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HomeMy WebLinkAbout1592A (9)tea.. ... - WORKERS' COIvIP$AtA`flf1LeG4�' APP ..... LICATMT ELEC C PERMIT . . [ fiereby affirm that t have a cernfi@ate of consetlt to self CO U.NTY'OF•LO$ AK�GMEV* BUILDING AND'19FETY insure, or a certificate;of Workers' Compensation insurance, or .. . a certified copy theceo c. 3800, eb. C.) h 7� n+Cc3 hL(/vf Mho - - - " - - - -. . .__ FOR APPLICANT YO'•F l -LL fN', _ yam, JOB Policy No Company - EhZ! L-.. ---- t4jfurnished. _.,... .. Newgs &Pools Residential Bid _ .: -.... 1 & -: F7 - T•FamllySq EACH NO. FEE ADDRESS l.<^Gr�Z LOCALITY S _ $ eRtfied copy is hereby _ , . : - •' "" -' - Multi•famlly S9. Ft. - — T �r T. n Certified copy is filed %with the county building inspection _ Residential Swimming Pools. • NE q OR '�%%/-!•:E�. IY���. "'�'�tc_ .department. .. - FIRM NAIGI Date -- Apphcant - W " Outlets: Reed` Light Sw. ( t 44, 1A'AlL S` uwt r CERTIM-ATE OT EX'E'Mlf'1'Id�i �"iC6 A S ., First 20 Total No. Additional ' CITY COMP$NS4T16:'�Cfi•511'RfiN'.`�•µ�M• , „ PLAN CHECK-.-,-" - CAN APPLI. T 5[ (This section need not be completed if the work involved Lighting Fixtures Firsf20 - . ADDRESS by the permit is ,far one hundred dyllats (5100) or.lesa.) - -- r Additional ... .. :.,wN O .. w...,. . ., . . 1 certifv that fn the performance of the work for which this' permit is issued. I shill hof employ any person in any manner ' Total No. .:. � . Fixed Appliances Not Over 1 HP T o. CITY al No PERMIT f�Ez2 N ��G . APPLICANT' �Y. d U •,y r1 so 'as: tbecome subject to the Wrkers' Compensation, Laws. Range_ Heater D.W. _ .... _-•.- - _ - .. .. .- - _ '. ...' Oven :_ Dryer _ W.M. _ ADDRESS 9� %$"-f?.,p'T.C'!yC- Z Date • Applicant Top FAIL _. W H..., CITY �OtiTC.t-H//J No. N0710E TO"AP'�f-I'C 'N f a ter making this Certificate of Hood Fan Other, Disp, _ Room Air Cond— ,Tel ,�- •� - © LICENSE OR REG. NLIMBER',7r�i�4 7 Class Exemption, you should become subject to the Workers.' Compensation provisions of the Labor Code, you must forth- with com 1 with such provisions or this permit shall p be Power Apparatus & Large Appliances Size & Type HP, kW'l<VA, or l DISTRICT NO.' PROLE D BY / deemed revoked. - .. --_..Up to 1 Incl. ... ,......,. _._ FINAL .. .._ .a wk+ r+.>-` Rii Oyer 9 to 10 Incl. DATE T tD cQ p o2 VALIDATIONS, I;ICEN5ED C'PjIN'IiL C FSR$• lOh Over 10 to 50 Incl. - I hereby'affirm that Iain licensed under provisions of Chapter 3 of Busi- Over 50 to f00'Inc- FINAL BY - 9 (commencing with Section 7000) of Division the ness and Professione ode, and my license is in full force and Over 100 -. effect. - .. Services - License'Number Lic: Class -•" r �y^ N x 0-200 Amp. -Under 600 - 201.1000 Amp. Under 600V -... .. Over 1000 Anil or Over 5601V -- Contractor --- -- a vZ _ HOME OWNER" 119t.DER D. E"ATf ATJl Temp. Power Pole & Appurtenances- 5 Ci 2 R Sign with One:8ranci curt._,• I hereby - affirm that I -am exempt from the Contractor's Additional Sign B-ranc6•G°ircuits� #.c a e s 2 License, Law for the following reason (Section 1031.5,-Busi- ness and Professions Code): '- -- - " I e e 2470 - � -- -- - -- - El I, as owner of the property, will, do the .work and the P P .. Misc: Conduits & Cnntluctore _ p "' " ' Other (See Complete Fes'SeYiedul.el— " 2 4, 7 0 structure is not intended, or offered for sale (Section' , ,;. x ° e t=••' 7044, Business and Professions Code). CONST Ri1CTI0'.V_ ,L'E17'biFaG"�aCiiNi•.•,.: . .. _ . . O 2 1 8-82 I hereby affirm that there is a construction lending agency" -• for fire perform erica' of the'work 'Pqr which,thispermit is '' PERMIT FEE' (Sub Total) issued (Sec. 3097, (:iv. C). - Lender's Name - - _ PLAN CHECKING F'EE (One -Fourth Permit Eeei• Lender s Address• - PERMIT ISSUIKI..,,---.,...-T.,...,... J certify that I have read this application and state that the TOTAL FEE - above 'information is correct. I agree to comply with sit County •:- - - - ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this Count: to cmerupon for I spection purposes. ' - - .... _ ... -' .: - - :, ,e.typ�y., ..rn,•,,rmRay.. '.->r "'°�-eD`=^""" '•�" ,F• the ab e -mentioned property e 5EEREVEit"S$'F2Y"R"'E'�4i2a LLUAGF. /�I�Oe� Signature, permittee Da - of .- WNEP-B1J1LD'" TYOti • ? he-reby affrm tfrat-11, amexempt from the Contractor's INSPECTOR'S --€.1Ee:i53''iaw•fr5r• Ilouln A'Ca6Q"r.(Serribn 70S"i. $, the fo ;APPROVALS -� DATE SIGNATURE -_-,. y .. .. - ...-t�11bl:leS3 and �OjfK5iOn8- ['.Dde). Any city Or COnnry TEMP. POWER' POLE which raga:ier a permit to tonslruet, after, improve, : ....' - . '.:..... .._,-.-"...._ . ., ... !<• 'any rrrurture, prrio/to its isuance,demodsh, or repsir " UNO RSLA'S WORK 7 r^s also rite applicant for such perm#, M ,fate a - - '- ROUGH CONDUIT-�' ' ` - r -' i ned statement Char he s kcertsed pu ta+anr to rhe p&,v #ons of the Cont arror :s license Law /Chapter S � fL"" -1 �-g�.— - �oommenctng with- Section 7000) of DlvWort 3 of the nusmess and' Frofessions Code) that he is exentyr 'or therefroa and the basis for rh alleged axepr_. a - POWER-:UTHORJZE D, .. >'+OlariOn Of SCCirOri7011$by a7y applicant for a permit - . 6 -' : sub4ecrs th- apFracarr to a civiP Pmore than enao.V .. ,,..U,TILiTv CO. No - I. .not 1. p' FINAL _... _ ., -' a�iss�2 X7tt �so+r c ..... L as ownero Th • ropert will do -the work, and .. .._. .__. structure is *sot intqgded or offered for sale. S- NOTE.. I3'ec. 77; 4 1ZusTness rind Professinrs. Cade.• ;The.,Cbrt • .. .. _ ri*jorh• License. Law does nor apply to -an owner of ._- ., ^-'- ...., .:• — '� - • --property who builds or impru,>es thereon, and 'vhu does . _ _ . ; . :..- .. - suah -work.hi:irsey pmpided that such itnprovemenrr are intended o ojfeied";jor'saa. If, however, 'rte. - .. --�—' •' - .. Improvement. is sold wilhin one year, of building or - -- - •— ----- ..cempiepo ., the ownenbuilchr w711' hope the. burden ,. ..... ,.,_.' ..-.. _ .....: .._ .. .. .. .. .-. ....- -,. - - _. ...,for se.. rhe oj, pzuving that �he did not build or iJnpro : purpuseot rale.j .: . . . am exempt utiiter'Sec-. $ & P, C. for tris s anon .. ,.Dat@ ... .. ..._ : `Cwnar .. Y VV t , 1 4 , r w+ertmwyt.-. :.w-to+a+.-.�.nn..-r,:.a.^-..?H: rr oM..-.,:..mmw.-nneMz-a:::¢,:4.Lr, .• '' t