HomeMy WebLinkAbout0580A (4) S:'ORKERS'CO.'•"PENSATION CECIARATION 76Afrh7 �o.a� � qpp��CATION FOR ELECTRICAL PERMIT `�°
1 hrreby nN�rm rhat I hn�P o cr.�i�f�cair.of consrni ro srlf CE-&'MG ��
�nsv�e,o�o cen�f�co�o of�•�o�kers'Compensoro�Insu�nn<�, COUNTY OF LOS ANGELES BUILDING AND SAFETY
o��«,�;r��d,�p�'���oi�s��.asoo,i�b.c.� Tract �f42565 Lot /I40 Plan 23
Panlicy No.���g Compony V�'ausau �f15. FOR APPIICANT TO FILL IN J09
Cert�(�ed cepy is hereby 1urn�sh�d. Nr.w Rr.sidentiol Bldgs.8 Pools EaC�� NO. FFE A�CRESS 24424 E. enrose Ct.
� Certified copy is illed wiih the couniy 6uilding inspPc• 1 8 2�Fomily,Sq.Fi. �gg4 5 — S ]5 $ LOCALITY Di arrond Bar }'�l�1 S
��on depa�tr�eni. hAuhi�(omily Sq.F�. — h`-/+4E5�
Residrntial Swimmin Poals �ROSSST.
Da�e �-25-86 ,aP�,i��a,,,Grcy Hill Elcctric � o•;:Nc2ov
FIR'.SNAME BC�lICS Cal i fornia, Inc.
CERTIFICATE OF EXEr!.PTION FROM V10RKER5' Ou�lets:Rec_Li ht_$w,_ �`�P'��
CO.M.?fNSATION INSURANCE 9 ncoaE55 3151 Ai ruay Ave. SU 1 tC V
(Thta�•c�lon�••d�e�b.compla�.d iI fha work involvad 6y Firs�20 85� I Q�1
fhe permtt ts For one hundred dellon(5100)er I�ss.) To+ai No. Additionol � CITY Costa tiiesa Tel.No.
I ce�!;Fy�ho��n ihr,pr.rFormnncr,of the work for which Ihis ' FInN Ci�ECK
mii is issued,I shall no�e,m to nn son in an manner ��' A77LICANT
P^� P Y Y P^� Y �i htin Fia�u�es Fi�st?0 ADDRESS
so as io become subjec�io ihe Wo�kers'Compensnhon laws. 9 9
T�1el No. Additional
Dnrc Applicont CITY Tel.No.
h" ' E TO AFPLICANT: If, of�er m�kin�this Cerrifica�e of Fi.ed Applinnces No1 Orer i HP pEQ.M.ii
E. rrion, you should F.e.tomr subje.c� �o �he Workr.rs' Ron9e—Heater_D.W._ /+F�uCP.NT CRey Hi 11 Electric, �l1C.
Compensa��on provis�ons ot�hc labor Code,you mus�(orrh- Ovr.n _Dryer _W.M._ ADDRES$ 6i 6G-6 Cent ral itVe.
w�ih comply wi!h such pro��sions or �h�s permii sholl br. Tcp —FAU —W.H._
dr.r.medre�oked. CITY Riverside 7eI.No354 HJOO
� IICE�vSED CONTRACT025 DECLARATION Hr.od _Fan _Other—
Dlsp. _Room Air Cond. _ U�ENSE oR
I hr.reby a�firm Ihol 1 om licensed unc�er provisions of Chop�er 9 R:G.NUMBER�I I GS7J Class. C-1� }
(commencing with$ection 7000)o!D��+s�on 9 ef Iho Business power Appororvs 8 Large Appliancr.s DISTRICT n0. / PR0.ESSED BY �.
and Pro(essions Cede,and my licensr,is in full force and effed. ( � V
Sire 8 Type HP,KW,KVA,o�KVAR
Licr.nse Number 316579 �ic.Class C–�� Up lo I Incl. FINAL �
Grey Hi 11 Glectr��, 7-25-86 ov��1�0 1D Incl. DATE �� U
Coniractor lU�lio�� VALIDATION H
OOvr,r IO to 50 Intl. FINAI a
I nm exemp�undr.r$ec. Over 50 l0 100 Inc. BY N
6.8P.C.for this reason Ovar 100 �� z
Dnte: Servicr.s,Swbd.,M,CC 8 Panelboards �
0-700 Amp.Under 600 V
5ignarure 701-1000 Amp.Under bOp V
❑ Over 1000 Amp.or Over 600 V ''C��3�l��
E.>mplion fo�Reg.hlnin�.Elec�.
SINGLE FAP.IILY "�° � � ��
HO:"E OWNER-aUILCER DECLARATION Temp.P�wer Fele 8 Appur�enonces
I f $ign wi�h One B�anch Circui� � +: •&v�II
�y c�firm thr.t I om e.empt irom the Con:�ottor's license Addiiional S�gn R�onch Circuiis
lo.. .or the followin�reoson(Sectian 7031.5,Businn,ss and t �`;�`;`;V
ProFessions Code)� °
❑ I,as owncr of the rc Pr� Misc CondoHs 8 Conduuors p �_
struUurr, is no� �nlended or of(e ed'�cr sair. (Sc�Ciion O�her(See Camplete Fee Schedule)_ �•, 1 J ��
7044,�us�ness and Pro[essions Code). ►
CONSTRUCTION IENDiNG AGENCY
I hcreby a!firm�hat ihere is a consiru<tlan lend�ng ogenty ior
ihe pr.rformance of thr,work fcr which ihis permit is issued PFRMIT FEE (S�b-To+aIJ ]5 3$
(Se.c.3097,Civ.C.).
PLAN CHECKIKG FEE
Lender's Nome
PERMIT ISSUING FEE
lrnder's Address
I cen�fy ihot I have rcad ihis appl�cofion and s�otr.ihat thr. TOTAL FEE �
obove�nformr,uon�s co��ec�.I nqree�o comply w��h all Couniy
o�d�nnn<�s and S�a�e laws regularinp Elec�rical w�ring,and
he�eby outtio��:^repres�n��aves o(th�s Counry to r.nte�u�on
ihen o�e� enr�o�nd p,one«y for tnspecron pu�poses. SEE REVERSE FOR EXPLANATORY LANGUAGE
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