HomeMy Public PortalAbout10053 BOGUE ST_Electrical_7/20/1987 W KER6' CAMP Na cerci DECLARATION CE-806 10i81 APPLICATION FOR ELECTRICAL PERMIT
I reby l-6, ;ri�o�fiave a certificate of consent to self CE-806G
re; ff'a certifite of Workers' Compensation 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'
Certified copy is hereby furnishedNew Residential Bldgs '& Pools EACH NO FEE ADDRESS
Certified copy'is filed with the county building inspec- y, q. LOCALITY
1 & 2-Famil S Ft. $ — $ L G,
tion department Multi-family Sq Ft. — NEAREST ,((��
Residential Swimmm Pools CROSS 5T �( Y LA N / y,
Date Applicant g FOWNER OR
IRM'N ME pC/Q M/ /— /!� 12 1,'15
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets- Rec LightSw._ MAIL �'C
COMPENSATION.INSURANCE First 20� a ADDRESS S.Q
(This section need not be completed if the work involved by Total No. Additional CITY ' LC Tel. No.57,/7l
the permit is for one hundred'dollars ($100)or less.) I
I certifythat in the performance of the work'for which this PLAN CHECK
P APPLICANT
permit is issued, I shall not employ any person in any manner
so.as to become sublect to the Workers'Compensation Laws Lighting Fixtures 1 First 20' ADDRESS
J,/�^/ Total No. / Additional
Date'`t��-7 Applicant / l �i/rAi R� CITY T No
—i Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT- If, after making this Certificate of APPLICANT "
Exemption, you should become subject to the Workers' Range_ Heater_D W.
Compensation provisions of the Labor Code, you must forth- Oven -7— Dryer _ W.M ADDRESS
with comply with such, provisions or this'permit shall be Top _ FAU —W H" —
deemed revoked CITY Tel No.
Hood Fan _Other_
LICENSED CONTRACTORS DECLARATION Disp. _ Room Air Cond LICENSE OR Class.
I hereby affirm that I am licensed under provisions of Chapter 9 REG NUMBER >_
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO PRO BY 11�
Power Apparatus & Large Appliances
and Professions Code, and my license is in full force and effect. /I O
Size 8 Type HP, KW, KVA, or KVAR r 1/ 0
License Number Lic. Class Up to 1 Incl FINAL 112�
Over 1 to 10 Incl DATE j J �f VALID ION 0"
Contractor Date Over 10 to 50 Incl.
FIN LLJ
I am exempt under Sec Over 50 to 100 Inc. B
B.&P.0 for this reason Over 100 z
Date: Services, Swbd , MCC& Panelboards
0 -200 Amp. Under 600 V
Signature 201 - 1000 Amp Under 600 V
Over 1000 Amp. or Over 600 V
Exemption for Reg. Maint Elect.
SINGLE FAMILY Temp Power Pole & Appurtenances 65-27 A
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit # o o,o:o.o 2
1 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 :1 o -:1 3.50 ,
Professions Code)"
Misc. Conduits &Conductors 0'a 01a 5 0;0!I, as owner,of The property, will do-the work and the
structure is not intended or offered for•sale (Section Other (See,Complete Fee Schedule)_ , 2 8 8 7
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I Hereby affirm that there is a construction lending agency for
the performance of the work fog which this permit is issued PERMIT FEE (Sub-Total) 3
(Sec 3097, Civ C )
PLAN CHECKING FEE
Lender's Name
PERMIT•ISSUING FEE
Lender's Address
I certify that I have read this application and state that the . TOTAL FEE 131
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 ve-mentioned property for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
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gig-nature of Permittee Date