HomeMy WebLinkAbout1371A � MPENSATION DECLARATION ��� �p�81 qpp�{CATION ��OR ELECTRICAL PERMIT �
I hereby aff,irm ihat I have o cerrificate of consent to self CE-Bo6G
insu�e,or o ceriifiw�e of worke�s Compensaf�o��osu�o�re, COUNTY OF l0$ANGElES BUIlO1NG AND SAFETY
or a certified copy ihereof(Sec.3600,Lab.C.)
Q�Y A25859571 Compaay INA FOR APPLIUNT TQ FIIL IN DDRE
Cerritied mpy is Fere6y f�m�shed. New Residential Bldgs.&Pools EACH NO. FEE
n Certified ropy is filed with the caonry building inspec- 1 8 2-Family,Sq.Ft �56'� S = S LOCA ITY
�C tian departmenL Multi-fomily Sq.R. NEARE
�.� �� Residentiol Swimming Pools CROSS 57.
Dcle�.$(3_—Applicont C OWNER OR
FIRM NAME A11 BII GIp.
CERTIFICATE OF EXEMPTION FROM WORKERS' putlets:Rec_Light_Sw._ MAit
COMPENSAiION INSURANCE ADOREsS 107k Park View Dr.
fTh(s��Nion ne�d not M eom I�rod if�hs wo.k tnvolved b FirS�20
h�p�rmif la for onv Avndrod dollors(5100)or lass.) Y � Tmal No. Additional GTY COVfIId Ca. Tel.No. 967-9541
I certif rhor in rhe ariormance of the work for which this PtANCHECK
Y P APPUCANT
permil is issued,I shall not emp�oy any person in any manner
so as ro become sub�ect�o the Workers'Compensation laws. lighting Fixrures First 20 ADDRESS
To�al No. Additional .
CITY - Tel.No.
� �PP11CO"� Fixed Appliances No�Over 1 HP PERMIT
�vv�ICE 70 APPLICANi: If, ofter moking ihis Certificote of APPLICANT ��T�� McGee Electric, IttC.
Eaemp�ion, you should become subjecf to the Workers' Range_Heater_O.W._
Compensation provisions of�ha Labor Code,yoo must fortb- Oven ____Dryer —W.M._ ADDRESS > Q B } 11�1
with comply wiih such provisions or Ihis�parmi� sholl be
deemed revoked. H od _Fa� _or e,_ �'T"Ch3na 91708 Te1.N°. 591-6461 �
LICENSED CONTRACTORS DECLARATION � LICENSF OR
I hereby aHirm ihai I om licensed under p�ovisions of Chapter 9 Disp. ,Room Air Cond — REG.NUMBER �� 3 ��ass' (J— Q },
(commencing wi�h Se<tion 7000�of Division 3 of rhe 8usiness DISiRICT NQ. PROCESSED BY 0.
and Professions Code,and my license is in f�ll force and eHect. Power Apparotus&large Appliontes / Q
Siza&Type HP,KW,KVA,or KVAR `� �+
Licensa Number �S90Q83 Uc.Class C-10 L�
Up to I Incl. FINAL
Over 1 to 10 Ind. DATE j j, �� �
Controc�o� E12Ct11C81 Date 8I20l8b ( VAIIDATION v
❑ Over 10 to 50 Ind. FINAL � W�
I am exempt under 5ec. Over 50�0 100 Inc BY �/��� � p-�
B.&P.C.for fhis reason
o�a�,00 ""a". z
pafe: Services,Swbd.,MCC 8 Panelboards ►
0-200 Amp.Under 600 V
Signature 201-1000 Amp.Under 600 V
❑ Over 1000 Amp.or Over 60o V , :.� � 3 7.� A
E.emprion for Reg.Main�.Eleci.
�'� SINGLE FAMILV •e .
�' HOME OWNER-BUILDER DECLARAiION Temp.Power Pole 8 Appurlenances �:��• ��2
I hereby affirm tha�I om ezempt from ihe Conlractor's License Sign wi�h One Branch Cirtuit � q�„��a 2
law for ihe follawing r¢ason(Section 7031.5, Business ond Additionai Sign Bronch Circuits
Professions Code)� o a.<�. ']�.(i�,�
❑ I,os owner of the �o ert Misc Conduits&Conductors �
p p y,will do the work and 7ha �2 s,�,8 6
sfructure is not infended or offered for sale (Sedion O�her�See Complete Fee Schedule).r , �4�
7044,Business and Professions CodeJ.
CONSTRUCTION LENDING AGENCV
I hereby affirm thal fhere is o tonsirocfion lending pgency fo�
ihe perfarmance o4 the wo�k for which this permi�is issued pERMIT FEE (Sub-Total) (�z� Z
(Sec 3097,Civ.C.).
PLAN CHECKING fEE
lender's Name
PERMIT ISSUING FEE � O O
Lender's Address
I cer�ify that I have read ihis applicorion ond srate�hoi the TOTAL FEE
above informalion is mrrect I ogrea to comply with all County
ordinonces and Stote laws regoloting Electricol wiring,ond �
hereby uthorize represen�atives of ihis Counly to enter upon
the abo e-menrion properry for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
� � �/ 8120/86
$ignoture of Parmit�ee pofe �
�1 �� A' �L � � �C�� ,���lTlt��.� �+
.�1 �� ai'r KOVAt5 pq'� �� . -�OWNER-BUILDER�ECl.,CIFATI'QF��.
._�____,.�_ SIGNATURE
� i TFMP..PJN✓FR PO:.E . � � heraoy affirm inat i om axem�t from iho Contrac�or's
. .� � . , --� --��— .- Licanse Ldw•for the follawing reoson (Section 7031.5,
� �� l;Nr�[R4 A�'ddC�i�K F,vstnees and Prof�sslons Cade)�Any cify or�rounty wN7ch
� gOUGt�-C�1d�U;T � � - . reqvfres epsrmR to construct,aleoa imp�ove..demolieh,
����'or-repaF'��cMiy sfructvre,prtor fo i�s(ssumrze,�d7so r
�Vl1RING �� �V �f�/ ��� quirtetheappflconflorsucFspermitiofllevatgnedstote�
,�i �"-'-'r- --'-�—� �� ment tba}he fs Ilesnsed punuanl to IMe p�ovlsians al tbe
F�M �' � Ccn�rcctor`z L(cense Law(CfipPter 9/cwnmsnc�ng wlfh
�,�.._. ...
- � ' � �� j�pyy�g p�}ypgir�p � �i� - '� Seation 7�'UO)of Divislon 3 of fF.e 8usiness and Prof�s-
s7ans Code)or tiiat be 7s exempt thsrefrom and�ho(wsis
'UYiUfi!O N�T�FI:;D for ihe allsged exempTian. Any violafion of Secnon
�tti�� # �-'� 7w3i.5 by vny applicarst for a permlt subjcrts ihe opp7�-
. ��y C..nEur on .�rrsrf canf to o Uvd penalty o�noi more fhcn flvo hund�sd
NoTFs . dal(nrs($50�').r .
.[]k,cs owner of ihe properry will de ihe work,-snd
� �� � ,_�_,_,r,� , _ ?ha struciure is not intended or offerad for sole.
. . (Sec.76dA,BuslnesscndProfosatonsCode� 7haConkac
�' ��, ' ' - tor's 4icense taw doas not npply io an ownar of prvperty
; � . ,, � wha 6otic�s or'fmprovos ffiareon, artd who does such
,__ _,_ , __ ._,_i_ ,__..,_ work hlmseN provldnd}hat Such�FmprovemeNs ore nof
.. . .. � � � l�fended or ofiered lor sale.If,however,the 6ullding or
�� - �_ „_ __ irnproverrieni ls sald w8hin one year of comp�etion,Ihe
� - � � oi+'ner-6uilder wt(I bove fha 6urden af prov(ng thai h�did
� � � J _ _�_____ _ - nap bultd or improve/or tha gurpose of sale.)
_ '...-- -_.�,`.. !am exempt�nder Sec: .
- ----- -- — B&P.C.far this renson
.� _ ___. ..�.._._.. �_ . � Dnte _...�_
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