HomeMy WebLinkAbout0995A (9) WORKERS'COMPENSATION DECLARATION 76A663 10/81 APPLICATION FO AL PERMIT �
I hereby offirm that I heve o ceriNim�e of consent to self �E'� ,
insure,or o•cerrifico�e oi Wo�kers'Compenso�ion Insurance, COUNTY OF LOS ANGELES 8 ILOING AND$AFETY
or b cert� c� of(Sec.38p0,lob.C.) , AC 43 12 �
Policy N0. 7 Company STATE FUND FOR AMLICANT TO FIIL IN JOB
�'rx'� Ce��i4ied copy is hereby f�rnished. New Residentiol BIdgS.8 Poals 'EACH NO. FEE RESS N GOLDEN SPRINGS
1 8 2-Fomil q. LOCALITY
O Cerlified copy i3 filed with the county building inspec- Y.5 F��� E _ S —21 DIAMOND BAR
tion depa�lment. Multi-Family Sq.Ft. 9OLE� NEAREST
'� 8/8/86 RAINBOW ELECTRIC Residential Swimming PoolS cRosssr.
Dale' Appliconl OWNER OR THE ANDEN GROUP
� 'CERTIPICA�E OF�xEMPTION FROM WORKERS' FiRM NAME
COMPENSATION INSURANCE Outlels:RecZlight 7 Sw.7 .75 Z� 15 �� �''°tl P,Q. BOX 33 �
ADORE55
ihis��ction nead net 6e com 1�1�d if Ih�work tnvolved b first 20 .
� P Y Total No. Zl Additianol arr VINA Te1."�.967 9541
fh�p�rmit i�(or ona hundred dollars(SI00)or la��.) �
I teriify�hat in the performance of the work for which this � qppNGaNTK
permit is issued,I shall not employ ony person in any manner �
so as to 6ecome suble«�o the Workers'Compensotion Lows. lt9hting fixtu.es First 20 ADDRESS
Torol No. Addi�ionat �
7 CITY Tel.No.
�Appllcant Fized A Lances Nol Over 1 HP
t��NvIICE TO APPIICANT: If, afier moking this Certificote of PP a a�cnNr RAINBOW ELECTRIC LTD.
E.emplion, you should 6ecome subjett to the Worken' Range_Heafer_D.W._
Cempensoiion pro�is�ons of�he Labci Cede,you mus�ferih- Oven _Oryer _W.M.— ADCRESS 11(� B. S�. LEMON
with tomply wi�h such provtsions or �his permit shall be Top _fAU —W.H.— �
deemed revoked. � CITY �,LERTON Tel.Nd�9Z 2231
. �LICENSED CONTRACTORS DECLARATION Hood _Fan _Other_
DiSp. _Room Aif COnd. __ LICENSE OR C—ZO
I hereby affirm ihof I am licensed under provisions of Chopter 9 REG.NUMBER 398621 Closs. r
(commencing with Section 7000)of Division 3 of the Business power ApparafUs 8 Lorge Appliances DISTRICT NO. PROCESSED BY . a- ,
and Prolessions Code,and my license Is In full force and eHect. t a U
C—lO Size 8 Typa HP,KW,KVA,or KVAR
license Num6er 398621 ���.��a=s FINAL •�
Up to 1 Intl.
eo�,�ouo� RAINBOW ELECT�� 8/g/g(� Over 1 to 101nd. DATE ��/jg`g�'v yp��DATION � �
❑ Over 10 fo 50 Incl. FINAL a. .
I om e.empt onder Set. Over SO to 100 Inc. BY N
0.8P.C,for�his reoson Over I00 Z
�� Oa�e: Services,Swbd.,MCC 8 Panelboards �
0-200 Amp.Under 600 V . .
Signat�re 201-1000 Amp.Under 600 V
O � Ove�1000 Amp.or Ove�600 V
Exemption for Reg.Main1.Elect.
, 1 SINGLE FAMIIY Temp.Power Poie 8 Appurfenances
J HOME OWNER-BUILDER DECIARATION Sign with One Branth Circuit �0 9 9,J�{{
I hereby oifirm thot 1 am ezempt from Ihe Contractor'S License qdditional Sign Bronch Circuits
law for the following reason(Section 7031.5, Business ond ���• • • •''�
Prafessions Code): � �
❑ I,os owner of ihe properly,will do 1he work ond ihe Misc.Conduits 8 ConduUors . � .3[i�8 1
str�crure is not imended or o(fered for sale(Settion Other(See Complete Fee Schedule)_ ► • e'3��8 1 U
70A4,Bus�ness ond Professions Code).
CONSTRUCTION LENDING AGENCY 0 S.2 0—�8 b
I hereby affirm Ihal there is a conzlrucfion lending agenty far
the performance af fhe work for which�his permit is issued pERMIT FEE - (Sub-Totol) 336 31 " �
(Sec.�097.Civ.C.).
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE ZO SO
Lender i Address
I certify rho�I have read this applita�ion ond sto�e Iho�the TOTAL FEE 346.81
obove informotion is correct I agree�o comply with oll County
ordinances and State laws regulating Eletlricol wiring,and �
hereby authorize representatives of this Counly to enter upon
rhe a6ove•mentioned properr for inspection purpoies. SEE REVERSE FOR EXPLANATORY LANGUAGE
� • � � ti� • a/s/s6
Siqnature ci Permitlee Dale .
. - i - -� -- - - .. _....._._. . .--- � - �-- -
; , �. � � : ; .
' i , _ , '
. _ , ; . ,
, I _ I I f
�; � �
_ � i � i
, . � . ' • ' •' �
; _ � . .. , . i , , � �
. ; � � . .. . ' � " . .
� z T C O X � O Z � - .
�1
. ;O DZ - � c � C o y
v
i . . 'cn ,� O ni Z 2 V • ..
• � � �n r � �' � A •o. �
' ' � � � w i. �'i . . '
� Z =. , . 7 � A O
. p CJ C z � . .
. ...� 7u , � �', D
. , . T T -1 T T. N . _.
. • . .. � V p '"
. . . ? _
y_' . ' ,. _ . . . . .. . l - . .
.- ' . ' i A 1��+ . . .
; .._ . - 1 ; .' _f _ . _ i ' . . � :1 i • m i _ .. .
� i i i � � . i i ' i i . � . .
� �- ' - ' - i - -- - � - • ', .' - -. �- - - - ' .
i � i , � � I � � . � �..
.i � _ . . _ I _ __'_ . i '1 i- . _.i. .__ .. ._ Y � - - �7 f� (t� 1.
( ! I � 1i I • - � ' � C� • e '
" "' _ ' "" ' ——_ __ ' _" _ 7�77C� .
e i I � m� -
. . S 7 . ' . I r .. � � , .
� � � . . . _ . �'.
` � ' . ' �.. � • • + �. . .. _. , �_ '• , .
; ; . . . . .
I , � . ' ' , ' ' � . I ' ;J .'
. . . . . � .� .� - : . j � . (. � 1
'� � " _ . ' . j ' . . .
. . � ' � . . � ' , � . .
i • � � . . ' . .. I
. � I . � `. . ::. ' .. . _. i
. _ - I ' ' . . • � , � , . � .. . � i - .
1 - . p ' w ' '� � o oT.,7 'a^ va� �,�n3a o,-. ,a•- _
. ! - . ' � � � � � O � , W Q ° z v m' � r� o � °° w� o n.j O ��,.a « p p � ' ' •
� e .3 .._�� � x° w-.n v o� ... « - � :. o o E.�'� �,
� • • � � �° r, . �c � � o°'?'°��o� ❑vp' �^qrl�.aa.�n:'e « eo- -
� - . , . ' ' n •�-� c'c3op `a� i�. No,�� aQo' To » M ? i
�n V i 0 O O ..
• . - - ' � �� �� ' T� o a"c' ° o„ c '-°.ow-n ov � f » :
„ _ , . . . . , ° =v � � � °, o « N. o ���'cmo�,,,°a,'� � �- - � , .
o • -- c ` •3 �03 �
- N' .� a � « mo •fuo �. �L°.Q.=°m �" - o •Z .
. • - � - -� Q � a �om � 3a�•- ; ''''oo �.Owm� � c" N �- m
� � . . � - . • . Q � � � a�`a O � L � ��. �^p 0 G:w � � c' n N U� p � ' ..
N �
. ' ' . , . . . . p ' � i � � � N a O 7 4 7 S � .�.b N'O 0 C� 4 N N.O p C ,
� n �-�-03�'" ova.m - o =., c� � �v � 3. � .
' �`' � � � - ' � T�' � m� �p O d'O � o x W-.� S� c o 5 m m � .
. . . . .. . . .�ce'o _ No� Moo 0o ? 3 �oa�roo' ^ a� x A '
� . , � � ' �'o c � �.� b v b �u O e� � ''`.�[: � p -
.. . - •.� -, �,�� o � '� a � ; . 0 3 �
� . , tin '� �-�-o 0 3 ^+ � s- � mr
. , :. . . �u .°�m F •' o' � m'i o 3�c 3-o Q a 3 0 � 3� � :� ,
m
. -� ' � '. � � .. " - . �. � :'9ti,° �a ; � llaf m � `. � �o7p « '.n � 3 .� � .
o u O -..
- , - ' °.?' °.� o ao a.., rc - �� �M 3 o N �
� • .. ' ; . o o'� . < F f n Q a ° o-°_3 y;3 t' r�c�° �` T � , •
. . . - _ , � . . - _ ._ - : .o w y �-� � � y fl �, �,°n j q '^ � � u �'° n •ni � �Z • .
- . . - � . . � d-� d�.,p�, . 0 N O 4 5 � o� F � c O a . .
� . ��-�c N a F' T� a.� a> > , .
N m n
. . .. _ . . , . . . QO �Q ,NOO F, �.� N��� NN � ` vO ' .
, .. . _ S J 7 ��] C � - ` O � �n
� ` � • . � ' . -- �`� _ .. �.. � �'J N bm ; � 2b ...,�+f O' � -. T� '
,. . , a � � � n � � H r, . o'
- ' . , ,. . . . �' � ._ a,.,�o o s,� q • 'a a '� N " re 4 n �-�.yN