HomeMy WebLinkAbout0999A (9) WORKERS'COMPENSATION DECLARATION 76A669 l0iei qpp��CATION T AL PERMIT - ��
I hereby aifirm thor I hove o cerii(icate of consem�o self CE-Ea6G �
insure,or o'cerrfffca�e of Workers'Compensation Insuronce, COUNTY OF LOS ANGE 5 ��f ��QZ 8 ILDING AND SAFETY
ar o certified topy thereof(Set.3800,Ln6.C.)
��,.No. U I_� T�2��7 sompany STATE FUND FOR APPLICANT TO FILL IN ,oe
Certifi ieby f�rnished. New Residentiol Bldgs.8 Poois
EACH NO. FEE SS 444 N. GOLDEN SPRINGS
� Certified copy is filed with the coun�y building inspec- 1 8 2-Family,Sq.Ft. b — S �ocnuTvpNITS 29-35 DIAM
lion departmen�. M�Iti-iamily Sq.Ft. � — S NEAREST
Residentiol5wimmin Pools CROS55T.
Date R/R/R6 APPi;�o,,,RAINBOW ELECTRIC 9 OWNER OR
FIRM NAME THE ANDEN GROUP
CERiIFICATE OF EXEMPTION fROM WORKERS' Outlets:Ret 7 Light 7 Sw.7 •75 2'� 15 � �q��
COMPENSATION INSURANCE AD�RESS
Thi�fxflon nssd nol bs com leted if tha work involv�d b Fin�20
� P � Total No.�.L Additional CITY Tel.No.967 9541
ths parmit it lor one hundred dollars(SI00)or Is«.)
I certify ihal in the perfarmance oi the work for which this APPlIG4NTK
permit is issved,I shall no�employ any person in any manner
so as to become subjec��o�he Workeri Compensalion Laws. Lighting Fixtwes First 20 •75 � ADDRE55
To�al No. 7 additional
pplicant CITY Tel.No.
�Iv.,�CE TO APPLICANT: If, citer moking this Certifimte of Fixed Applionces Not Over I HP pERMIT
E.emption, you should become s�6ject to ihe Worken' Ra�9e_Heater_D.W._ aPaiG4NTRAINBOW ELECTRIC LTD.
Cempensa�ien provisiens ef the Leber Ced^,yov mvsf/orlh- Oven _Dryer _W.M._ ADDRES$ S0. LE,�tOY ST.
with comply wirh such provisions or this permit shall be 7op —FAU _W.H.—
deemed revoked. CITY gUj,LERTON iel.r�io.992 2231
IICENSED CONTRAC70RS DECLARATION Hood _Fon _Othar_
IICENSE OR
I hereby affirm that I am litensed under provisions of Chopter 9 Disp. _Room Air Cond. — REG.NUMBER 39SE 21 Class.C-1� }
(commencing wirh Section 7000)of Division 3 of the Business pISTRICT NO. PROCESSED BY CL'
and Professions Code,and my license is in full forca and efleU. Power Apporatus 8 Large Appliances �v . U
Size 8 Type HP,KW,KVA,or KVAR
License Num6er�QR��� lic,Cless r—�n Up to 1 Intl. FINAL �
Over 1 to t01nd. ��/��l�G
Contractor$.�TNRf1W FTF('TRT(hate 8/$/86 DA� VAIDATION U
❑ Over 10 ro 50 Ind. FINAL li1
I am exemp�under Set. Over 50�0 100 Inc. 8Y a-
Over 100 N
B.BP.C.for ihis reason � Z
Dafe: Services,Swbd.,MCC 8 Panelboards �
0-200 Amp.Under 600 V .
Signalure ZOl-1000 Amp.Under 600 V
❑ � Over 1000 Amp,or Over 600 V
ERemp�ion for Reg.MainL EIeU. ';�9 9 9(�
\ SINGLE FAMILY Temp.Power Pole 8 Appurlenances
J HOME OWNER-BUIL�ER DECLARATION Sign wilh One Branch Circuit �e• • • e'�
_ I hereby affirm thai I am exempt from the Contrattor's Litense Addilionoi Si n Branch Circoits � --
Law for Ihe following�eason(Section 7031.5, Business and 9 � •J 11�x 8�
Professions Code):
❑ I,os owner of the property,will do�he work ond the Misc.Conduiis 8 Conductors � "3 4 G 8 1 c=i
s�rucrure is not intended or offered for sate(Section Other(See Complete Fee Schedule)_ ► D��O�8 6
7044,Business and Professions Code).
CONSTRUCTION IEN�ING AGENCY
I here6y oifi�m that there is a construction lending agency for
Ihe performonce oi the work for which Ihis permil is issued pERMIT FEE (Sub-To�al) 336 31
(Sec.3097,Civ.C.). �
PLAN CHECKING FEE � - '
Lender's Nome •
PERMIT ISSUING FEE ZO S
Lender's Address .
I terlify�hat I have read�his applimfion and state that the TOTAL FEE � 346 H
above information is mrreU.1 agree to comply with oll Counry -
o�d�nances and S�ate laws�egulating Electrical wiring,and
hereby aWhorize represen�a�ives of this Coumy b enler upon
the obo�e- f�n laned propert for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
fU � $��86
ignafure of Cermine Da�e
i ._ __. ---. ____. _. - - - ---. - - . - - .
: i , , �. ..; _
_ . ( �r � ; l, ; i � .- i , i i � �
, t - ' ` , � , i
. -• . - i � � • •
• - i , � . �
, _ - . • ' ' . ' .
: , - ..- � '. -
, i � , i : . ; - .
! -, � � � i_- � � �,, ,
• ;
' i _ ' O D � O .-_j�i � p � S ..
.. _ � �!n '-1 m �- Z L� rn� � :
, ' n D v+ Gl vr v : . r
" �O C � � � . .
. a.�� � �• -, - . � w � �o . .
, •: ,
. . -- _ . . •.�
O
. : -. � iZ O' O r2 � < ,- .
� I !p � C � O �
� j ;?� � ~ �c � .
�m }�i in
, � . . i �'1 ' . � v v , _ .
_ _� � ' _ � _ 1 . R.
1. .` ;. �'. I .' ' i ; ' . . _ _ _ - ^,! I � I . �� ,• r^• .
. ; ' i i, � , i i i ' � ; i , o_ ' - i _ ' m � ' : .
� � I � � i i � i , �... �� , I
�
, �
. . i �' - - 'J � : - . .. . . _ _ .
- -� ..,
` I � � - � - ' ' �1 ' ' - - � - -. .. � � _ • r .
F I � , ; � • t ( i' � � � A '" p�'.a
� I - -,- -I .i � . _ . � .. � _. _.1 . - �- --'---- � �- - -- � • '� m �' .
. . � I _ � � . ., . . I . ' �, ' .
; . . . � - _ � . . . : . . • �. ,
� . � . ' .. � . , . ��� ,.
� � � - `' � , . ,' . . • '• r
. [ ' � . . . ` �. . . ,. � . ; - . � , : J '
� � - � . , , . . . .
e , � ' � -. , �• • • _�� . i ..
. - , i .. . . .. . . ' , .
� � � . . . , Y .. , . _ . . ; .
I = ' . ' . .- : t ' � ' � ! ' • , , _ _ � . , � , � _ . i ' .
, . O � i ff' ` . o � 3 � FFain�T !0000`" mn�aom '''r - ' - .
' . _ - � . � � �,.. o . ia � or� oc�. ' w�.° ., ° a � ..nNmT ; -
� 0 3 "a.� -, � x-o '";, � A -�.-•' ;, c c � �
c� �+ Ur �o '�• 'N
• , _ . '� . . � • . � I I ' (1 � � 1� � Cr� Q�'� n O�...., O V,C O� n S— U'w .� � ' .
. . � ; � ' I � ' ; •� I o c 3 0 3 a5 „�c ' .No�c `coo ° ¢'u o 0 0
0 3 ., Qa o N � ° on o °o sq n� � 2 �
' ' v "3 i 3 0 �o ;'M`N .o'.o`�'cro o��'�°b,� ti � O
_, .. � , ' : ' s � b i �: ov .Q �'� <' �a a o,-"��N.3 0 3 �z
` . ' . ' . ' �,' � �N � M n � -p. S �0 �. O _ .
' � - � - _ � . . . - - : d � �O C < 3 C '- -r�. �b qi �.p� Q ' � ' o T �^i � ..
.. " , .. . . . - • , Q � � , � �4 4 m O � o �.p O n a �-��a ❑ ^ � N c�� . � ..
� 9 N � ry �O C N_'r-A O C�� O W
:' , . ,.'. ' • o � °qF� Naooa� :r. '� �"-ouosaa ° MH °a c _
' � ., � . � � �-a o 3-'^ � v a`� o,' n � � c c B '- _ .
. ' ' _ „ - • �n � �; �.poaro_ °o'� w-•M �� co: c m�
� � n
, . . . , . _ f..a c o ._ a ti 2roi r � n o Q � .^.�-C b o � ���� �A � ��
J , .� Q q T S a„�m o q '� ).� �� � � � p �-� � .. 0
, " , , . - - - �o �m ° � o' � c�' 0 3� �? ° o � ° � �� v_ .•n .
F ? � o . � � .
. . ,= , - .. . - - ;:��oo� a � n�_ _ C: c_ 1p .o�oa' noo A •
. . . � ti � o « o ' � 3 .��
. : .. . ' - .. n � � �°e �� �o_o: ja..oaN:oa ,��'� `� -a
n '
. . , o H co' 3 � o' oc o -, ��
. . � � ' . p�3 A��'u O� �� � +,n , Q „' '3 � ,N �7 � n n �n O . .
. . . - � a-3a°,m" `o '" o c� � '",o.m � o a
. `o� ` " Q� n . o �-m~�-�; N � �o 0 7 = ' '• -
- - o` ao N a o F c �+c �� a-3 '` "a ..
. . : ' � ' ^ . - - m? � '� NW � �'yb° n �oF °.00 °. sw� ,
c -�o
. ' . • - • �' _ - a7O ° �-�'c ? a a�� N � 'sa R ? �.^�-•"'N . .