HomeMy WebLinkAbout7914AVORKERS' CO.
have
SATION DECLARATION 76A669 IO•P, APPLICATION FOR ELECTRICAL PERMITthat1he•eby affirm that I have n certifimre of consent to eel( F'Y''
insure, or o certificate of Workers' Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY.
rn r d r .py thereof (Sec. 3300, Lab. C.) 524f;1 8b1ff ARGONAUT INS• PLAN 40
PolPolicy No. Company FOR APPLICANT TO FILL IN ACD,RE55 LOT 47 , Tr . 35742Certifiedcopyishombyfurnished. New Residen'ial Bldgs. R P r`s EACH ND. FEE
PY i Y 3 r.c- Certified ca s filed with thtr coun' budding ms ,r I R 2-Fpmil S Ft. •842 5 I—ISY. q LOCALITY DIAMOND BAR
tion deph!tmenl. Multi -family Sq. Ft. — ST.
sre,.s s
Date ntts/W 83 Applimnl BiRNE BLEC• CO• Residential Swimming Paws
CPO55
URMN ORFIRMNAME M. J. BROCC & SONS.
CF FI ATE OF EXEMPTION FROM WORKERS' Oudr.'s: Rec_Light_Sw._ VA'L
1698 Greenbrier LaneCOMPENSATIONINSURANCE
This section need not be completed if the work involved by
the permit is for one hundred dollars (5100) or less )
First 20
Total No. Additional
ACCRE55
CITY Tel. No.
1 certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner
so as to become subject to the, Wrrko,s' Compersohon Lows. Lightinq Fixtures First 20
Date Appliront
NOTICE TO APPLICANT: If, after mrkirg this Certificate of
Exemption, you should become subject to the Workers'
Cempensci ion provisions of the Labor Code, you must forth.
with comply with such provisions or this nrrmit shall be
deemed revoked.
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I nm I; --d under provisions of Chapter 9
commencing wi•h Section 7000) of Division 3 of the Business
and Fireless—, Codo, rind my license is in full force and effect.
License Number 195476 Lic. Closs C -LO
Can!racror — B me E1e2.CO- Dn!e Z/83
I am exempt under Sec.
57TTU
R. BP.C. for this moson
Date:
Fxemption for Reg. Mainz. Elect.
SINGLE FW,'ILY
HOME OWNFR-BUILDFR DFCLARATION
1 hereby affirm that I am exempt from the Controcier's License
low for the following reoscn (Se:tio•, 7031.5, Rusiress o^d
Profp si— Cad?):
I, as owner of !!in prcprrty, will do the work and the
structure is not intended or offered for sole (Section
70.14', Rusin -ss and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued
Sec. 3097, Civ. C.).
Lender's Name
tender's Address
I certify that I have read this application and state shot the
above informe'ion is correct I agree to comply with ell County
ordinances and Sate laws r yfnting Eloctricol wiring, and
xv
outhorire represen'a Ns of this County to enter upon
ve-mentioned prep Y for i^` -Pett ion purposes.
5/2/83
a-natureof Permi. ee. Date.
Total No.
Additional
Fixed Appliances Not Over I NP
Range_ Heoter_D.W. _
Oven _ Dryer — WAIA.
Top _ FAU —W. H. —
Hncrf _ Fan _ O'trcr_
Disci. — Room Air Cond. —
Power Apparotus R Large Arpliarces
Sire R Type HP, KW, KVA, or KVAR
Up to I Incl.
Over I to 10 Ind.
Over 10 to 50 Incl.
Over 50 to 100 Inc.
Over 100
Services, Sv,hd., MCC R Ponelbo-da
0 - 207 Amp. Under 600 V
201 - 1000 Amp. Under 600 V
Over 1000 Amp. or Over 607 V
Temp. Power Pole R Appmter,oncrs
5g with One. Rronch Circuit
Adddinnr.l Sinn Bronch Circuits
Mise Conduits R Conductors
Other (See Complete Fee Schedule)—
PERMIT
chedule.)_
PERMIT FEE (Sub -Total) 73 1681
PLAN CHECKING FEE
PERMIT ISSUING FEE 1O 5
TOTAL FEE 64.18
SEE REVERSE FOR EXPLANATORY LANGUAGE
PLAN CHICK
APPLICANT
ADDRESS
CITY Tel. No.
AM CANT BYRNE ELECTRIC CO.
ADDRESS 922 CATARACT ARB.,
CITY SAN DIMAS TPI. No. 599_%
uCENSE CR 195476 GPFG. Nu MSIR ass.
DISTRICT NO.P OCE BY
FINALDATE / l7 VALIDATION
F INALBY
I`
Z
o
a
LU
E7 -C Q— Q[O0\&$%fk 6ƒ [£b
z
6
m\
7 ®0-0
G
CL ¥
E e
D 'n
m-"-ocn E
G i 2:)CL kj 0,au— o ]R0
e22s>a` ems°
0k,
noe
oma` ice;;f@,ol, 2/qf 2«
0 B`;Z»!§ zz
n I E2\$/\0%- 2 - _- _ _
10
2
@
r:- §\/
Jcl
0
f
nB.n0;/ =- Et(q§k2f Bz
E7 -C Q— Q[O0\&$%fk 6ƒ [£b
Dto(C',C,
RR®R m\
7 ®0-07
aee_
2m s/n f;2f\4(7§
CL ¥
E e
D 'n
m-"-ocn E
g\e!o§§\\Erƒ(
G i 2:)CL kj 0,au— o ]R0
e22s>a` ems°
0k,
noe
oma` ice;;f@,ol, 2/qf 2«
0 B`;Z»!§ zz
n I E2\$/\0%- 2 - _- _ _
10 r:- §\/
0
f