HomeMy WebLinkAbout1738A, .... ..c ._ .. ..i,n, i:T'�q h'WS..,4.;,l..�..wyi:.5 " ...:E....... ..uaf~•nj,.:,.}yye,.✓�Fuwr. +i
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WORKERS' .COMPENI .I7x DECLAR.ATLO) .:µ•b.
I herebyaffirm that I hove a cerUficafe of cons nr to se f -
76A664' 10/81 APPLICATIO_J09.1"LECTRICAL PERMIT
CE -806G
insure, or a certificate of Wgrkers Compensation esurance,
��j"`�f�M2'}%'�j�p5 ANGETES
-' BUILDINGANO
or o certified copy thereof (Sec- 3W, Lab. C.
SAFETY
Pout' N�fCkt74656 y41E$T AMERICAN INS.
Y Compon
"rOW APFLICANY TO FLLL W""' •'
JOB
'-
❑ Certified copy is hereby furnished., _ ,
ry
New Residential BId s. Pools
g
EACH NO
ADDRESS 23171 E. RIO LOBOS RD
FEE _ ..-.., .... e... ., ..,„,..-...,..,•..:..
_
Certifi4d copy is filed with the county building inspec-
1 & 2 -Family, Sq. Ft. 169 5.
_
S E
LOCALITY, IRM034-1
flop deportment.
nt.
.” ..
Multi -family Sq. Ft.
CROSSET,Ss CQGBURN I�jNE
,Date Applicant -
Residential Swimming Pools
OWNER OR -
CERTIFICATE:OF EXEMPTION'FRCIM'WORKERS'
-;COMPENS`AY12iM1,1:jAKfC"'°"""'`'•'•--•
Outlets: Rec'�_Lighl Sw.,�_
'First
75
FIRM NAME SOCAL-ANO GROUP
MAIL
3 00AooREs
• -.. ,.. r..••.,....,,.. -,.,,•v,....,;
(This seefion" need not'be coinpPefed if Ina -Work involved fry
20
the permit is for ori.e_hun{'1',rad,dollars,(5100) or less.)
...
Total No. Additional
CI GE 26 8 Tel. 8_
I certify that in the performance of. the work for which this
PLAN CHECK ..... .. -..... _.,...,..,.......,,
_
permit is issued, I shall not employ any person in any manner -
APPLICANT
,,,,__ --__.,,,,._.•w,
sd as to become subject to the Workers,'_Comm nsotion'Lows.,, _
-'
Lighting Fixtures First 20
�...^__. ,......,.:...
ADDRESS
Apl
to f,
I Additional
Tota No.
Fixed Appliances Not Over I HP
- -'_. .... ._ _ - _._..,. ..., ......._. .,T
CITY Tel. No.
I
-ICrTOAPPLICANT: f, ft
6fter'mekmg this Certificate�of
-
�T
~INC.
.mption, you should
become. subject to the Workers'
Range,_ Heater_ D.W. —
AP�+IPLICANT VICTOR ELECTRIC,"j��yr-
Compensation provisions of. the Labor Code, you must forth-
Oven _Dryer _ W.M. �-,
ADDRESS 2222 KPtN$A$ /-1Y�e 51M D u`
with comply with such provisions ar• this permit shall be
Top __ FAU —. W.H.
,
deemed revoked:,, CO'
--- .. .. _
LICENSED NTRik OR -
S DECLARATION
Hood _ Fon _ Other_
._,.,,,,,,„,,,,,,,,,,
CIT'RIVERSIDE 92507 Tel. No788-9110
I hereb offirm that I am licensed under ..,„., nsof w.. ' � ""
y der pravisidns of Chapfer9
Dis Room Air on 1.
p' '— C — •
uCENSE OR.....
REG. NUMBER Class -in
(commencing with Section 700D) of Division 3 of the Bq'sineis
and Professions Code, and my license is in full force and effect.
-
power Apparatus &Large Appliances
Size 8 Type
DISTRICT NO.
PROCESS BY -
Y
�.
License % 1_ Class C 1
r
yp HP KW KVA o KVAR
"•-�
' �`�"'
V
Numb er44_ Lic.
Q
Up to I Incl.
FINAL
Cont -51o, A'-'ftp—Deco
— , Over, to, 10 Incl,._
DAA /
VALIDATION
❑ - ERCT -T_-- -
I Sec.
Over 10 to 50 Incl.
FINAL
H
am exempt under .., ...
B.&P.C. for this reagon
10.0 Inc.
Over100
- 100
BY
w
IL
' ' '• .
Dbfe:6r;
Services, Swbd., MCC & Panelboards
. _ - •, ,
0 - 200 Amp. Under 600 V
Signature . ,,. ,"..._..,..
201 -1000 Amp. Under 600 V
❑Exemption for Reg. Maine .. - ..
Elect.
Over 1000 Amp, or Over 600 V
` I 73,8A
SINGLE FAMILY '
HOME. OWNER -BUILDER bECLARATIbN
Temp. Power Pole & Appurtenonces
4tl
• reby affirm that I am exempt from the Conctor's License "
tra
Sign with One Branch Circuit
Law for the following reason (Section 7031.5, Business and
Additional Sign Branch Circuits
I e -81.30
' Professions Code): '
❑�
' I, as owner of the property, will do the work and, the
Misc. Conduits 8 Conductors. „
. -81,30'.
structure is not intended.. or offered for sale (Section,._..
7044, Business and Professions Code). `
Other (See Complete. Fee Schedule)_
► 0 2 L r7 F5 4
CONSTRUCTION LENQfNG'AGENCY
- ... _._.....,-_.
1 hereby affirm that there is a,construction levyding agency fore
"if;,
'
the performance of the Work for which is permit is -issued
-Civ.
",_,r,�
PERMIT FEE (Sub -total)
]0 80
(Sec. 3097, C.).
-
PLAN CHECKING_FEE
Lender's Name
., .. . .:_,,,. ,.......,,...»r,«r..................„..,.,,M
Lender's Address -
PERMIT ISSUING FEE
I certify that 1 have read this Application and t11gtihe ,±..
TOTAL FEE
81 .30
_sjaie
above informotl�anv correct I agree to cwmply'with ali County
ordinances an'I r - te•1gve regulating Electrical wiring, and
he,etly autho�ife rept ' nt�itiyes•of1this County to enter upon
-. -. -- -- _.._".. ...,,„_.-.. .F., _�....,.„...•,;,._,.<.•;...a.,,o,..,,..tl,,,e,
-
:,,,,�__ . „2„-.,.::.,,,..., "'-""�'`""""•' ^n^"" -"^---
--_
o0 -e
v the mens ,Wied pr pgsRy for tis ect on pup ses.
f lerf f�tl P
SEE REVERSE FOREXPLANATORY L�4NGUAGE,
_ _ -_
_
Slg acute of Permipee� ... Date•., .. ,.. .,..
...,.. ...._,,...... ..t..;:.,.. ,...e .....,_. -.
APPROVALS DATE
SIGNATURE
TEMP. POWER POLE -
UNDERSLAB WORK
ROUGH CONDUIT
WIRING
FIXTURES
POWER AUTHORIZED
UTILITY CO. NOTIFIEDLIE-
FINAL��rr,.__-
Gnfer on. Jreni
OAMNER-BUILDER DECCARATION
i hereby affirm thor I am exempt frons, the Ccatractar3
License Low for the following reason (Section 7031-5,
Business end Professions Code): Any city or county which
1 requires a permit to construct, alter, improve, demolish,
Y or repair any structure, prior to its issuance, also re-
quires the applicant for such permit to file a signed state-
ment thot he is licensed pursuant to theprovisions of the
Contractors License Law (Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Profes-
sions Code) or that he is exempt therefrom and the basis
' for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit sublects the appli-
cant to a civil penalty of not more than five hundred
- - NOTES - dollars ($500).:
❑ I, as owner of the property avid do the work.
structure is not intended or offered for sale.
(Sec. 7044, Business and Professions Code: The Contrac.
for's License Law does not apply to an owner of property
-- - who builds or Improves thereon, and who does such
_ ............._,-...work himself provided that such improvements are not
'intended or offered for sale. If, however, the building or
improvement is sold within one year of completion, the
owner -builder will have the burden of proving that he did
build or improve for the purpose of sale.)
W W1 am exempt under Sec.
...,..�...B $ P.C. for this reason.
. - Date
Owner -- -<.,.. �....,..,«.«..�....