HomeMy Public PortalAbout9192 JAYLEE DR_Electrical_8/8/1985_heater Wfirm th'CI have a TION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self CE-806G
insure, ora certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
oaa certified copy thereof (Sec. 3800, Lab. C.
Policy No. Company FOR APPLICANT TO FILL IN JOB
Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS
❑ Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY
tion department. Multi-family Sq. Ft. —
NEAREST
Residential Swimming Pools OWNER CROSS ST.
•FIRM
NAME T.
Date Applicant t
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ t MAIL
COMPENSATION INSURANCE ADDRESS C1 I q9_
s section neenot completed if the work involved b First 20
(Thitid t b
p Y Total No.— Additional. CITY pl-fC f Tel. No,
the permit is for one hundred dollars($100)or less.)
I certifythat in the performance of the work for which this PLAN CHECK
P APPLICANT
permit is issued, I shall not employ a y ' rson in any manner
so as to ecome subject to the Wo r ' om nsatio Law . Lighting Fixtures First 20 ADDRESS
i Additional
Total No. CITY Tel. No.
Date Applicant a Fixed Appliances Not Ov 1 HP PERMIT
NOTI E T APPLICANT: If, aft r, aking this Certificate of APPLICANT
Exemption, you should bec subject to the Workers' Range_ Heater D.W.
Compensation provisions of t� Labor Code, you must forth- Oven _ Dryer _ W.M.— ADDRESS
At
with comply with such provisions or this permit. shall be Top _ FAU ,W.H. —
deemed revoked. Hood Fan _Other CITY Tel. No.
LICENSED CONTRACTORS DECLARATIONd LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER Class.
(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& Large Appliances
Size & Type HP, KW, KVA, or KVAR- V t V 0
O
License Number Lic. Class Up to 1 Incl. FINAL U
Over 1 to 10 Incl. DATE _ VALID TION 0�
Contractor Date Over 10 to 50 Incl. FIN
❑ 1 am exempt under Sec. Over 50 to 100 Inc. BYpvCL
ua
B.&P.C. for this reason Over 100
Date:
Services, Swbd., MCC & Panelboards
0 - 200 Amp. Under 600 V PON.
Signature 201 - 1000 Amp. Under 600 V tit:
❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V 9 2 b 2 7 A
SINGLE FAMILY Temp. Power Pole & Appurtenances #.a 0 o o.o 2
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits ) 'o - 3250
Law for the following reason (Section 7031.5, Business and
rofessions Code): o 0 - 32506
I, as owner of the property, will do the work and the Misc. Conduits& Conductors
(((/// N structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ ® -0 8.08-85
7044, Business 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 PERMIT FEE (Sub-Total)
(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
above information is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby au orize��o
sentatives of this County to enter upon
the ve entior inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Si Itore of Permi ee ate