HomeMy WebLinkAbout0996A (7) WORKFRS'COMPENSATION DECLARATION 76n663 IOi81 qpp��CATION F ICAL PERMIT � {�
I hereby oifirm Ihal I have a cerliiicole oF tonsenl 10 self �E'8� /-
insure,or o'certifica�e of Worke�s'Compensa�ion Insurance, COUNTY OF LOS ANGEL � �(p BUILDIN('i AI�D SAFETY �J
or`a certi{y�dOcopy�p�,eoi(Sec.3800,lab.C.) 4351
Policy No, �J COmpOny CTATF FT7TIi1 FOR APPLICAHT TO Flll IN JOB
Certified co is here6 lurnished. EACH N . ADDRE55 454 N. GOLDENSPRINGS
l.X PY Y New Residential 81dgs.8 Pools
n � I 8 2-Fomil LOCALITY
w Certified copy is iiled wirh rhe county building inspec- Y�59•F�• S — s IJNITS 8-14 DIAMO
�ton depo��menr. Multi•fomily sq.Ft. 9�16 — NE^REST
Resideniiol Swimmin Pools CROSS ST.
Date $�8�86 Applicant RAINBOW ELECTRIC 9 owNea oR�E ANDEN GROUP
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' puilets:Rec�light�Sw.� .75 2� IJr Q� �'��
COMPENSATION INSURANCE F.5f 20 nDDRE55 p . BOX 33
(This fecflo�naed not M compl�lod I(1ho work Involv�d 6y Total No. 21 Additionol CITY NA rei.r,o.967 9541
tha parmif i�ior one hundrad dollar:(5100)or lass.) MAN CHECK
I cern(y that in the performonce of the work for which�his APM�CnNT
permit is issued,I shall not employ eny person in ony manner
so as to become subject to�he Workeri Compensation Laws. l�9hling F'ivtu�es First 20 ADDRESS �
Total No. Addilionol
�— CITY Tel.No.
��pplicon� Fixed Appliances Not Over 1 HP PERmiT
Nvl CE TOI APPIiCANT: If, after moking Ihis Certitica7e of APPIICANT
Exemption, you should become su6jec� to ihe Workers' Range_Heafer_D.W._
Cempensation provisicns ef�he Lebcr Code,ycu must fcrlh- Oven _Dry=r _W.M.— ADDRESS 114 B. S�. L��i�
with comply ith such provisions or this permit shall be Top _FAU —W.H.—
deemed revoked. , GTY g[jI,LERTON - Te�.No.992 Z231
LICENSED CONTRACTORS DECIARATION Hood _Fan _Other—
LICENSE OR
I.hereby offirm�hal I am licensed�nder provisions of Chap�er 9 Disp. _Room Air Cond. — kEG.NUMBER 398621 Closs.C-1�
(commencing with Section 7000J of�ivision 3 of the Bosiness DISTRICT NO. PROCESSED BY �d
ond Professions Code,and my license is in full force ond eHect. Power Apparatus 8 Large Appliances �O U
Size 8 Type HP,KW,KVA,or KVAR
litense Number-�Q$62.]__Lic.Class C-1� Up to 1 IncL FINAL �
Controcror RAIN804J Fi F('.TRICte 8�8�86 Over 1 to IO lnd. DATE f//,2//�/ yp��DAT10N �
❑ Over 10 l0 50 Ind. FINAL W
I om e.empt under 5ec. Over 50 to 100 Inc. 6Y fJ��� n.�
B.BP.C.for this reason O�er 100 �"� Z
Daie: Services,Swbd.,MCC 8 Panelboards �
0-200 Amp.Under 600 V
Signarure 201-1000 Amp.Under 600 V
aOver 1000 Amp.or Over 600 V
Exemption for Reg.Maint.Elect,
� SINGIE FAMILY Temp.Power Pole 8 Appurtenances �O 9 9.b A
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit �a � �.� �.Z
I hereby affirm thm I am eaempt from�he Conhador's License Additionai Sign Branch Circoih
Law for the following reoson(Settion 7031.5, B�siness ond
Professions Code): I •3 4(z 81
� Mist.Condui�s 8 Condoctors .
I,as owner of the property,will do the work and�he � o. x
s+rucfure is not intended or ofiered for sale(Section O�her(See Complete Fee Schedule)— , . J 4 6 S� �
70d4,Bosiness and Proiessions Code). ��,2 b�$b
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a consrruUion lending agency for
�the perio�monce of the work for which ih�s permil is issoed PERMIT FEE (Sub-Totol) 336 31
(Sec.3097,Civ.C.�. ,
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE � LO 5O
Lender's Address
I certiiy that I have read this applico�ion and state thoi the TOTAL FEE 4
above information is correct.1 agree 10 comply with oll County
ordinances and Stale lows�egulaling Electrical wiring,ond � •
here6y aulhorize representalives of this Counly to enter upon
ihe obove-meniio�ed prope�ty �inspection p�rposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
_l(%� "(� l� 8/8/86
Signature ef Permivee Date
, . i , ; : , ,. . _ .. ._ . ; ..
. - � . � .
:'; � ; 'i ; , ;
� � � I �
, � .
� � ' . ' , �
_ � .
; . _ .
. � - -
' . � � • � ' . ..' .
. � , - , �
- -- -i I ! � ' :
.� l IZ .T C � T C 7o C -+ .
y O {
� i0 D _ � -xi z� � p � . .
- ' �� �^ c Z G) ^� � , '
• � � m G� = N �,
; _ � 'O y V' � O w � •y� •. '. . .
' Z p. � � � �i :O ' • .
� . � i U .C .a , ,
, � � a� . � � � p �
' � � • � • , rn rNn ' ' � n, V' � - ..
. • v �• _
� - ; � (� � _ , .
; ; •- ..- • •1 , - -- -- a � _ C i .
i ; - ;- , ; - ' - - - - -- -- � - �, i ;� . ,
' � ; �' i , i � ' i � � • a ; 61 � '. • ' . .
� � • � ' � - � - ' �" '
f . ; - -; ; . - - , - - - i .. ;
� � '- � t - - -; - ,_ � , f l�+ I 1 �2'� A1 ..�
� ,
. I . � � ,- ;
r _ _� _ , I ..�_ _ I. ! . . .. .. .. _ ..- � - '-- t _ �_ � i�� � - .
. I I � I • � � •I Rl 4 • Y
_ ' � ' � _ 1, . .' _
• .l � � . ,. . _ I. • � � •
. I , , . ' ' ' ' � ' '
. 1 � � � .. . . � - . ' . . ' y� "
- ' I I ' � - _ � - _ ' . � ' _ � . . ,. . � � . . ,. �
I � - . I � ' .. .
' � � �. . ' �. ' . I
� j � . . • 1 � ' . .. ; , � ', _ - . . � r .
� � . . ; � : - . .. . . . , .
' i - � . . � � ' . �, _ . .. - ` -, . .
! ' -. . . ' - '' . I.. _.. ._ _._. . . _. __. ..._ _ .. -_' ". ' "._ ._. .. . ._.� ,.... ...._. .. -_' _"-'_'...._. .. � ._' � ' ,
. . � . - . . . ' • ! . . � . � � .. , � . • _• ,. . .
i . ` • � . . . ; ' � . : ; . - . _ � : . �.. � .
� - �- � � • CP 1 - %'7 O a f f O in T. !2^ v V.� In�(1 7.A O W�'; - •
- � - � � • � �� - ' ' � � , . to �o + ° � b o o T� o.r.. "°� w� � .°,;,°� � � ,'a w � �' • _.
, ' - ' � � . �� � � :.� '3 ; o-c o � ic-° �^'y �� " �•�.- -'. o �"�. �'= m
. .. � .. ., - � ' ' -c ; 7 �.a...c�_. pi� ❑N o a'�fl��o �v m N c � :. . �
' . . ' . . ' -w I�'� � O C 0 O N N� A C' O O n C ��Q..G 1'S� O � J b p .
. ' . � i � � n� Q o m o . o � o o u m,a° �� a 2 �
3 ., _ o.`o r-« H o��-�`c�i ° �.�� a�c °.� :.� •
, s c v � '^ �a 'F > > �. vv° a3'o'� �^N'3oo� • 7
- . - � - n� � Q �Q � � � a o O 1 4y y Q p d N �n T C�� N T •m '
- i • � �aaav o � � � `�M SM m � „ Q Q.� �
. , ; . � � � �mo � o oa.o �oac' ^ _ m
.e•! � - � - �- � O .�.� : � � �• � 40-' 0.� �- � :.b u o � 4u � j r o o C � . ..
. . . i . . . �� ' a . n ?'-�-o s" O� �4-c O .. � � .�Tl C �" 3 .
' '. , ` , r ?'° � m° o r.�ir �o x c„.�c nti � na -v '
. . 4 S O � � � r Cl.�w ''� C o 2 m ,.
� . � �p _a O � C p O O O �S C 'D O � q 7 x A . .
. . ; � . . � c Q n a�-a � '" o,� ' � D b 7 v° � � � n •`•"� 3 mp '
. ,, i �. - '._o � mo � oj �� a = � ;.� i . ao' �jQ � n .
. � m � : �
a w i� � _ o ' - ° -« �D. .
.. , . . '. . - . _' " . � o° o�.o � n� �: �. � p'•o o u .n'o o . .
... .. : � " , . . , .°.� Q,Qo' ao �,�- �� °�'".��;� � = ' 3 ...y . • -
- ' ' . ' ' o < ^ ' < F � � a �- � C.00 � o�° � v `� -�
. - ° s3.�-o � o 0 3 � 3 0' o o-o ° n�?, • O. -
� ' - � ,'��'rp � m m o � -�° m �'.^. a ° '" "� �. � �.� ^ � 'Z - .
b �' Q Q n p O a �C 4� 3 w.tp � ' C p O� . .
. �[ . . � • _ ' , _.. 7'O[ yi O f S„''- LL� � 7 ' .�l> > y .
-, . .. . .. .. y p a� Nb � .O. C q N7-��.? GO O ,C V . .
. . � - _ . � �� S 7 7 G b 7 . F�\J O 0 8'o � 01.a o O S� O❑
' � ' � � ' � i � .0 1'a ... O f O =S W� ' . .
` . • I' � . ' . 2 O C O �,,� n� ,. a a b. j M ��n .?,�fJ 9 S�,U� � "