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HomeMy WebLinkAbout1376A �NORKERS'COMPENSATION DECIARATION '6A663 i0/91 ea� •a a�+ ' Ai�PLIP'eT,(1Ae Fno� Ce �P'rper wo �i �F_R(1/.!_ , � hc,eby afflrr.�rher I hnve n ��,41,c�nte ;;{;;,;,.-:-!,:,;ets _ - �+r:. i• wre ..fVm�on���L4hL ��. IV��� � + ins��re,or a ce�nficaie o!Worke�s'Compe�satio����s��a�ice. COUNTY OF!O$ANGELES BUILDING AND SAFETY � i or a cer��Fied copy�hr�eof(Sec.330U,LnV,� C.) 3 C25859571 IV.ti FOR APPLICANT 1'O FIL!IN �OB PulicY No._.�'__Co�n�vny___—._.�_ � r�� Cerhfir.d co s here6 fumished. A���=�nY 71 S T i a. C 2irt } l.�_a PY�� Y New Residential 81dys.8 Pools =ACH NO. FEE 1 9 � Cenified mpy is filed with�he:ounty building inspec 1 &2Forn�ly,Sq.FL_ 7 S('4 S �S �LGC�At�TY_��Z;f42586 Diamond Bar _ � r—� NEARF$T'� tion d?partment Mulh f�rnily Sq.FL � '�J "—�— CRO55 C7.�,_ ' 3 20 d6 "T" ?�icGee Els tric Res�d'ntial Swimrtiing Pools -OWNFk OR — g °a�c 1' A�F'�"°"'_— ` r ann N,sMe The Anden Group t CERTIFICAiE CJF EXEMPTION fROM WORKERS I i I MAiL � �� � COMPENSRiION WSURANCE Outlets:Rec_tlght_Sw._� � � I �qDDRESS 1074 Park View nL_ � Firsi 20 I _ I_ � (This secfion need not be compieTed if the work involved by Total No._ qdditinnol I JI �C�TY Ca Te1.No����� � /he permit is for one hundred dollure(5700)or less.) ' ' ,Y3.Clc�r �y prrm� P Y Y P- } Addilionol �'1� �PLAN CHECK I certify 7hat in rhe performance oi the wurk for whlch this I ��APPUCANT _ �� �i is issued,I,holl no+em lo un erson in an manner � so as�o become subjeU to the Workers'Cornpensation Laws. ��ghfing fix�ures Fvst 20 �._ ^�ADDRESS _ __ Total No. � I f CITY Tel.No. � � f' '[ —Applicanr__ Fized Appliances No�Over 1 HP I I� � ��PFRMIr j i�, %[ TO APPLICANT� If, nfier mokin rhis Certifimte of � � � �«�� t Ex�rt:p<ior, y:w >hodld ue�ome sunjc9c� to the Workers' Range_Heoter,_D.W. � IyAPPLICANT_ 1_:"fC_C.+PP- rZECt.I'1C 7IIC. � Cnmpensahon provisions of ihe L000r Code,you must forlh- Oven _Dryer —W.M.— I I �j ADDRESS � Q }�OX ],11.1 � with wmply iih such provisions or ihls permit sholl be 7op _FAU —W.H.— � - "� $ deemed revoked. � �arv Chino 3170& ?P��No, yn�_��;6z Hood �_Fan _OYher� ICENSEOR S LICENSED CON`RACTpRS DECLARA7ION � I IT"� —�"_—` ". . Dis _Room n�r co�d — � 'aec.n�uMaEa 4900i33 C��ss.C-10 g i hereby offirm that I qm!icensed under provisions of Chaoter 9 �� � `�^� , ;+-� ; (commenring with Section 70W)o£Division 3 oi the Business p�wer Appo�utus&Large Applinnces ' I � UIS7RICT NO. ���� PROCeSSEU BY t�� " cnd Professions Code,ond rn Ilrense is iri fufi ferce ond effecl. .p � Size 8 Type HP,KW,KVA,or KVAR � `�� ' ��� Y I � u�P�sP N�,,,:�e, 490J83 ._u�.ei�ss �-10 uP,o i i�d. �I�F�rvr+� _ �,;,. I i Over 1 to 70 Ind. i I i �DATE � � co�iro��o�-�Iect.rical po�e s�2Ci/�tl �— �FINAL �7•"t�� � ^—LIDASlt�N �^� , � OvPr 10 to SC Inr.l. � � �Service,,Swbd.,MCC&Ponelbornds � eY ` A� � I om exem �undEr Sec pv�r 50 to 100 Inc. I,______ ____ . � �� p _ {- � B,BP.C.hnr this reoson Over 1�0 �� .,_I__.__ _ � II..... I � .—,__ ____Date:_._. U-200 Amp.Under 600 V �fi_ � � � '� Signoture _____ _ � 207-lIX�.4rop.Under 600 V �__, __'�, _ _4?�:� ('-� .i . � LJ Over'OC�Am.p.or O�aer GW V �.� � � , • \ Ezemption for Reg Mainf.Eled. � , °c_ � SWGLf.fAMI!Y �Temp.?uwer?ule&Appur�enances �_._II � I " fi� Y HOME OWNFR-BUILDER DECLARATION i j� SVgn wirh One 8ranch Circuit � �•Y 7��{ I hereby o(Firm 1ha1 I am exempf f�om Ihe Cuntrarror's License � - � Additional Slgn Brpnch Circuits 1_ , s %�,,;�'�: � Law for Ihe fnilowing reasan(Se:hon 7031.5, Business and , x Professions CodeJ: � d � Misc Ccnduits&Conductors � �,,. !� � I,�s owner uf Ihe property,will do the wark and the ' • �.� �+�v " shiic+ure is not iNended or offered for sale (Settion Oiher(See Complete Fee Schedule)_ ► ^rc � 7044,Businesx nnd Professiuns Code). _ � V.;. CONSTRUCTION I.ENDING AGENCY -- - � �� I hereby atfirm thaf�here is a consiruction lending agency for i - —�----- ---��-- � � .�tl+ � ihe pe�fonnnirce uf Ihc work ior which this permil is issued PERMIT FFF (Sub-To�nl) �2 ) � � (Sec.3097,Civ.C.). � PLAN CHECKING PEE s� Lender's Name !' PERMIT ISSUING FEE 10..7 � Lender's Address____�. fI certify ihqt I hove re�d this application and slcte ihn�fhe 1aTaLFEE �3.� S ohnva InF��mofion Is corrc;f.!cgre�to comply w h all County . ordinonces and Slnte lows rryulotiny Eleclriml tw ring, and � hereby outhorize repr�sentnhves ot ih�s County to enler upon � � �he o ve-menbo d property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE i �;' �Z+B �°� / �120/�� � 5ynoWre of Pr.rminee �c;e 1 -�� F . ' ` ..; , i { , � . .` , �'` ' . ' . , , . �`t . ., , i; . .. ; ' . . ' ' . , ' i:� ' ' ' . ' . �' .'�..;. , �� . ' . . . . ' , • . ' . i . . . . � ' � . . � a�r , ' � � � .�'� . � . . . � � :,i • . � ' � . . � � � � . . - ' , ' . . . 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