HomeMy Public PortalAbout10538 DANBURY ST_Electrical_7/11/1989_air cond & heating 1 WORKERS'COMPENSATION DECLARATION 7GA663 10/81
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�'_I"here4y'affirm ave that I ha certificate of consent to self insure, CE-8066 APPLICATIOKFOR ELECTRICAL PERMIT LJ
or a certificate of.Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY "
copy th�eYkopf,(Sec:*8001 Lab.C.)
Policy '�'J6 --•Compani "" -03FOR APPLICANT TO FILL IN JOB //
;ADDRESS. iO •D�N HIG 6-k.
❑; Ce Ified copy Is hereby furnished. - New•Residential Bltlgs.& Pools EACH.. .NO. FEE,
1 & 2-Family,Sq. Ft. S — S LOCALITY
Cert
ifietl copy Is filed with the county hu' 'ng inspection. _
NEAREST
dR C
e rime Multi-family Sq.FL , CROSS ST
Residential Swlmmin Pools
Date '� /� Appliba g ,FIRM NAME _
CERTI CATE OF,EXEMPTION FROM WORKERS' Y
COMPENSATION INSURANCE Outlets: Red— Light Sw. _t _ ADDRESS �� h1
(This section need not becompleted if thework involved by the - First 20 j
permitis for one hundred dollars ($100) or less,) Total No. _ Additional - CITY !� Tel.No.
I certify that in the performanceof the work for which this permit PLAN CHECK _
'
is issued, I.shall not employ any person in any manner so as to APPLICANT
become subject to the Workers'Compensation Laws' .Lighting Fixtures First 20 ADDRESS- -
Additional
Total No. - - - CITY - - Tel. No.
'Date _ Applicant Fixed Appliances Not Over 1 HP.
NOTICE TO APPLICANT If, after making this Certificate of 'PERMIT •�' r
Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APPLICANT/
provisions of the'Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M._ ADDRESS Nr, OWk
p(dvisions or this permit shall be deemed revoked. Top FAU _ W.H. _
LICENSED CONTRACTORS DECLARATION ^ CITY 1 Tel.'No. _ '
Hood— Fan _ Other_
-76
1 herehy,affirm that I am licensed under provisions of Chapter 9 LICENSE OR n
(commencing with Section 7000)of Division 3 of the Business and Disp. —-Room Air Cond. REG:NUMSER 2'
Professions Code,and my license is in full force and effect. DISTRICT NO PROCESS
n`� Gr,. /fix Power Apparatus& Large Appliances / '
License Numberd/�D 6O Lia Class C-dU - Size 8 Type HP,KW, KVA,or KVAR' a
11 _. Up to 1 Incl. FINAL - - U
TT 4e L 7 �� Over 1 to,101nc1. DATE VALIDATION
ContraCtMI Y date
ElINA
U
am exempt under Sea Over 10 to 50]net. F
Over 50 to 100 Inc. gy l+J
B.&P.C. for this reason Over 100 d
N
Services, MCC & Paneoards
200 A lb _ Z
_ Date: 0- 200 Amp.Under 600 V
Signature 201 - 1000 Amp. Under 600 V
❑ Exemption for Reg.Mat - Over 1000 Amp. or Over 600 V :Mart.Elect .._ :. .• ....5 .............,
- '- SINGLE FAMILY - Temp.Power Pole & Appurtenances _. '
. HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that 1 am exempt from.the Contractor's License Law _.. _ ..,....,.. ._..... �`�"� 6 .
for the following reason(Section 7031.5, Business and Professions Additional Sign.Branch Circuits .v
Code): ... - .3M7 14.50
❑ I,as owner of the property,will do the work and the structure Misc. Conduits& Conductors ! 1 ITEgS
is not intended or offered for sale (Section 7044, Business Other (See Complete fee Schedule) .
and Professions Code). - - D CE
EOTzJA�yLz 24. 50 C�r
CONSTRUCTION LENDING AGENCY 'CCKp 14.50
1 hereby affirm that there is a construction lending..agency for the _ - ,.,,,,. CLIAIIf_•c ,,,.,_ .00
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE •� - . (Sub-Total)• - `
Civ. C.). •__.... .
.PLAN.CHECKING FEE O'
Lender's Name • - -DD01 7/11/89
Lenders Address
PERMIT ISSUING FEE • _ 441E 1 AHII-31'
,
]-certify .that I have read this application and state that the above TOTALFEE
.. .. _
Information is correct. I agree to comply with all County ordinances
an of State laws re ating Electrical wiring, and hereby authorize
representatives of hi County to enter upon the above-mentioned -
gKBert'Porins n purposes. SEE REVERSE FOR EXPLANATORY,LANGUAGE,.
Signature of Ybrmittee D