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HomeMy WebLinkAbout0572A (4) . .. �. ..: ,�� WORKERS'COMPENSATION DECLARATION �� �� 76A663 10ie1 APPlICAYI�hI�FOR����EL�E��YIt1C�AL P�E'�tlilll�'��"-� � I hereby off Fm Ihot I ha e a certif mte of Mnsent io self� CE-806G ��- �" ins��e,o�a�e�t fi�ate of wo�ke�s'C Pe�sa+io��osu.o�ce, GOUNTY OF L�$ANGECES ` BUILDING AND SAF�TI/" or a cer£fied c t r �Sec 3900,Lob C.) °G�1�� 42565 Lof ��32 Plan 23 P❑ollcyNa� nS��74/1-.`��mpany-,.." WdUSdU I115. ; FORAPPLICANTTOFILt'IN'... . . JOB � . . _.. ._ _. . Cerfif�eo copy is he eby f nished. New Residenliol Bldgs.&Po015 EACH NO. FEE, ADDRE55 1238 S. Deerfield ❑. . . . . . . .. .. ........ . Cerrified copy is filed with ihe counly building inspec- 1&2-Pamily,Sq.Fr. �c��4 � — E LOCALITY plNmnd BdC Hl j l S tion depar�ment. Mu�fi-fomily Sq.Ft. — NEAREST'�"'� ` � �� � ��� �- �-' Residentiol Swimming Pools CRO55 5T. oare _7-25-86 ApPi;�a„� Grey Hi I 1'Flertri owNeaoa � FIRMNAMEBrc�77H,iea California, Inc. CERTIFICATEOP�EXEMPTION�FkOM�WORKERS' - � � nna,r � � COMPENSATION INSURANCE �� � Qutlets:Rec_Light_Sw._ ,.,_ ADDRESS 3151 Ai.rway Ave. Sui te�N�� (This secfion rieed nof tie compfefed if fhe work involved by FirSt 20 the permit is for one hundrod dollars(5100)�oi less.) Totol No. Additional ❑TY CpStd �S3 iel.No.$50 IQO L I certify ihar in�the performdnce�of�the work�for which this 7LAN CHEIX - APPLICANT �permit is issued,I sholl not employ any person in any manner - so as to 6ecome subject to fhe Workers'Compenspfion lows. ��9hting Pixtures First 20 ADDRESS � � Totoi No. Additional Date Applimnt - CITY Tel.No. M"�"E TO APPLICANT: If, ofter moking ihis Certifica�e of Fixed Appliances Nol OoeFl HP PERMiT - .. E. �tion, you should become subject to the Workers' Ronge—Heater_�.W.-- APPLICANT CrC2 Hill Electric --Ine. Compensotion provisions of the Lobor Code,yov must forih- Oven _Dryer _W.M._ AD�RESS 6760-B Central Ave. with wmply ith such provisions-or�this permit shall 6e rop _Fa.0 _w.H:— 354 8900 deemed revoked. � CITY - Hood _Fon _Other_ R1V2CS1Cl2 Tel.No. LICEN$ED CONTRACTORS DECLARATION��� LICENSE OR Disp. —Room Air Cond. _ 3 I hereby affirm ihat I om licensed unde provisions of Chapter 9� REG.NUMBER 16579 Class�-1Q (commencinq with Section 7000)of�D s on 3 of the Business power Apporatus&Large Applionces I DISTRICT�NO. PROCESSED 8Y O and Professions Code,and my license is in full force and effecl. - � � � � � Size&Type�HP,KW,KVA,or KVAR I �71 C) License Number 315579 i��.eiass C-10 � � - . Up to 1 IncL FINAL DATE � �� Over 1 to 10 Ind. c convacro��y Hi l l Elecdwe 7-25-86 / -G?-�f' VAIIDATION � . -�..- . ...... . .-.�. . , ..�.... . �. . Over lO to 50 Incl. FINAL - W ❑ I am exempt under Sec.�� , _ Over 50 to 100 Imc, BY �� 8.8P.C.for this reason �Vef�� Z � � �Dote: Services,Swbd.,MCC 8 Panelboards , 0-200 Amp.Under 600 V � Signature � 201 -1000 Amp.Under 600 V �„ - � Over I ODO Amp.or Oyer 600 V .°.V`5 7'G�i � Exemplion for Reg.Maint.Elect. � �0 4 G G SINGLE FAMILY A� e Temp.Power Poie 8 Appur�enonces � � HOlv�E OWNER BUILDER�DEGLARATION . �� . Sign with One Branch Circuit � �'° A c�.��FS� eoy affirm fhat I am�exempt from the Contractor's License � �.. for the fallowing reoson(Seaion 7031.5, Business ond Additionpl$iqn Branch Circ�its ' m ? . Professions Codej: t'S.`'�`` ❑ I,as owner of rhe properry,will dv the work and the Misc Condvirs&Conductors U�:j w_�(� struc�ure�is noY intended or offered tor sale(Section O�her(See Complete Fee Schedule)_� ' 7044,Business pnd Professio.ns Code).-- � CONSTRUCTION tENDING AGENCY I hereby affirm rhor there is a consiruction lending agency for the performonce of the wo,k for which tliis permit is issued PERMIT FEE � � � � � � ��($ob-Totolj 75 3g (Sec.3097,Civ.C.1. � �� � PLAN CHECKING FEE Lender's Name � � � 7ERMIT ISSUING FEE �. � I O SO Lender's Address I certify tha!I hove reod this applicofion ond sto�e ihot ihe� TOTAL FEE $ g above information is mrrecf.I ogree to mmply with oll Counfy � ordinances and S�ote lows regulating Electrical wirinq, and here6y authorire representotives of rhis County fa eMer�pon �� - � - the o�e-mentio�ed pro erty for-inspection purposes. 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