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Home My WebLink About1701 CLIFFBRANCH DR (3)WORKERS' COMPENSATION DECLARATION 76A663 taut FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-Ba6C APPLICATION insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES `or a certified copy thereof (Sec. 380Q Lab. C.) ' BUILDING AND SAFETY Policy No. Company FOR APPLICANT TO FILL IN Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. ❑Certified copy is filed with the county building Inspec- 1 B 2-Family, Sq. Ft. E — Lion department. Mulli-family Sq. Ft. Date A licanl Residential Swimming Pools PP CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec S light / Sw.- COMPENSATION INSURANCE ( P by First 20 This union need not be Born olla I! the work Involved Total No.7 Additional the pemslt is for one hundred dollars ($IIX7) or Ins.) I certify that in the performance of the work for which this ADDJOB RESS �O' LOCALITY FEE S NEAREST CROSS ST. s' OWNER OR - FIRM NAME MAIL ADDRESS 11 a" Sb 10519 CITY HE Tel. No. N CHECK 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 ��/3�� Total No. I Additional ADDRESS CITY Tel. No. Dole�/�LApplicanr NOTICE TO APPLICANT: If, after makingthis CerI,fic01 f Fixed Appliances Not Over 1 HP Exemption, you should become subjet to the Work s Range— Heater_ D.W. — Compensation provisions of the Labor Code, you must forth- Oven —Dryer _ W.M. — with comply with such provisions or this permit shall be Top _ FAU —W.H. — deemed revoked. Hood _ Fan _ Other_ LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _Room Air Cond. (commencing with Section 70D0) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Power Apparatus 8 Large Appliances Size 8 Type HP, KW, KVA, or KVAR License Number 1I10's 3 Lic. Class Up to 1 Incl. ' S 5 Over 1 to 10 Incl. 'Il PERMIT APPLICANT •"� ADDRESS qq CITY - Tel. No. 8677/9)6,` O 4 LICENSE OR REG. NUMBER Z O Z• 3 Class. f 0. O DISTRICT NO. - / ! PROCESSED BY FINAL tJ DATE, Z VALIDATION O 0 Contractor �/ Dateme Over 10 to 50 Ind. I am exempt under Sec. Q�2_i Over 50 l0 100 Inc. Over 100 B.&P.C. for this reason 13 YJ Services, Swbd., MCC & Ponelboards FINA BY d Z 0 - 200 Amp. Under 600 V Signature N L[, 201 - 1000 Amp. Under 600 V ❑Over 1000 Amp. or Over 600 V Exemption for Reg. Mainz. Elect. SINGLE FAMILY Temp. Power Pole 8 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)- s, 9 0 7.4 A • • • �• 2 - I • • .1 650 Misc. Conduits 8 Conductors I, as owner of the property, will the work and the d for sale (Section Other (See Complete Fee Schedule)— structure is net intended or offered • • , x 1 6 5 O �- 7044, Business and Professions Code). Poo. 0 & 0 U — 8 5 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 PERMIT FEE (Sub -Total) - (Sec. 3097, Civ. C.). - PLAN CHECKING FEE Lender's Name - PERMIT ISSUING FEE V Lender's Address I certify that I have read this application and state that the TOTAL FEE 5 6 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 - obovevm7ygntie d properly for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 85 _the Signature of Permitte APPROVALS DATE INSPECTO SIGNATURE TEMP. POWER POLE UNDERSLAB WORK ROUGH CONDUIT WIRING FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED n[� cc77 FINAL Gntcr on ...Yronf UWMK-BUILUEK MCLAKAIIUN I hereby affirm,that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business end 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 file a signed state- menf that he is licensed pursuant to the provisions of the Confratlar's License Low (Chapter 9 (commencing with Section 7000) of Division 3 of the Bvslness 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 a civil penalty of not more than five hundred - NOTES _.dollars (SS00).:,i 1, ,_ \i. _ 0 I, as owner of the property will do the work, and the structure Is not intended or offered for sole. -1• _ - (Sec.7044, Business and Professions Cade: The Contrac. fors 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 said within one year of completion, the owner -builder will have the burden ofpravtng that he did not build or improve for the pureose of sale.) I am exempt under Sec. ' "B 8-P.C.: for this reason Date Owner