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HomeMy WebLinkAbout7914A (212)WORKERS' CO. have SATION DECLARATION 76A669 ID•P, APPLICATION FOR ELECTRICAL PERMIT1herbynffirmthatIhaveaccrtificareofconsenttosol( /"F'Y'' insure, or o certificate of Workers' Compensation Insurance (//_ COUNTY OF LOS ANGELES BUILDING AND SAFETY. n• r d r .py thereof (Sec. 3300, Lab. C.) PIAN 40524f;1b8b1ff ARGONAUT INS• Policy No. Company FOR APPLICANT TO FILL IN ACD,,"E55 LOT 47 , Tr . 35742 Certified copy is hereby furnished. New Residen'ial Bldgs. R P r`s EACH ND. FEE Certified ca s filed with thtr coun' budding m, I R 2-Fomtl S Ft. •842 5 —IS LOCALITY DIAMOND BARPYiY3 nr. c- Y. q ion dephttmeni. Multi -family Sq. Ft. — NEAOE ST. X1tW /83 BUM ELEC CO Residential Swimming Paas nwti..o nuDateApplicant CF FI ATE OF EXEMPTION FROM WORKERS' Outlr.'s: Rec_Light_Sw._ COMPENSATION INSURANCE This section need not be completed if the work involved by Total No. Fust 20 the permit is for one hundred dollars ($100) or less.) Additional 1 certify that in the performance of the work for which ihis permit is issued, I shall not employ any person in any manner so as to become subject to the, Worke,s' Compersohon Lows. Lighting Fixtures First 20 Date Applicont NOTICE TO APPLICANT: If, after mrkirg this Cenlficale of Exemption, you should become subject to the Workers' Cempensnrion provisions of the Labor Code, you must forth. wRh comply with such provisions or this permit sholi be deemed revoked. LICENSED CONTRACTORS DECLARATION I hereby affirm that I nm I;ce d under provisions of Chapter 9 commencing wi-h Section 7000) of Division 3 of the Business and Profess—, Code, and my license is in full force and effect. License Number 195476 Lic. Closs C -LO Can!racror — B me E1e2.CO- Dn!e ZW/83 E]I am exempt under Sec. 57T[U R.&P.C. for this reason Date: Fxr.mption for Reg. Maim. Elect. S!NGtE FA,'ILY HONE OWNFR-BUILDER DFCLARATION 1 hereby nffirm that I am exempt from the Controcror's License law for the following reoscn (Sccllon 7031.5, Business old Profp!siars Code): I, as owner of !tin prcpr-rty, will do the work and the structure is not intended or offered for sale (Section 70.14', Busin-ss and Professions Cade). CONSTRUCTION LENDING AGENCY I hereby affirm that there is n construction lending agency for the performance of the work for which this permit is issued Sec. 3.,^97, Civ. C.). Lender's Name lends: 5 Address I certify that I have read this application and state that the above informe'ion is correct I agree to comply with all County ordinances and Sate laws r yfnting Electricol wiring, and her authorise represen'a Ns of this County to enter upon ove-mentioned prop Y for inspection purposes. 5/2/83 S'-gnnture. of Permi^ee Dote. Total No. Additional Fixed Appliances Not Over I HP Range_ Heoter_D.W. _ Oven _ Dryer — WAIA. Top _ FA — W. H. — Hncrf _ Fan _ O'trcr_ Disci. — Room Air Cond. — Power Apparo!us R Large Arpliarces Sire R Type HP, KW, KVA, or KVAR Up to I Incl. Over 1 to 10 Incl. Over 10 to 50 Incl. Over 50 to 100 Inc. Over 100 Services, Sv,hd., MCC R Ponelbonrda 0 - 200 Amp. Under 600 V 201 - 1000 Amp. Under 600 V Over 1000 Amp. or Over 600 V Temp. Power Polo R Appmtpnoncrs 5g with One. Bronct, Circuit Adddinnr.l Sign Pronch 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 84.18 SEE REVERSE FOR EXPLANATORY LANGUAGE iE acss 1698 Greenbrier U CITY Tel. No. PLAN CHICK ADDRESS CITY Tel. No. AM CANT BYRNE ELECTRIC CO. ADDRESS 922 CATARACT ATB., CITY SAN DIMAS Tel. No. 599-9720 uCE45E CR 195476C-10PFG. N'uiwq ass. DISTRICT NO. P OCESO BY FINAL DATE / " l7 VALIDATION F INALBY n e„ I w Z o§ T, a 2\)(°° E 7—,=Q[O\&$%fk 6ƒ [£b z 6 z§§2CL7 G af\,7§ E J=©E`.a}l., e mL0L 2-'E G i 7E kj({/))]R/ ea '3—c ezn° Z;00z-©- oma` i f@,Col, 2/qf EaI o`'` tA\' 2«zi - ' 11 §)\/®/§ E} zz n I 2 @ J w nBn0;/ =- Et(0 CC:Bz2\)(°° E 7—,=Q[O\&$%fk 6ƒ [£b to(n£EE'an z§§2CL7 gee_ 2m s/n f;0':-- af\,7§ E J=©E`.a}l., e mL0L 2-'E g\e!o§§\\Erƒ( G i 7E kj({/))]R/ ea '3—c ezn° Z;00z-©- oma` i f@,Col, 2/qf EaI o`'` tA\' 2«zi - ' 11 §)\/®/§ E} zz n I 0 f