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WORKERS'COMPENSATION�ECLARATION J6A663 70iB1 qpp��CATION FOR ELECTRICAL PERMIT �
I hereby affirm that I have a certifimre of consent to self CE-Bo6G
insure,or a,certifimte of Workers'Compensa�ion Insurance, CQUNTY OF LOS ANGELES BUILDING AND SAFETY
or a cerlified copy thereof(Sec 3800,Lab.C.)
Poi;� NoC25859571 INA
❑ y Company FOR APPLICANT TO FILL IN JOB
Certified�opy is hereby furnished. New Residential Bidgs.8 Pools EACH NO. FEE ADDR S
� Certified copy is filed wi�h the county building inspec- �g 2•Fomily,Sq.F. 1409 � — 8 LOCA TY TR4}42586 ia Bar
tion departmenf. MuNi-fpmily Sq.Ft. — NEARES
CROSS 57.
�� PP n v Rasidential Swimmin Gools
Date �� 186 A licont � McGee Electri 9 OWNEROR
FIRM NAME Anden Gr .
CERTIFICATE OF EXEMPTION FROM WORKERS' htnu
O�tle�s:Rec_Ligh�_Sw._
COMPENSATION INSURANCE ADDRE55 1074 Park View Dr.
(Thls�oction ne�d not 6e compl�tod if tho work inrolwd by First 20
fM permfl is for ono hundred dollars(SI00)or la�s.) Total No. Addi�ional CITY Covina �Ca. Tel.No.967-9$41
I cartify�hat in the performonce of the work for which ihis VU1N CHEIX
permit i5 issued,I shall nol employ any person in ony monner APPLICANT
so as to become sv6jacl to ihe Workers'Companwlion Laws. Lighting Fixtures First 20 ADDRESS
Toipl No. Addilianol
!—� CITY Tel.No.
' opplimnt Fized Applionces Not Over 1 HP PERMIT �� �
� .,CE TO APPLICANT: If, afier making this Certificate of qpp���,qN7 '"T" mcGee Electric, LIIC.
Exemp�ion, you should become su6ject to the Workeri Range_Heafer_D.W.._,. .�_�_,
Compensotion provisians of the Labor Code,you must forth- Oven _Oryer _W.M.._._ ADDRE55
wi�h comply wilh such provisions or this permit sholl be Top _FAU —W.H.-�
deemed�evoked. C�TY Tel.No.
IICENSED CONTRACTORS DECIARATION Hood —Fan _Other_ C.t11A0 917Q$ 591-6461
Dis _Room Air Cond. — LICENSE Ok
I hereby affirm thot I om licensed under provisions of Chopter 9 P� REG.NUMBER 49�083 Class.(�.—l�
(commencing with Settion 7D00)of Division 3 of the Business power Apparatus&Lorge Appliances DISiRICT NO. PROCESSED BY � d
ond Profasaions Code,and my license is in foll force and effecf. Q'
Size 8 Type HP,KW,KVA,or KVAR� �D V
License Numher 490083 �{�,Qlass C_lo fINAI �1G
Up l0 1 Ind. `y
Coniractor �lectrical pate HI20�H6 . Over 1 to IO lntl. DATE `2 yt1 pr-� yq��DAT10N �
Over 10 ho 50�nd. V
❑ I om exempt under Sec Over 50 to 100 Inc 8Y AL 4��'�J'��y��,r-�- �
B.BP.C.for this reoson � Over 100 z
Date: Services,Swbd.,MCC 8 Panelboards , ^
0-200 Amp.Under 600 V
Signature 201-1000 Amp.Undar 600 V
❑ Over 1000 Amp.or Over 60D V -
Exemplion for Reg.Moinf.Elecf.
,'�" SINGLE FAMILY Temp.Fower Pole 8 Appurtenances `1 `��9�
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit $i.o o a e •'�
I bereby affirm tha��am exempt from the Contracior's Licanse Additional Sign&anch Circuils
Law for fhe following reason(Settion 7031.5, Businass ond ( �^ �E��.b,6
Professions Code):
❑ I,as owner of the property,will do the work and ihe Misc Condui�s B Conductors +, � �,L��,C��
s�rucrure is not intended or offered for sale{Sedion Other(See Comple�e Pee ScheduleJ— ,
7044,Business and Professians Cade). Q f',�€����
CONSTRUCTION LENDING AGENCY
1 here6y affirm Ihot 7here is a consiruction lending ogency for
the performance of ihe work for which this parmif is issued PERMIT FEE (Sub-Total) r,�,3
(Sec.3097,Civ.C.J.
PIAN CHECKING fEE
Lender's Name
PERMIT ISSUING FEE jO.$
Lender's Address
I certify thof I have read ihis opplication and slale fhpt ihe TOTAL FEE 66.8 �
above information is mrrect.I agree�o comply with oll Counry
ordinances and State laws regulating Elactrical wiring,ond
hereby authorize represematives of ihis Couniy to enter upon
the fhove-menrioned proper y far inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
� � 8/20/86
Signalure of Perm�Bee Date
i_�Si�9 .A }�y ' � � ! i *�' � r�O�iJk}I !*1A
' • ' - . . ■�a � _
�. �OWNER-BUILDER RECLARATI�hl.
� APt=���+A.S _....� DC,?E' S4GN?,7UI7E - . .
~ ? w� � I horeb offirm?hal I am exem t from ihe Controctori
i7fN;p.PGt° POLE. � .,. . . Y P
_ . .. � ....-..--��.�-.r.� Lic��s� law fo� tha following rnoson (5¢clion 703L5,
�UNDe'RSLAS bJG7K �V� � Eustness and Professlons Cade):Any elty or county wh)ch
. �r ri(�.�'��;j�' � �..��. gulrns the op���tt to mns�rnct,alter,im rore,demolish.
..I fFOUGF!C�{!DU'T_ �. (e4�,... F , .. .P .
---� F y ructure,prtor to Ns'fssuanca, also re-
Vt RIN �p Q casit fw such permit to ftle o sigrfod stata-
''�' � " ��JR�:S �� � ment t$a4�e Is licgnset!punuont to fha provtslana o1 the
, �.�_.._. �_._w.__�.._._.._
Gontractark ticense law(Ch�pter 9(commwncing with
- �- �FOVJER FUTHO�I.L3 � Sec�ton 7000J o{Divfsion 3 of the Buslness and Profes-
` s'ronz CodeJ or'thai be ts exempt fhervfrom and tha basls
�U7�.I7Y CC�.Nt)T�F€�C � far thc aflr�gad exempfian. Any viaJQtron of Sect/on
Fi�.���� .. . f� ��" � 7631.5 by any ag�pltmnf for a permit subjecls Tha oppl�- .
�"�°P°0£ �P4� car,t fo o dvti per,alty of not more than IWe hundfed
. NUT�S � ' dollnrz(5$00).: �
� ��- - �J I,os o�wner of tha property will do ihe wor�., .�d
� '� �.���'.��-:�. � ��� ' � ihe siructure is not intended or otfered for sale.
� . � . (See.7t]44,&�slness ond Professlons Code� 7he Contrac-
_ .. ... . .. . _. __ tor's G:anse Law daes nat cpply to an ownor nf propeNy
., . � . ., � . , -. �. , ` . wha bu1P4s or�fmprovss Tfimrean, and who dnes svch
�_..__ ....__..._ work hlmseff prav{de>d tha�such Improvemems are nol
� � � � ' � - � � � _ intundsd or a?tsrnd/or safe.if,hawever,+ha bul7dirg o�
.�. _____. _ �_____._ ircprovement is sold within one year of comp7etior�,fho
,. . � own�rr-�utlder wtll have the burden of proving fhat he d!d
_ .._.. —.-.------_... nbf 6+itid ar improve for the pucposa of sola.J
_ __— _.___�,__.___ �_�� � I am�xempt under Sec. ,
— ___ _______..�,.�...� --- �.�_______._ B&P.C.for Shie reason
__,_.. � _.. _._. _____.___ -. Datfl �
- --.,_.._ ---- _�.... ._,.. ' Owr,er _.� - .— .
e._... ___,_.._.�___�_�__._—..._..._.._._...._._��_�__�__\ ` . . . .