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HomeMy WebLinkAbout1254A j _, _ . . , ...r, ..,-... ...,,,.,e;: ....W=.� , ,. ....»� �,., _ � :wu. r .r � .. ;.�., x. .-: ,w r,,.,>-:-_ ' � WORKERS'COti1PENS�iT10N�d�CIA'k�AT1�N �6A663 �0%el APPLICATl011�`�"`p���'LECT�'�'AL PL�RMIT � � � �he�eby affi.m thot I hove a certificale of conse t to self CE B946 � . . -,.,.....� �.,.,,-�, e�_....,a.�. �>. . . .. . .. . .... . _.� . ."-insure,�or a certificote of WorkErs'Compensaiion Insurance,� . � COUNTY�OF�LZS�S�ANGELES�� BUII.DING AND SAFETY or a cenified copy ihereof(Se<.3800,Lah.C.� na .vuwt . , ,�.... .,..,... ...,...,..,,�s�B.:� _���y�N�29�-54-lOcomP��m�loyees �Benifi S FOR_APPLICANTTQF�LLIN ..,��. �.--���-�-�-� ,�BRE55,22615 L'a2y MedC10W DY. Certified copy is he e6y f�rn�snad ; New Residenrial Bldgs.8 Pools "� EACt� NO FEE � -�� �---�•'-•�^^-�' ��-� ���� � 1&2-Famil S Ft. � — S LOCALIT1�1dIllOriCl BdY � �X Cernfied copy is filed w fh ihe co� .y h i�d� e- Y• 4� ��`�-� ���-' - - � tondeparime�l . . J� M�In-familySq.Ft. � — �NEAREST , _ 7_1_gg " 'L��'� ResidentialSwimmingPools OWNERO m 4 Dqfe . , ,�,� Appl�c . � FIRMNAr,+�ountr Estates Asso.c.•..... � CERTIFICATE��OF��EXE�iV�pYl N ROM WORKERS �- MA�� ����� - � ����-� � ' - - �COMPENSATI'6 I URANCE o°tie'S:Re`_u9h,_sw._ aooR�ss 22615 �La�zy Meadow DY. F�,sr zo _.. ..� .... This section aeed�nof be com ed if the worklnvolved h � ( d� r ro,Qi No. Add�,�o„o� - arvDiamond Bar Tei.No861-4114 - , �Ihe permtf ia ior ona hvndred dollors(S100j or�less.} PLAN�cHeCK- - � . ��1 certify�ha1�n ihe performonce-of the work for which this qppliCANT� . �-permit is issued,I sholf no�empluy ony person in any monner . . � � �� so os to become subjetl to the Workers'Compensation Lows. Lightina Fixlures Firsi 20 ADDRE55 . .. .. . � . Additional ._ . ....,. ..:._._.....:........,. `.,. ,.:�� . . . � � �_�_ ' _.: , . . Totol No. � QTY Tel.No . � � . .. _.'_.„.. . ., ,.. �� Date Appl cant..... ... ......r ._�.,,..�..:--- Fixed Appliances No+Over 1 HP PERMiT T � NO710E TO-APPCIC1tiNT�: 1f o�ter mok ng this Certficote of APpLICANN Ok1R A-. Martiri�H.t.g. & A� . Exemp�ion,���you �should become subject� to Ihe Workers' Range.�Heaier_D.W._ � ���-- , . _ Compensotion provislons of ihe La6or Code,you must forth- Oven��Dryer _W.M.�� ADDRESSdL�Z W. �Bonita _Ave r..,_ wifh tomply with such provisions or this permif sholl be Top —FAU --W.H._ CITYSafI D1IDd5 � TeL NoS99--2901 - � ,deemed revok�d �._,� Hood �Fan _Other_ � _. . . ..�.._... ._..,� .. . .. _: ..a. � � �� LICENSED CONTRACTOIfS��DECLARAiIQ�I ,, . . LICENSE OF 315103 �� �� ciass. �� I here6y offirm ihat I am I tensed unde pro isions of Chapfer 9 Disp. �Rocm Air Cond. — REG.NUMBER C 2� _.__ �commehcing w Ih Senion 700p)of D s on 3 of the Business DIS7RICT�NO,- �� �� PROCESSED�BY �� � Power.Apporatus&Lorge Appliances ,' .�- -.and Profegsions Cade ond my license s n full force and effect. jG G d � -� • "' � �'���- Size 8 Type HP,KW,KVA,oi KVAR O y License Number 315 03 Lic.Class C20 FINAL Up ro I Ind. � ..Contra � � Date 7-31-90 , . A�e�l to 101nd. DATE. �"Z�/..^��' VALIDATION _.... ..� (D � ' "� "` Over l O ta 50 Incl. ❑ . _ FINAL � Cy om empt under$ec. � Over 50 fo 100 Inc,� BY � a Over 100 � . .C.for th s reoson � , � � ���� - :. Dote�- � ' � Services,Swbd.;MCC&Ponelboords � � � .. . . 0-200 Amp.Under 600 V . . Signature � -... -. .-,-. .....•-.....:_..�, 201-1006Amp.�-Dnder 6D0 V .. � . ...� .�.. "..��,. . ... . �..�. Over 1000 Amp.or Over 600 V � �� Exemption for Reg.Mainr.Elec� � �1 �r�.!'? fi �' � SINGLE KAfvfi(Y � ���� _ . „.. Temp.Power Pole-8 Appurtenances- �'�� ° ° ` °G � HOME OWNER-BUILDER D�CLARAi10T�� � Sign wilh One Branch Grcuit , ,� � I hereby affiim that�l am�exempt from ihe Comracror's L cense . . Additional Sign,Bronch Circuirs i s � � �'`��' - �Law for the followmg reason (Seclion 7031.5, Business ond Protessions Code): � +^ -�`* I �r`:;:i'•� � ❑ I,os o ner of the praperty,will do fhe work and rhe Misc.Conduits&Conduciors ' � R strudure is not in�onded or affered for sale (Section O�her(See Comple�e Fee Sched�le)_. , !i FS.�. I "".-� � 7044,�Business and Pro{essions Code). --- --- � .. _.c.... ..�-.. � � "� �CONSTRUCTION 1�EN�ING AG�NCV'�� �� � � I he�eby offirm that there is a conslruciion lending ogency for the performpnce of 1he work for which�this permit is issued PERMIT PEE � (Sub-Total) C'��/ (Sec.3097,Civ.C}. - � � � . � . � . �� � �' PLAN�CHECKINGFEE � � lender's Nome . . . , . , . .. . .�� GERMIT�ISSUING FEE��� � � U � lender'sAddress - � ��----��.�-�-.-�- . . �t I certify that I�have read ihis npplimt on and stafe lhaf rhe TOTAI FEE�� � � . ,��.�V ._.__ ... .. _..,......:. abave informotion is eorcect.I agree to comply�«ith oll Coonty � � � ordinonces rnd Stote law5 regulaiing Eleciriml irin ond � , � � ., hereby outh -ze re se totives of t is nty t ente upon � .. e ' ve tio d pr r fo � ecfio f�L pose. ....:..:... . .,.... ,. ... . ..,.,., ...::...... .:,.. .... . .. � � r SEE REVERSE FOR�EXPLANAT6RY'CANGUAGE����� -�-�� . . .. � � � �� ' � � . � � 5' n re of Permiitee � Uot .... ... ... ... �• . �..:-.-::�.,. ,�, ,...., .:::•, . .. .�_., . . ..�.,. ���.�; .�.' �..r i i —__ ;'�.-�. ;': `;: .,.: „_,Y .,., �.. . .. _ ....�_ .._,H .. . . .... .. ... .�. _ , _,, _ :.i. . - . ..:�. ,.:.�.�. ......�. .. . .. . . ......_ . ._.... .._.�....... . ... . � . , ER-B�L ER DECLAP.ATION ... .. ., . . . _. .... � i OR . � . . �OWN U!D . APPROVACS ��!TE SIGNATURE � � ,,,, ,. ' '. '. . � � I hsreby nffirm ihaf I u e�xempf from 'hc Controaor's � ��� ?EMP.PCWER POLE� . J _ �Scerse Low for ihe following raason (SeCion 7031 5, --� � � - � � � � ���--�--��� � '"' I � 9usiaessandProfessionsGodef.Ar,ycihyorcoonfywhi<h , UNDERSLAB WORK �� � � � J i _ _ reqWres a permit fo conseruct,elSer,:mprove,demofis . � � ROUGH CONDUIT - I or repoir any s'ructure,prior fo irs issuance, a7so re- �..' ..,,.._..___._. � i qulres the aopflcar.f for 5✓ch permit to file a slgned staPo- � . 1NIRING � - � � �' � ment tha}�e is lieensedpursuan/to fFe prowisians o�tbo � � � � � FIXTURES � - � , Contractor's ticanse Law(Cfiapter 9(commencing wtth . � - .... - ' � � Se[f�on 7000)of Dlvision 3 of)he&usinoss and 7rofes- ---..-.......'..... . . . POWER AUTHORRED � . . . . � :.� . . sions Code)or ihaf ne is exempt fheref-on anri the basis �-�� �--� � ��- �� UTILITYCO.NOTIFIED . for the alfeged exempfion. Any violcticn of Section . . , �e . ..._.,..... . . 7031.5 by anp applican!for a permit subjects the appli- � � �. _ . . .. ��.�� FINAL (�At�r ort �rrinf can!to c Nvil penaify of not more than five hurdred � :. ,, ...�. u..... .......... . ..� �dolfavs(55001.: . _. .. . .... NOTES ..� . �� . �.. . . .:� . .. ..❑I,�as owner of the proporty will do ihe work.ane - �,�' '. . ��: . � _ �..�� �.-. � .� � .,tha s1ructure is,noi.intendod or ctfered for sala. ,. . ,... .� .. — ,,. � � � .. ; ...-_..._ „_.....,.,...µ _ . .'.-. �.. ...-,' z �� .•,;Set.7044,9usines3 and Professions Codc: YFe Conirac- , ... ...... ._...., . ...._. . :_.�., . . ._ _...� <...�.....,........, . .__. . . �'- � r�� �` - - ����� � �� . - . .. � � . ior's License!aw dees noV appfy fo an owner of prop=rsy ..-.. . ...._....�. ...,, .u» :. �.Y:`.T�,x, �.w.;:.i:_, ,,.:..y:.. . T��.A�:.Ar. .. wFyo builds or im rosses fhereon, and who does such ,._,�d .. :,.�_i�-«_3 .>.,�:.....:..... ,. , . 1� . . „- . ___. . ... � - - . - . � work b�imsel(provlded}hat such improvemenis ore not � " � � � - ��' ' - •��" '-" ' '`�- `� intended er o fered fov sal If bowevz:,ihe building or . . . _..v,.,,... ....,a. :..,:; . .,..��6-' . ,.;..:,, ... .::. .. ..__. . . �.. . . - . ... .... . , .. -'.. _ ..... ..�...,... ,. ._,.,. ......... . ... ., . 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