HomeMy WebLinkAbout1385A i �
WORKERS'COMPENSATION DECLARATION 76A663 �o,e, APPUCATION FOR ELECTRICAL PERMIT �
I hereby affirm that I hove a certifica�e of[onsenf to self CE-806G
insore,or a cerrificate of Workers'Compensotion Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy ihereof(Sec.3800,Lab.C.)
O�Y NoC25859571�om��y INA FOR APPIICANT TO FIIL IN DD
Certified topy is hereby furnished. New Residential Bidgs.&Pools EACH NO. FEE
� � 1 8 2-Famll s F�. 1314 s _ s LO ALITY
Certified copy is filed with the counfy building inspec- Y' 4' NEA T
tion departmani. Multi-family Sq.Ft. CROSS
Residentiol Swimminq POo�s OWNER Oft
Date�_Applitant ��'�'�� 'M^�'^^ ��^^ FIRMNAME Anden Gro
CERTIFICATE Of EXEMPT�ON FROM WORKERS' Outlets:Rec�Light_Sw._ �MAIL
COMP€NSATION INSURANCE ADDRESS �074 Park View Dr.
First 20
(Thia��tfio��Nd no1 6a comploted lf Tho work involved by Total No. Additional C�TY C•OVj.IIA� C.S. rei.No. 967-9541
tha permif i�for ona huadrod dollan(5100}or loss.) PLnN CNECK
I tertify ihot in Ihe performance of�he work for whith this APPtICANi
peimit is issuad,i sholl not employ any person in ony manner
so as to bemme subjxt m�he Workars'Compensation Laws. Lighting Fixtures Firsi 20 ADDRESS
Addirional
�,.,, Tmal No. CITY Tel.No.
applicant Fixed Applionces Not Over 1 HP PERMi7
h_JGE TO APPIICANT: If, aher making this Cartificate of AVPLiCANT ��T�� McGee Electric
Exempfion, you should become subjeU to ihe Wo�kers' Range_Heater_D.W._ �
Compensatlon provisions of the Lobor Code,you must forth- Oven _Dryer _W.M.� ADDRE55__ ��0. '$pg ],111
with comply with.such provisions or ihis permit sholl be Top —FAU —W.H._- CITY Tel.No.
deemed revoked. Ct11II0 91TOS 591-6461
Haod _Fon _Other�
LICENSED CONTRACTORS DECLARATION LiCeNSE OR 440083. Class.C—ZO
Disp. _Room Air Cond. — REG.NUMBER
I hereby affirm that I am licensed under provisions of Chapter 9 �
(commencing with Sedion 7000�of�ivision 3 of the Business powar Apparatus&Large Appliances DISTRICT NO. PROCESSED BY 0.
ond Professions Code,and my license is in full force and effecl. d U
490083 C_j� Size 8 Type HP,KW,KVA,or KVAR
License Number Lic Class Up to I Incl. FINAL �
Electrical S/20/86 ove�i ro 101nc1. DATE R„ S �'f VAUDATION U
Controctoi �a�e Over 10 to 50 Incl. W
❑ FINAL �
I am exempt under Sec Over 50 to 100 Inc. BY N
B.&P.C.for�his reason Over 100 Z
�8. Services,Swbd.,MCC B Panelbaards ,
0•200 Amp.Under 600 V
Sigaature 101-tOW Amp.Under 6DO V
❑ Over 1000 Amp.or Over 600 V .
Exemplion for Reg.Moin1.Elect.
. � � SWGLE FAMILY Temp.Power Pole 8 Appurtenantes
HOME OWNER-BUILDER DECLARATION Sign with One e�anch Ctrcuit '1 3 a 5 A
I hereby offirm tha�I om exempt from the Controctor's License Additional Sign Bronch Circuifs #�.w e • s i�
Low for the following reason{$ection 7031.5,Business and
Professions Code):
� Misc.Conduits 8 Conductors � '� Q b�0 6
I,as owner of ihe property,will do ihe work pnd the Other See Com lete Fee Schedula , �
structure is nol intended or offered for sale(Section ( P �— - m,a c�;,.O(�
7044,8us�ness and Professions Code).
CONSTRUCTION LENDING AGENCY G�2 F'�H 6
i hereby offirm that there is o mnshuction lending agency foi
the performance of Ihe work far which Ihis permi�is issued PERMIT FEE (Sub-Total) 6
�Sec.3097,Civ.C).
� PLAN CHECKING FEE .
Lender's Name
PERMIT ISSUING FEE ZQ. O
Lender's Address
I cerlify that I have read Ihis opplication and sta�e lhpt the TOTAL FEE .�(
above informafion is correct.I agree to comply with oll Co�Ny .
ordinances and Slate laws regulafing Eledricol wiring, and
hereby authorize representatives of ihis CooMy lo enier upon
the ove-mentione poperry tor inspectian purposes. SEE REVERSE POR EXPLANATORY LANGUAGE
� /�yJ��/J� 8/20/86
aii i�Et
Signature of Permitfee Date
� ��92i. }� ��t' r .� F �{—. ; �arZiT� � 'fg�
� �.
P���dt,ts ' pqT� ����A1t1� 'VtVNER-BUILPER DECLARiATit�N'
..... , .1',. � `---_ __._ .�_.____..._._.__._. .
- � '" it y F' pCW R'F -Le � � � . i hereby offirm ihat I am exempt from 1he Cantwctor's
. , �-- � -� � . L�cense taw for rha followiny�reason (Secnon ]03�.5,
' �C.'dDERSLr�� dC�K � � ' . -� 8usfness an�;P'rof¢ssbrts Code)�Ar�y clty w county wNJcb
�—.__
j2�UGH C7hDU`T �. .A� � - - � rsqofres a permtt to construct,oker,�mprove,demo0sh,
� :'nt feptlN'��bny atruc�ure, pNor fo l�s is9,uart�e, a)so rQ-
. �_ �JIF'fNG� _ ���j�'f �,! j �.yJ.�� � � t,]V(rBSfH�O�Dp�lE3n}fOfSUCIi()G(ni�}f0I7I9OiigqB(ISlOfE-
F�X��`� —"��"—(—` mertt thaf he fs llcensecd pursuant�o tha provisions of the
�.�.._� Contrador's Lttertsa Low(Chap�er 9(commencing witb
�... , -,.. .. .F� 04JER AllinC7�i`rtD �—` ��� .. Sectic.n�900G)of DiVtsian 3 0l the Bustrwss and Proiss-
� - --�- -- � . sions Codej or tFsai he is exempf theretrom and�f»basis
. tiTfLi7`(C�.:"�;�TEFi`eJ {ot Iho etls�ged exemptian. Any riolation o/SecNon
7031.5 by any oppltcanA for a permlt subJacis the oppli-
�FItSA' __� ��y(gr a� �r.�,yyq� . �a�//o a tivf7 pEr.o!ty of not more thon i/ve hun��ed
. Nq7E5 �� . dotJws(�'SCh:J,r .
. , � � [�1,as owner of the properry wlll do the work, .�id
_.___'�}�� ��_�,_,_. �he shucture'rs noi inteaded or offaresi for sole.
( �� •��� , � � {Sat.POd4,8uslness and Professlons Code: Th�ConMvc
_ ,� � � � „_�, tar's Llrans�Law does na/appfy ta an owrt�r of properfy
_ �- _ .._ , �; �. ,,,. : � who 6uilds or'fmprovas Thorepn, and who does surh
' � ., __�_ `____ ___,_.� � � wark hlmset{prov)d�d ihat such�imprwrments ore not
.... `. . . ,. . �tniendsd or affared fw sa1e.If.howevsr,Ihe bulfding or
__ ___��_ impravemanf is sald wifhin one year of completion,ihe
� . � ownsr-bo7lder wtlt hova the 6urden af praving that he drd
.�,,. ,r.� . .�_Y,��._,_� �,� � -:ntit�#vNtl or tmprove for thapw�poee.of sole.)
�_ __.._��_� _ V an ezempt onder Sec.'i ..>. .
------- � --------�— ------ B&P.C.for this renson
_�.�._. _.._..�_.�..— �._._._. _.._...�...�._ . . Da..�, ��__�
.____ ._,__— ___. __
... _ Owner __._ —�
_ ._._._______�. _._........._ .�\._ . . . .