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"'°RKERS•`°^^PE"5^T'°"°E"ARAT'°" '°""' ,°,81 APPLICATION FOR ELECTRKAL PERMIT �a� 1� �
I hereby affirm that I have a cerrifimte of consent to self CE-e�nG
insure,or a certifimte of Workers'Cornpensation Insura�ce, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or o certified capy thereof tSec.3800,lab.C.) �
P❑ol�icy No. C22��4O.�mpany INA FOR AP►LICANT TO FILL IN � JOB
Certified copy is hereby furnished. New Residentiol Bldgs.8 Pools EACN NO. FEE ADDRESq,OL 12 Mod. �F
� Certi4ied copy ia filed with ihe munty buitding inspec- 1 8 2-Family,Sq.Ft. 13J.3 $ — 5 LOCALITY F
fion deportment. . Multi-family Sq.FL C OS5557.
Date 7�1'2�g5 Applitant,f��t �cGee Elec. ResidentialSwimminqPools OWNEROR
FIRM NAME Anden Group
CERTIFICATE OF EXEMPTION FROM WORKERS' OuHe�s:Hec2 Lighl.�._Sw.� '��� 107k Park View DT.
COMPENSATION INSURANCE � nDDRE55 � �
(Thit tedion n��d no�b�complafed if Th�work inrolved by 4 Fir51 p cirr Covina 91724 rai.N�b7-9541
Yhs permit fs for one bundrad doliarc(5100)or less.) Total No. Additional
I certify fhaf in the performonce of the work for which fhis � A PN AHNTK .
permit is issued,I shall nof employ any person in any manner
so os fo betome su6ject to the Workars'Compensation Laws. LigMing Fixtures First 2D 75 ADDRESS
- � . Total No. �' Additianal CITY � Tel.No.
Date Applicant Fixed Applianws Not Over 1 HP PERM�7—�����
�`^TICE TO APPLICANi: If, aflar moking fhis Certificate of APPLICANT T McGee Electric,Inc.
' iption, you should become subjed to ihe Workers' Range_HeaterTD.W.� ,��
Gumpensatian provisions of the Labor Code,you most forth- Oven _Dryer _.W.M._ ADDRESS P.Q. BO]C Illl
with comply with such provisions or this permit sholl be Top _FAU —W.H.—
deemed revoked. � Hood _Fon _Other_ CITICA�IIO 91�OH rei.nio.591-6461
LICENSED CONTRAC70RS DECLARATION � LICENSE OR
�here6y affirm Ihaf I am licensed under provisions o4 Chppter 9 Disp. —Room Air Cond. — REG.NUMBER 4Z��4$ Class. (�,-1�
(commencing with Section 70pp)af�ivision 3 of the Business DISTRICT NO. PROCESSED BY
ond Professions Code,and my license is in full farce and effecl. Power Appa�alus 8 Larga Appliances �� a
� . � Size&Type HP,KW,KVA,or KVAR� - O
License Number 42Q748 i��.cia55G10 Up to 1 Incl. fINAL /// �
ElecCrical ��12�$5 Over 1 to 10 Incl. OATE (�l/'�j/S'S VALIDATION �
Conlrac�or Date Over lO to 50 Incl, FINAL / V
❑ I am exempt under Sec. Over 50 fa 100 Inc BY ,f'),�'� . �
Over 100 �� � �
B.&P.C.for�his reason y
. Services,Swbd.,MCC&Panel6oards � � z
Date: 0-200 Amp.Under 5W V
Signoture 201-1000 Amp.Undar 600 V -
� _ Over 1000 Amp.or Over 600 V � z 1 3 Z 2 A
Exemption for Reg.Moint.EIeU.
� SINGLE FAMILV ���� �'���2
Temp.Power Pole&Appunenances
HOME OWNER-BUILDER DECLARATION Si th One Bronch Circuit
�\eby af{irm ihal I am exempt from the Coniracror's License 9�W� ��� •6 9,1 7 �
�_.,for the fallowing reason(Section 7031.5, Business and Additional Sign Bronch Circuils �� � �6 9 � 7�
Professions Code): �
❑ I,os owner of the property,will do the work and ihe Misc.Conduits&Conducfors . O Z� (��8 5
structure is not intended or offered for sale(Section Other(See Complefe Fee Schedule)_ , �
7044,Business and Professions Code).
CONSTRUCTION LENDING AGENCY '
I hereby pffirm that there is a consfruction lending agency for
ihe performance of�he work for which this permit is issued PERMIT FEE (Sub-To7al) 58 67 � . �
(Set.3097,Civ.C.). . .
. . PLAN CHECKING PEE � �
Lender's Name 10 5�
� PERMIT ISSUING fEE .
Lander's Address 69.�.7
I certify that I have read this opplication and state�hat�he TOTAL FEE . ,
obove information is correct.1 agree to mmply wi�h all Counry � , ' . ,
ordinances and State laws�egulating Eleciriml wiring, ond
here6y outhorize represenlalives of this County to en�ar upon
the a ov�ntionefi pro�y for inspec�ion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE '
J%LT l r� � /
$ignoture�of ParmiBee Do e � .
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� '� �� � !'i4��!� +��J! � - r�e :'i...�+�.�...�. -��
-,•,, �a.. n.,��... �,+�� � ,,,,�� • .�, _
. � - , APPROVRLS oA7E . � OWNER-BUILD€R DECLARATION
SI
� , 7EMP:POWER POLE . .�� I he;aby affirm thct I om exampt from the Controctor's
� � � � License Law for ihe following reason (Secllon 7031.5,
UNDERSLAB WORK Busin�ss and Professlons Code):Any cl�y or toun�y wMith
. ROUGH CONDUR 7'� /;�:' `� . . reqefres a permH to mnsfrucf,alter,lmprove,domolish,
�or ropolr any strudure, prior fo!ts Issuance,'dfso re-
�-. _ -. � -MNRING� � qolres tl»Cpplltant for such p�rmlt to ille a slgncd state-
FIXTUR€S .. , ment tAaf 6o is lieensed pursuant to�he provlsfons o/the �
� .. . �� � . Confraclor's Llcsnse Caw(CRapter 9(commencing with
POWER AUTHORIZED ���,. � Sac!(on 7000)af Divlston 3 of ihe Business ond Frofes-
UTiLITY CO.NOTIFIfD � � --' slons Cadef o�}hat he is exempt therefrom and the 6asis
for !ke aLl�g�d exemptlon. Any vtolatlon o( Setl/on
� FINAL . 7039•5 by aiyr applimnf for a permlt subJec�s�he appli-
nfrr ox innf � cantfo a cfvA ponolry of not more thcn flve hundrsd
, . NOTES dollars($i00J.:
• �� ' � � - � - � - . , � ❑i,ae owner of the propevty will do ihe work,and
the atructure is not intended or offered for sale.
- - � � � � � � -� (Sec.7044,Bwfness and Frofassions Code: The Com.Wc-
tor's License Law does not cpply to an owner of properly
- � � � � �� , � who 6uilds or fmproves}hereon, and who does such
� work himseff provfded ibal sucF 7mprovemenfs ore nof
� - � lnfended or offared for soJe.If,howuver,ihe 6uifding or �
� improverr+ent Is sold wiffiln one year of completion,tfre
� - ovm�r-bvlld�r wif!have the 6urden of proving fhat he did
� not bu!!d or improve Ior fhe purpose oi Sale.J
- I am axempt under Sec.- ,
B&P.C.for this reasan
Daie
Owner