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Home My WebLink About3333 BREA CANYON RD (4)WORKERS' COMPENSATION DECLARATION 76A663 IorBt APPLICATION FOR ELECTRICAL PERMIT1herebyaffirmthatIhaveocertificateofconsenttoself CE-OOeC' insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certifi o y the, f (Sec. 381X), Lob. CC.))(/ pp`` No. Company R~/rVC• FOR APPLiCAW TO FILL IN JOB 6ADDRESS33-33 fjYlEA ,Ai s vim ILDPolicy Certified copy Is hereby furnished. New Residential Bldgs, 8 Pools EACH NO. 5 t,/ FEE LOCALITY PAVV,0 vv 471 V— Certified copy is filed with the county building inspec- 1 8 2 -Family, Sq. Ft. — tion department, Multi -family Sq. Ft. — NLARESTCROSSST. Iryr 040? J _ 9'S L-/ Date ApplicoN ResidentialSq. Fl. SwimmingPools OWNER OR /7_- _ r l" CERTIFICATE OF EXEMPTION FROM WORKERS' FIRM NAME l MAIL COMPENSATION INSURANCE Outlets: ROIE5_Ught_ Sw._ ADDRESS This section nerd not be completed If Me work involved bP T First 20 Total No. CITY $G/{ T.I. No. 7S1—Z" the prrmit Is for one hundred dollar ($IoO) or less.) Additional I certify that in the performance of the work for which this APPPLIICCK APPLICANTpermitisissued, I shall not employ any person In any manner 7S ssoastobecamesubjecttotheWorkers' Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional e Total No. CITY Tel. No. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT ^ 60IIJ Exemption, you should become subject to the Workers' Range_ Heafer_D. W. —. - APPLICANT Compensation provisions of the Labor Code, you must forth- Oven _ Dryer _ W.M. _ ADDRESS 2 with comply with such provisions or this permit shall be deemed revoked. Top _ FAU —W.H. CITY 51WP%4 AiA Tel. LICENSED CONTRACTORS DECLARATION Hood _ Fan Other— Disp. _ Room Air Cond. LICENSE OR jQ A'TL/ 2 ve Class. j-jtJREGNUMBERr{ hereby affirm 1-111 am licensed under provisions of Chopter 9 commencing with Section 7000) of Division 3 of the Business Power Apparatus & Large Appliances DISTRICT NO. PROCE and Professions Code, and my license is in full force and effect. - / L p3 4p Size 8 Type HP, KW, KVA, or KVAR /4 Y License Number rr UClassoss — - 7— Up to 1 Incl FINAL NC-(. Over 1 to 10 Incl. 00 DATE a , CoNroctor Date Over 10 to 50 Incl. FINAL I am exempt under Sec. Over 50 to 100 Inc. BY B.BP.C. for this reason Over 100 Exemption for Reg. Moint. Elect. SINGLE FAMILY HOME OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason (Section 7031.5, Business and Professions Code): I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued Sec. 3097, Civ. C.). Lender's Name Lender's Address certify that I have read this application and state that the above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authoriz Akfrty of this County to enter upontheabve-menlr inspection purposes. azure of Permittee Date Services, Swbd., MCC 8 Ponelboards 011. 0 - 200 Amp. Under 600 V 201 - 1000 Amp. Under 6DD V O Over 1000 Amp. or Over 600 V Temp. Power Pole R Appurtenances Sign with One Branch Circuit Additional Sign Branch Circuits Mist. Conduits 8 Conductors Other (See Complete Fee Schedule)_ , PERMIT FEE (Sub -Total) /i8/ PLAN CHECKING FEE - ,g'l .10 PERMIT ISSUING FEE TOTAL FEE r ro SEE REVERSE FOR EXPLANATORY LANGUAGE VALIDATION 5 0 0 8 A fi• •19 1.15000 15000E 1216-82 f500.9A 2 11.21 7.50 1.21 f.50: 216-82 Y OU Cd O V d 2 APPROVALS DATE SIGNATURE TEMP. POWER POLE UNDERSLAB WORK ROUGH CONDUIT y) i WIRING FIXTURES O POWER AUTHORIZED UTILITY CO. NOTIFIED FINAL ss cc77 fer an .3ronf UWNtR-t3UILUtR UU.LAKAf1UN I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Code): Any city or county which requires a permit to construct, alter,.improve, demolish, or repair any structure, prior to Its Issuance, also re- quires the applicant for such permit to fife a signed state- ment that he Is licensed purs uant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Divislon 3 of the Business and Profes- sions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the appli- cant to o civil penalty, of not more than five hundred NOTES - - dollars ($500).: 2 :3 / _ _ L ' It as owner of the property ff will do the work, and ic-c`,-Le-o Zd the structure is not Intended or offered for sato. Sec. 7044,Businessand Professions Coder The Contrac- lot's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself provided that such improvements are not Intended or offered for sale: If, however, the building or Improvement Is sold within one year of completion, the owner-buffder will have the burden ofproving that he did not build or Improve for the purpose of sale.) I am exempt under Sec. B & P.C. for this reason Date Owner