Loading...
HomeMy WebLinkAbout0620A I herebv affirm tha[ I�fia�e a cert�ficace of consent�to selfa CE-806G(2-801COUAP�PLI�CAT�EON. FOR �E.LE�CTRI B.N DIrLRI�II � � � �4'ORKERS C6�iPEtiSAT70NDECLARATION 76A663 ' � A TY insure,or a certificate of W'orkers'Compensation Insurance,or � a certified.copy thereof(Sec.3800`,Lah.CJ � � � � �' FOR APPLICANT TO FILL IN �pg �/\ �`s J\ Polic �o. � Company �� � ADDRESS �<�«sa�- �/��7�(L— � ' New Residential Bldgs.&Pools EACH n10. FEE ❑ Certified copy is heieby furnished. 1&2-Family,5q.Ft. � — S LOCqU7v �"�� � � � � MUlti-family Sq.Ft. — NEAREST ��q �S,/ . � Certified copy is filed«�ith the county building inspectiun � .2. CROSS ST l7c l.6d �7 department. Residential Swimming Pool�r'7 ��,� . oWNEa OR L1N � � . . �� FIRM fVAME f7 Date Applicant " � ��- � , � - Outlets�,Rec�ignt�Sw. � +���MAIL P�..i Aw� ' �,�] First 20 ADORESS dJ's�•�[� CtRTIFICATE 6F�EXEStP'tiON FROM1t�VORKERS' _ Total�o.�L Additional CITV {3/�(� �' Tel No. � ��'�r } ' COMPHNSATION INSURANCE � .. . .. . . . � � � PLAN CHECK a- � � APPLICANT � (This section�need�not be�completed�if�the'wock involved ` �,� by the pecmit is for one hundred Qoliaxs ($IDO)or tess.) Lighting Fixwres First20 ADDRES5 � � � � � ' � �� Total No.� Addi'tibnal O I certify that in the performance of the�work for which this Fixed Appliances Not Over i HP CITV 7el No. F permit�is is5ued;I ihall nof employ`�anY Per$on' y manRei PeRMIT �. ' U so as to be om subject to�fhe Wbrkers'Co ensat$ La�c�s. Range_Heater_D.W._ APPLICAN7 � � � Q a 3 � OVen _DryBr_W.M._ ADDRE55 ,_�.. " �', z �ate � � `,qpplican � Top _FAU _W,H._ - - — Hood_Fan �Other_ CITY � � Tei No.�u ��� NO'liCE T0�.9PPLTC.4NT:�Yf,after making this Certificate of Disp. _Room Air Cond._ LiCetvSE OR .�ar��j� � _i Exemption,� you shoutd�Aecome�subject to the Workers' REG.NUMBER K3A Ciass I Compensa[ion provisions�of the Labor Code:you must forth- Power Apparatus&Large Appliances DISTRICT NO. PiiOCESS ❑BV with comply wi[h such provisiorts or this permit snatl 6e Size&Type HP,KW,KVA,or KVAR deemed revoked. � � � �� � l� ��f,��� :. � � .., . UP to 1 Incl. FINAL Over 7 to 10 Incl. oArE ���,� � VALIDATION LICEFSED CO'VTRACTORS DLCLARATTON Over 10 to 50 Incl. I hereby affirm tha[I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL 9 commencin w•ith Section 700Q of Die�iaion 3 of the Susi- —_ eV � g ) . Over 100 . �v'�;(X/��`-�-. ness and Professions Code,and my license is in full force and , � effect. � - � � $ervices License Number� � ^ -� Lia Class �� � 0-200 Amp.Under 600 V � `- ( y'— 207-1000 Amp.Under 600 V Contrac[or �� ate /� d o Over 1000 Amp.ar Over 600 V . t`: H I+E 01'N�R-B IL �CLARATIOti , Temp.Power Pale&Appurtenances v � 5ign wi4h One 8ranch Circuit l C b,L G A I hereby affirm that I,�am�exem t from the Contractor's Additional Sign Branch Circuit5 License Law for the following reason (Sectipn 7031.5, Busi- ness a�d Professions Code): � o e e o e � Misc Conduits&Cnnductors fF' 2 � I. as o�vner of tlte propert}',will do the�vork and the Other(See Complete Fee Schedule)— ' A o jy�v Q ' structure is not intended or of£ered fur sale (Section 7044.Business and professions'Ctide).� ' .,� a e 4 5,v��� COIYSTRUCTION LGNDWG'AQF.NCY' � [ hereHy affirm��thai,there is a cons[ruction lend�ng u�en�,: ! 1,1 6—8 1 for the performance of the ��vork��fbr which��[his permit is pERMIT FEE (Sub-7otai) , t ! issued(Sec.3097,Civ.C.). ' �f�L Lender's Name ..,__,.-,,_.,. pLAN CHECKING FEE (Dne-Fourth Permit Fee) � Lender's Addross "' � . ,„ � . � . .. pERMIT ISSUING FEE S���(i � I certify tha(�I�have�iead'4his�.3ppCic�tion'"and stnte that the � TOTAL FEE . � ,�,!, a6ove information is correct.1 agree to comply witfi alt Counry � �� �� - -����- � ��� � ��� ��� � - �---•� �� ��� - � orclinances and Sta[e laws regulating Electrical wiring,�and � herehy authorize reF�� es nf this Ctiunty�fo eiiter upon'� � � � � -'� � � -� � � � � � � �� � � ��- - � � � �c m ' ned"prop�[ for inspection purpos � - . . . � SEH'RLVERSH L'�R EXPLANATORY LANGUAGL 1 f�� � Signature of Permi[tee Date _ . ....... __.._.. _ - ------- __ � . , , z . . . _ , . ��r�ZEii��'II�I3�,�.F3E�'�A�'cR.TIQ1ti `• , . � . ... .,.. . .. . , .. . ....- . .,. . C tiereby xP:a;m�ihat i an+.e�empt f:cs.^.Y?�e Ceniractc.r's ' !NSPF..CTOR'S Aa��oVa_c . o�;-�s� ' � ;.;.cWnse 3.a1s fet ttie fa1Co��ing maso±s jSecrren 7�31.5, � I s,�va?uaE i - . , � .r . .. � .---� . � - �useness er,a Frofessrmac Cooel: .�1ny c�ty o>.count�� - - TFMP.PO+M�R FOLE,^�� f � � wht�ir rrg�%ire< a �erm�r !a crtastn+cr, alxer imprnce. . � . . �.. UNOEFiB�Ae WofiK. �-} �evnoish,ar reyn�any ste'urt[;re,�/�rior to rrs is.,uance, �I a a . . . . ... ��� ROl4G'ri CDMOUIT � �/Z ,�,,; ;�.rn � .. � . 526Y.C'CEgf0C2YliPHI t:le5"iT_'rIS Ircenseta rpuYsua:tr snslel•e , ' / � --- - •�� . . � YOYtS1Un5 O ttte CUYt% . . ., fi j` S'�7:FJY'S L'RLC)ISC'IR�' tC'13af%CY"�f ... �NIR�NG I � �- .7 �� (f!�!PFYnCl3Citlg w?!h S¢rt?IIr; %GuCf af�iviSloY .1 G,f F'fiP F Xi JR�S - _ .... -� _�� _ . f3us�n.esc aa;..a Pr�fessr3*�s f'^r1eJ or thar he rs<xem,nr r � —' � tixeYe.,�'ro'rr and the basas jo�the¢1leged exemprion..d��}� ' � . ... � . j Pcaa4rrt a�'i r,orziz�� -�� � i diolurimn of Srctior. 7;iii.5 h}�e:�y a;rp3iccn.*fpra p2rnait . . ._ j iJTILiTY CG.NOTiFIEC��—; � � yub;ects,ke r.+;ir1,'carat ro e rivi?pFria.ty of nr�t mnre thnn , �-- --3 � yeve irun�red r.'oddar;(�uSOGj.: � . . - . . �FLNAL �e�.��t a�t '�2� _ . � ' �1=,�zti o�i•riar ot:he rroDerty witi dc:lie-,ra��,and NOTFS � � ' :;ae s>.rvcture is�otintended oe,offe;ed fnr saie. - - - - � � - (Sec. 7Q44, Bu.clners cnd Prof•rssiaas Code' The Con- " � � � ' � . r;rc1t�='s,Lirer,se�1 cw.dc2s.noi applv to-an nwrier of _ .:. -., . .'• ... . :.-' . - ..__ ,__�._-- ____ _...�_........_.._..�..�..�----'----�'�.-'----y_�� ��npeK}' wi:�'�u�tds tr"inrprevea�t�kereran.and who dr,es -� ' - � '� � � such wor`k hi:rrxe:J� qrcvecte�f ;Mnr Ua;�'re i,mproyer�e>ri:� . . . . �-----�._._.._____..� . .'_--'._.._ �—..-----.. ....__.__.__....._._____ . _. _. ' .. , , "-----. - � �aru ndt 1'r<te,ded`br'afjfred'.Ior sale:�ij,�fiawn$e;, amr- - - - � �� � . zuilain; ar�imNrovem,ertz is sold wizhi;: ore year uj -� - � � , ' com�r!eticra, 'the d�Jner-5ui%der wi'. Y,u.�r the 3urdem � � � � �� " - � oj prov-;rg rhat he d;d raot build vr i±trpra�r far tr:e ..._� � ._. �.purpose ejsdlr../ . : ... . ,. . . ._ . — ��_.__.___-.____�______.__�.,_..._ -----.�� �aan Pxrxiipe ier�der�ee' . —__�_ � .__._._._._�_._--.--.-__..---,--_ _..__.__ ��:�..r'.ior khis reascn_�.___�' — -- . � �� ... ..�...�:6e._.._ .. . . � _. �__..,._. �...._..,_—. . . � . .... � '' ,.:?4u'Fer_.�.�- �.. , . ._..- -,- -� S' , .. .. .. .-. . ,. .._.. .. . ........... .. �: "aw� � .� _,. ._.......�..�.--P.w.�..w� ..,_'. ... ��1�.1 1'.� . ... . . . A� � . . . � . , , ., . , . . . � i.. .. .. , . �- ... . ,�.�, - . . . . .... ..�..: .. .. .. . ., ... .. . . . . . . . . , . . ..... � . . , , ' ` . . . . . . .�... . .