Loading...
HomeMy WebLinkAbout1254A (6) Z � _ : ._r, ...w ...�„m;: ...W. , ,. ....» , . . .r, ' � WORKERS'COti1PENS�IT10N�d�CIA'k�AT1�N �6n663 �0%el APPLICAT1011�`�"p���'LECT�'�'ALF P�RM��T �� �� t �� _ . ..;�. �hereby affi.m thot I have a certificate of conse t to self CE B046 �.,.,,-�, e�_....,a.�. �>. . . .. .. . .... . _.� . .`insure,�or a certificpfe o4 Workers'Compensa�ion Insurance,� � 'e"��� � o�a cenified copy fhereoF�se<.3sao,�ae.c.� COUN7'Y OF C75�S dNGELES 4��" BUIIDING ANb SAFETY m .s� _. ...... ...... �uYr�s�s.:� _���Y�N�29�-54-lOcomp��m�loyees �Benifi S FOR_APPLICANTTQF�LLIN .,��. �.--���-�-�-� ,�BRES5,22615 Ld'Ly �2dC�OW Dr. Certified copy is he e6y rurnished ; New Reside��ial Bldgs.8 Pools "�� EACH NO FEE � -�� �---�•'-•�^"�• ��-� ���� � 1�2-Famil S Ft. � — S LOCALIT1�1dIllOriCl BdY � �X Cernfied copy is filed w fh+he co� .y h i�d� e- Y• 4� �'-�-� ��� ' - - � tondepdrime�l . . /� M�Ifi-familySq.Ft. � — �NEAREST , _ 7_1_gg " 'L��'� ResidentialSwimmingPools OWNERO � 4 Dqfe . , ,�, Appl�c . � FIRMNAr,+�ountr Estates Asso.c..•..... � CERTIFICATE��OF��EkE�iV�p71 N ROM WORKERS �- g aooa�ss 22615 �La�zy Meadow �Dr�. � ' -�� COMPENSAT16 I URANCE Outlets:Rec_Li M_Sw._ � � �First20 ����� r"' � This section aeed nof be com ed if the worklnvolved h �� �- � ( d� r ro,Qi No. Add„�o„oi - arvDiamond Bar Tei.No861-4114 - �fhe permtf is ior one hvndred dollors(5100)or�less.) - ' � ��1 certif �ha1�n ihe erformonce-of the work for which this PLAN�CHECK- � . y p APPIICANT� . �-permit is issued,I�sholf no�empluy ony person in any monner . . � � � �� so as to become subjetl to the Workers'Compensation Lows. Lightina Fix�ures Firsi 20 ADDRE55 . .. � � Additional ._.. . ....,. .:._._.....:........,. ���,. .. ,.:�� . . � �_�.. " _.: . � . . total Na. � � � QTY Tel.No. . . . _:. .. . .. _.'_.„.. . ., -... � Date Appl cant....._ . ._�.,,..�..:-`� Pixed Appliances No+Over 1 HP PERMiT T � .<..a„ � ' NO710E TO APpLIC11NT: If O�ter mok rg this Cerlfitofe of APpLICANN Ok1R A-. Martin H'tU. & A� . Exemp�ion,���you �should become subject� to Ihe Workers' Range.�Heaier_D.W.� � --�- , . _ Compensoticn provisions of ihe La6or Code,you must forih- Oven��Dryer _W.M._� ADDRESSdG�Z W. �Bon ita _Ave r..,_ wifh tomply with such provisions or this permif sholl be Top —FAU --W.H._ CITYSaYI D1IDd5 � TeL NoS99--2901 - � ,deemed revoked � .� Hood �Fan _Other_ . ._... . .. '-: w.. � � ��� LICENSED CONTRACTOkS��DECLARAiIQ�I �`� ,, . . LICENSE O� 315103 �� ��� ciass. .,_. �� I here6y offirm that I am I censed unde pro isions of Chapfer 9 Disp. _Rocm Air Cond. — REG.NUMBER C 2� __ �commehcing w�h Senion 700p)of D s on 3 of the Business DIS7RICT�NO,- �� ��� PROCESSED�BY`��� Power.Apporatus&Lorge Appliances ,' �- -.and Professions Cade ond my license s n full force and effect j� G d � � -� • '''� � �����- Size 8 Type HP,KW,KVA,oi KVAR O y - . License Numkier �315 d3 Lic.Class C20 �" FINAL �� Up ro I Ind. � ..Contra � � Date 7-31-g0 , . A�e.11o101nd. DATE. �"Z-/..^��' VALIDATION _.... ..� (D � ' "� "` Over l O ta 50 Incl. ❑ . _ FINAL � Cy om empf under Sec. � Over 50 fo 100 Inc,� BY � a Over 100 � . .C.for th s reoson � , � � µ ���� - :. Dote�- � ' Services,Swbd.,MCC&Ponelboords � � � .. . . 0-200�Amp.Under 600 V - Signature --- -- ���•-- ��-�•-����•�_..�, 201-1000�Amp.�-Dnder 600 V .. � . ...� .�.. ....��,. . ... . �..�. Over 1000 Amp.or Over 600 V � �� Exemption for Reg.Mainr.Elec� � �1 �r�.!'? fi �' � SINGLE KAfvti[Y � ���� _ . �„.. Temp.Fcwer°ole-&Appurtenances- �'�� ° " ` °G . � HOME 04VNER-BUILDER D�CLARAilOT�� � Sign wilh One Branch Grcuit , ,� � I hereby affiim thm�l am�exempt from ihe Comracror's L cense . . qdditional SIgn.Bronch Circuirs � s � � �'J�' - �Law for fhe followmg reason (Seclion 7031.5, Business ond Protessions Code): � +^ -•`* 'I �r;;:('•�� � ❑ I,os o ner of the praperty,will do fhe work and rhe Misc.Conduits&Conducfors ' � R strudure is not in�ended or offered for sale (Seciion O�her(See Comple�e Fee Sched�le)_ , !i FS.�. I "".-� � 7044,�Business and Prv{essions Code). --�-- � '� �CONSTROCTION 1�EN�ING AG�NCY'�� ����� ������ I he�eby offirm that there is a cpnslrutliort lending ogency for the performpnce of 1he work for which�this permit is issued PERMIT PEE � (Sub-Total) C'��/ (Sec.3097,Civ.C}. - � � � . � . � . �� � �� PLAN�CHECKING FEE � � lender's Name . , . , . , . .. . .�� CERMIT�ISSUING FEE��� � � U � lender's Address - � � . . ..._....._._�. I certify that I�have�ead ihis npplicat on and stafe lhaf rhe TOTAI FEE�� � � . ,� .� ._.__ ... .. ....,......:. abave informotion is eomect.I agree to comply with 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 , pose. . „'.....� ...-•".' `�::.'.. ... .:.... .�:. . . .:., ..,.:.:.,. ......:.,. . � � r . SEE REVERSE FOR�EXPLANATORY CANGUAGE�� . . .. f, � � _ �� r . . 5' n re of Permiitee � Dot .... ... ... .. , .. ... H ., .:::•, . .. .�_., . . ,�.,. ���.; .�.�.. �.. i i —__ :,.-. ,-, �:� . ._.0 ... . ... . �..�.._. .:-� _ .. .,:,H • .-� , r,� �.:. .,.. .... ..'..��� ,:�i �_ _ , _,, _ :.i. . - . ..:�. � � ,.:.�.�. ......�. .. . .. . . ......_ . ._.... .._.�....... . ... . � . , ER-B�L ER DECLAP.ATION , _. OWN U!D .. ..� � i OR' . � .-: . . . , ); � APPROVACS ��!TE SIGNATURE � .,,,, ,. . . . � . . I hsreby ofFirm ihas I am e�xempf from ihe Contro<ior's � ��� iEMP.PCWER POLE� . _ �Scerse Low for ihe following raason (SeCion 7031 5, --� � � - � � � ���--�--��� � ""' � � 9usiaessandProfessionsGodef.Ar,ycihyorcoonfywhi<h , �UNDERSLAB WORK �� � � � � � _ _ reqWres a permit fo conseruct,elSer,:mprove,demofish, � � ROUGH CONDUIT - 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 . � - .... - � � Secflon 7000)of Dlvision 3 of)he&usiness 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 .. . . .�.-. �.. ...-, s �� ••,;Sec.7044,9usiness and Professions Code: YFe Conirac- , ... ...... ._...., . ...._�. . :_.�., . . ._ _...� <...�.....,........, . .__. � � - - � � . - � � . ior's License!aw dees noV appfy fo an owner of prop=rsy ...:: . ..._..�.�. ...,, .u» :. �.Y.`.T�,x, �.w.;:.,:_, ,,.:..y:.. . T��.A�:.Ar. � wFyo builds or.im rosses fhereon, and who does such ,._,�; .. :,.�_i�'�«_3 .>.,�:.......... ,_ . g . . „- . ___. . ... � - - . - . � work b�imsel(provlded}hat such improvemenis ore not � " � � � - ��' ' - •��" '-" ' '`�- `� intended er o fered fov sal If bowevz:,ihe building or . . . _..v,.,,... ....,a. :..,:; . .,..��6-' . ,.;..:,, ... .::. .. ..__. . . �.. . . - . ... .... . , .. -'.. _ ..... ..�...,... ,. ._,.,. ......... . ... ., . '.� ��� ; . mprovemen}s solr7 wHfiin one year af compfetion,fhc - �.... .,,,.T.q.,r�Ny.����y.__.���.��A�w.����w�� ..��4 ..:.. �- � .:.. �,_ .:� ... : oi�3�terb�ilder w'rfl have th�6urden of prov'rng that he did .w�.waw+*,.��- .�.�a_.�:.v: -��:..* _.,:.. .. ... . . . . � . � � no7�sii�r]�or irnpro�e 6or fhe purnose of safe.) . .� � .... _.... �...:... .::�.:_ e. ...,:::__,.._,.._��r_..�::._ _...._.F;:.:e� . . <.; ;.� � . ___.. _ _,....._ ._ . . ,��-,:.> �--- .. ... .g ,„ ._ ... .-.. ..:.� .'.. k� ... :' , ...v. ..... �- .�..� ,, • I am exemp-t under Sec. _.. ..__;.....�.�.. ;..�.-,�.-„.-».w. �,,.;� ___ . ,,. ,,.,<. ._.:.;.,� .� ,�.U;:.,: .J..,__v:.......<..: _ _. _ . .� , . . . . r. �_ . .. a.:��.,x, a. . , �- � � � - � B&P.C.for this reason � . ., .� . . ,:: . .n_:,: ...;:�:;.:.,M,.�:w,� -'����.�».��;.�.�:n�.;�.....:� "�",.».::��...�..«H .._�:.�.._«�.�.....,.......,x.,�•..».M.,..,......,�..�».:....,.,...,���.,�....�..,...':,,.;�.,.T,�,..(,..,.�::�.•we.�=.r.r«�.-;�,. �. ��.,.. ..��� :�. , . . ._...�.:. .�M.,.,..._,.�+w,,.�.;>,:...... ._.�<�;i� t � �I..�..-.Tx:.3va.� w _ c,� a�av kk�.. --•--,. ,«... �-,-..... , .. ,. , . ..., .. . ...::.:�.. _. .... � .... . ...... - :. ,. -.<:... r ,. :�:.. .»�.�._..�...:.. ,..- ._.r.'����....- �3.r-. �t.,�. . ��� ' . � ��. . . :�. ,,. ,� .._.... . ... „,.,«.�:a.,.,..«.....oa�-�,-...-.... ......,,,.-.�:����-'.�..�..�.,.:,w,.:,..� -�,«�,.;:�.: '�. .... Pote. .._ ..._. ....._ .. .. . . .,,. .._,.,,. -,...w.� , , , r�.. .�_.... .... .,. .,...,«.Mm,..�w.,�...,.w. . ,:�..�6. �-,..-:..�.. , .„.... . ,, . . . . . . � . .._ .. . ,. ,.._. .........: a.. . �.:.. ._,,.... . . , . . ... . . :.....�.. . ., .. . . :... . _. . . '. . . � ... . Owner __... , .. ._. . - . �t . .. . � .... .,,, ..;:, ..� .,;.,. . :-..,,..,,n.a.u,�.�[� .v.a....de:r.'.. .. .. _. , _. .. __..,. ._...... ..... . ............... �._i _ - .:':� .� r ` .... . � - � ..__ �_��-..... �...,......,...�,:.W.. .w.-�,_:.�.. ,..::�.< ..,,��;.q�.:,__: ..w,.«.:',w� .�a.s-���. ...,..��..;e � , . .. � ,,: �.:.,. ... �.� c a . ...,,:...... . ,. _..;..<._ ..,��. .n:._,...._..:x..�.�»� b�:��m ...r.� �....-,::..r�..,._�.'.,�4 . .....�..�:', .»`�,.�...x:x:�;. ,,... ,.���:.:a,.,.rr.....:...sn.,�.,...xr,?sms:.�vL��s�uti�::;:�_ ..i,..,_:..i.� .r�,,.,.,.�.�... ,.. .... .. . � . .. .....� . . ..., ...:, ,.,.. ... .- , _..�:,;a ..... .,..... . ... . _. _,..... ... ........: .. .,..:�n,;�. �eu�.w;w:,.., ..ik.,.n.,�.,... ..� .. i,x�+.a�.��. . � � ' . �.r� .. . �<..<..n.... ... .,.-. ....., _. � ::�.- ...,, <. ,..__ .:.::�:' � � ,�..;�,`_ . .,: .:,.. � �.,-.Mw..�..-..,._.. . .u.s�«.. ��'�r :�.�3bwp- - ... w.-�.. ...,�,� . .._ .:..��;,�.�.;..�;.�,>:. ............ . _..,�_.�.,........,.» .,w..,.«��- .. :�«�..�-. �...a. . . . . ... _............. ...........:.. ,..�;...„.:._o. ....�:c� . ......�,:_: .,. .�..».::� . - ` ': ' .., ., .. _. .. ._�,.._., ... .. ... . ... ._,. z ', � •, , .,._ .. � �,: ,., <. ,�,u , .,, ,,,. � � . : ��.:-; ._.�._;x:�.._, s�::r-.•.�,-,�—i.rTT.:-.. ... . .::: . .._:.;:�w „xw..:,;s,. �.�r�:, ..e �.,..'{...�..�.<..�ua�.3�:��._m-«„ .. ., _... ., ..._.... a+" . . .. �..._... ....._�.:..., _.,.._....,. .,�_...�.:a.n�...w�ax.�:�^nx.:�#:-�'^.;'�,„ „�,:�.....:,��,�,.... �.�-�'�4�.:,.�:.�a-rx.xx�fi�'P:: ..�z".'�*.}�„a�x+,e. 3 z... � � ..., �:.::: .,��.-^ ..:-�.. � .,-,. x x f .�;"'"R a'. :xk _.. „- e-:, . . ... .. ....... ,.. .. ....... t . :... _ _�.... . :,.. , . . , .. � , _ � ,,..� .3. _ . _ , . ........ .. . _........ . . :.�..... . ....::.:�:_.,, _..�.-;�,:.a' .. ,h,....:i...,.,, w_ ..:,.=H-n w_n::�::...�x. ..+ .,� �. tseaasia'�@.e^t�+ ==-k5ae1#�a.:sv"9¢+:�.ta�,.h...4.���.,.,.-.+da+vr-> ..<_,.....