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WORKERS'COMPENSATION DECLARATIDN 76ann3 ��iB� APPLICATION FOR ELECTRICAL PERMIT �
I hPrehy atfirm�hol I hove o cerfificare of consenl 10 self CE�806('
�nzure,or a ce�tifica+n,01 Wo�ke�s'Cempensarion Insorance, COUNTY OF LOS ANGELES II-3 BUILDING AND SAFETY
or.a cerrified cepy!hereef(Swc.3A00,Lob.C.)
POol�icyNo. 761JBl��nny I� INS BROKER FORAiVU[ANTTOFIIIIN 1CH
Ce���fird cepy is hereby furnished. New ResideMial Bldgs.8 Pools FACH NO. �E nCDRE55
� Cer��fied copy is flled with Itie coun�y b�ilding inspec- 1 8 4�Fomily,Sq.FI, S = 5 LOCALITY D AMOND BAR
tion deparlment. Mulli•family Sq.Ft.�'� "E"°EST DIAMOND BAR & GRAND AVE
Dole�[/_��Applitc�ATMpIN ELECTRIC Residentiol Swimming Pools OWNER OR
Crf'f/+�� F,RUNA,�PRESLEY OF 50 CALIF
CfRTIFICA OF E%EMPTION FROM WORKERS' putlet::Rec�liqht / Sw. / N-"'�
COMPENSATION INSURANCE ��p ADDaE55 4
�Thls�ecffon nNd nel b�templNsd if 1hs work involvad by ,�. First 70
the pa�mll is fo�ona hundrad dvllors(5100)or Isst.) Toral No. Addi�iannl cird�TEWPORT BEACH Tel.No.rjQ OOSQ O
F'LAN CHECK
I certi(y fhat in ih�performa�ce of�hw work far which rhis napuCqNi
permil is issued,I sholl nol employ o�y perso�in a�y ma��er
so�s lo betome subject to Ihe Workers'Compensolion Laws. l�9hling F�xlures First 20 -� ADDRE55
Toral No.,�_ Add�r�onal
Do+r.- epplimnl ��TY Tel.No.
NOTICE TO APPLICANT: If, o!ter moking this Cert�fito�e of Fi.ed Appl�onces Not Ove�1 HP �RN''�� WATMAN ELECTRIC INC
Eaemption, you should be.come subjeU to ihe WorRe�s' Ronge_Heole�_D.W._ APPLiCANT
Com�ensotion provisions oi the Lobor Code,you must farlh- Oven _Dryer —W.M._ ADDRESS
wiih tomply w'th such provisions or rhiz permit sholl be Top —FAU _W.H.—
deemed re�oked. Hood _Fan _O+her_ CITY rai.Na.859-8108
IICENSED CONTRACTORS DECLARATION ��CcN�
I here6y offirm i��ol I om licenud under provisions of Chopter 9 Disp. _Reom Air Cend. — REG.NUMBE4 4 3317 4 Class.(.,`-1 Q
(commencing with Section 7000)of Division 3 of Ihr,8usiness power Apparolus 8 Larqe Apoliancas �ISTRICT NO. PROCES D BY �
nnd Protessions Code,ond my I�cense is in iull force ond effect. �
Size 8 Type HP,KW,KVA,or KVAR � 0
LiCPI15P Number 433174 ��� Class C�10 Up fo 1 Intl. FINAL V
WATMAN ELECTRaF o�e,i��IO lntl. DATE ��/85� VAUDATION °C
Con!rac+or �e Over 10 to 50 Incl. �
❑ FINAL
I om ezempr�nder Sec. Over 50�o I00 Inc. BY ti�n � 6
B.BP.C.for ihis reoson O�er 100 i� y
Services,Sw6d.,MCC 6 Ponelboards , �
�O�P' 0-�00 Amp.Under 60p V
Signature 201-1000 Amp.Under 600 V
❑ Over 1000 Amp.or Ovxr 600 V
E�cmption fo�Reg,Ma�m.Elecl.
5!NGLE FP..M.!LY Temp.Power Pole 8 Appur�enances
HOME OWNER-BUILDE4 DECLARATION Sign wiih Onr.Brcnch C�rcuil
I hPlPbY C�fllT�FIC�I OI'1 P.NPTni IlOT IF.0 CO�«(iC10�T L�[PIITP � A[IfJIIiO�If1I SI n R�anch G!(IIIIS I 7
Law for�he following reason(Sectlon;031.5, Business nnd � ;�Q�'i..l�1 ii
Profe<sion5 CodeJ:
� M�sc.Cond�i�s 8 Cor,duciors i•• • • • •L
I,as owner of�he pro�r.r�y,will da ihe work and Ihe
s�•ucpire is not iniended or offered for salr. (Section Oiher�See Comple�e Fee Schedule)_ , � • •,�Q J 9
7044,Bus�ness on�Proi=ss�o�s CodeJ.
CONSTRUCTION IENDING AGENCY • • •7 Q 3 G�
I hereby affirm�hai!here is a tons��ut�ion Icnding agency for
ihe performencr oF ihe work for which this permit i5�SSUPtI pERMIT FEE (5�6-To�ol� O�.G J—�[4
(SPC.�91,�IV.�.�.
PLAN CHECKING FEE
lender's Name
PERMIT ISSUING FEE /Q l
Lender's Address
I cxrtily thor I ho�r,�e.ad�h�s appl�co��on ond s�a�e Ih�l�he TOTAL FEE �n,�
above inlormo+ion is cerrecr.I o�rer to comply with oll Co�nty
ord�nonces ond S�o� laws reg�lor�ng El=ctr;col wiring,and
h=reby author?e xesnnloliv�s o!Ihis Counly lo e��er upon
the o6ov n nad proper�Y I r ins .uion purposes.
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