HomeMy WebLinkAbout1373A - � NSATION DECLARAiION �a,�3 ,o,e, qpp��CATION FQR ELECTRICAL PERMIT ,�o� /I j�
I hereby affirm tha�I have a certifiwte of consent�to self �E-BD6G .
insure,ar o certifitate oi Woikeri Compensation�ns�mnce, COUNTY OF LOS ANGELES BUILDING AND SAFETY L
or a cerNfied copy�hereof(Sec.3800,Lab.C.) �
C2277405A IhA
�❑ol�icy No. ompany FOR APPUCANT 70 FILI IN JOB
Cenifisd copy is hereby fumished. New Residential Bldgs.&Pools E�CH NO. FEE A��RESSLOC 11 T10Q. 337 Armitos Place
� Certified copy is filed with the county building iaspec- 1&2-Family,Sq.Ft. Z4�� S — 3 IOCALITY TR�42854 �Diaaand Bar
�ion deporlmen�. Mulfi-family Sq.Ff. — NEARfST
CROSS 5T.
7/12/85 "T" McGee Electric Residenfiol5wimmingPools OWNEROR
Date ApplicaM � ' FIRM NAME Anden Grou
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec 1 Li ht �- Sw 1 �MAIL
COMPENSA710N INSURANCE g 3 3Z Ao�RESS 1074 Park View Dr.
TThi��ectlon nsed not b�eom bNd lf fhe work involved b 3 Ftrst 20 Covina 91 24 - 9
ha pvrmif ia for ono hundrod dollon(SI00)or Iosi.) Y Total No. Addltianal CITY Te�.No. —
I wrtif Ihat in ihe erformance of fhe wo�k for which this PLAN CHECK
Y P . APFLICANT
permil is issued,I sholl not employ any person in ony monner
so as to become s�bject to the Workers'Compensation laws. Lighting Fixturels First 20 1 ADDRESS
Totol No. Addltionai
Dafe Appliconf CITY TeI.No.
Fixed Appliances Not Over 1 HP PERMIT
�`TICE TO APPLICAN7: If, afler making this Certifimre af APPIICANT ��T�� McGee Electric IRC.
mption, you should bewme subjed �o �he Workeri Range_Heoter_D.W._
Compensafian provisions of the Laboi Code,you must forfh- Oven _Dryer _W.M._ qDDRESS P,Q, $QX ]_].11
with comply with such provisions or this permit shall be Top� _FAU —W.H.— �
deemed revoked. CITY Chino 91708 Tai.ni591-6461
LICENSED tONTRAtTORS DECLARAiION Hood _Fon _Other._ �
Disp. —Room Air Cond. — L�CENSE OR (y2�748 � Class.C-10
1 here6y offirm ihat I am licensed under provisions of Chopter 9 REG.NUMBER
(commencing with Section 7000)of�ivision 3 of ihe Business DISiRICi NO. PROCESSED BY
ond Professions Code,and my license is in full force and effect. Power Apporatus&Large Appllances ,/ � 6
Size 8 Type HP,KW,KVA,or KVAR� /i' Q '
Litense Number 420748 �ic,Class C-1� Up to 1 Ind. FINAL V .
Electrical 7f12�$5 Ove�I�o 101nc1. DATE j� �' �y YAUDATION Q
Controctor Date Over 10�0 50 Ind. �
❑ FINAL�� {J
I am exemp7 under Sec. Over 50 to 100 Inc. BY w
B.BP.C.for Ihis reason O�er 100 �
Date: Services,Swbd.,MCC B Panelboards �
0-200 Amp.Under 600 V � ,
Si9nature 201-1000 Amp.Under 600 V
❑ Over 1000 Amp.or Over 600 V
Exempfion fo�Heg.Maint.Elect.
SINGLE FAMIIY Temp.Power Pole&Appurtenances . �1 3 7.3 A
r.^-� HOME OWNER-BUILDER DECLARATION Sign with One 6ranch Circuif #� � � • •2
.:ereby affirm thai I am exempr from rhe Comractar's License qdd�tional Sign Branch Circuifs �
�aw for fhe follawing reason(Settion 7031.5,Business and � � �'��3 8
Professions Code): �
❑ i,as owner of Ihe property,will do the work ond the Misc Conduits 8 Conduc�ors � '� • •�3,3 g�
s7ructure is nat intended or offered for sple(Section Other(See Compleie Fee Schedule}_ . LL �
7044,Business and Professions CodeJ. D��� �'�8 5
CONSTRUCTION LENDING AGENCY � .
I hereby affirm fhat ihere is o constroUion lending agency for
the perfoimonce of fhe work for which this permit is issued PERMIT FEE (Sub-Totol) 62.$
(Sec.3097,Civ.C.). - �
. PLAN CHECKING FEE � .
lender's Nome
- PERMIT ISSUWG FEE �.Q.S .
Lender's Address
I certify that I hove reod ihis appliwtion and state that�he TO7AL FEE �3.3
above informofion is correct.I ogree 10<omply with all County .
ordinances and Sfate laws regulafing E�ectrical wiring,ond
hereby aWhorize represeMatives of Ihis Couniy io eMer upon .
the above-menti ad proparty fo.�nspec+ion pu.poses. � SEE REVERSE FOR EXPLANATORY LANGUAGE
„��a�,y���w �//��
Signafure of Permittee pate .
- _- �—�-..rr�- _
1 ' � � � �� � ��� i' � ` • �1r� '�V+��'�M/�w -;a� �
f .a� r1f +�►
-__. .�" """ i��t��� ,-� .r;.v.�� _ . _ . . .. .
. -. �. _ ,
� � " . � ��. . .- AGPROVALS DATE �WWER-BUtLDER�RCI�
si
- . ' TEN1P.POWER POLE I hersby offirm thpt I am exempt from the Conirocfor's
� � Li<erree Law for the following reason (Sectlon 703I.5,
UNDERSLAB WORK �Business and Profess�ons Code):Any city or�county wliich
ROUGH CONDUIT - , �rrqWres v permft to construcl,ofter,Improve,demofish,
� �or r�puk any sfr�c#ure,prfor fo ifs fssu6nce, afso re-
� WIfiING -�- /C '��j . _. qulrx T6�appllcant for such permlt fo ftle a slgned stafv�
� FIRTURES�� � • . m�nt thaf ha fa licenssdpursuanf to the provfsfons of fhe �
� � . , ton�rociar's Lfcense Law(Chapter 9(commenctng wifh
� POWER AUTHORIZFD �j..- �,,,� Sectfort 7000)of�tvislon 3 of ihe Buslness ond Profes-
sions Code)or that he is exempl�herefrom ond Ihe bosis
UTItITY CO.NOTIRED /or Ihe aNegw! exempiton. Any violat(on o(Sect�on
FINAL n , 7031.5 by orty appllcant for v permif subjecis fhe appl�-
Gntei on�ronf . eont fo a e7vU pweelfy of not more thon five hundred
NOTES � dollars(5500).:
, ; . � ❑I,as awner o4 the propeny will da the work,^�
� � � � � the structure is not intended or offaved for sale.
� . . . -. . (S�a.7QI4,HusN�sc and Proiessions Code: 7he Confrao-
� for's lieense Caw does not appfy to on owner of property
� who buflda or Improves tFeaeon, and who does such
- ' work htmss!(proWded tFa�such Improvements ore no�
�ntended or offerod for sale.If,however,fhe bulfding or
impravament!s sofd wl�Nln ono yeor of compfotion,tfie
� . � ownx�bufldsr wlll hove ffie 6urden o!proving thai he d7d
nof bvild or Improve for ihe purpose of sale.)
� � I om ezempt undar Sec. .
B 8 P.C.for fhis reason
Date
Owner