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HomeMy WebLinkAbout1823A ` ....._a _. .. ,._�. _. .. _ ,. ,,aX :,�,. u,.. .: ..�R�;,.�.. R`ORKLRS'C0�9PENSATION�DECI,XR97TCSP�� -7Ya6S3�" -'APP�IC�AT14{�i Fbtt� �LECTRfCAI ����1fi��fiy CE-SO6G;2�B0)-' - ..__.. ..,.._.......... ... _. � I hereby affirm �hat [ haoe a certif«ace of�o�sent to sel* COUNTY OF CbS�AII�GEL�S�� � � �t ' BUILDING AND SAFETY insure,or a certificate ot Workers'Co nsation Insuranc^,or a certified cnpy her of c.3800, C.) . . . .. ,,.,._ ..-.. .«��...:. ,.. - �., _.� . p�,y�����J �(/' FORAPPLICANTTOFILL�IN � Jpg FW�� I """"' -"'� � �"ny EACH NO. � FEE ADDRE55~� I � . . . . New Residential Bldgs.&Poois � Certified copv is hereby furnished. 1&2-Fgmily,Sq.Ft. � — � LOCALITY Multi-fafrlily Sq.Ft. — NEAREST Certified copy�s filed avith the county building inSpectior. CROSS ST departme�t. Residential Swimming Pools OwNER OR �j��+� / FIRM NAME DaY � � Applicant-J��� Outlet5�.ReM Light,S�.v._ ADD S F�rst 20 CLR'fIF7CATE�O�F'�XEw315'1`I�b.'�'L7i`O'13�1��"�"������'� TotalNo. Additional C�TV No �1f . C0�9PL?rS�lTf"ON 7fVSL`'�:4�7'�lE"� ������� � } � - PLAN HECK a . . . . . . .. . .- APPIiCANT � (This�seMion need not be completed if tLe wo:k imolved Lighting Fixtures First 20 � by the pexmit is fox one hundeed dollacs (S100)oc less.) Additional P.DDRESS � � � � Total No. � �� � I certify thnt in the pzrforman^e oF the work for w�hich this CITv Tel Na. O Fixed Appliances Not Over 1 HP � permit is issued,I shall r.ot employ any person in any manner PERMIT p so as to become iubject to the Workers'Compensation Laws. Range_Heater_D.W._ APPLICANT Lt! Oven _Dryer_W.M._ ADDRESS � U�J Date ADPlicant Top _PAU _W.H,._ � � Hood_Fan —Other— aT NOTICE TO.�PPLT�;�7vT:�if,-'atter maki"ng�ttiis�Ce'r't'i�icata oP�� Disp. _Room Air Cond._ LiCE O . Exemption, you should become su6ject to the Workers' REG.NUMBER � lass Compensation provisions of the Labor Cotle,you musi fortn- Power Apparatus&Large Appliances DiSTriICT rvo. `" � � PROCES$,gd"BY��� � - with comply w�ith such provisions or this permit shall be Size&Type HP,KW,KVA,or KVAR �� dcemed revoked. � �Q Up to 7 Incl. �'��Z FINAL LICESSED CONTRACTORS DECCARA'I70N -' �-" Over 1 to 10 Inci. DATE � r�Q pa VALIDATION Over 10 to 50 Incl. � d ' �� I herebq affirm that I am licensed under provisions of Cfiapter Qver 50 to 100 Inc. FINA�� 9 commencin th$ect+on 7000 of Divisian 3 of[he Busi- BY � < B��� ) Over 100 ness and Yrofessions'.Code.�and my license is in full force an� eftect. �/ Services I License Number-�i-�/—�/--7--�ic.Class „ 0-200 Amp.Under 60D V �/ 207-1000 Amp.Under 600 V Contractor�_ .'�_ Date_ e�/% Over 1 D00 Amp.or Over 600 V HOMIL OWNP:R-Bl71I,D13R D�CLi1R�'7`POTS'���A�����-�������-���� TemP�Power Pole&Appurtenances I hereb� affirm [hat i am�exem t from tlie Coafractor's Sign wiih One Branch Circuit k � Y P Additional Sign Branch Circuits �t �2.��i Licensz Law for the following reason (Section 7031.�5,Busi- ness and Rofessions Code): t�.�'o e o c o G � Misc.Conduits&Cnnductors � I, as owner of the property.w111,do the�vork d the Other(See Complete Fee Schedulel—. � a e a g,1�u� structure is not intended �ir offered��for sale �(Section ?044.Busineas and Professions�Code).�� � o e o -�� CONSTR'UCTIOTv�LEN1JING i1GF^.�Cl'�� � ��� � � �9' � �" I hereby affirm that there is a construction lending�agency �3 1 � �c�i,2 for [he performance of�the�vork (or which�this�permit �s pERMIT FEE (Sub-Total) issued(Sec.3097.CiJ.CJ. � Lender's Name . - PLAN CHECKING FEE (One-Fourth Perrimi4 Fee) . Lender's 9ddress I � PERMiT ISSUlNG FEE I certify thet 1 have read this application and state[hat the TOTAI FEE �C above information is corr I ugree co ply with all C�unty ordina and State u•s regu i g ectrical wiring, and here uutl orize repr e ve of ounty o enter upon [he ove- entione r y or tion poses. � - - - ��..-•��.�.��-��-��_-:.��:_--•.�.:;�_�. ......:.........,.,.....,..: ,.-.,..:....«�.,,.z_:._.. SEL:�REVERSE tOR EXPi.ANA'1`OT�S'"�,A:V�liAG�� � -//'-���.----� Signature of Permitt llate . . ,?ddh;�'PZ-s�t�'8f.�3�iZ IILC��Et.�i it3i°] `:.erF:;�::Pfrhi y:ai i am e:eem�x fc�m the Cor.irsc?or's .. . . , "z . . . � - '4 .� .��� r. aLir�r."7l�3i._;. .. i �, �acv,��s { , ua�t I Ns�r7cR-s ! , _ c,. x +e+!rssh � . ,.. o ''\:".. _ . �.•�" � --------�---� _ { SIGNATURE�� . .. . . . . . . ' ��,...:...n.e.rS m-.-rYo"�e3 � . �,.� ' � '.: ; � �4� .�nae� � .:> c.ry�oY catrnr'r , . ` i �v�r� ov�rFst�Yi;4� 4 . : .,,r,.r ,•e ires i Permi� ;o ^oncrn�cr. alter. srayrove, ��' a�'`t aa� �: a, . . ,''�� �`- -� - --�----'--�.- -- . . . riemoturt, or'rypair any strur,rvre.pr:r,;•ro ts�d �encn. .•.,� •� �IJ ti�ac3 VV(.NK . . �... . �_. ... . � ... . �. e:sv rryurrss z;�e a pt�cnr.t Ju� surn per>n�r ro�E7o c G . . . aOU�H�O�aU7, � . _ .-�� � . � ,•E��?;� s;�t�vr.erzt�ihp; �l.e ;� trrdr.sea pur,l�arf �h:he ' , , -,"�, � ,.... 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