HomeMy WebLinkAbout3333 BREA CANYON RD (16)WORKER$' COMPENSATION DECIARATION 76A669 io.a, APPLICATION FOR ELECTRICAL PERMIT1herebyaffirmIhatIhaveocenificaeofconsenitoself
CE-BO6G
inswe, o a ce rflcate of wo ke s' Compenw ion Insuran e, COUNTY OF LOS ANGELES BUILDWG AND 5AFETY
or o certifi o y ther f(Sac. 3800, Lab.
yCQ.)(/ p/
P ol icy No. Company w'" r'' FOR A PLKAM TO:RI IN JOB y + p,,, /(,/
Cerfified copy IS hereby furnished. New Residenfial Bldgs, 8 Pools EACH NO. FEf ADDRE55 %3Y w^ C.f" /r
Certified mpy is filed with the counry build ng inspec- 1 8 2-Family, Sq. Ft s — 5 LOCAUTY ( ,Qan}-
fion deparfinent, Multi-fomily Sq. FI. — A ST w ^ y
Residentiol Swimmin Pools
CROSSST. ryriilN/ J ty
Z'I:9'SL- /S' 9 OwNER OR /7__ _ rDateApplicoN
FlRM MAME ! !
CERTIFICATE OF EXEMPTION FROM WORKERS' Oullets: Rat Light_Sw.__ `^A .p •
COMPENSATION MSURANCE , noorsE55 ( .O X o foD
Thi Mbn n d not 6 com Id d IF M work {nvolv d b n/ first 20
P Y Toial No. Addit onol CITY Tel. No.7S1h p rmit { ior on hundnd doltan (SI00) or I».)
I cartify that in iha periormnnce of ihe work for which this q C MjTK
permit is issued, I shall no employ ony pe son In any manner
so oa to become subject to ihe Workers' Compenwtion Law:. Ligh ing Fixtures First 20 '7S ls AODRE55
Additional e
Toial No. CI1Y Tel. No.
Date eppliwnt Fized Appliances Not Over 1 HP pERM17
NOTICE TO APPLICANT: If, oNer making this Certificate of A%,iCyM
Exemplion, you should become subjett to Ihe Workers' Range_ Heafer_D.W. _. . -
Compensation provisians of the Labor Code, you must forth- . Ovan _ Dryer _ W.M. _ ADDRE55 2 .
wilh camply wiih such provisions or this permit shall be '.'7op _ FAU —W.H. _ A
deemed revoked. C TY --,'4 j s Tel. No.j`
LICENSED CONTRACTORS DECLARATION
Hood _ Fan Olhar_
Disp. _ Room Air Cond. — ' LICENSE OR jQ 2 Aw Clou.
I hereby oHirm that I om licensed under provisions of Chopter 9 REG. NUMBER "E "tL/
commenting with Sattio 7000) of Division 3 of the Business po,,,er Apparatus 8 Large Appliances DISTRICT NO. PROCE
and Proiessions Code, and my I ca se is in fuN force and eHen. - /
p Size 8 Type HP, KW, KVA, or KVAR % y
licen5e Nombe rr 3 p . Goss - -
7— Up to 1 IncL FINAI
C-(• /Z.y/'( _$y _l/IL_ Over 1 to 10 Incl. 00 DATE
a, CoNroUor Date Over 10 io 50 Incl.
OFINAL
I om exempt under Sec Over 50 to 100 Inc. BY
B.BP.C. for this reason Over 100 .
Exemption for Reg. Moint. EIeU.
S NGLE FAMILY
HOME OWNER-BUILDER DECtARATION
I hereby offirm 1ho I om exempt from the Con7rocror s license
Law for iha following reason (Section >031.5, Business ond
Professions Code):
I, os owner of Ihe property, will do fhe work ond the
slructure is not intended or offered for sale (Secfion
7044, 8usiness ond Profezsions Code).
CONSTRUCTION LENDING AGENCY -
I heraby offirm Ihot the e is o conshuclion lending agency (or
the performance of the work for which this permit is issued
Sec. 3097, Civ. C.).
Lender's Name
Lender's Add ess
I certify thot I hove read this appiication ond stote ihat Ihe
obove information is mrrecl. I agree to mmply wilh ail County
ordinancas a d State lows reguloting Electricol wiring, and
hare6y auihorize repre entoiives of this County to enter upon
the ob ve-mentiony perty for inspaction purposes.
Z—/6-82
ature of Permiltee Da1e
Services, Swbd., MCC 8 Panelboards
0- 200 Amp. Under 600 V
201 • 1000 Amp. Unda bOD V
Over 1000 Amp. o Over 600 V
Temp. Power Pole R Appurfenances
Sign with One Bmnch Circuit
Addilional Sign &onch Circui s
Misc Conduils 8 Conduclors
O har (See Comple e Fea Schedule)_
PERMtT FEE (Su6-Tmal) /` i'
PLAN CHECKING FEE - ,g'1 'J
PERMIT ISSUING FEE . I
70TAL FEE 7J(. (j
SEE REVERSE FOR EXPLANATORY LANGUAGE
L1_I
31
VAIIDATION
5ooaa
i
I•15 00
15G00
1216-82
f50G.9A
1 • • • 'Z
1 1.1 7.50
I.0 1 I.JQ'
1216-82
Y
Ol.l
OC
O
V
d
2 _
APPROVAlS DATE SIGNATt1RE
TEMP. P.OWER POLE
UNDERSLAB WORK ,? ' / .
ROUGH CONDUIT ( 5 , '
WIRING `. , / -.,..
y . . ..
FIXTURES a _ .
POWFR AUTHORIZED
UTI ITY CO. NOTIFIED .
FINAL Gnfer ort .3ronf '
NOTES
3 e -o s -
e ' /N-'--,- a p '
OWNER-BUILDER DECIARATION
I hereby affirm ihat I om exempt from the Contmctor's
ltcensa I.pw for iha following reason (Secfion 7031.5,
Buslnoss ond Profssslons Code): f ny clly or counfy wh/ch
requtres a psrmlt fo ronstruct, alter,.improvo, damolish.
or repair any sfruduro, prlor to tls Issuanco, afso re-
qulrn }6 opp6can! forsuchpermll fo flfe a slgned s o o-
monf Iho hv Is Ilcensedpursuanl fo f6e prov6lons of fbe
Contraclori Llcenso Cow (Chopfcr 9(commencln wl h
Sec}fon 7000) af D!vlslon 3 of Ihe 6usinest and Proles-
slons CodeJ or fha7 hols exempr fborcl om artd }Fe bv,is
lor fhe alfegsd oxemptfon. Any vrofaflon of Socfion
703t.5 by any oppllcant for a permlt subJects tho appli-
cani fo o efvl! penelty of nol moro thon (ive hundred
dollors (5500).:
I, as owner of fha proporiy wlll do ihe work, and
the structuro is not In endod or offered for saio.
Sec. 70M, Buelness andProfessions Coder 7ho Contrac-
lor's Ltcenee Lawdoes no cpply to an owner of property
who bullds or improves fherean, and who does suth
work hlmseff provlded ifiaf avch 7mprovoments am not
Infended or olfered lor sale: ll, however, ihe bvllding or
lmprovement Is sold wlthln ono year ol compleflon, he
ownen6u(fder wfll hdvc tFe 6urden olproving thot he did
not bulld or Improvc for fhe pvrpose ol sale.J
I am exempt under Sec. ,
B E P.C. for this reason
Owner