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voeQ� M NSATION DKIARATION 76A663 ,o�e� APPUCATION fOR ELECTRICAL PERMIT �
I hereby aff�rm thot I have a certificale of consent to self GE-806G
insure,or a cerr�flmte of Workers'Compensation Insurance, COUNTY OF LOS ANGEIES BUILDING AND SAFETY
oro ceriified cdpy ihereof(Sec.3800,lab,C.) _
P❑olicy N�'• S��Company I� FOR APPUCANT 70 FILL IN �OB . "
Certified copy is he�eby furnished. New Residential Bldgs.8 Gools EACH NO. FEE ADDR s Lot 5 Armitos Place
� � i a2-Fom�a 7409 �OC irr
Certified copy is filed with the county bu�lding inspec- Y•59�F+� b '—` E Z $6 �8 BIIT
tion department. Muhi-fpmily Sq.Ft. NEARE
u n Residentipl Swimming Pools CRO55 ST. �
Date 9(1«b Applicant T m +PP F.l.p . OWNER OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Owlets:Rec�Light_$w.` N'A��
COMPENSATION INSURANCE ADORE55
Thb s�etton rrood not b�eom la�d if rbe work invoYwd b first 40
( P Y Total No. Additional ��T� rei.No. 6 - 541
th�parmit is for ona hundr�d dollars(S700j or Iv:s.) �
I cerri thaf in fhe erformonce of the work�for which this PIANCHECK
fY P APPLICAN7
permit is issued,I shall not employ any parson in any manner
so as to bacome subject lo fhe Workers'Compensotion lpws, U9hting Fixiures Flrst 20 ADDRE55
Total No. /addi�ional
r`� CITY Tel.No.
R Applicanf Fixed Applipnces Noi Ovar 1 HP PERMIT
M`,...�.;E TO APPLICANT: If, after moking fhis Cerfificata of APPUCAN7 ��T�� McGee Electric, TIIC.
Eaemption, you should become subjecl fo ihe Workers' Ranqe_Heater_D.W,_.
Compensorion provisions of rhe Labor Coda,you must forrh- Oven _Dryer —W.M._. ADDRE55 P�Q. �pX 111�.
with comply wi�h.such provisions or �his�permit sholl be Top _fAU _..W,H.—
deemed revoked. Hood _fan ,Orher_ CITY C �y,0 917�$ iel.No.591-64fi1
LICENSED CONTRACTORS DECLARATION uCENSE OR
I hereby affirm ihar I am licensed under provisions ot Chapter 9 Disp. �Room Air Cond. — REG.NUMBER $ ClanC-10 �
(mmmencing with$eciion 7pOp)of Division 3 of Ihe Business power Apporatus&Large Applionces � DISiRICT NO, pROCE55ED BV �-
and Professions Code,and my license Is in full forta pnd effect. 1 d U
Size 8 7ype HP,KW,KVA,or KVAR-
490083 C-10 c�
License Number Lic.Closs FINAL
Up to 1 ind. �
Contractor ElecCrical ppte 8�2��86 Over 1 ro 101nc1. DATE �?/]-2/�� q��ppTION �
Over 10 to 50 Ind. FINAL a
❑ I am exemp�under Sac. Over W to 100 Inc. BY �jj��N_� N
B.&P.C.for fhis reoson
Ovar 100 «� Z
Date: Services,Swbd.,MCC 6 Canelboards ,
0-200 Amp.Under 600 V
Signature 401-1000 Amp.Under 600 V
Over 1000 Amp.ar Over 600 V
Enemption for Reg.Mainl.Elecl.
� SINGLE FAMILY Temp.�ower Pole 8 Appur�enances ��-� J Z O A
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circui� ,�!...0 a o •f
I hereby offirm thm I am exampt from the Confracior's license Addilional Sign Bronch Circulhs -
Law for fhe following reason(Section 7031.5,Businass and � �c��+6 E�8 6
Professions Code):
❑ I,as owner of ihe proper�y,will do the wo�k and tbe Misc.Conduits&Conducrors a � �,U�L�s
struc�ure is not infended or offered for sale (Sedion Other(See Complete Fee Schedule)_
704d,Business and Professions CodeJ. � D&�2—�6
CONSTRUCTION 1EN01NG AGENCV
I hereby aftirm that ffiere is o tonstrudion lending ogency for
the perfarmonce of the wo�k tor which ihis permi�is issued PERMIT FEE (Su6-iotal� 56 36 �
(Sec.3097,Civ.C.).
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FFE �
lender's Address
I certify fhof I have read ihis applicolion and state�hot the TOTAL FEE 66.g6
above informofion is correct.I ogree to tomply wirh oll Co�nty
ordinances and Sfate lows regulating Electricpl wiring,ond �
here6y authorize represenfatives of ihis CouNy to enler upon �
the abpve-mentione property for inspec+ron purposes. 5EE REVERSE FOR EXPLANATORY IANGUAGE
� � gf2n/86
Signature of ermittee Oare
� �,�: t� � +� 3�*� �? r1 �� a ti�r.�,- A ,i,����
� �. , . '
� a�c ova�s o�rE � S�Gn�Aft�� OV�4NCR-BUILDEk DECIAR,�'RO1V:
_ ' �_.__ _ . _.�� '
�TEMA.p�Jr P S'C iE � � --�_..a I hereby of`irm ihat V am oxempi from the Cantractor's
- �� ---------- ��� license Law for the 4ollowinc� reason !S�cf7on 709L5.
Utwb.a.�.GIA�S N-C.K ( E Bustncss ar.d Professtons CodeJ�Any c�ty or counry which
________L____�
� .ROUGf I CON�ll'7 m } ��^A� . lequlrexp permli to consirucr,alter.lmprore.demoltsh.
��ro�rdpofr any st�ucture, priar to fts issuartrv, olso ro-
�VtIRI!�G �Ir �jv_"-,�,� , qu(restheop�f)cantfars:rchpermRttallleasignedsfare-.
. j .. :"-"""" meni ihaf he is 1(cz nsed pursuartt io fhe prov151ons oi the
^ • ' FIXfu&s �•� �- � l � Contracror's Lkense low Cfia �er S commenoin t�h
r— s 6;�� } -�~� 5ecficn 7f1G0 of Divislon 3 af he Buslness Gnd Pro/K�
, .. - �F04V�R AC17NE7k1ZE^v � )
sions Co�aJ or thoi he Is exempt therefram ond ths Iwsiz
UTi���IiJ7iF(�C {ar tha ctle��d axemptica Any vtolbtrcn of Secfbn
F;NA: t� c � � 7Q3L5 6y any a�pttcon�(nr a permii subJecfs the appfi�
I nFe�.sn �ronE can4 to a e3v((�anafty o(not mo�e ffian five fiu2dred
.P________.._r��_...._.
VOT€5 � dallars(5504J.:
u 1,as ownE�r of ihe property will do tha wor..,«r+d
� ,,,,_,.: �� ' the atructure is not infendad ar off�red for sole.
. �; . _ � (Sec.70R4,8us�nesz anc�Profsssions Cade: The Contrao- -
� �� � ' . , far's Ucartse Lnw does noi npply fo an awner oi properly
- . � who bulfds or'lmproves fhereon, nnd who doez such
—._..v�_.__ . .— _.._.._..�.�� work h�mseifi prov+d�d ibuf such fmprovements are nof
' � . - intendsd or olfareu'for sale.IG�however,the 6u�ld+ng or
�. . __.mm._,,,,. impwvement is sold wtfhin one year oi completion,Ihe -
- awner-bv�lder wqf havo Tbo burden of p:oving thaf he did
� � ______ not huUd or impro•✓o for the pvrposA of sa(e,)
_ ._ �;I.pm exem�t under SQc. _
�� _. _.. .�._.�_..._._._._ 6$?.C.for ihis roason______
._____ . ._..._�_....._. .�._,_____.�._ �. . baie .,�.'_�_
..._ _..�.. _...� ^_......_._____..�. � Owner . _..._,_
. . . , ��� . , _- , _