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HomeMy WebLinkAboutNo Permit Number (9)WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lob. C.) Policy No. C2277405 ,Pony INA Certified copy is hereby furnished. QCertified copy is filed with the county building inspec- tion department. Date 7/15185 Applicant" " Mrrpp_F Qr]L c CERTIFICATE OF EXEMPTION FROM WORKERS' ( COMPENSATION INSURANCE (This section need not be completed N the work involved by 1 the permit is for ono hundred dollars ($100) or less.) ' 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers Compensation taws. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be deemed revoked. LICENSED CONTRACTORS DECLARATION I hereby affirm that f am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, andm license is in full force and effect. 420/48 C-10 License Number Lic. Class Contractor Electrical Date 7/15/85 ❑ I am exempt under Sec. B.&P.C. for this reason ❑ Exemption for Reg. Maint. Elect. SINGLE FAMILY HOME OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Low for the following reason (Section 7031.5, Business and Professions Code): ❑ 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lenders Address I certify that I have read this application and state that the above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. 7/15/85 Signature of—Permittee Date 76`'663'0'61 CE -806r, APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFJTJ. MountainLaure FOR APPLICANT TO FILL IN 'C" New Residential Bldgs. 8 Pools EACH NO. ffE ADDRESS `lard Litiag - S. Diamond Bar lvd. 1 8 2 -Family, Sq. Ft. Multi -family Sq. Ft. Residential Swimming Pools Outlets: Rec_Light 41 Sw._ First 20 Total No.. 1 Additional Lighting Fixtures First 20 Total No. 41 Additional Fixed Appliances Not Over 1 HP Range— Heater_ D.W. _ Oven —Dryer _ W.M. — Top _ FAU — W.H. — Hood _ Fan _ Other_ Disp. Room Air Cond. — Power Apparatus & Large Appliances Size 8 Type HP, KW, KVA, or KVAR Up to 1 Incl. .Over 1 to 10 Incl. Over 10 to 50 Incl. Over 50 to 100 Inc. Over 100 Services, Swbd., MCC & Ponelboards 0 - 200 Amp. Under 600 V 201 - 1000 Amp. Under 600 V Over 1000 Amp. or Over 600 V Temp. Power Pole & Appurtenances Sign with One Branch Circuit Additional Sign Branch Circuits Misc. Conduits & Conductors Other (See Complete Fee Schedule)_ PERMIT FEE (Sub -Total) 511001 PLAN CHECKING FEE PERMIT ISSUING FEE TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE LOCALITY TR#34831-2 Diamond Bar NEAREST CROSS STOWNOR. FIRM NAME Koppell Services ADDRESS 3703 Long Beach Blvd CITY Long Beach Tel. Na959-48' ADDRESS CITY Tel. No. PERMIT T TIT" McGee Electric,Inc. ADDRESS P.O. BOX 1111 CRY Chino 91708 Tel. No591-6461 -._... _. ._ ..._------ _. 16 FINAL V DATE 7% 1 3 VALIDATION 0 FINAL F U BY W h Z L9137,9A e s i e s2 J •e61,50 -s is • 61,5007 0716-85 z 0 ƒ \ § } z A- A / /ƒ\!2$f$«041 f$- }-,}}�2�!%g£k% » tz rQ.,� - m� z f[„!I §{$°©§;���$) ` a�l�7$� /.§ •#$°~j ;. @X"oc C©-; ƒa&2§°°[(|ƒk{ ���\fit*(m\ — CL 0-0 �,§n $}�!lto�le e:fE,�����_.§/\@22°27)-� 7a|>(}}/} nf�&-ƒ�[® £2$[ k}¥,/C?E%-40,!0 '�|$\£§ o�0 &�ƒe`m $m- E °,ƒ0CL0c©f a»(D ;f a%%t©■e-0»moo. \\/{����CL �/-(k/\\/}\}\ \���^°-Z, :0 E a©©.��ba.�f�2•- -z2 o �e�KE�|k})■§=ƒ2t]» !.--:ct^Q)« ;.-0 •\�$\$(�� . �Eu«.o��� f -»»f22 ) \ } L 2 j \ 0