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HomeMy Public PortalAbout10662 ARROWOOD ST_Electrical_2/5/1982_amp service panel WORKER S'COMPENSATION DECLARATION CE-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT CE-806 I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES j BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.) FOR APPLICANT TO FILL IN ,JOB Policy No. CompanyADDRESS New Residential Bldgs.&Pools EACH NO. FEE E] Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY F-1CertifiedSq. Ft. — NEAREST Certified copy is filed with the county building.inspection CROSS ST department. Residential Swimming Pools OWNER OR QjJ �,, FIRM NAME Lf�-GGr Date Applicant Outlets: Rec.—Light— Sw. MAIL // First 20 ADDRESS ©Q 2 CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY C Tel No. COMPENSATION INSURANCE PLAN CHEC d (This section need not be completed if the work involved APPLICANT O by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS Total No. Additional CC 0 1 certify that in the performance of the work for which this CITY Tel No ermit is issued, I shall not em Fixed Appliances Not Over 1 HP � p employ y an y person in any manner PERMIT w so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT d Oven _ Dryer_W.M._ ADDRESS Cn Date Applicant Top _ FAL) _W.H. Hood — Fan _Other_ CITY Tel No. UX NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond.— LICENSE OR Exemption, you should become subject to the Workers' REG.NUMBER Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCES ED PY with comply with such provisions or this permit shall be / deemed revoked. Size&Type HP, KW, KVA,or KVAR Up to 1 Incl. 7 O FINAL _ Over 1 to 10 Incl. DATE LICENSED CONTRACTORS DECLARATION VALIDATION Over 10 to 50 Incl. � +� I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL BY � 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 ness and Professions.Code, and my license is in full force and effect. Services 0-200 Amp. Under 600 V ' License Number Lic.Class 201-1000 Amp. Under 600 V Contractor Date Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances } I hereby affirm, that I am exempt from the Contractor's Sign with One Branch Circuit G . License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits ness and Professions Code): Misc.Conduits&Conductors ap 2 8'6 8 A El I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— structure is not intended or offered for sale (Sectiori- l 0 o'o o o 2 7044, Business and Professions Code). ; ' CONSTRUCTION LENDING AGENCY 2 0 o 23,50 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is PERMIT FEE (Sub-Total) o o o 2 3,5 055 issued (Sec. 3097,Civ.C.). Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) 0 2.0 5—8 2 Lender's Address PERMIT ISSUING FEE I certify that I have read this application and state that the TOTAL FEE 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 above-mentioned property for ins ction purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE 21aa::12 a - Signature of Permittee Date