HomeMy Public PortalAbout9192 JAYLEE DR_Electrical_10/26/1995_outlets,fixtures WORKERS'have
a ."rti- DECD^3ATiON CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of eon8ent to self insure, CE-806G
or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec. 3800,Lab.C.)
Policy No.' Company � FOR APPLICANT TO FILL IN JOB .-
❑ .Certified copy is hereby furnished. EACH NO. FEE :ADDRESS" Z _ JA
New Residential Bldgs.& Pools
❑ 1 & 2-Family,Sq.Ft. _ $ — $ LOCALITY e�J�
Certified copy is filed with the county building inspection
department. Multi-family Sq.Ft. — NEAREST p�
CROSS ST.,: 1 JJ
Date Applicant Residential Swimming Pools OWNER OR re '
1 - - -
-FIRM NAME L W IQ-
CERTIFICATE OF EXEMPTION FROM WORKERS' ' MAIL
Outlets:Rec Light Sw.
COMPENSATION INSURANCE f,?� 6� � "ADDRESS �Z
(This section need not be completed if the work involved by the First 20
permit is for one hundred dollars($100)or less.)
Total No. Additional CITYrt Tel.No. �
I certify that in the performance of 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 PERMIT
NOTICE TO APPLICANT: ,If, after making this Certificate of L.
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
provisions or this permit shall be deemed revoked. Top _ FAU W.H.
.LICENSED CONTRACTORS DECLARATION Hood — Fan _ OtherCITY Tel.No.
I hereby affirm that I am licensed under,provisions of Chapter 9 LICENSE OR
(commencing with Section 7000) of Division 3 of the Business and Disp. Room Air Cond.' REG.NUMBER Class.
Professions Code,and my license is in full force and effect. DISTRICT NO. P SSED BY
Power Apparatus'& Large Appliances
Size & Type HP,KW,KVA,or KVAR Q
License Number Lic. Class Up to 1 Incl. FINAL - U
Over.1 to 10Incl. DATE VALIDATION Q
Contractor Date Over 10 to 50❑ Incl. U FINAL
I am exempt under.Sec. Over.50 to 100 Inc. BY W
B.&P.C.for this reason Over 100
0 V10��0 p C/)Services, bd.,
19c( z
Date: b/�
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 -.,7A
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License.Law
for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits
Code):
Misc.Conduits& Conductors
I,as owner of the property,will do the work and the structure
.is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) ,
and Professions Code).
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(Sec.3097, PERMIT FEE (Sub-Total)
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 above TOTAL FEE _
i
information is correct. I agree to comply with all County ordinances
and State laws regulating Electrical wiring, and hereby authorize
representativ f th's County to enter upon the above-mentioned
proper or i e ti n purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signat r of P rmittee Date