HomeMy WebLinkAbout0578A � ,:�02KER5'CO:"PENSATION DECIARATlO!V ����� ���81 qpp�IGATION FOR ELECTRICAL PERMIT ��
I hrreby offirrn iha�I ho�e o cer�dim�e o(canseni�o self CE�[i'MG �' �
insu�e,o�a cecp�iq�fico�r,(o�(\'lor4ers'Con+pe�soron��s�roncr., COUNTY OF LOS ANGELES BUILDING AND SAFETY
o�a ceitilird LU1���U�r�53���.�°n.e.�
P❑olicy No.��]$IZ_Co�pany�r�dL15�11LIII5� FOR APPLICANT TO FIIL IN �CN .
Ceri�l�ed copy Is hereby furnfshed. New Res�dentiol Bidgs.R Pools EACIi NO. FEE ACORFSS
Q CP��iiiCd CCpy is flicd with the county buildinq insprc- I R 2-Family,Sq.Fi. 2144 5 — 5 $5 � LOCALITY Di arrond Bar Hi 11 s
t�on depariment. Mulri-fnmily Sq.Fi. — �EnaES�
7-?Jr-$fi CiCC I-1i11 Glectric Residen�ialSwimmin Pools CR�SSST,
o��� nn�u�o�� Y � O'h'4FRCRgrarrelea California lnc.
CERTIFICATE OF EXE1.aPTION FRO!A WORKERS' ' . F;R.N NA.ME f
'' ' rrna
Ou�lers:Rec_Light_Sw._ �
CO:'.PENSATIO•'J INSURANCE . �DC4f55 3151 Ai rway Ave. SUl tC iV
(Thif teNion n�ad not 6�compl�fed i1 eha work Invelr�d 6y Fi�st 20 CITY $$0 (��1
1he permif tt 1er en�h�ndrad dollan(5100)or lasc.)
Total No. Addit�o�al CAStII ti��S3 Tel.No.
I ccrKf tha�i��hc (ormancc of ihe wcrk(or which�his RAN CMECK
Y P^� AmIICANT
pnrmir is�ssued,I<.hpll nor employ ony person in�ny mnnner �
so as lo betome s�blect lo Ihr.�Vorkers'Compensai�on laws. L��hiing Fiztures Flrst 20 ADDRESS
Total No. Additional
CITY Te�.No.
Da'e Appllcant Fi�ed Appliances Nat Over 1 H? �q,y�.i�
N'"':E TO APP(ICANT: If, a(ler mak�ng this Cerrifica�e o( APMiCnNT Grey 1-ii 11 CIE.'Ct�IC� If1C.
E jtion, you should b�com� subjecl lo ihe Werkers' R�^9e_Hen�er_D.W._
Ce.�;+��sa��p�p•ev�•�••e•^[t�••ivbor Ccdc.Yoo mu.!fo:.h- Qcer. _Cry�r _L':.�•�.._ ADDRE�� 6760-B Centra 1 t1V@.
ith comply wiih such provisions or Ihis pr.�mil sholl be Top _FAU —W.H.—
dee�ned rr.vcked. Hood ,_Fa� _Olher_ CITY Rivers ide, �f Tel.No35� 59��
LICENSED CCNTRACTORS CCQARATION IICENSE OR
D�sp. _Room Air Cond. — n[G.NUMBE2 3 1 GS�9 Closs.C-]�
I hereby o'firm that I om licrsnsed unr!r,r provisions of Chap•er 9 y:
(commencing wi'h Seclien 7000)of Divisian 3 of rhe Business DISTRIC7 NO. PROCESSED BY �-�
ard Pro�essions Code,and my lirrnse is in full fo.ce,nnd r.ffecr. Pawer Apporotus 8 lorge Applionces /
Sizc&Type.HP,KW,KVA,or KVAR !� � U
Licensr.Numhnr 316579 �ic.C�nss C-1� Up�0 1 IncL FINAL �
Grev Hi 1 J Elect�, 7-25-86 Over 1 io IO lncl. DATE /
Can!ractor U'�iI"CL ALIDATION W
❑ Over IO lo SO incl. FINAL
I am errmpl und�r Sec. Over 5010 I W�nc. BY N
6.8P.C.for�his rrtasnn Over 100 �f�"' Z
Dorc: Se�vices,Swbd.,M.CC 8 Panelboards ►
0-2W Amp.Under 600 V
Signaturr. 701-1000 Amp.U�de�6CVJ V
❑ Ovr.r 1000 Amp.or Over 600 V
E�Pmp�ion(or Reg.Main�.Eleci. =:Q`.�.��
SINGLE FA!,1ILY Tpmp.Power Pole 8 Appu�le�o�ce5
HO:'.E 04VNER�BUI(DER DECLA2ATION S{gn with One eron�h Circu�t "° 8 ' � ��
1! �y atfirm thot I om e�empl irom Ihr.Cont•atto�S l�cr.nsr. Addi�ional Sign Pranch Circuits
La.. , r the following rr.oson(Secr�on 7031.5, Business ond � •, •9 F C�
Pro(essions Cod��:
❑ I,as ownr.r of Ih�preperty,will do Ihe work and thr. M,sc Condui�s 8 Conducrors n e a q;•i i,�
shutlurr. is no� inrend=d or affernd icr solr. (Seclion Oiher(See Comple�e Fee 5<hedule)_ , _r
70e4,8us��ess a�d v�ofr.ss�c�s Codc). 0 a � �J-��J
� CONSTRUCTION IENDING l�GENCY
I here6y afFirm thot lhrre is n cnns�r�ction lending a9ency for
I ihr perfermonce of the work lor which this permit is issued FERNIIT FEE (Sub-To1nl) 85 76
(Sec.3097,Civ.C.�.
�'LAN CHECKING FCE
Lnnder'S Nom�
PERMIT 155UING FEE I O SO
Lend=r's Address
I cr.rlify thal I hnvr.read ihis applica�ion and s�o�e Iho1 rhe TOTAL FEE 96 26
abovr.infort���ion is mnecl.I aq�cc�o comply with oll County
o�dinanrrts n�d S�a�e lows requlo�in�Elec!ricnl wiring,ond
hereby auihoriee rapresrtnt�tives oi Ihis Counry ro rn�c�upan ,
Ihe n c-menGon��rly for inspecuon pu�poses.
� SEE REVERSE FOR EXPLANATORY LANGUAGE
7-25-86
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