HomeMy WebLinkAboutNo Permit Number WORKERS'COMPENSATIONDECLARATION CE-806G(2�80) APPLICATION FOR ELECTRI�AL PERM�T
i hereby afei�m that � have a certificate of consent to se�t COUNTY OF LOS ANGE LES BUILDING AND SAFETY �
insure,or a�certi�cate of Workers'Compensation Insurance,or .
a cectified copy thereof(Sec.3800,Lab.C.j
� �Fl^PI[IpII �Tri[7- . n�� FOR APPUCANT TO FILL IN JpB
� Po���y�g��62�SA`Q�Pen'' EACH NO. FEE ApORESS Lot 31 – 20600 E. Alda Gt.
.� . New Residential B�dgs.8{.Pqds
� Certified copy is hereby furnished. i&2-Family,Sq.Ft.�U37 a — a �ocAurr Tg#33645–A . Racaland Heig
Multi•family Sq.Ft. — NEA EST � � � .
�Certified copy is filed with the county building inspection Residential Swimming Pools CROSS ST
department. � OWNER OR-
�+r.1-�SZ "C" �McG�e �Electr].c FIRM NAME �
Date Applicant Outlets:Rec.�Light�'5w._ 2. Q ADORESS �6�� US J �T'.
F rst 20
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No.. Additional CITV Newport Beach rai rvo. 540-0500 }
COMPENSATION INSURANCE a
. P�Ah CHECK
(This section need not be completed if the work 1t1VOlved 6O APPLICANT � V
by the pecmit is for one hundred dollazs ($I00) oc IesaJ Lighting Fixmres . First 20 apoaess �
- Additionel
I cer[ify that in the performance oP the work for which this Total fVo.� - ' CITV Tel No. �
fixed APP�iances Not Over 7 HP
permit is issued,I shall not employ any person in any menner � � PE RMIT
so as to become subject to the Workers'Compensallon Laws. Renge,Heater_p.W._ APPLICANT"C"� McGee :Eleatric � .y
� � Oven _Dryer_W.M._ AODFESS P•O• $� y
Date Applicant
Top _FAU _W.H..^ Z
Hood_Fan _Other— . CITV -Tel No.
NOTICE TO APPLICANT:If,a@er making this Certificate of pisp. _Room Air Cond,_ IiEG N�MseR � 15337$c��� - C-10
Exemptlon, you should 6ecome subject to the Workers' �
Compensation provisions of the Labor Code,you must forth- power ppparatus&Large Appliances DISTFICT NO. PAOCE6SEO,BY
with comply with such provisions or this permlt shatl be Size&Type HP,KW,KVA,or KVAR �
deemed revoked. � �. --
Up to 1 Incl. "
� Over 7 to 10 Incl, DA EL '�7
^7 � VALIDATION
, LICENSED CON'IRACTORS DECLARATION Over 10 to 50 IncL � ! � r �
I here6y aff'vm thet I am ticensed under provisions o[Chapter Over 50 to 700 In0. F4NAL � -
9(commencing with Section 7000)of Division 3 of the Busi- Over 100 BV
ness and Professions.Code,and my license is in futl fotce and
effect: Services � �
License Numh�S.337S Lic:ClessC^10 0-200 Amp.Under600 V
. 207�1000 Amp.Under 600 V
Contrector F.1 ant r'i na 1 Date !+-,1=$], Over 7000 Amp.or Over 600 V
� � � :'�'�;l.�'!'.
� HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurxenences
� Sign with One Branch Circuit �'." `� " �
1 hereby affirm that I am ezempt from the Contractor's qdditional Sipn Branch Circuits
License Law for the following reason(Section 7031.5, Busi-
ness and Professions Code):
Misa Conduits&Conducton � � �.I ,' "��<�I
� I,as owner of the property,will do the work and the Other(See Complete Fee Schedule�-- ,, �!.-
structure is not intended or offered for sale (Section . � � � --
7044,Business and Professions Code). � �
� CONSTRUCTiON LEN�ING AOENCY . ' L 1�.C'[-'r S�I
1 hemby affirm that there is a construction lending agency
for the performance of the wurk for which this Oermit is pERMIT FEE� � (Suh•Totall -
issued(Sec.3097,Civ.C.).
Lender's Name p4AN CHECKING FEE (One-Fourth Permit Feel .
Lender's Address PERMIT ISSUING FEE� . -
I cettify that I have read this application and state that the TOTAL fEE 72. 67
a6ove information is correct.1 egree to comply with all County
ordinances and State laws regWating Electrical wiring, and
hereby authorize representatives of this Councy to enter upon �
the above-mentioned tty for inspection purposes. SEE'R£V ERSE FOR EXPLANATORY LANGUAGE �
a-i-ai
Sign e of Permitt Dafe . � � �
\
, _ _ ir
. . . 4 �_ - _ S .
. . . '� . «. : .
. � owr�w-Bu�.�E�a�c�a�a�ror�
. � 1 haceby aftSs�n Niet i am exempE€remtire Co�vb�'s
� APeRovn�S DnTE �NSPEC70a• � Licens� Law� Soc [1�e followin�reason/3ectior¢ 7031.5,
, , _ ___ _ �sicNaTURE � � Euxir;ess orYd ffoJessfons Co@�J: kny��city or rounry
� � , TeivtF:PowER aoi[ � � � , �� - ivhicia requires o perrxir �o consrn[u, after, rmprove,
- � � UNOEF;SLAL'VJOFiK � - demOlis31,or repRir�Wy szritctL•re,priFH'to its iRsuBkce,
� � � alsa requires the upplicant for such permrt to file a
� ��� � � � � � Fou�fi cor�ourT � - � � � sioried slarenrenr tHet he is (icensed pursuarir ro �he
� � - . 1h�IRING c, provixinrac of the Cotttr¢cfor's I.icettxe l.oN�(Chapler 9
. . . .��D . � � (ron��nencYn„ with Seciion 7000/ of Orvisiw��3�oj the
" _ FiX7UFE� � � - . Businesc anr�Projenions CodeJ ar thdt he is exernpt
�.. � . _ . _ , - . thnrrjronr and tlre Irasts Jor the alleged exemptron.Any
� ., . . �i-oiveF auT�ioF:izeo �� ' violction of Secrian 703/..5 hyarty app!icant fora perrcrir
UTILITY CO �i��iriro � subjecrs the upplica-�i to a civi!penelry of rwr mere thnn
�------ � � ffve hkreQred dallors(.SSOOj.' .
� � _ Finl.�� �_ ��i .:�.! a��+� �n"+� O 1,ac o�r-net of ttce propec[y wifl do the�rork,ar,d
� . -- � . thc structuce is n€it iniendec!or offecwl Fnr s�4e..
� � N�-�s � � (Sec. 70-F;', BusHrcas a»d Profeuions Cod�: The Cori�
- - . � '. . � trastrx's Lic�tsa !aw dsies noi appf}�� to rµ ow�r of
----- --- — . - praperty wim M.•itds or irnproves rhereon,arid who docs
. . .. . . - �- such wnrk h•'rrr:elf provi�fed thut serck irnprovenaerrrr
. . , . ��`-'_ --'— , . � rre not i�xe+�Fcw'or offered for ss7e. (f. Irowc-ver. the
. . . .. . - . . � . . build;rrg or i�;;prorcm¢sr is sr�&I wi[Me'w onc year of
. . - --- -.-;-----�— corr�plrtian� 11�s nwreerba!lrter wiN hore tFae barQett
� .. ... � . � oi 7�r'orl+qg tkuf lte ditl no3 bccild or iawpnve jer!he
. � ---- ptrpeee of s»k.J . -
----� -------- ----- — I am exempt ur.der Sec, ,
-- -------- — — B&1'.C.for this reason
Ih�[e.
D�.r,er