HomeMy WebLinkAbout0998A WORKERS'COMPENSATIONDECLARATION 76A66J 10i8i APPUCATION F EL RICAL PERMIT � �
I hereby af(irm �hat I hove a certifimte of conseN�o self �E'�
insure,or a tertifkatr,01 Workers'Compensation Insurance, COUNTY OF LOS ANGELES � BUILDING AND SAFETY
or a cer�i(ied copy thereof(Sec.3800,Lab.C.) . TRAC 43512
Polity No.U_�omPony STATE FUND iOR A►FIICANT TO F�EACH wo. cee /�ODRE55 44O N. GOLDEN SPRINGS
QCernfled copy Is hereby fumished. New Resideniial Bldgs.8 Pools
� 1 8 2-Fomll S Ft. a = S iocaurr UNITS 36-42/DIAMOND BAR
Certified copy is filed wiih the munly 6oilding inspec• Y' 4' NEAeESi
lion deportment. Multi-family Sq.FI. 9n1 Fi CRO55 ST.
Doie 8/8/86 qppiican� RAINBOW ELECTRI Residenfial Swimming Pools F�IRM NAMe 77'1E ANDEN GROUP
CERTIfICATE OF EXEMPTION fROM WORKERS' Outlets:Rec 7 light 7$w.7 '75 Z� 15 �� DDRE55 P•Q� BOR 33
COMPENSA710N INSURANCE Fi/3f p
(iht.s«�son�..d�or b.compi•r•d if�h•we.k tn�olvsd 6y To�ol No. Zl Additfonoi .50 1 ��TY CONVINA Te1."°.g67 9541
ihe p�rmlt Is ior ono hundred dellar�(SI W)or lafs.) PIAN CHECK
I te�lify lhat in Ihe per(ormonce of the work for which this APPIICANT
permil is issued,I shotl not employ any person in ony manner
so os to become subject to the Workeri Compensotion lows. Lighting Fi.twes First 20 7 5 ADDRE55
Total No.7 Additiorwi CITY Tel.No.
pplimnt Fixed Appliances Not Over I HP ppRMIT
�Nvi CE TO AVPLICANT: If, oiter moking rhis Cerlificde of AaR�CANT
Exemption, you should become s�bjecr to �he Workers' Range_Hea�er_D.W.—
Compenso�ion provisions of tha Lobor Code,you must iorth- Oven _Dryer —W.M._ ADDRESS 11/{ �j. rjQ. LF��fON
wi�h comply wi�h such provisions or this pe�mit sholl be ToP _Fau —w.r+.— arr�JI,LERTaN Tel.No. E SS
deemed revoked. Na� _Fan _Other_
LICENSED CONTRACTORS DECLARATION LICFNSE OR Closs. '
Disp. _Room Air Cond. — REG.NUMBER
I hereby effi�m�hat I am licensed undar provisions aF Chapter 9 Yj
(commencing with SeNion 7000)of Division 3 of the Business power Apporotvs&Large Applionces DISTRICT NO. PROCESSE�BY n.
and Professlons Code,and my license is in full fo.ce and effecL �p V
Size 8 Type HP,KW,KVA,or KVAR' �
License Numbe� �98621 Lic.Closs C-10 Up 10 1 Ind. FINAI
Over 1�o IO lncl, DATE �p �v S'6 VAIIDATION ti
Comrocto� R�IPIBCIW FT.FCTRT�ie�5�86 O�er 10 to SO lncl.
❑ FINAL�Z��'/_ � W
I om e:empr under Sec Over 50 to 100 Int� BY ���s/�`l. �'
B.BP.C.for this�eason
Over 100 �� Z
pa�e, Services,Swbd.,MCC 8 Panelboards �
0•200 Amp.Under 6W V
SignaWre 201-1000 Amp.Under 600 V
❑ Over 1000 Amp,or Over 600 V
Eaemption(or Reg.Maint Elect. d�9 9,8 A
l SINGLE FAMILY Temp.Power Pole 8 Appurlenonces �3•a • • +2
' l HOME OWNER-BUIIDER DECLARATION 5;9�w��h One B�anch Circuit ._
1 hereby effirm tM1o�I om exempt from�he Controt�or's License qddifional Sgn Bronch Circoifs � �0 4 d 8 1 .
— low!or Ihe following reason(Sec�ion 7031.5,8usiness ond
ProFesscons Code): � � e�e 3��8� �,
❑ I,os owner of the proper�y,will do�ha work ond ihe Mist.Conduits 8 Candvctors
s�rudu�e is not intended o�oflered for sole(Secfion Olher($ee Complete Fee Sthedule�_ , ��2 Q�8 6�
7044,Business and Piofessions Code). .
CONSTRUCTION LENDING AGENCY
I hereby a(firm�hal there is a co�ttrot�ian lending agency tar
the performance of ihe work for which rhis permit iz issued PERMIT FEE � (Sub-Total) 336 31
(Sec.3097,Civ.C.). " �
PIAN CHECKING FEE
lendei s Name .
PERMIT ISSUING FEE LO SO
lendei s Address
I certffy iho�I hove read this opplico�ion ond s�ate tha�ihe TOTAI FEf 346.al
above informa�ion is corred.I agree�o mmply with oll Coonly
ordinentes and Slole lows regvloting Eledrical wiring,ond
hereby a�thorize represen�atives of ihis Co�nly lo enter�pon
the abo.e.menY ned proper�y ar iaspettion porposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
�r J 8/y./86
Signotore ef Permivee Daie
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