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Home My WebLink About1379AWORRIM ATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. C2585957kompany INA Certified copy is hereby furnished. ® Certified copy is filed with the county building inspec- tion department. Date 8/20/86 Applimnt"Ttt McGee Electric CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed If the work Involved by the permit is for ono hundred dollars ($100) or lass.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws. ["� Applicant N, ..:E TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you must forth- ith comply with such provisions or this permit shall be deemed revoked. LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Number 490083 Lia. Class C-10 Contractor Bleetr#eel Date $6_ ❑ 1 am exempt under Sec. B.&P.C. for this reason Date: ❑ Exemption for Reg. Moint. Elect. SINGLE FAMILY HOME OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Code): ❑ 1, as owner of the property, will do the work and the structure is not Intended or offered for sale (Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is o construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby outhorire representatives of this County to enter upon the ab ve-mentioned property for inspection purposes. m&lR%20!86 Signature of Permittee– Date C6A663 ID/eI CE -80611 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN JOB EACH FEE ADD New Residential Bldgs. 8 Pools $ NO. _ $ LOCA ITY Ti1#42586 is Bar I & 2 -Family, Sq, Ft, NEARS Mubi-famlly Sq. Ft.— CROSS Residential Swimming Pools c�wNER oR Outlets: Rec_Lfght_Sw._ First 20 Total No. Additional Lighting Fixtures First 20 Total No. Additional Fixed Appliances Not Over 1 HP Range _. Heater,.._ D, W. _ Oven —Dryer _ W.M. Top _ FAU _ W. H, _ Hood —Fan _ Other— Disp. _ Room Air Cond, Power Apparatus & Large Appliances Size & Type HP, KW, KVA, or KVAR Up to I Incl. Over I to 10 Ind. Over 10 to 50 Incl. Over 50 to 100 Inc. Over 100 Services, Swbd., MCC & Ponelboards 0 - 200 Amp, Under 600 V 201 - 1000 Amp. Under 600 V Over 1000 Amp. or Over 600 V Temp. Power Pole & Appurtenances Sign with One Branch Circuit Additional Sign Branch Circuits Misc. Conduits & Conductors Other (See Complete fee Schedule)_ PERMI7 FEE (Sub-Totol) PLAN CHECKING FEE PERMIT ISSUING FEE A63 TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE CITY Tel. ADDRESS CITY Tel. No. PERMIT MAM "T" McGee Electric, Inc. APPLIADDRESS P.O. BOX 1111 CITY Chino 91708 Tel. N.,591-6461 LCESE OR RIEr;NNUMBER 490083 Class. C-10 {6 FINAL DATE AIr' VALIDATION =:137,9A 'e ses.2 reo6306 4re6�,06� 0F.2C -86 �JaIt Aa ROVA s DATE SIGhAYURRE TEMP POWER PC' r Uri 'bf£ F WORK ;; ROUGH CO%,' 3Ut7 WRING - i�fi 1 cAr cyf• `P'nr iR 5 -r _ rPOMR AUTHU'JI-ED UTUTY CO. NOT lfI-D NNA C seztcr .brz:ni NOTES , OWN[P.-BUILDER 0MRRATM f hereby affirm that +. am exempt from the Carl—tar's License Law for the fotlowing reason (Section 703L5. flushness and Professions Code): Any city or county which rogalros a_ptermli fo rtonsiruct, alter, fmp--, �demolisb, or repair any structure, prior to its issucnce; also re- quires the applicant for such permll to fife a signed state- ment that he is ilcensed pursuant to the provisions of the Contractor's L)cense Low, (Chapter 9 (commencing with Section 7000) of Divlslon 3 of the Business and Pfof— sicns Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by eny appl?cont for a permit subjects the appli- cant to a civil penalty of not more than five hundred doliars ($500).; _ Q i, as owner of the property will do the wo, .rd the siwcturo is not intended or offered far sale. (Sec. 7044, Business and Professions Code: The Controc- for's License Low does not apply to on owner of property who builds or'tmprovos Maroon, and who does such work hlmssif providwd that such Improvements ore not intended or offered for sale, if, however, the building or improvement is sold within one year of tomptetlon, the owner-buiidsr will have the burden of proving ihof he did noK.butld or improve for fire„puepase of sale.J I am exempt under Sec. , B & P.C. for this reason -. _.. Gare �. Clwner.._-,._.