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Home My Public Portal About6009 ALESSANDRO AVE_Electrical__ h WORKERS COMPENSATION DECLARATION 63 10/91 . APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of`c'bnsent to selt� CE CE 8 8066 f insure or a certificate of Workers Compenscr ion Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY _or a certified copy thereof (Sec 3800 Lab C ) Policy No Company FOR APPLICANT TO FILL IN JOB ADDRESS .r �/ Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE S — Certified copy is filed with the county building m 1 & 2 Family Y q Ft $ $ LOCALITY -� tion department Multi family Sq Ft — NEAREST CROSS ST q 00 F Residential Swimming Pools OWNER OR Date Applicant FIRM NAME + CERTIFICATE OF EXEMPTION FROM WORKERS / )D � MAIL Outlets Red Light Sw �J COMPENSATION INSURANCE First 20 / ADDRESS In,DO 66AM W?Q (This section need not be completed if the work involved by Total No CITY Tel No the permit is for one hundred dollars($100)or less ) Additional that in the performance of the work for which this PLAN CHECK I certify P APPLICANT permit is issued I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws Lighting Fixtures First 20 ADDRESS 1 Total No Additional CITY Tel No Date Applicant Fixed Appliances Not Over 1 HP PERMIT l NOTICE TO APPLICANT If after making this Certificate of APPLICANT,jDAQ.0 IN -- it Exemption you should become subject to the Workers Range_ Heater_D W — Compensation provisions of the Labor Code you must forth Oven Dryer — W M — ADDRESS with comply with such provisions or this permit shall be Top FAU —W H — IL deemed revokedHood _ Fan _ Other_ CITY -,G L� Cir Tel No 1,C) 7,e LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp _ Room Air Cond Class REG NUMBER (commencing with Section 7000) of Division 3 of the Business DISTRICT NO PROCESSE BY and Professions Code and my license is in full force and effect Power Apparatus 8 Large Appliances ` Size &Type HP KW KVA or KVAR V L CLO License Number Lic Class Up to 1 Incl FINAL V Contractor Date Over 1,to 10 Incl DATE VALIDATION 0 ❑ Over 10 to 50 Incl FIN I am exempt under Sec Over 50 to 100 Inc B W B &P C for this reason Over 100 Z Date Services Swbd MCC & Ponelboards 0 200 Amp Under 600 V Signature201 1000 Amp Under 600V Y Over 1000 Amp or Over 600 V ;21 4 5 9 A Exemption for Reg Maint Elect r» # c, 0 0 0 o 2 SINGLE FAMILY Temp Power Pole &Appurtenances HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit i o - 2550 j hereby affirm that I am exempt from the Contractor s License Additional Sign Branch Circuits Law for the following reason (Section 7031 5 Business and g e o 0 255 0 5 Professions Code) 0 1 3 1 =8 5 © I as owner of the property will do the work and the w Misc Conduits i&Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)- 7044 Business and Professions Code) a 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 PERMIT FEE (Sub Total) (Sec 3097 Civ C ) ' PLAN CHECKING FEE Lender s Name t PERMIT ISSUING FEE 16 Lender s Address I certify that I have read this application and state that the TOTAL FEE /�SS above information is correct I agree to comply with all County ordinances and State jaws regulating Electrical wiring and hereby authorize representatives of this County to enter upon " /thnabove mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE + lure of Permittee Date 14 J,uccZ. Tf&,