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HomeMy WebLinkAbout1001A WORKERS'COMPENSATION DECLARATION 76A663 10i8� qpp��CATION���FOR E�LECT�RICAL�PE � ��1T � �� � �� � � � � I hereby afflrm !hat I hove a cenifimte of consent to self � CE-806G insvre, or a ce Fkate a4 Worke.s''CompensaGoh Ins�rance, �COUNTY OF LOS�ANGELES BUILDIN A D$AFET or o certified���rP�ec 3800,Lob.C.J RECREATION BLDG TR T�40387 �cv No. UNIT 27ComPa�y STATE FUND FOR APPLICANiTO FLL M JOB Ce:tified copy is hereby f�rnished. New Residentiol Bldgs.8 Pools EACH NO- PEE ADDRESS 24155 E. SYLVAN GLEN RD � Certif�ed mpy is filed with the�ounty bullding inspeo � 8 2-Fomily,Sq.Ft. � — $ �ocaurv RECREATION tion depar!menf. Multi-family Sq.F1. — NEAREST 8/8/86 RAINBOW ELECTRIC Residenlial Swimming Pools ceoss sT LDEN SPRINGS � -Date � Applicanr . � OWNEROR FiRnn Na,rne THE ANDEN GROUP ' �CERTIPICATE OF'EXEMPTION PROM�4V0'RKERS' Ootlets:Rec��igM�Sw.z I MAIL � � - : � COMP��NS�A710N INSURANCE'� � nDDRE55 P.O. BO% 33 � (This section need noY�be�complefed�if}he�wor�C�involved by FirSt 20 the permii is tor one hundred dollors(5100)or less.) iotal No. Addi�ionol CITY COV1R8 Tel.No967 9541 PLAN CHECK I certify that in the performance of the work for which this AroLICAN7 permit is issued,I sho�l not employ any person in any manner so as fo bemme subject to tMe Workers'Gompensation Laws. LigMing Fixtures First�20 ADDRESS Total No. 5 Addifionql �' 3 75 � � CITY Tel.No. �� Appliconl Fixed Appliances Not Over 1 HP pERMIT Iv...�CE TO APPLICANT: If, after making this Certificate of � APpLiCANT RAINBOW ELECTRIC L?D. Exemption, you should become subject 10 the Workers' Range_Heater_D.W._ Compensation provisions of rhe Labor Code,you mus�forth- O�en _Dryer _W.M.�. ADDRESS 11[F B. SO LEMON ST. with comply wirh such provisions or this permii shall be Top —PAU —W.H._ deemed revoked. Hood —Fon _Other_ CIiY FULLERTON Te1 "�. gg2 2231 IICENSED CONTRACTORS GECLARATION Disp. _Room A�r Cond. — uCENSE OR Class. I hereby affirm thor I om licensed under provisions of Chapter 9 REG.NUMBER Zl (]-1� � (rommencing with Section 7000)of Division 3 of ihe Business power Apparatus 8 Large Appliances DISTRICT NO. PROCESSED BY p_, and Professions Code,and my license is in full force and effect. 0 Size 8 iype HP,KW,KVA,or KVAR O License Number 398621 i;�.ciass C-10 1 uP ro i i�d. 4.00 � 4 �0 FINAL � �o�o-o�+o� RAINBOW ELECTRI�1e 8/8/86 �— OVe��ro 101nd. DATE Il/�q'/�ito VALIDATION � D . Over 10 to 50 Ind. C.S FINAL I om ezempl under Sec Over 50 to lOD Inc, BY p.; � B.&P.C.for this reason Over 100 � Date: Services,Sw6d.,MCC&Panelboards 15 �� 15 �� ► � 0-200 Amp.Under 600 V Signature 201 -7000 Amp.Under b0p V � Over 1000 Amp.or Over 600 V Exemption for Reg.Mainf.Elect. r: I O G.� F. �"`�''� SINGLE FAMILY ' � HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances ��.'`G.G FA @ 0 2 Sign wi7h One Branch Cirtuit I hereby affirm rhat I am exempt from the Conrro<tor's License ^p C Law for the following reason (Section 70315, Business ond Additionol Sign gronch Circuits 1 " �- J� Pro4essions Cade): _ . _ � Misc Conduils 8 Conductors � c %`�4`"" I,as owner of the property,will do the work and ihe siructure is nor intended or offered for sale(Satlion Other(See Complete Fee ScheduleJ_ , Q�i�-•ty(� 7044,B�usiness and Professions Code1. �� CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is o conso-uction lending ogency for the performance of the work for which this permif is issued PERMIT PEE (Sub-Totol) 49 00 (Sec.3097,Civ.C.). � � PLAN CHECKING FEE Lender's Nome PERMIT ISSUING FEE ZO SO Lender's Address I cerrify thot I hove read this applica!ion and state thot the TOTAL FEE 59.50 above informotion is correct.I agree to comply wi�h all Counry ordinances and State lows regulating Electriml wiring,and hereby outhorize representatives of this County to enter opon the ebov�e-'me{'ti/a��pro.peny f�nspection purposes. 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