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Home My Public Portal About5553-5553 1/2 SANTA ANITA AVE_Electrical__ •4WORKERS;COMPENSATION•DECLARATION 76A663 10/81 d o a •�I hereby affirm tha} I have a certificate of'consent t6self CE:80� &VIEFLOC�KNON FOR ELEC URICAL PERMIT insure, or cf,,certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or"a certified copy thereof(Sec. 3800, Lab. C.) P;Iic;No. cWC647173&mpany Homeland Ins., FOR APPLICANT TO FILL IN JOB 1 Certified co is hereby furnished. EACH NO. FEE ADDRESS 55532 Santa ANita PY Y New Residential Bldgs. $Pools ❑ $ _ $ 69 4 LOCALITY Tem le Cit Certified copy is filed with the county building inspec- 1 $2-Family, Sq. Ft. p tion department. Multi-family Sq. Ft. NEAREST CROSS ST. _-.Residential Swimming Pools OWNER OR Date At 2e Applic FIRM NAME San Gabriel Properties CERTIFICATE OF EXE ION FROM WORKERS' Outlets: Rec Light Sw._ MAIL. COMPENSATION INSURANCE �'• ADDRESS 217 W. Las Tuans Dr. G This section need not be completed if the work Involved b First tt„ , K•. ( p 1► Total No. Additional•:��'�• •- ..4 �-' ' CITY San Gabriel Tel. No. ______ the permit is for one hundred dollars($100)or less.) y ; •pLANCHECK I certify that in the performance of the work for which this ' ' -' '� �. `'APPLIbANT permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. I Lighting Fixtures First 20 ADDRESS Total No. Additional CITY Tel. No. -Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of Range— Heater_D.W. APPLICANT Cobine Electric Co. Inc. Exemption, you should become subject to the Workers' 9 — Compensation provisions of the Labor Code, you must forth- Oven --)LN Dryer W.M.— ADDRESS 1607 Chestnut -St. with comply with such provisions or this permit shall be Top _ FAU W.H. — deemed revoked. Hood Fan _Other— CITYAlhambra Tel. No. 282_0315 LICENSED CONTRACTORS DECLARATION 5 17 .5 LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp.. Room Air Cond. REG.NUMBER 229847 Class. C10 (commencing with Section 7000)of Division 3 of the Business DISTRICT NO. P ED BY and Professions Code,and my license is in full force and effect. Power Apparatus 8 Large Appliances r� �✓ Size$Type HP, KW, KVA, or KVAR' Ov O License Number 229847 Lic. Class C10 Up to 1 Incl. FINAL U 11/30/86 rt0 a Over 1 to 10 Incl. 1 / 7 .1 DATE VALIDATION � Co Over 10 to 50 Incl. FIN v y� exempt under Sec. Over 50 to 100 Inc. B 1m 9L B.$P.C. for this reason Over 100 y Services, Swbd., MCC$Ponelboards Date: 0 -200 Amp. Under 600 V 15 Signature 201 -1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V \ Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole$Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Law:for the following reason (Section 7031.5, Business and Professions Code): ❑ I, as owner of the property, will do the work and the Misc. Conduits$Conductors structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ 7044, Business and Professions Code). 9557.9 N CONSTRUCTION.LENDING AGENCY I hereby affirm that there is a construction lending agency for # 0 0 0 0 0 2 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) 1 ea 9J3, (Sec. 3097, Civ. C.). I a o79.90 Tokai Bnak of'California PLAN CHECKING FEE 0 0 0 0 $ Lender's Name 7 9 9 0 c1 Lender's Address 534 W. 6th St. . LA PERMIT ISSUING FEE 1 O •5 O 1.0 6=8 6 I certify that I•have read.this application and state that the TOTAL FEE 22 1 19 . 0 above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and 77,70 hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 0/03/86 o mitt a Date WORKERS'COMPENSATIQN DECLARATION 76A663 10/81 APPUCAMN FOR ELECURECAL PERMIT I hereby affirm that 1 have a certificate of consent to gelf •C"06G J insure, &a certificate of Workers'Compensation Insurance, COUNTY OF (LOS.ANGELES BUILDING AND SAFETY 'br a certified copy thereof(Sec. 3800, Lab. C.) ' Policy No. WC647173&mpany Homeland Ins.' M FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS 5553 Santa Anita Pq Certified copy is filed with the county b ' in inspec- 1 &2-Family, Sq. Ft.16 13 $ —Is 62t .52 LOCALITY Teml le Cit tion department. Multi-family Sq. Ft. — NEAREST Date 04/01/87 A 1. —Residential Swimming Pools CROSS ST. Pp OWNER OR FIRM NAME San Gabriel Properties CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL COMPENSATION INSURANCE Outlets: Rec Light Sw. ADDRESS 217 W. Las Tunas Dr. ,G First 20 i ' iA �. (This section need not be completed if the work Involved by ' �' ' "�+ 'C(TY San Gabriel Tel. No. _____ the permit is for one hundred dollars($100)or less.) Total No. Additions{ .,�: •„r\ , - PLAN CHECK I certify that in the performance of the work for which this 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 Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making,this Certificate of 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 41—Dryer W.M.— ADDRESS 1607 Chestnut St. with comply with such provisions or this permit shall be Top FAU W.H. — deemed revoked. Hood �_ Fan Other_ CITY Alhambra Tel- Pia• 282-0315 _ LICENSED CONTRACTORS DECLARATION 5 1 •5 LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. REG.NUMBER 229847 Class.0 10 (commencing with Section 7000)of Division 3 of the Business DISTRICT NO. OCE SED BY and Professions Code,and my license is in full force and effect: Power Apparatus&Large Appliances � 0 � Size&Type HP, KW, KVA, or KVAR• 00 License Number 229847 Lic. Class 1210Up to 1 Incl. FINAL 11/30/86 l� V Over 1.to 10 incl. DATE DATE ✓ VALIDATION ° Over 10 to 50 Incl. 4:::a FINAL V �1.m exempt under Sec `: Over 50 to 100 Inc. BY L' Over 100 B:&P.C. for this reason Services, Swbd., MCC&Ponelboards 1 15 .011 Date: 0 -200 Amp. 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 Misc. Conduits&Conductors structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ 557,8A 7044, Business and Professions Code). � CONSTRUCTION LENDING.AGENCY # 0 0 0 a o 2 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) 1 7502 (Sec. 3097, Civ. C.). PLAN CHECKING FEE 6 '0.0 0 7 5 0 2 5 Lender's Name Tokai Bank of Claifornia 534 W.6th St. LA PERMIT ISSUING FEE 1 .0 5 0 1.06_86 Lender's Address I certify that I have read this application and state that the TOTAL.FEE 44J"-5-2-- above a;'-.52above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and 7s D Z hereby authorize representatives of this County to enter upon the above-m2enLiqnadSroperty for inspection purposes. SEE REVERSE FOR EXPLANATORY QAR9Q'sIYAGE 10/03/86 ignature if Permittee Date