HomeMy WebLinkAbout0997A (9) WORKER$'COMPENSATIONDECLARATION 76n663 10/81 APPLICATION F ICAL PERMIT � �
I hereby nffirm that I hove a certificote of consenl to self CE-B06G
insu�e,or o'certifica�e.af Workers'Compensa�ion Insurance, COUNTY OF LOS ANGELES AC # 43512 UILDING AND SAFETY .
orb certiGia�GopY�+j�rfof(Sec.3800,Lab.C.)
'� � STATE FUND
P�cy No. Ti1.fTT 77 Company FOR APPIICANT TO Ftlt IN DD 458 N. GOLDEN SPRINGS
Ceriified copy is he�eby f�rnished. New Residentlal Bldgs.8 Pools EACH NO.
� Certified copy is filed with the county building inspec- �g Z-Family,Sq.Pt. s = E iocnurr�ITS 1-7/DIAMOND BAR
tion deponment. Mul�i-family Sq.Ft. �— NEnREST
8�8�� A � ResideMialSwimmin Pools CROSSST.
Da�e pp�ca�i RAINBOW ELECTRIC 9 OWNER OR
FIRM NAME THE AMDEN GROUP
CERTIFICATE OF EXEMP710N FROM WORKERS' pullets:Rec 7 Lighl 7 Sw.7 •7 Z � 1S OO µqi�
COMPENSATION INSURANCE ADDRESS P•�• BOX 33
Thi���cfien n�ad nol b�com le��d i(thv work involv�d b Firit 20
� P � Total No. 21 Addirionol .5 CITY Tel.No.967 9541
Ihs p�rmil Is ior on�hundrad dollars(5700)er less.)
I cerlify Iho1 in th2 per(ormonce oi ihe work for whith fhis A PNCC�H�K
pe�mi�is iss�ed,I shall nof employ eny person in any manner 5 25
so os to become subject lo the Workers'Compensation Laws. Lighting Fi.tures First 20� 7 ADDRESS
Tatol No. � Addi�ionol
l • CITY Tel.No.
J---�`PP�1CO^� Fixed Appliances Not Over 1 HP P(RMIT
Nui CE TOl APPIICANT: If, afler meking this Certificpte af APPLICANT RAINBOW ELECTRIC LTD.
Ezemption, you sho�id become subject to the Workers' Range_Heaie._D.W._
Compensotion provisions of the lobor Cade,you musl forth- Oven _Oryar _W.M.— . A�DRE55 114 B. S�. LEMON
wilh comply wifh such provisions or ihis permit sholl be Top _FAU —W.H.—
deemed re�oked. C�TY FULLERTON Tei.No.992 2231
Hood _Fon _Othar—
UCENSED CON7RACTORS DECLARATION uCENSe OR
I hereby aHi�m�hat I om licensed under provisions of Chapfe�9 Disp. _Room Air Cond. _ REG.NUMBER $621 Class j',-10 }
(commendng with Sec�ion 7000)of Division 3 of the Bustness DISTRICi NO. PROCESSED BY �-
ond Pro/essions Code,and my license is in full force and eHect. Power Apparatus 8 large Appliances U
Size 8 Type HV,KW,KVA,or KVAR !�
License Nomber �98fi21 Lic.Class C-10 Up to 1 Ind. FINAL �
RAINBOW ELECTR�C LTD.����'� o�a�1 to 10 Ind. �ATE // xs'/gG o
Confraclor a�e FINAL yALIDATION W
❑ Over lO to 50 Incl.
I am exempl under Sec. Over 50 to 100 Inc. BY n-
�
B.BP.C.for th�s reoson Over 100 z
Doie: Services,Swbd.,MCC 8 Ponelboards � �
0•2U0 Amp.Under 600 V
Signatore 201•1000 Amp.Under 600 V �
❑ Over 1000 Amp.or Ovar 600 V �0 9 9,7 A
Exempiion Ior Reg.Mainf.EIeU.
� SINGLE FAMIIY Temp.Power Pole 8 App�rtenances ��A � � ��
HOME OWNER-BUILDER DECLARATION Sign with One 8ranth Cirtuit ( •3 li Q 8 1
I hereby afffrm that 1 am ecempt 6om the Controctor's license qdditionoi Sign Branch Circo��s
taw for the follow�ng.eoson(Section 7031.5, Business and �3 li fi 8 1 cxa
Professions Codej:
s
❑ I,as owner of the property,will do the work ond ihe Mist.Cand�its 8 Conducfo�s ��,2�`8 6
structure is not iNended or affered for sole(Settion Olher(See Comple�e Fee Schedule�_ ,
70G4,Business ond Professions Code). .
CONSTRUCTION IENDWG AGENCY �
I hereby affirm rhot ihere is a construction lending agency for
ihe performonce of�he work for which this permi�is issued PERMIi FEE �s�b-ro�oi� �336 31
(Sec.3097,Civ.C.).
PLAN CHECKING FEE
lender's Name
PERMIT ISSUING fEE ZO SO
Lender's Address
I certify thol I hove read Ihis opplitalion and slate that ihe TOTAL FEE 346.8
obove�informa�ion is mvect.I agree t0 compiy wilh all CouMy
ordinances and Sta�e laws regulaling Electrital wiring,and ' . �
hereby auihorize�epresen�aiives of rhis Counry fo enrer upon
�h obo�e-m n ioned proper y fa inspedion purposes. .
A'/ SEE REVERSE FOR EXPLANATORY LANGUAGE
•(/11' GI�''� 8/8/86
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