Loading...
HomeMy WebLinkAbout1376A (7) �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 . � —"t , � � ' - . � y . , . . ..1 , �. , . � ' • � �� � . . - , . ' � � � . . . ,t . , . ',..,` , . . . � . ' . ... ' � , . . , � . . �'t . , . . . � ' . . - . - . . �y'+4 . . . : . � . . . . � " ' . . 'y.., . l � �, . �. . ' . ' - , ' � . • _ � . , � ' , ' � '. . . ' ' . . � . . ., � �. . � � � ' • `�i . . � � . ' . . �. . . ' . • . _ - " � � . ' " . . � . , ' , ' � � :.`i . . . . , ���n . ' ' ' " �. 1 _ �� t. � - ' , .,e@i, ' ..; . '� ' '..R '. , _.. : � , . ' . . ' 'E ' , ' � . � ' � . . , Y . ' , ' �.., ' ' ` 1' . �' � ' ,� } � . ` 't?. ' . ' ' ��. 1 , ' - ' . , i . , . �t � ` . 1. � , � . _ , � ` ' �` , -. , b . . ,5 ' . . . ' . ' . ' . . . - . . �, . � 1 , i . . . • ' . ' . ' Ai � . , 1 � • � � � f ' '�,1 ` 4 , 1 ;1 t 4. � ' � i ` i �S . . . � � " ' _ � i . ' . . }i " . � . . . . . ' `4 'l - ' . . _ t . . . � � , . �{. . . �r, . • �y ': t t , S � '� ,o�. S .; " . ,�� 1 � I C .� ' . - • �k„ fe �' •E � ' } " . '� 7 ., ` .. ;�Y t'� . . ��i - � '' 'k �' .. . «�, � . ` ., ^. � '�� ... ' " Ii�. � . . .i ' . a� � . `. • ` .., .. '.� i — . . ^ r' � .. . .� i .. .... _ ., �. . i ... , � .. •,_ n r ..+ .. �. . ., . - • '.. ... .. r ... .. . .. . .. . 1 . . .. '* .. . . ��C� .. ,:* ` e��w ' - ..}'.. ' .v ': .' . ,� `n: ' . � . . _ : .., , . ... . . . • .._ ' . " ` .. . .� is: - 1 �{ � . ... , .� r.� �.. �� . . .j '' _. r.,, '. ` ^'. , ::. ,. � i.Y M i ; w-. , � . .. . ..: ''"r .. .. .. ; . .. ;' '�� � .' ��i s� � � •. ;..`�' 'r(`_._�;g V',�'.��S, _Y.��� > �'`� y . 1 � x �{,; , '`- C '� '� r�. J �(7 - . - i} , ' _ • :1.r(1' -3 � � ••b - • ^5 ' �� � . . . ... ''4', ". M� � J, t' 3 ,..~S �_rv ._m�.!Y� `�h - ' :i '.hw 3 � '; . � � �.�.' ..= - `''9 _ . , ' . . ;S3 ���ti t� '�l.�j ,^. . p., �c? L,.C�'p. =r';: .p �� .. � .. �i � , ..� _. C C' n� -_� � �Y .. ' �.. . . '` ,'4 � �-�� - , '��{.,w �� i1 ��..�' 9 ..- . . _- . n � ' ..- . . i, �. , '� -- ' . . �`. ``� .'1, •� ... I ' . i �n_�_,,,,_.._ �,,,,,,,�,,,,...