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HomeMy WebLinkAbout1369A (7) lVORKERS'C014PENS.�fi1'[01 D�E�L�RATI6h' 76Ab6� � }'�/�,'{ -/,��c=� ��-- � --� - -� �..: : ... _:CE$06GPYZ$b�I ������Lf11�O���� ���ML� �� i heceby a£firm�{fiat I ha��e�a cerpFca�e of consenY to se7f ' COUNTY 0�eDS Al�1�EL�$ �� '� ��_ -�-' �� &U I LD(N(i ANT3 S/aPETY� insure,�or a certificate of Workers'Corripensatiori Insurance,or� �` �- ` -" � - � � - � _ .�.,. . . ___. ___ _... . . . _ ... . .. .. . a certified copY ttiereof(Sec.380a.Lab.C.) . . . . . �-._. � _._,__ .:.-_�. „„ ..,,. ...tl,. �,...�,_ ,:_��T_,��-_,__ ` .�':' '- '`- ^" _"' �`='� � �-` ` `�� " :�: FOR APPLICANT TO-FILL IN. . . � � - ._.-- . .. .. . . -� Polic}�No ComPan3 � .. - . .:. ..__.. JOB � � � 7 T � � -- ,.�s New Residential B�dgs.&Pools�--� EACti n10. FEE - ADDRESS �O`� y��Jp/��'��. ��� � ❑ Certified copp is herebl'furnished. �-� � , -�� 1&2-Famity,Sq.Ft. -- - � — S LOCALITV pj � Certified coDY�s filed with the count buildin �- �- Multl-famdy Sq.Ft.� � � � � . EAREST �, . � � �j./ _ y girtspection i - CR053S7 � department. Residential Swimr»ing Poois - - OWNER O_R � �� -�� �� � � -� - - PIRM NAME -- 3 Zd�.�. G•(f' � . Date �Appl�can[�.. . � , . �Outlets:_Rec.�Li9ht �� Sw.� � .`jcN1AIL �. .. . .:- . ... . . � ��� ' - ," -� Frsf�20 � � AD➢RE55 � � CERI'ITICATE�OF'�E7�Iv7P't`fp�1V�FYtO�M-iiTrO"R'f{�R5`���`- Total No: -�' Additional � CITY ��'- Tei No. � L i. `} CO:�SPENS.4`(TON INSY71FdNCE � ' � -� � � _ . . �J- / . ` ,..' .: :� . .PLAN C . . �ya . '� ' . - ` APPLICANT by the pecmit is £or one'h'mp�et'e�it�tlie'�voilc—mvo�ve3.' Ligh2ing--Fixtures Firs2�20 �� �qDotiess- � O � This section need not be c _ _ undred dollazs(5100)-or tess�� .� �- �, . . � � � �-� ' - Total No.�_ Additional � -� � � �• I cer[ify that in tfiz performnnce of the work for w�hich[tiis � - � - CITY ' � �Tel No. � " ' -- � � F�xed Appliances Not Over 1 HP- - � permit.is issued,I shall not employ��any person in any man�ner PERMIT �-� -- -� "; � V � so as to become subJect(o . 'Compensati0n Laws.� Range-_Heater-_D.W.!.. . APPLICANT �. � �� �� . � � -� � . Oven`�_Dryer-W M. �_ �._ . . .__ . . _ . _ n- _ � . :� . � ADDRESS - � - U} _FAU W.H D3ie _ � Applic&nt � . � - � CITY. - .. Tel fVo. - � _ � �� � ��� ' ' Hood—Fan. �..f�Other� __ . -- � - � � 'd07TCE 70 4PPL3CAT"f��`f"'after makmg tfiis CerT�ii`icate o�" Disp. Room Air Cond._ (�J LICENSE-OR - Exem tion . . . . . - - ._..:_. . .-...._ p you chould become s�be�t to the^4Vorkers..� - REG.NUA%fBER �--- "-`Cias's � »,_,, C&mperisatwnpro�asionso�'t�ieLabor`�o�e oumust#o'�t5� Power�Apparatus&.LargeAppliances DISTRfCTNO. -"�� ` ��""` PROCESSEDBY ��- - with comply with-such provisions or tfiis permit sha1C�`be-" - �- � - - - � � - - deemed ievoked. '� �� ` -� - Siie&Type HP�,KW,KVA,or�KV(QA _ ��:. � � � Up to t IncL �� l.c�LCP-�•�� �.. , ` _ .: � FIiVAL � . . . Over 1 To 101ricl.. _ - DATE �'��/a � VALIDATION LICENSED CONTR`>CC'TDR'$�b`�Cl`A`tY'eC7'[d'�f".` "- . Over 1Q to 50 IncL� - ( - � --- hereby aff¢m that I am ticenseiY under pro is�ons of��iapfer-F� Over.50 to 100.Inc.��� FINAI. - � . - 8Y� � (camm�ncing�v�fh Sect on 70210)oT Divis�on 3 of tfie Busi . Ovee 100 � �ess and Professions Code,and�my ticense��is in full�[tirce and� � . - � ffect.-.. .. ._. ._ . .., ._ ... . . ... . . . .,.. �, .,.' ..... Services`_. . � � �- -_--- 0.260 Amp.Unde[`600 V �-�� -� - , License�umber -- -L c Class��� _ 201=1000 Amp.Under 60D V--- � �- . . � . _..,; �.�.,; n_.,.>«.. ,� ,_ -,. ..� � _- : - Contractor �� -- Date � rt _ Oyer�1000 Amp:or Over 600 V.._�-_,- - HOti1E dti4"'3ER$"L77;i5�'K"DECC:Al2'�"I"Y"OR.�;.:�.",Y_ _,.. . . . . � . Temp�.Power Pole&AppurtenanGes-'� I hereby��affirm ttfat 7 am��exempt�from�-{he Contractor's `- Sign wiTh One BranCh Circuif,- - - . -"�'_ �- Additional S�gn Brancfi Circuits Licensz��Law for��[ke followmg reason(S,ect on 7031�.5,Busi- -- -- - - - � __ _. ._ _.._ . ...- nes5�a71d Profzssions Cod'e)i . . -� . ---� - - - � � -' -` � - Misa Condmts&Crzntluctors - - - �' 3�4 A i,as oxvner of�the propeii .w•ill do�[he �ork�and the- Other(See_Complete Fee Schedule)— � _... _. . structure is not mtended-ur nffered'fot sa(e�(Section � e-��� • � . 7043,Business'a�d Profe`ssions Code).`� �-- - - - - - �� . �- -- . -� . - . �f . .2 � -' CONS'C12L'CTE'6I�7�EPll'�N`�'.iiGEIV'"CY'.......: .._'.. . . .. _ I hereby�affirm t6xt�there is'a constructiort tending agency -�� j •-°�v 2,v� . for the�performance of the �cork fnr u•iiich this pe�mi[ is��- pERMIT�FEE --�- �-- --15u6-Total�--� � � � o.o-e,,zj'Z,3�� issued(Sec 309"7,"Cic.�.). - -�� ��" � �� . . � � Lender'sName ,� PLAN CHECKING�FEE (One-Fourth Permit�Fee� Lender's�Address �� � �- � . Q�:C�''..-8 2 , . PERMIT-ISSUING�FEE � _ ��� " -� .��J � e I certify that I have_read this.application'�andvstafe�iFiat tlie �TOTA�FEE � �- �� � � x � ' � bove informanon is correcT.I agree to comply�iith a1TCoimty : � . . . . . .. . , __. _ ,. _:.. � ordinances Snd Sthte [aws`regulating Electncal wiring, and �� � � - ^ - . .�_ � ` --- " _` �___ ._. , _.. _ _.:- - ::. ... �hereby authorize�representatives of this Courtty�t'o�e�ter upo7t - ' - • �- �- -� - - �ea ementionedprnperfYforinspectio�-PurPoses." .. .' ` - �.. ` �. . ,,;;: _3. :_;,. _,.,�._,:__ . v_, :-...,_, - fi - -� 5EE REVERSE FaR EXPCANt�T072Y Li�G�A��""" � '-� " " �' .M'���LC` i�✓✓l��-C''��"�� /"wZ,�S'-r�".�u _ . - Signature of Permittee �� Date- :� ..�__. . �.... .. ..-_��- ....,r ..... .. . _ _... : , _ :,, � . .'_ k . '. -. .: " , .; . . .... � .. . --,.. _ ��3"JtIE12-��'g�13EF�DEi�.hR.�T'ia'ii4 - . . - - .- . T''�� .��. - - � � � . � � - - -�7 heteoy�a.87mi.thaf L�ar,a esempY�f'ior the.6ertY;acaor's.. . .. _.. APPR�VA�S � � DA E —�'���PEC OR., .. ,'.ic r.de L3w�..oi Yhe fo,laz5mg reason/3e iea°� ��13. � - , . S,GNA7JRE ... Eus nz.,s and--Pr�)esc¢cn� �rule)_.rinY cny r c�anty .. TEMP PCvvFR-PO E�� �._ T _ wn[ch re�uires n Oe r_it zo eensiruct after �irrp ov'z, � �. -�� � �2YP1DClSh GP Y2P¢iY HYS'.+'Zl'GC'2dY2 p."I�J 3Q!IS IsStL�C�', - ' - - UN�Eas�as woaK � � n . e;tra r Gta�.Zse applicGnt f r s�r.h per»ai; to j%1e�-a ' ��J• �� �_.nec statastienr Phcs�he rs tz�en�ed ur uor.i- a-:l:e '_. x:: .�. R� CsUGry CONG+.�°T �F�-5.�9 � I t�J�t'�(L '; S P .:.. _- . .-,- . .� . � _ — '" .� . - liovxrio<s of��#.ke Pnntr.eciors Lacerrse Lctw(Cna➢te:4 : ;.s. -. . .. � - ;. �:� - - . � _. ... i N.RihG i ., .-. . . . . . . . .. . . ,_- ;.� ... . , ..,co.er�e�s,.�r.g.�we:n.�ectiwa.7v"�Oj-os`Devisien:��oj-t1:e - �,_. . . .�. -__:.. �'i�xTUr't��S`.. -._ I�.: ' `_.-_..; . ..?.� '.__ , . . �.� .. . �3usz e�s ara�-Fro es�i�ns �fo¢eJ cr tfat he�ia--exemp¢ . .._ . ,: . - — � - . . . , -.;,� .:. _ -.... .. . � -�rtizrefm i cnd+h�@asi;�`fi�r the_a?tezed exe�r--tio=�.-Arey � . : ..�, . ...._.._: ._ ._ :�- . . . ? ... . . �..Pew�a.aU�wGa��ZE o � - - � . . . _ �io.c<<�n o,�Secttor 7(137.S.bj��a,.y rsp�tFccnt Jo-a permir- ,_.. ... .. :,' ' . � � .--i . . . . . . . : � u��LiTY co.NOT�FtEC ! �. � �� � . s.e�Ejects tN.e apgticar�t�ta a cevil penqit�of r.ot�nore than� ;_ -. _..... .. --4 . - _ � j$ve f�rr r.r.d dofta;s�/5500 _' � �. .- ,:_ .._.. _.._ ;.. .r Fitvs�� :_._.. .�'✓�R�i- � �:�!-.•� ._ _ -j�' . .�� . �- G�F, s ti�a-[!ec o:t;ie�pxoPe-rY iti?i do th:wor5,ane.. . � ._ .- .,_. ... _. . ;... " :_rhe atiucxu:e.:s na:intended oz oF}�2.•ed fnr sale.��- . . ` _..-_. ._.._ _.._�uOTeS --.. . .- ' . . � . . . �- .�' .�.(ee: 7044-.-Business pnd Prose.esiiins C'a�e; .:ihe�'on- . � � . . . , - . �� . '.: � : �. . .. �. -.-r�;act�r.'s.l.icen=e L¢wrrloes iru•_a��pfv to.a:.�ox�ner.:af - `_... �. .`"'.; . � ....�_ __.... :_. —�----._ .. . __ . �pzc z:z�w�re�pvesv��o:=.np;oves:thereon;an.d x:hs does . . .._�. . _:_: .. . .._.. _ . . . . � � - . . � . . �:....-r.ee� wt�rk�..tzsmseif ;iravide� that.stPr im�ro�emer.�s ':_ . ..._. __ __.. � .� . ... _ . . . . . .- .:,:. .-- — .. ...:_.� . .... —. _ �.-.,.-- ,.:.. . .�.-.._:. ---:are.^�z-inxence��:.c7fe>ed'�;o>suie.-3f.-hewever.'i&e .. - . . �:�� � . � . -� ; - � � � � 'nuildirg e� irnproiemeni.:�i.P sold-�w+ihir� ai�<-:-Yecr-:o; �. . . ... _.._. �,.�... ..� ,_., .. .:� .. _.: _ _. ...., _�,�......� _._ ._ . . .� .�....corr��ar,o;.;-�tn.e owner.our�der ri�d r.ave fhe &Nrd2-r ': _.. :`_ ....... ,.�: . . . _„__ .. .,.,, m . . . � . . . .-- .-:-_-erf�r:�•vrng.-titnt Cte did.ttor bu,'i�'-or i.-npra:�.e_for.th. . ' "� _; �� . ..:_ , �.:.... : __.___ .�__ ._._. . ..„.�___.,. . �.,.,,. .,...,, .:.�._ .A ::. >:. ..;pactpoae���:�ate.) . . .. _ .,.. :_. .. < ' _ ___ --_. _ ,._. � , i sm exempt c:rcqef�:d, __ `' . _,., ,x,_.�,-. . , _._ _: � I N 2:i.:�r t?tis.easar _ , ;�a€� _., .__,..._ . _.,,.::_ �._.,,._._ �_�_ .__ _.,...-...�__. .,.:_, v�,r.�, � _..�.�_ — -_:_ . , _. tiw n�;� „ . . � --______�.—�.� — � n`: . , :�- . . . . . .,. . ;. .. . .... . :'� � . _ � „ -�, . . . . .._... .... _:. ..... .__.,._:_ _.-- - .-.>. . . _ . , . ,�.,. �;- .. . ... . --- , � - -ri...:_.,_..�....., ....„�...�-.,=.�,,..s..r,�...,�_-,.., ...._..� . .. . -�� . . . . . _. ..._.._.__ ....._,...._. , __.._....._. _ .�_:_:..,.,,..,�...a..�,.:..__..�.....,.�....,;�:>��.�4::,.+;rr._,a�s,..s-.�.;.,. � a,�,�.-a;-.H..�