HomeMy WebLinkAbout1369AWORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self
insure, or,o certificate of Workers' Compensation Insurance,
or a certified copy thereof (Sec. 3800, Lob. C.)
Policy No. C25859577eompany INA
Certified copy is hereby furnished,
® Certified copy is filed with the county building inspec-
tion department.
Date 8/20186 Applicant "T" MIGG, 121ectriC
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section neednot be completed if the work Involved by
the permit Is for one hundred dollars ($100) or lest.)
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
r riCE 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-
with 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 Lit. Class C-10
Contractor 8126trial 1 Datea1�tA. F_
❑ I am exempt under Sec.
B.&P.C. for this reason
Dote:
❑ Exemption for Reg. Maint. Elect.
SINGLE FAMILY
HOME OWNER -BUILDER DECLARATION
I hereby affirm that I pm exempt from the Contractor's License
Law far 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 sole (Section
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a 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 authorize representatives of this County to enter upon
the abov -mentioned �opertyflor inspection purposes.
r ,`t 8/20/86
Signature of Permittee Date
' .!t' Is .fir
A 10/81
CE -806806G APPLICATION FOR ELECTRICAL PERMIT
CE
COUNTY OF LOS ANGELES BUILDING AND SAFETY
New Residential Bldgs. & Pools
18 2 -Family, Sq. Ft. 1114
Multi -family Sq. Ft.
Residential Swimming Pools
Outlets: Rec_Light_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 1 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
M,sc- Conduits & Conductors
Other (See Complete Fee Schedule)_
PERMIT FEE (Sub -Total) 6
PLAN CHECKING FEE
PERMIT ISSUING FEE
TOTAL FEE
SEE REVERSE FOR EXPLANATORY LANGUAGE
CITY
SLot 4 5 Armitos Place
Ty TR#42586 is Bar
ark View Dr.
Ca Tel, No.967-9541
ADDRESS
CITY Tel. No.
PERMIT
"T" McGee Electric, Inc.
ADDRESS P.O. BOX 1111
CITY ChinoTel. No. 591-6461
LICENSE OR
REG. NUMBER 490083 CIOSSC-10
DISTRICT NO. ,d PROCESSED BY
LAI
FINAL
DATE 12/x.-7- 'i y' VALIDATION
I
41369A
e 4 e • • 2
I •463.06
R �: • b '.GbL
0£28-86
-—APPROVALS DATE
SiGNATUveE
- TEMP. P JVtFR POLE.
UNDERSLAB 'WORK
ROUGH CONrUIT -_
-'
'FIXTURES
4 POVaFR r',UTfi',3,�cI7.rD I
U7tLI;Y CO NOTiFIrP> c`
FINALnfer ars „„cad
NOTFS
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's
.. License tow for the following reason (Section 7031.5,
Business and Profosslons Code): Any city or county which
_ requires a pormit. to construct, offer, Improve, demolish,
or rep Ir any sfrucfure, prior to its Issuance,` also re-
quires the applicant for such permit to file asigned state,
mcnt that he is licensed pursuant to the provisions of the
Contractor's License Law (Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Profen
slons Code) or that he is exempt therefrom and the basis
far tho alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the appli-
cant to a civit penalty of not more than five hundred
dollars (5500)..
❑ I, as owner of the property will do the work, -d
the structure is not intended or offered for sole.
(Sec. 7044, Business and Professions Code: The Controc-
for's License Law does not apply to an owner of property
who hutfds ar improves thereon, and who does such
work himself provided that such improvements are not
intended or offered for sale. i6 however. the building or
firprovement is sold within one year of completion, the
owner-bullder will have the burden of proving that he did
nq?. bold or improve for the purpose of safe.)
_ I �m,exempt under Sec.
B & P.C. for this reason
Date
Owner