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HomeMy WebLinkAbout1047A (5) ;, _ .:,. . ..�.., �._._. .., _:- :.� ._:�, .,,�- ,a:���.,� .�.�� .. , ;_. _ ,. ... `4'°RKERS'�°`tpEuS;,�°"�Ecti�R"T'��"`�� �6A6�' APPLlCATION FOR ELECTi�ICAI PERM_IT� ,1 . � CE-SO6G 1280) I hereby affirm that I haie a certiflca�e of consent to se�r. ,COUNTV-OF�LO��AN'G���.��5���y���""�-� �� � BUILDING ANp SAFETY {� inaure,or a certiticate of 1Vorkers'Compensa�ion Insurance,or ' � a certifiad copy thereof(Sec.3800,Lab.C.) '" � � � � � � " ' 1 � , ..._... . .. .« .. - - � , , . � FORAPPLICANTTO�FI�LL�1�7`� , � ��g )636 DER&INGER LAN� .� Yolicy Vo. Company' EACH NO. FEE A�DRE59` , � - � � New Residential Bldgs.qg�Pgg Is - - � Cer�ified copy is hereby furnished. � 1&2-Femily,Sq.Ft.J 111�'�i 5 s t — 5 LOCALITYTHG �1 �+71 � O � . - .� . . ..- . � Multi-familV Sq.Ft. — NEA.EST . ... . .,. . .A...,. � * _. - '- Certifiad copy is filed with the county building inspzccion CRO55 ST ,,. , depurtment. ResidentialSwimmingPools oWNEROR' �.�� �� T 4, fLL =�� Y: GARAGES �� t� $,75 13� 9. 75 FIRMNAMEpIERMAE�T�E H�1MES INC. w.. .. _ __.. Data Applican[ Outlets:Fec.�Llght,Sw._ MAI� ' 3320 BREA CANYON 80AL � . � � First 20 � ADORESS .. . CER'C[i'ICATE Or�EX��fP'��1��.'"�'�O�'f"4VOR'ICE:�S'"`�'��i�- Total No. Additional aTvDTAMODiD BAR Te,rvo. 14� 4— � COM11 PE V SATiON�I�SU RANCE� - ' - PLAN CHECK a ' APPL�CANT O (This section need not be compieted if 4he woxk involved V hY the permit is for one hundred dollazs ($100) or lessJ Ligh[ing Fixmres Firs[20 qODRESS � , . . 1{ Additional 5 �4 3. OQ - �-- �* � I czriify that in the performance of the��•ork For which[his Fi�ced Appliances Not Over 1 HP CITV Tel No. � permit is issued,I shx1l not employ any person in any man�er ' PERMIT B�Q� E��i`(�"j�IC y� so as to become subject to the�Vorkers�Ci�mpensation Laws. Range_Heater_D.W._ APPLICANT _ p. �.(16/84 DOid "i'. HF>OFFtil Uven _oryer_w.n4._ aoortEss13880 SPSOKE TRfiE`ROt1D R~�W� � Date ApPlican[ . 7op —FAU _W.H.._ � . _��.. ...M� .. �- ,_._,_,;., , . Hood_Fan _Other__ c�rvVZCTCRV�LLE � Tel No��- • � NOTICE TO APPLIC.4TV'P:�If,�after making this Certificate of Disp. �Room Air Cond._ UCENSE OR Exemption, you should becnme subjec[ to [he Workers' REG.NUMBEq2�OPO.3 . ClassCl�+ Compensation provisions oi the Labor Code,you must forth- POwer Apparatus&Large Appliances DISTRICT NO. � PROCESSED BY� with comply �vith such provisions or this permit shaJl be $ize&Type HP,KW,KVA,or�KVAR deemed revoked. �l u�h� UPtotincl. . -. ... FINAL • ' . Over 1 to 10 Incl. DATE 7 LICE�SEDCOTI�'2ACTORS�DECL�RATIO\ '"� ���- �� Over10to501nc1. �/aa'`f�� VALIDATION 7 hereby affirm that I um]icensed under pro��sions of Chapter Over 50 to 100 Inc. FINAL 9 (commencing with Seetion 7000)of Division 3 of the Busi- Over 700 Bv ,��,/�� ness and Professions Code,and my license is in fulf force and �" '- '�� effect. Services 230203 C1� 0-200 Amp.Under 600 V � '� License Number Lic.Class BR�WN �.LEC'f127r 1r�.47$� ZOt-7000 Amp.Under 600 V Cnntracior "13ate 6ver 7000 Amp.or Over 600 V HOhIE 0�4'NER=BtJYI.D�12�5�C-��.�RP.��T��N�������� � Temp.Power Pole&Appurtenances I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit �,� D�,7 A License La�u�for the following reason (Section 7031.5, Busi- Additional Sign B�anCh Circuits ness and Professions Code): �j'.e • c e •'� ' ' - Misc.Conduits&Cnnductors � [, as o�aner of thz propertp,will do the work and che . Other(See Complete Fee Schedulel— � 0 2 C Z I J � str�cture is not in:ended or offered for sale (Sec[ion � 7044,Businese and Professions Code). ° °�2 7,7 3� CONSTRL'CTION LEN�INC AGENCY �y I hereby affirm thnt there is a construction iending agency - O�I.�"�i"8 4 for the performance uf the �rork for which [his�Vermit �s pERMIT FEE � (Sub-Total) � Z��7' '�$ issued(Sec.3097,Civ.C.). Lender's Name -" ".'""-...""""`".'".•." pLAN CHECKING FEE (One-Fourth Permit Fee) �z )�j Lender's Address - , ' pERM171S5UING FEE �� �' � � � �O S� I certify thaf I�ha��e read this application and s[ate that the i TOTAL FEE 5 aa7 �� a6ove information is correc[.1 agree to comply with all County ordinances and State ivws regularing Electrical wiring, and - � - �- �on entatives of this Countc to enter upon the by aut nFize re res ty for i spe ' . �x...:.:.� -,.....,..-,..,�.<.�,:,:,...:....,.. ..�. .. p .. . . _.___..�_....�,........,��-�. ......,r: T�,, f�,�s�t(� ��$L} SEF-REVF.RSEFOR�LXPY,:4N?.`Cb`[2�5�'�L:\N`C1JAG�E����V •� � -...:.... ....:. ............. , J� � . . . . . .. . .. ......... , .,. . . . . ._.. . . _..._.. .. . _. ignature of Permit Date , . .. ;«,+.�e ..,.,*z"*.4N.'t . � :�aY.��. , . ... � >v,v-:.•��� ..t,� "+ _...... . _....._. ......., . ..,, . ,_Y- .;..� .- ..; �ry.::... . -;,� .ae..�.e....-_� , . Qt'd':`:�:a-ii"s.ili's`i;�t,�3E^L9,/xRA�'[�?�! E�creby a:ttxm tlra:S nm��empt;xom ihe Cnntsac±or.. � � � �� � �IN3PECTOR'S 1 �.:CeIIne s r� i�r ti2e fcii�w�tne,casoa�jec;ion 703i.5. APPAQ.Ja�S DA-E I � S'✓.5[ness a.[1 I:�oi¢se(Dats C .. �l S1 R4TURE f -. vG`2J. -3ny crlp or :�e�retv . .. . . , . �A.POW_nPOLE �� . .... . �. . .. %JkiCn req:�ires Q F'PYiYltt -'O EGRS[:ftC7. GfPEY. 'ei];rlYp6'c'. . . . ' -.:. �-. -�--� '—� � �eenotis•n,cr repcer eny s�ntcrurE - r � aseunn�e. - � � - UND�RS�RBWORiC E . , ISO YC uiYeS t.h2 G �fF'an2 �_� _� � 4 , rP ra sucF pa�rr z o fale e - - Roucsi cocv u�� �� ! �/ ��'��- . fnna atatem.enz tra- ne �-:: � �xrsuarr ro rhe . .... .. . -—�(a:�Cr i� �/ - � ..ror�„au oj the Cana eo��s B,i�.t�.c,. .aw j(.�tapter G IWIRING- �_ J' _ __ :rommerecrrey, with Sert,or. i0�?Z�•o�Dia�is'on 3 cf tH.e .. . '_. � t'�IXTURES �-�- . v j r3usiizess cr:k ProfEssiuns C.ode; a' i�at nn is i�Rc�r:�r �'i ... . ._' - . '--.'------�— ..---_.--j--.—.--�. .. .. . . t�:ercj,n�:r�a:a3�e i�as�is j'o;;he clteged a;:er.n�tioa..a:?� . IPOWERAUTNORIZEO , ViOi.!['OY'LfSCCPiGl.'��037:�Shy'a=ay�ienp?i��n.iorlperf:aiz i -' sMbjeers rfre appticar.t ta c civ?i t�er.aity ofnor wnare zFen i uriirrv co.Nonr-iFo i � i . f�� -- five hw?sired�otl�:a j55'J�).: . �FIIVAL.. .Fa�Y4.�"/��GJL��2� e � ' � � , �,°,...'4tl're'cf!he�pro7er{y a'ill dG:11t;tt'O�n.::nSi ' � - ' , [fi'$�'aU(;Ci1LP iS:l(DT i11Yi:11Q1`li Jt.�i4SC�C4:OY S:it;. � Nores � ' ' - - - !Sc-c.-��Y.,�z�stne.ca and°r,nfn£siotxs Code: The!'on- � ..- , . . � � ,rccrar:r.Liczrse LUw does no:upply ro an owrer af --- , _ _r_ ,_,_. — . .. . -�--` proyreriv wlic>triiais cr��ryrpue9 thcr�eun,oitd K�f.o dors ,..- ... . _. serch�;wbrlc �F,inzsel,�!pr�:idzci .hat s�ch ir;rpF:iverrerris ., .-.- .- ... - '�---;""."^ . � . -.,.,.., '- . --� .- - - - , _ .-- are.nor inrenceu m oj,+e;ed jor sala ij, hawr.;e�, rne �- � � �»i�dir.g or improverriesit 's �old wiJhin one yecr n; , .. .'.". � '--'—�-----'— �or,iufeaierr. !iec a�.ner�o::iFder x�r7. iaave (i+e, buruen --'- �----`---- ' . .,.. 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