HomeMy WebLinkAboutNo Permit Number I VJORKERS'COMPENSATION DECIARATION ����� ,��A� APPLICATION FOR ELECTRICAL PERMIT
� I hereby cffirm+hat I have a cr.n�ficn�r.ef mnsem to sel( fE-A�G �
i insure,or�ce�li(icn��of wo�keri Compensniion Insu�anca, COUNTY OP LOS ANGELES BUIL�ING AND SAFETY
ar a certihed copy�he�eof(Sec.38�,Lnb.C.)
, aty ho.�'1 Qfl(197 7Y'ompony_jj1Il fOR A►►LICANT TO Flll IN 1(� —
Ceriified cepy is h=reby f�rnlshed. New Resideni�al B!dqs.8 Poals fACH n0. Fpc ACDpE55
�X Cer!ilied ccpy is filed wiih ihr.coumy bu�ld�ng inspet- 1 R 4�Fnmlly,Sq.Ft, �],32 S — 5 LOCALITY TR #35742-3005 Diamond Bar
tion deparlmenl. 1.lulii-family Sq.Ft. — NEn4f57
n n Residenliol Swimmin�Pools C�t055 ST.
oo�e 8 8 63 AP�,i;�e,,,_C McGee Electric OWNFR O4
FIRM h4ME M J
CERTIFICATE OF EXEMPTION FROM WORKfR$' M4't �ZZQ
� COMPENSATION INSURANCE Oullels:Ret_li�hl_Sw._ AD�RF55 1698 Greenbriar I,I1�
� (This��cfion nead not bs complNad if fh�work involv�d by First 20
th�p�rmi�is for on�hundr�d dollart(f100)or Iss�.) Tar�l No.�_ Additionr.l CITY BY28 Tel.No.529-817�
I ce�r�fy ihat in ihe per(o�mnncr,of�hr.werk!or wh�ch ihis FLAN CHkCK
APPLICAtiT
permil is issued.I sl`all rol emplpy�ny pe�son in any monner ���h�in FiRiurr.s First 70 75 ADDRESS
so as to become su,�jec1 lo fhe Worke�s'Compensa�ion laws. �
1 Addiuon�l
Tar�l No. CITY Tel,No.
Da�e Applltnnt Fi:ed�ppliances No�Ov�r 1 H' R41•.II
�'nTICE TO APPVCP.NT: I(, pftqr mokinq ihis Ceriifica�= 0� � APP���Nn� ��
; �npiion, ycu should become subje:i �o the Workers' Ron�.±_Heater_D.W. ' �
.��pensnlion fravisinns nl ttie(ohor Code.,you musl forth- Ovr.n _Dryrr VJ.hI.� A�DRESS Z390 S, Reservoir
wii4 comr.ly wi!h such provisicns cr ih�s permii sholl be Tep —FAU L W.H.—
�.leemed revokcd. CITY Tel.N
LICENSED CONTRACTORS DECIARATION H�od _Fo� _o�hP,_ Pomona �27-0936
D�sa. —Room A�r Co�d. — 7 OO ��CFNiE OR 153378 Closs. C-10
I hereby oHirm�tia�I am I�:ensed under p�ov�sions of Chap�er 9 REG.NUMBER
(commenc�nq w;Ih Sr,ctien 7000)of Division 3 cf the Business power A DISTRICT NO. PR SSED BY
ond Pro�ass�ons Code,end riy license is in full force and e!fecl. FPar��us 8 Lergr Ap�lionces � � � �
Sire R Typ�HP,KW,KVA,or KV:1R �
�. ticxnse Number 15��� lic.Closs C-10 Up�0 1 Ind. FINAL V
Over 1 io IO lncl. DATE ` p�
Con!ractor��trical Dote 8/6/83 I�p�'�� VALIDATION �
O O�er 10�0 50 Incl. �—
I ff"1 PrPm �undrr S�. c F�hA�
{� c Ovrr_0!o ICYJ Inc. � BY �f,� / W
B.&P.C.for ihis r,.m.en Over 100 � l``.:C�--� �'
N
Se�v�c^s,Swbd.,.Y•CC 8 Pa�elbocrds ► � ��� ?
DO��� 0-700 Amp.Und�r f,00 V
Signature 201-1000 Amp.Undrr 600 V
OOver ID!�J Amp.cr O�er 600 V
E.em,!!on for Reg.f:.�int.Elect.
SINGLE FARIILY iem�.Powe�Po�e 8 Pppurlen�nces
V!O""E OY:NrR.oU!LCEF^�C!/�4ATION $i�n wi�h One 2roncl�Ci.cuit •.�, ^. I w
+rnhy c!firm thoi I om�.emM Iro�i4r.Ceno-cCor's licens�
`i ler t��following reoson(SeUion 7031.5,Dusinexs and Addi�ienr.l S�rn Pranch Circuils � '' • • ' " .
�Prcfessions Cc!ln):
{� Misc.Canduiis 8 Conduttors I e � ,' ^';„
t__i I,as owncr cf the property,will do ine wr.�k ond�h�
struclwe is nol in'r.nded cr offered!cr sole(Section Othnr(Se?Compiete Fee S:hedulr.)_ � • ^ � ., ...
70A4,6usirrss and pro!essions Codr.).
CONSTRUCTION LENDING AGENCY I ���� ' " ' '"
1 hereby a(f�rm th��rtiere�s a cons'r�ci�on Iending aqency for
�h�performance ol thc work fo�which Ih�s p^�mii is iswed pERh"IT FEE (Sub-Tc�al)
(Set.3097,Civ.C.).
PLAN CHECKING FFE
l�nder's hame
PER.^AIT ISSUiNG FEE 1� $0
lender's Address
I cert�ly itiot I havr, read lhis o�plicn�ion�nd s�a+e tha��he TOTAL FEE 106.53
r.bove info•molion is co�rect.I og�ee io comply wi�h oll Counly
a�dinantes ond Stn�e Inws re�ulatin�Electricnl wirin�,ond
ha�eby,nu�hcrize represeniatives of ihis Couniy ro eni=r upon
tha�6ve- m�v�cd p.opr..�y iar insPattion porposcs.
✓/ �/ SEE REVERSE FOR EXPIANATORY LANGUAGE
_r/i1/ _ 8/8/83
5;, a� �ef�Perminee Da�r,
/
� � � . �._ '
� .
�� � �
� . .
�
� .
�
� ,•` .� � �,
T � '(1 X _ O � J3
o -' N i� '., r
�c�
� v� i =� ;:; � � Y � o -�
N �" .0 �7 ^� (1 S' • ju
N v�
O � � � �.z'. <
, V � � D
7 �j c, �� �
� �� T. �,.
. i�• U
. �
��
e �
� � �
1 n
�' n�
�a�.l
�
O
:n 7..
�u,
e .
�"� D
�\, G
, � n�
� 'n U
�..
\
Sl p O C n S
y N l'1:1 C i: O {7
� y p � O O c: j H {j
� C"Cl O �j "� 7 N'U H G .��c
'� � � ?O �o � u: a ' V,^'(7 j � '-_^'v` � P O
(7 � O : ,[�, o O d S�i, �n�il��`� �C c�n�p'i �� -�p� •� O
O O � � � a n� � � $..c � o� � �a�L-Nv;�in 3 o Q l
;o r, i^
� , c n x ac3o � N� ae,00<,cu o G -� - � c=,ii '?�
c; �� ,nj � �� o »,o e N � % " �� �o Q� � �� � � � - �
C
-�. � � ~_^ f 4 � �,' 3 ro.% -'M.� � O e U N O C Y
�
� v � '^ � �� n.N � � °0 3` go�Ne , n�� �
" � =a a. n -t ±. H �v c.., r r. ;C
u� � n"o v. � � '� r. a � ^ � � o ' '
� �' o � a"o c.c � n�i_c °o o x w n' �o _^_ r�r-�s ' `r��
�N `^ o� �. � =No o`� o � � �. o ??'f � �,1n3 .n-
o ,n �.o� n n �,,00 N�=+ _v 'y�`= :; 3 ° �;� �. _" z
�, o
'� q `b �c i,�N o �', Q " -c ��z"'.o° o'w '_.� � :1 :�
�' C c `� o p -°� ii ! , 3 < <,c' ^`� r''".;;�c v.% O
h � G � .� ='p 4 C ' O
� � � � ? n � n�_ �-e o� c �v c �� ° `' 1
• n Ty O r.� ,Q F� i��: L � Q � C � G v.iJ r �O �� 7
- n
o .� =-3 u°.-+c G c N ° �-c-�'� �=°-� S�. w�
-� i c o a -- . 4 ^-'. - v u p � p °3--o
� `=i;c H o-o n ° �o ;, c�� ° . �'^ �'
-- � G �' 6 � } C Z7 -� C c: " �� r N
�, 'p c �� :� C �v c N '"• S
�'> > c N � �' _
h t= � G
Cy�.p U '�^'G,.
4 r � � ..
. `—��
—�
—_—,��'
��.�
���—_�
—�~—'r