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HomeMy WebLinkAbout0857A (4) :x1z"' s. 9 `' : � . � , 4 M1.,.'S':i^ . . � , .:._ ..r �. ._ Y' � ,` -.. ! E � WORKEkS CONiF�ENSATION DECLARATfON ' Y6Jib�3�-�Y'0 el � i - � -��� � A►PPLICATfCJN..�O�t�_�LECTRICA� PE`RMIT � � ��- , � �I hereby affirm thaf I`hove a certificate of consent to self � ' , � � , ..,�.....,_. .,w.�,_r ._w,.....�... ,N�-»m,.a-,m :� �...,� ` 'orsarcer�f ed co�y thereof Sece3$00 Lab �,n sorance, �""�"�`.`""'��'"" , . Y f p Craompen �o C�UNTY,OF"C��%1�f`,��'�54"" �UICDII�G AND SAFETY t ...,,,.� ... , .. � Cert fied co is 6';, ` �.. .. FbR.KP'PY�i.'AT71�7�,S�FiTL•�IN"�„'.•••_.•.••.. JOB� ._'.•� .. ., . �.:� p Pofic No. C,om any�_ ,� , �. , ApDRESS a , �� ` ����"'� �"" ' EACH NO. FEE- py ereby furnished. _ New.Res dential Bidgs &Pools � "� .�� . . .-1&2-FamJ S Ft S �� — 3 LOCALITY " y[, t Certified copy is tiled with,ihe�touMy building inspet-�� � Y� q �-� 'NEARE57 ' ' ""' �"" "�� "�- 4 � tion departmenf. � Mulii-fami,ly Sq.Ft .� � _ ` �� . ���- � � . .,_ .: . . . CROSS ST. . . ) { ResidentialSwimmingPools OwNEet�R ������� Dpte..7��✓T Appl cant . _ FIRM NA E -� CERTIFICATE OF E EMPTIO FROM WORKERS �. . �`�'Q���� � „ , _ � -, ,,.„. Ou11e15:Re[ �T_Light_$w._ A�DRESS . � �� r ;: C6MP�NSATlON1��2�C�E" �„ . . -- . _..., � , - ; ... u, �. ,,. d. Pirst 20 . . . . . h�s sectlon��neadmh9t 6e complafed ii f�e woJ�f.nyolved by �. "Tota I No � CITY� Tel.No Stj � S"J �,:;�,the permitis for one h�n�red dollan.(5100)or less.) �����. . - . -.Addrtiongl� , , . .; �FLAN�CHE . � ..--,�.�..... � I certif'y ihai in the perfof�ripnce o�,;ihe woik;for wh c,,,,7.! �wls��,x �, . . APPIhbA.Y ' � - "perr�iit s issued,I shall nof employ any person inpny manner . e ' . �-.� "�'. � """`�' '�� �`�""' � ers Compensat on Law;�. Lighting Fixtures-� �.-First 20 ';.� � Ap�RESS � �.:: Add Y onal,� � ,..,. ._... .._. ...._ .__....e........,.,, so as to bQcqme sub etYto the Wo�k:: ., .-' .. _ ' . .. -.:. _ _ - a: � ... . .,: A R .. � .,- c� r , ; >7. . . � � Total No CITY Tel No. _ � Date �� Applimnt �;, .:,.,. Faed Appliaoces Not Over 1,HP � . MR �'� - � NOTICE TO AAPLICANT -If after mak ng this Certif cate of Ran e_Hepter_D.W � P���'�T 9 � ._.,. . Exemption, ybu"sKoV(d'_FjeG,om,e,,,sub�ect to �he,Wo�'kgr_s,., 9 ��.� -"-� -� r� Compensation provisions of the Labor Code,you musi fo�ih- Oven;—�Dryer ._W.M ,,,.,,.�. ��ADDRE55 >�� ` : with comply:w th such._provistans��or ihis permrt shall be �Top _fqU �W.H - � (�(�/a•�D , � - CITY� � Tel:No 7 � deemec�rev„oked Hood �Pan _O}he � � . � � UtENSEDCOf„`(TRAC70kSkDECLARATCO✓Y�! � N�- � "" LICENSEOe y �y ` � " � I-,�=�� � . , ^��s�.oc?#� a F �+-� �Disp _Room Air Cond .REG:�NUMBER m��r 7 � Class.�� �w, � I hereby aftiirn that I am licensetl under provisiq��;of Ghapter 4 � �- " '""'�� commenan"w th Sedion 70D0 of�Di is on 3�o,f',the Business„„, - RISTRICT Nb ��� " PROCES$ED�Y . '� d d Profess ons Code and my license s n full fofee and e4fect Power Appprotus 8 Large Appliqnces . - - .>.� .r� l�a :�{% �0. : �� �' ' � /'' ' � ��Siza 6�Type HP KW,KVA,or KVAR � V License Ny�rt�ber �,_L c Classj-,`'�,�_�. .�iP to 1 IneL . FINAL ..�� . .' .... `.. ._Ove 1 t9 l0.lnd � DATE '�: �; �� VAIIDATION � �`. .__ ..: � � :-� � o � Contracto - . . � �D4te ...:`�.�/ ,,. �. � .O e 10 to 507nc1 ... FWAL � ! . � ..-:.� � ❑ ._. _� a lame e c , .Oer50to1001nc ,,, . BY � ����jL �� . � :. � �.. �:� Over 100 - i � . ,... __...U„_...._..._.._... B.&P.�C for this repson HI . .. � ..._..-�-_....,_ .. ... � f „ ' - .,� s ." Services $wbd.,MCC&Panelboard ��y.d � E" �. ��� ' �P1e a..-p-�.� -��,.-� 0-200 Amo.Under 600 V ., � ,::•. ...., .. • .. Signature ..:_. � ,.�,,,,,,�,�.,,,n".� ... .201 T000'Amp Under`600 V .:.: ....... . '� ' � ' ` '�Y . Over l OfJO Amp.or Ovec,�6D0 V � � ��Exemphan for Reg.Maint El�ct � �❑ �SINGLE PAMILY .Temp.Power Pole&Appurtenances, � . . . � � , Q y � . - HOME�WN,ER 6111LDER.D�CLl�RAYION „�- .S�gn with One BFanch Circ�i? � �. �`G��:7 A E I hereby affiim ihaf I pm exempt}ram the Coriirqctor s�icense,� ;Addivonal S�gn�$ronch Circu�is � �-o-m.a �:•2 E � Law for the followmg reason(Seclion 7031.5,.Busmess dnd, - � � .�professions Code)� , , _ . . ! e a 2�j,�j Q f'—I Misc Condu is„&Conducfo[s . o � LJ I,as o ner of ihe prope ty,w II do the work and the , e L��(�� siructuie is not iniended or offered for saTe (Ssciio,�i_` Other(See Complete Fee Schedule) � _ � ' 704A,Bus ness and Profess ons Cotle) . _, � � � �.�.Q[�-�`�..U. . , � ��C6NSTRUCTION IENDIN�AGENCY -- .�� -� :. (( ��.�. g ���I hereby affirm that ihere s a consiruction(ending agency�or -- �-.- .,.-:--»�-� ,.-..,.,�.,„, i, the performance of�the_work far wh ch th's perm���5 ss�ed PERMi7 FEE �. . ..� (Su6 To�ol). r ` � �� .._....�m.. . . q. (Sec..3097,C v.C.J . � . . i .: '' :. . . �� .. ,; . PLAtJ CHECKING FEE .. . ._. � . � . 'le der's Name � � � � � � , � � ...,��. .,,...� :'. ,".^,"'"":� PER/�AITISSUING.PEE _ ,.»,r..� �� .. . � . . . . �Lender s Rdd ess , m,� I cerf fy that I have read this applicat on and�state t ati��t e p T6,TAL,FEE ;. .- �.._ � . _.. .. I above information s correct I„agree tocomply-wdh oll Coanty `. ,."""" "`"'°'�`"""°"'" .... _. ... .. . .... . ..... . . �ordinqnces�pnd,$tat,e,lo,ws eguldling Elec+rico,l w r nq, and ��5 a " � .herebyaufhorzetepresentahvQsofJhis,Cpunty�toenterupon' � "' `�- �� ��� ' � "" � the above-rpent o,nPd property or inspection purposes SEE REVER$E POR,k7CPLANdTORY LANGUAGE . . . � ) il' '�'� ' .. �. ��., . .+v.. ,.. .. .-^r..eaiw �...w�+„.�.±e. ..ww,. ;u 1 . .. . ,.. . . � ... /� . a.,a.�_,.:. e�„ ,,..�s , . ....:�,. < .........: . .... ,, ti �SignatuFe��ofPermiffee..,.` �" Dafe . �., . '� .�.: �� .�. - . .� .. . . .. .... ... .. . �,�_: . -. .._, :, , , ::'c _�,'� ' � ..r . .�.... �--�� .'. .. .,.. . . . , . __ _ . � ., .., , ........ :.:.. ., a_:. ........, ._:�' SIGNA ., , � .... . .� -. _ .:. , . APPROVALS ��ATe �� OWNER=BUILDER DECLARATION TURE TEMP.POWER POLE' ���, .. .. . I hereby affirm ihat I am exempt 4rom ihe Contractorrs .• -�"�"� `'"'�' "' ' � �� � � � � �.Licenso Law tor�Phe�following reason (SecNon 7D3Y��.5, ' � ' - � UNDERSLABWORK - .... . . � � , Business�and-P�ofess/onsCodo):Anycifyorcoun7ywhlch � � �. -� -� ROUGH CONDUIT� ���� � �, � � � - � � - . � � ' � -� _ . .� . req4lres apermit to conssr�ct,aJter,'improve,.demalish, - ,, . ... � . , .. ` �, ,. . � � . � - or��rdpaFr�ony struciure,�pNor#o iis issudnce;�olso�re-� � WIRING � � � ��� - qWres fhe oppficgni.forsuch parmlf to�le a signed state- � �� `°' .�°:-' � � � menf thaf he fs Ncensed pursuant to tha provlslons oi7he 1 j�, ' � .- FIXTUkES � � � - � � �� � - . . . � Confracfor's License Cau�:(Chsp/er 9(commencing wHh ' �.,,,�� � ��"� , � ��-�-� �POWER AUTHORIZED �- - - � � � _ � � � � � - SecttonJ00DJ o{�Division�3�of.fhe Business and-Profes- � � " � � � � � � � � sions Code)or tHaf 6e is,exempi PhereCrom and the�basis ` ""' ' ���� ' ��-- U7ILITY CO.NOTIRED � � � -� � � . � ,' � � for.f6e afteged�ezeroptian. Arp violntion of$ecilon � � ..:.- .�.. .-. . FINAL`' . .�Gnfer o�a J'raxf � 7031:5�6yonyapplimnYfora.permitsu6jetts Iheappfi- ' .r, , . .,, „ ..� , �,;. � . mnt fo p aivlf penalty of noi more than fiive hundred- . .. .... ...... . . �NOTES- . � . . .�: . . .. dollors($500).: � � � �; . � . . .,.�... . ; . ._.. ._ � . . �,, -4 ',:�:' �� '� .��;�, �� � � , � 'CI I,as owner of fhe property will�do iha work,�and - � ���� ��'��� ��'��- ��"� '- � - -the strocture is not inTended:or offered for sale. ..� � � `_• .� � :'. ��- 4' �� ' � � �"� � � �` ''� �:� �(Sec.7044,Business andPrbfessionsCnda:.TheCoMrao- � ° � � � � . � �tor's Gcense Law does nof apply fo�an�ownsr of properYy �" � � � -� "��'' -� ' � � � ,�, - --� . who„butfds or 7mproves thereon, and wfio dosz'3tich � ... . . .�.. . _. . . .., . � ' � � � " _ . � ���' + ,. w6rk himsetf provided fhof sucti improvemenPs are not� � {'�� .�..�' . �� ` :..... ; .� , �� : . . . '.:s � �metovement 7s sod 4or safe_!f,however.the�butldtng o r - . .,,�. _. , � ..., . ,� . ,.. . . � � " � ' p -�Is!wifh(»one yaor of�completion,�dbe , . �'" �, � ". '.. � :. �: �. �, ��. ...' .-�- ' ..�.. owner-bvifderwl)fhaveihebvrdeqef�provi»gihathedid '� ' " ���` '�-" ' �`�� ��"��� ��� ' ' � � no't'build or improve for tf�e�.purpose of sale.) � , . .. _.. " - . . ... . . .. . , . .., . �,.: . �.�.�,�,.. :,,• � . . . 'I�. _... _.. ,., .: ��,� ` :._(. I am exempt under Sec. :` . -- , . .-... _ . . ;' _' _ ;. ;._ � : , r_: B&p:C.for fhis reason ' _ , " _ _..,.. __ _ . � . .� .. . _ .:... ;;�., �:-, .:.., Date� � . ,._... .__',. .... .........�...,:�...,_ .r_-�>,.. _.....,.....b.,_....,.�...... __..,,....,,,�....„.... .. .. . . . .. . . . ; . . . .. , ._� ,_. � . .. ... Owner _.. . . . .. , _. . ,. ,,. . _... ,_ ., _, _:,:.,. . . .. . . . . �,.;..�� ; :,..,_ . . �. . ... . . �.�-. . �... , :. _ -..: ""'_ ,.. . .. ::,... � . „_,.�..�. � : . ...: ,�_. . . . . . - . . . .�. .: .. � .- ... ��.. . . ._.� . ...__ ... . .... . ..3 - � . . .. � , .,:.. � _, � � . . . ,. � . � 3,�1,: ... .,. . ,�.... .; ., .