p _ ._ . . . -�• �' I hereby a4firm'tho`I am exemp�from Ihe CoMroctor's � . .... ". .. . - TEh,..-FOVJEF FOLE. �- ' . _ . . . ..Licerso Law fo-the following reaso�.(Section 763L5. --.. -- -.. -�� - "� UN�E£5[h6 V.'vRK � .., '' . '.. . . � ; � Duslness cr.d Pro(ossions Cade):Any c11y or munty which ROUGH CQDIDUlT. - �. � ��� �� .. ' .requtros a pormlt to canslrucf,oBer,lmprove.domolish. � .. _ . _. _. . . .._.. . . . - .. ,, . • - ..�or rope7r ony:fructure,pNor fo Its iuuance,olso rc� _._ ..� _ .. .. ._ VJtR�NG � .-- . �< ._ qulr�sJhoappliccnfforeuchpermif}oflieasignedstofo- � � � . � �� -� � � -� � ' ' � menf fhat hc lz Ifconsed punuent to the provislonz oi 4he ..._ _ _ ..�_�-.' . '. PIXiUZcS- - ' � � ' �. Confroctvr's Llcense Lpw(Chopter 9(commencing with , ' PO'JlER AUTHOFIZED . .. . �� -�-�- -�` � � �, Sevivn 7D00)of D(v�slon 3 0l fhe Buslness and Protes- --- ��� � � � � � , , slons Code)or lho/ho!s exompt Iherelrom ond 1he 6asis - ; UTILITY CO.NOTIFIE� ' � .(or the ollegad exemptlon.�Any vlolofion of.Secuon .. __ _ ... . - . FlNAI S - �� � � � ,��]037.5 by ony appifconf 1or o permit subjeu:�hn appl�- . _ _ _ __ _ _ C„�drr oa"�ronl ' cant}o o eA�li penalty o!nof moro than live hundrad vores da�re�:�ssao�.: __ _� — - --.._ __ - � � - - -� , �[]i,as owner of 1he praperly will do t6e work,ond ' � ' � �tho sfrucNre is not�intendod or offerod for solo, . � � • - . - . � _ . , . , , � (Soe.7044,Bustnv:s andPro�osslons Codr, The Confroc- ' ' '� � ' � � tori Lf<onso Caw docs nof apply fo an ownar of property - . � . ;�-� . - � . � who 6ulldx or�lmprovos lhereon, and who does such -- - - � - -- � - - �- ` " - " � work hlmseff provfded 16af such�ImprovemeMs are nct _ ..._ _ .. ..._ ._ . . . � � - - - -, - � - �- ' ' ' - -� " , �intended or offored far salo.ff,however,fho bullding or . ." . .. . . .. . ..'..'.. �...- .'. ..... . Imprwemont Is sold wllRin one year ot tompfellon.-Ihe � - � � " � � � ' owner-6u1(derwltlAavefheburdonofprovingihothedid � ' � �- I � ' nof buiid or Improve for ific purposo of svle.f � . . . _ - .. .. _. � ._.._ _ ; _. . � . ._ - . . . � " I bm exempt u�dcr Sec. , -- -—.. . .. . . .. _ -. _ _ . . . -. � -�-� � --�-�_ _� � . _ _ .B E P.C.fcr Ihis reosor - - - - - - � . , . � .� � --- �Oaie - . , � � Owner � , � . . . �-.