Loading...
HomeMy WebLinkAbout0768A �� -WORKERS'COMPENSATION�ECLARATION ,. �.76Abti3 ,oe� ,....�.. APPLICATION� FOR ELECTRICA.L PERMIT - ,,//�� I hereby affirm ihat I have a cer�ificate of consent.to_self �E=�OtiG ' _ , �i . _. __ . ._... .._ . ins re,or a certiilmte of Workers'Compensation Ins�rance, COUNTY OF LOS�ANGELES � � BUILDING AND SAFETY 1� or a tertified copy�hereof(Sec 380Q Lab.C.) � � � � �� " � ' �� 33020 Lot #48 ��Y,��6 RCS 13999$,.,Pa�Y Royal FOR APPUCANT TO FILL fN .. . . JOB . .. . . . Cernfied copy is hereby fumished. New Res�dential Bldgs.&Pools EACH NO. FEE AooRe55 E. S 1 van Gl en Road � Cerhfied copy is filed with the couny buiiding inspec- 1 &2-Family,Sq.Ft. ZrJDO $.� = 5 LOCALITY Diamond Bar rion depariment Multi-fomily Sq.FL NEAREST ' CRO55 5T. / Residential Swimming Poo�s OWNER OR - Dafe�l8 $6 qpplicant ��,J' FIRM NAAAE GERTIFICATE OF EXEMPTION FROM WORKERS' J The Anden Grou . . Dutiets:Rec_Ligh�_Sw._� '�'�� COMPENSATION-INSURANCE ADoeE55 First 20 (This secfion nead not be complefed if fhe work i�rolved by To�al No. Additional CITY (�,OVI Ild Te1.N�.967-9541 fhe permiT is for one hundred dollars($100)or less.) PIAN CHECK I certify fhoi in the performance of the work for which ihis APPLICANi permit is iswed.�sholl not employ any person in any manner so as ro become subject to the Workers'Compensation Laws. Ll9hting Fixtures First 20 ADORESS Additional � - ,,�., _ . Total No. CITV Tel.No. " Applicant � Fixed Applipnces Not Over 1 HP PERMIT h . NviICE TO APPLICANT� If, afier moking ihis Certificate of qppuCANT U ER tlTh' I_I •� Exemption, you should bemme su6jecf Io the Workers" Range_Healer_D.W,_, . . Compensation provisions of ihe Labor Code,you musl 4orth- Oven _Dryer _W.M._ ADDRESS P OX 2�J�8 with comply with such provisions or this permit shall be Top —FAU —W.H.— QTY Tel.No. deemed revoked. Hood _Fon _Other_ 1110 881-2553 IICENSED CONTRACTORS GECLARATION LICENSE OR � - I hereby affirm+hat I am licensed under provisions of Chapter 9 �isp. _Room Air Cond. — REG.NUMBER Closs.C_10 (commencing with Section 7000)of Division 3 of ihe Business power Apparatus&Large Applionces DISTRICT NO. ' PROCESSED BY p}„' and Prafessions Code,and my license is in full force and,effect. /� � Size&Type HP,KW,KVA,or KVAR �� Llcense Number 483115 Lic Class C-1Q Up�0 1 Ind. 5 PERIQR,TEMP PaWER ELEC. C NT o�e.i3O 101nc1. DATE� �'�3��`r� yq��pATION � c���dkaal�sion of JBR Incbo,e 8 18 86 o�e�,otoso�n�i. ❑ FINAL ��/J W I am exemp�under Sec. Over 50 70 100.1nc BY ����"v_ " U7 . B.&P.C.for this reason �°ef�� z Date: Services,Swbd.,MCC 8 Panelboords , � 0-200 Amp.Under 500 V . Signoture 201 -1000 Amp.Under 600,V � �❑� � . � � - - � . Over 1000 Amp.or Over 600 V :?�'7 Q�A Exempiion for Reg.Moint.Eled. ��� SINGLE FAMILY Tem Power Pole 8 A ' t:o e � w o''� p. ppurtenonces HOME OWNER-BUILDER DECLARATION gign wirh One Bronch Circvit � � m o']Q�j O I here6y affirm ihat I om ezempt from the Coniractor's License qdditional Sign Bionch Circui�s Law for the following reason (Section 7031.5, Business and @ � e�](1;.rj(J U Professions Codel: � ❑ I,os owner of the o ert will do ihe work and ihe Misc Conduits 8 Conductors Pr P Y' Other See Cam lete Fee Schedule ► �O I �"l�i�J struct�re is not intended or offered for sale(Section � P �-�- 7044,8usiness and Professions Code). CONSTRUQION LENDWG AGENCY I hereby affirm fha�ihere is a<onsiruction lending ogency for .. ihe performpnce of hhe work for whi<h Ihis permif is issued PERMIT FEE (Sub-TotalJ (Sec 3097,Civ.C.). PLAN CHECKING FEE 1 �jO Lender's Name - PERMIT ISSUING FEE 7 GO Lender's Address I certify ihoi I have read this applimiion ond stafe fhof the T07AL fEE above information is correct.i agree 10 comply wiih all Counly � � ordinonces and Sfare laws reguloting Elec�rical w rinq,ond hereby au�horire representotives of this County to enter upon he a ov�ned pr� operty for inspec�ion purposes. � SEE REVERSE FOR EXPLANATORY LANGUAGE '�ature ef P�rmittee ���$i Da�te�— . _.�._.._ . _.___.�- � �-, . ,. t��___. , i„ ,,, .:-�r.,�.,=�r, f ��,r,,,,,,. ,.., � � •, ,,.. � , , g, - -. __ �.. ,.,__.._ _ _,.�_ . �..�:. :. . ,.. - , �,. .r., . . . . ' . . . . .. . , r.. .j ., .S-,r-.� r.^3t.>. , .__ . __... .__.._.._._.,.....�—....:,_..�_.__....,.._�........: . .'s . . . -. , � . . _ - 1 _ ' , . � - � ._ ,,. .. _:�#. . _ . ,er . .. . . � � ....__ , _ . ... .._....,...._, . . � ' � . � . _ ��"`�.�..� ' Gj�.i d �.,,r,� :.s_.' x:�r:�e, . .. ._ .__.._ ...:�. .nr . � , .. .:.. . --d,.. ..._.� _ 4y'�__ .....� ., .. . , , .. J C .. . . ... .. , . . r . ... � ' . .,-,. . . , � 7 ' . ... . .. _..... . ..... ...�..�.��_... - �'. . -. . . - : .. , ......,.i .� .:. 1. � �, � ''� ( . ,. - . ) t u r,.__.._. __._.r--� .__.__...�._..J � �� z r: �� 3�- . , ... .i...�.. .... . . ..C: . .r.d .s �. �, .,..._.......,. ..__... ..�._..,.� ......._..... �.....�....�._... . �,... : ... 5 .. ;..<. , ...._...._.........: . �'. ,... .,.�. � :�• t ...�:';.: GS"�l:.re -,�:�z:_ � . . . . � , .. .�t . .-'+ .,:rc�_is 3ir.npei . . ,_ . ,..r: . . - . ..� . �.ry(`^: ,�.E ,. . �l���... v.�rl. .....� ' m.a.........e�....�......:....�..��.:.�_......._........�..._.r.a..._...�.r..._.,,.-...s.._.,...-.v..-..Yt�..1,f..s..=.Ya','1_.:«...:._.�..:4.Sw'lih«_...� ' '::x.�" �.,":-� � . .. ..,.,...—.. '._......,..__.,.._.......�._.�_._,e...._. - .. __ . e'Y".. . . 3+J'r' .. � . � ... . � . , .. < t..�..,. , ......... r :=�O�'.'t:;- . : .....,..__....., _...._...................�..__.. ......__.....___. .......�...__..,...._..._.n__.. . ..._..._..,_.„...�...�.... �.s....:a.:..�.�:.�•.uc..e..:w.,...J.aeh� � GG^-.�c�::,".t+.���trm..�' ....-' .Y:.-."..� .�« , ; .C..� r...�".L."'.^. �t ' . . . . . ^ ' '.__-.._. _,..,....,.a._. ...� ..,_ .. . .I,S..... .>.. , � --..__..___._._._.......,...._._--w_.. _...__.____w.._.. ._..�......`--_..:..._�_�.,...._ ._..._�_._._..__�_�.�.w....___..._.......____�.:....::.._....:�..V..''�..." . .. . . ..._ ... . -i "� ' .. ... � , . _ .,� „ _ _. . .. . . , . , . . ... . � .-„�'.,:-. .. . ,.. _ .r. �i- M,�: . � .,..c .„..;, 1 . e:.. y.:, : ."".._..,___...___..._.:_._,_._..,..._..._.._._,.,.."'___.._...._..,....__...............�...._...._.u......__...__._....__�....... _._._......_..:..:,:._�::..J.�_._.p.�..,.w���..........��.-a.f...�_.... �;.,. : .,. �. . G 'Y Gf. •_ , ' .... -.._.:.. .... . .�..�..... �,f�. - «f i•.. e.... -_�._..._.._,., . ..�_....,..,_._..._...._..' . ...,..._....�..,._....:......�__...._..._.„......._...._.......a .i..._ .tr.._ ... _ : . . ' . .. :. i.s .._......,._.s_...... .__..,._._....,.,._.�......_ .__....,.:._,...,....., a...,... :'.:i.:,� ..: .,-"').s.. . . '�... 'J.. . "_...^.,._...._�_.,_,.,.�__._._._._..,._..:___... . ....:_.._.._a...... _ , ... �. ... . ' - ( ' _ .. ,,.__.....,.�..�.._,.�........__'_..__.,� . . - . . ......._.,.. _......._,_x....._...�...�.�.,'a�.;,.._._�..._.............�=.5....Y :.�'[t rvv.. .-,. ...�...e .�.� ._,.._.. ,.. __...-_ _._x_,�............- � � ... . , . . .- . .. ... . . . .. . . , . _....__.__..__..., _m.... .._.._._.._.�..�..m.....�__..W ik � .. . . - _...n,_.......,-.w.�uC�r.._.__'..,,e.....+_.�ee.r._.,.. _._. ..� .�_.�:✓.:s.:4k!S.."�. . .. ., - . _... .�.....�. ...L':'='1'_......._..._._...-._...._.�..i:'' i+'r^ . , ..._..._...__ .. ...._.._,.... ._...�._.._..._. ,._..._....._....._._ �...a.._.,.v...�.__w�_e_e.....: .. . . . . . . A r. . .._,._..,..: .....i'__.�..,.,.....1 . . ,. . , . _.:�.,,_,...._u.'..............._._..� '..e..:�_..:":::,,,.r.._ .,.,m�---'.'--..-..r.,.�..,:+..%+,.rtr+..:�r...m�.E..s. "..':nt.:+Y. ✓.'.i52:L., . '�.,�.....: . . . .. . ............ .. ...._._...... _,.._._.� . .. __ .._.._._�._'..0.:.::_�'.=_.. � �.__ . ''. ' ..::..� . ..3_..: .., �.::......:. .... ....... � a. _ ._...._...__.�...,_..._......... _.._._"....._......_........_.._..._... . . . . .. .....:......�.::�,._.,�."_9'.:e:U'..24+:.«:5.:.:..a.�2"V`.:._ ,''�.. , . .,�V<40.4R<-�I..:t'A]i. ..__..., ...-.-F�i . ......,..W.,..t..__.,..__.. _.._..___.......... .. ... _. � - ' ._....._..,........._.......�,_.._......__._._.t.t......�_.,..r:�..._...J__...... .. . . ..:�:v:iF.Si.�.....d'.s.u...'.:_e:.�,`.+.s.':.v..a',:.,.::.'bet-.FJiv..-A'.htl'UHiiRf>.d.�NiL,r:HaY{.�S'r.aba�.:�a ......,..._,......, ..__...._. .:aXi�,.w�+s'.��hmE¢:::.J:.i.,-._. ..._._.......<... ._....._....�....__...____. . . . . . . .,.,....._......._ ,... ._....,..n..-.-�c-.�..�„.-._........-«.,».:...t.....�_��.._._.....:s_t._....i,'.?A..i.".:<n�✓,��.orr�-.�:_..�....-'.m_:..Ll..i;.-....,.'� _.....-. _i_. �-...-.-..i� .-. ...-�..,.,._.-..,. , . . . . ...................._.._� .<.... .._.........._�.,.... ._...................v._ .�.�.._...�n....1. . . . . . . . . , <r a xe ..__.._...... .,.....a..,,....: .. ..,.....�^,.. .. , .,.� w�., w. _..._._.........,�.1....v....�_....i........a.m...�. ... . ., rc'..,... ..._ . . ...n . ,r .: _. . ................ .. <m..._...,_..,_ .. .....,..�, . �M . . ..'.:.iv�a:...�........w.c...�«....r.«....,.:2;.: ' '�� . . .. � . . i ,v� . ..,.: . �..,.� ....... ... � ,.. .'� ..,:r.� _.____._ ._ .._._......,..,.._.__, ......__.,....,_ ,__......r,..,.,..,:..�...__x_.._....:.a..�.. ..�.3:.._. . . . . . .. ,. .. ._._......,.._.....__...._.__...J._....___.. __.._._..._._.__._..._.._...._:__w.o-a_,;...._. __..G...._.__.,,.._.__..._... �..,__....�._.._......_:a...�x=.u�.a..e.cu��."a.`..: .. " , ' . . . . . .. � ., . . ..,.._._._... _.....�..._. . ..._.._.�._. ...__......._._.... .__..._....__.. .._>._......�......_..:......___�.._,.a.___;�.. _.�._:.,._,.....__.__��.,_-�_�ri:..�s1.�ls,..'*i,:F;... _ . ... ...... . ....� ... ,,.. .. . �.,..,.. � ..t,r.-. ... . . ..... .. . . . . .. .., .. .�.. ... . .. .., ,. . �,..:,. ,��,,.. .y„