HomeMy WebLinkAboutNo Permit Number (22)WORKFRS'COMPENS.4TIOte DECLA,
wRATION,
76A663
CE -806G (280) APPLICATIOPI FOR ELECTRICAL PERMIT ..
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I hereby affirm'that I have a certificate of. consent to self COUNTY OF LOS ANGELES BUILUINsGNDdFETY
insure, or a certificate of W'orkers', Compensation Insurance, or
a certified copy thereof (Sec 3800;- b. C) - - N -
r % FOR APPLICANY'Y6"1LL:1't7`-' JOB - te
Policy No. Compan ' --" "'" ' """-" EACH NO FEE ' G ¢
y
New Residential Bldgs. & Pools
ADDRESS
Certified copy is hereby furnished. " ' 1 & 2-Family,Sq. Ft. _ - `$ '— $
LOCALITY
Multi -family Sq. Ft. — CRNEARESSS
fpCertified copy is filed with the-cotinty building inspection
CROSS ST
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department.
Residential Swimming Pools OWNER OR
I
FIRM NAME 1.
Date ®
J
pPltean Outlets: Rec. ! Light_ Sw._ MAIL
First 20
ADDRESS
CERTIFICATE OFEXEMPTION FROM WORKFRS Total No. - Additional / S CITY Tel No. }
m
0
COMPENSAt0.
B"N'NSUY2 AI E`' PLANCHECK -..-., .. ".. `..".,.
s"".
C)
APPLICANT _ U
This section need not,be completed if the work involved-- cc:-^-
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Lighting Fixtures First 20 ADDRESS
by the permit is for one hundred dollars ($100) or less.) Additional
Total No. CITY Tel No. UIcertifythatintheperformanceofthe, w;ork_for which this Fixed Appliances Not Over 1 HP
permit is issued, I shall not employ any person in any manner PERMIT 11J
so as to hecome subject to t e Workers Compensation Laws. Range_ Heater_ D.W. _
APPLICANTC-
v
Oven _ Dryer _ W.M. _ ADDRESS (
l7 ¢
Z
N L. .. Top — FAO W.H. _ ... Tel
Date Appi' n fJ— CITY q Tel No. 7
Hood — Fan Other— _
NOTICE TO APPLICANT: If, after making this Certificate of Disp. _Room Air Cond.—
LICENSE OR
R511—.44NU fv16ER
Exemption, you should subject to the.Workers' - PROCES DBY
Compensation provisions of the Labor, Code, you must forth- Power Apparatus & Large Appliances DISTRICT NO.
with comply with such provisions or this, permit shall be Size & Type HP, KW, KVA, or KVAR
deemed revoked. - U to 1 Incl `-
LICENSED.CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in, full force and
effect. .. - - . .
tlr
License r , Lic, ClassZ',C)
Contra to . v ate I0n;X'>1 l
HOME OWNER-BUILDFIt.DEC LARATION
I hereby affirm that I am exempt from the Contractor's
License Law for the'tollowirig reason (Section 7031.5, Busi-
ness and Professions Code):
4 as owner of the property, will do the work and the.
structure is not, intended., or offered for safe (Section
7044, Business and"Protegsions Code)--'
CONSTRUCTION L,F-NDING,AGENCY „
I hereby affirm that there is„;a,.coas"eticm lending agency"
for the performance of the work, hiclith s permit is
issued (Sec.ec..3.3097, 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
ordinane and State laws regulating Electrical wiring, and
hereby' uth rize representatives of this County to enter upon
the ove-mentioned pr ty for inspection purposes.
TNdature of Permitte . Date:'
P FINAL
Over 1 to 10 Incl. d DATE VALIDATION _
Over 10 to50lncl,"
FINAL ,
Over 50 to 100 Inc., gy
Over 100
Services
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 Ci Fcuits, ,.
Misc. Conduits &, Conductors
Other (See Complete Fee Schedule) --
a..,-wm-.,.-,,,.,
m_qPERMITFEE (5u b-Totalj Qd
PLAN CHECKING FEE (One -Fourth Permit Fee)
PERMIT ISSUING FEE, - -,-
TOTALFEE. .. ..... ... .. .. F 4
SEE REVERSE FOR EXPLANATORY LAI\CUAOE 4„ _
APPROVALS DATE INSPECTORSSIGNATURE I
T-MP.POWE.P POLE
FUNDEISL48 WOR. -
ROUGH CONDUIT
0
WIRI NG
1. -- - F` --PEG .
P.OWER.AUTHORIZED
UTILITY CO. NOIFiED
ii-~ EINAL ri6^..),f/L O.Z. 140fid
OWNER-BUTLDER DECLARATION
hereby affsrra 8iat Y am exempt from the Contractor's
License Law for the following reason (Seciion 7031.5,
Biiseness and 'A.>ofesseons Code): Any city a, county,
which. require; a permit to construct, atter, improve.
demolish, or repair any strut; ure, prior to its issuance,
also requires the applicant for, such, permit to file a
signed . siatement that he is lieensed pursuant to the
provisions oftheCoatractor's License Law (Chapter 9
conmiencinp, with Section 7000) of Division 3 o the
Bushters and Professions Code) or that he is exempt
therefrom and the basis for the alleged exemption. Any
violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penally of not more than
fire hundred dollars (3_500).: -
I, as owner of the propertq w:?t de the w•oik, and
NOTES the stfuctaee is, not intended pr aff,,d fos sale.
Sec. 7044, Business and Professions Code: Ti, Con-
trcttWe License Law doesnot apply to an owner of
j5r°i ei y who- uilds or improves thereon, and who does
such work himself provided that such impravemer:js
ie aot intended- or off,,d for s.JL. if, imwever,the
buieding, or improvement is so wttltir, one .year of
w -- - - - completion, the owner -builder will have the burden
proving that he did not build., or,impra vefor the
purpose of sale.)
am exempt under Sec.
B &P.C. for his reason
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