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HomeMy Public PortalAbout5545-5545 1/2 SANTA ANITA AVE_Electrical__ WORKERS'.COMPENSATION,DECLARATION CE-806 10/81 b�i������kJ ���g ®� ELECTRICAL it L+�js�����+ ��®pp�� ". I hereby`affirm that I Dave a certificate of consent to self CE-806G S Lir 1�3��11 LEC A RM insure, or d certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or"a certified copy thereof•(Sec,3800, Lab. C.) a cy No.1nIC647173 ompany Homeland Ins. - FOR APPLICANT TO FILL IN JOB 55451 Santa Anita New Residential Bldgs. 8 Pools Certified copy is hereby furnished. EACH NO. FEE ADDRESS z XE] Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft.17-324;_ $ —1$ 69 .40 LOCALITY Temlple City tion department. Multi-family Sq. Ft. — 'NEAREST CROSS T. Date 04/01/8X7Appli F Residential.Swimming Pools OWNER IRM NAME San Gabriel Properties CERTIFICATE OF EX PTION FROM WORKERS' Outlets: Rec Light Sw._ i MAIL COMPENSATION INSURANCE 20 ADDRESS 2.17 W/ Las Tunas Dr. G (This section need not be completed if the work Involved by First ti Total No. CITY San Ga reel Tel. No. -------- the permit Is for one hundred dollars($100)or less.) Additional ` I certify that in the performance of the work for which this PLAN CHECKAPPLICANT permit is issued,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional CITY Tel. No. Date Applicant - NOTICE TO APPLICANT: If, after makingthis Certificate of Fixed Appliances Not Over 1 HP PERMIT yC Exemption, you should become subject to the Workers' Range_ Heater—D.W. APPLICANT Cobine Eelctric Co. Inc:, Compensation provisions of the Labor Code, you must forth- Oven Dryer —W.M. ADDRESS 1607 Chestnut St. with comply with such provisions or this permit shall be Top FAU . L W.H. — 'deemed revoked. Hood Fan _Other_ CITY Alhambra Tel. No.2$2-0315 LICENSED CONTRACTORS DECLARATIONLICENSE OR I hereby affirm that I om licensed under provisions of Chapter 9 Disp. -24-Room Air Cond. 5 17 ' REG.NUMBER 229$47 Class. C 10 (commencing with Section 7000) of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. M and Professions Code,and my license is in full force and effect. Size&Type HP, KW, KVA, or KVAR- o G O License Number 229$47 ic. Class C10 Up to i Incl. Z FINAL V r Over 1 to 10 Incl. 1 7 DATE VALIDATION Contract a e 1/30/87 Over 10 to 50 Incl. FINA #� [[[ill ❑ U I am exempt under Sec. Over 50 to 100 Inc. BY LU BAP.C. for this reason Over 100 -� Services, Swbd., MCC&Panelboards 1—Date-0 -200 Amp. Under 600 V 15 0 Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp, or Over 600 V SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and . Professions Code): ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ ;2557. 1 5 A 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY # 000-002 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) 0 o o ']9 90 (Sec. 3097, Civ. C.). 0 0 0 7 9,9 0 v Tokai Bank of Calfironia PLAN CHECKING FEE 49 Lender's Name PERMIT ISSUING FEE 10 .50 0 1.0 6-8 6 Lender's Address 34 W. 6th St. , LA I certify that I have read this application and state that the TOTAL FEE above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, andl her authorize representatives of this County to enter upon, ?9r 9 D the above-mentio ro rt or inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 10/03/86 ignature of Permi tee Date `WORKERS'COMPENSATION DECLARATION 76A663 10/81. p 1'herebyaffirm•,that 41 hgve'a certificate of consent to self �������®� ©� ���������� ����� " ' insure, or,g Certificate of Workers'Compensation Insurance, ®� ItiBVY ®F ®$ AI�IQ'yIELE$ BUILDING AlM® $plp(sgY oF'J'tertified copy thereof(Sec. 3800; Lab. C.) .,1 P❑ol''icy No. 'C6471733ompany Homeland Ins-2 FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished, New Residential Bldgs. &Pools EACH NO. FEE ADDRESS 5545 Santa Anita Certified copy is filed with the county building inspec- 1 &2-Family, Sq.Ft. 6 3 $ _ $ LOCALITY Temple Cit tion department. Multi-family Sq. Ft. NEAREST CROSS ST. Residential Swimmingl Date 04/01/87 Appl is rtt'r` _ Pools OWNER OR ' FIRM NAME S$an Gabriel Properties CERTIFICATE OF EXE ION FROM WORKERS' Outlets: Rec Light Sw.First 20._ MAIL COMPENSATION INSURANCE ADDRESS 217 W. Las Tuans. Dr. G (This section need not be completed if the work involved by Total No. Additional CITY San Gabriel Tel. No. the permit is for one hundred dollars($100)or less.) I certifythat in the performance of th.e work for which this PLAN CHECK e p APPLICANT permit is issued,I shall not employ any person in any manner so as to become subject to the Workers!Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional CITY Tel. No.' Date Applictint Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of JC APPLICANT Cobine Electric Co. ,Inc. Exemption, you should become subject to the Workers' , Range_Heater_D.W. — Compensation provisions of the Labor Code, you must forth- Oven K Dryer —W.M.— ADDRESS 1607 Chestnut St. with comply with such provisions or this permit shall be Top _ FAU W.H. deemed revoked. 'Hood _K Fah _Other_ CITY Alhambra Tel..Wo,282_015 LICENSED CONTRACTORS DECLARATION 5 17 5C LICENSEOR 1 hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ –Room Air Cond. — 229$47 Class. C 10 REG..NUMBER (commencing with Section 7000)of Division 3'of the Business DISTRICT NO. P CE ED BY Power Apparatus&Large Appliances and Professions Code,and my license is in full force and effect. �^ G t Size&Type HP, KW, KVA, or KVAR' LJ G C7 License.Number 229847 L•ic. Class C10 Up to 1 Incl. FINALDATE 0W 1'1/30/87 Over 1 to 1.0.:incl. VALIDATION Contra r' Over 10 to 50 Incl. FINAL . am exempt under Sec. Over 50.to 100 Inc. B B.&P.C. for this reason Over 100 Date: Services, Swbd., MCC&Panelboards 1 15 0 0 -200 Arnp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY -Temp..Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License additional Sign Branch Circuits Law for.the following reason (Section.7031.5, Business and Professions,Code): ❑ I, as owner of the property, will do the work and the Mi`sc. Conduits&Conductors structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ 7044, Business and Professions Code). ;9.5 5 6 8 A CONSTRUCTION LENDING AGENCY # a o 0 0 0 2. I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) ° ° ']5 0 2 (Sec. 3097,'Civ. C.). Lender's Name Tokai Bank of California 10 PLAN CHECKING FEE S ­ 750260 50 Lender's Address 534 W. 6th St.' LA PERMIT ISSUING FEE', 0 1.06-86 . .1 certify that I have read this application and state that the TOTAL FEE ` above information is correct. I agree to comply with all County � ordinances and State laws.regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE —� ' 10/03/86• . gn-tur- mittee Date.