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HomeMy Public PortalAbout10714 ARROWOOD ST_Electrical_6/9/1989_light outlets, switches WORKERS' COMPENSATION DECLARATION '76A669oPw3iei APPUC A11ON FOR ELECTRICAL AL PERNT hereby; affirm that I have a certificate of.consent to self Ce eo 3G Insu�re, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS pr a certified copy,thereof (Sec. 3800, Lab. C.) Policy No, Company FOR APPLICANT TO FILL IN JOB �r+ a 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 CROSS ST. Date 'Applicant, Residentidl Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec A_ � MAIL COMPENSATION INSURANCE Light' Sw. '7 First 20 ADDRESS Q. ( /GJI , �WIJV 6�J. � (This section need not be completed if the work involved by Total No. Additional CITY_ _ Tel. No. the,permit is for one hundred dollars ($100)or'less.);, _ -PLAN CHECKo 1 certify that in the,performance of the work for which this APPLICANT r permit is issued, I shall not employ any person in any anner so as to 6 come'subject to the W e 'Compe alio Laws. Lighting Fixtures First 20 ADDRESS e' Additional L r Total No., -- CITY �� ' Tel. No. Date' Applica t' Fixed Appliances Not Over 1 HP PERMIT ,//�� NOTICE O APPLICANT: If, after making this"Certificate of "APPLICATION 1 �✓, Q Exemption, you should become .subject to the Workers' Range,— Heater—D.W. — Compensation provisions of the Labor Code,:you.must forth- Oven Dryer —W.M.— ADDRESS V A Igo with comply with such provisions or. thispermit shall be Top — FAU —W.H. — deemed revoked. CITY . Tel. No. Hood — Fan. —Other— LICENSED CONTRACTORS DECLARATION LICENSE OR. Disp. — Room Air Cond. �2--� Class. ' 1 hereby affirm that I am licensed under provisions of•Chapter9 REG. NUMBER (commencing with Section 7000)of Division 3 of the Business Power Apparatus,&Large Appliances. DISTRICT NO. f PROCESSED Y >_ and Professions Code,and my license is in full force and effect. I - - \ 0- -7 /f ` Size &Type HP, KW, KVA, or KVAR .J QU License Number—Z-:2-513 Lic. ClassUp to 1 Incl. FINAL r.., Contractor(f)L-f Date •Z"� Over 1 to 10 Incl. DATE /fes' fr (v 1 -SQA( 1 / VALIDATION O ❑ Over 10 to 50 Incl. FINAL F" I am exempt under Sec. Over 50 to 100 Inc. LU gY U B.&P.C. for this reason Over 100 0- a Services, Swbd., MCC& Ponelboards D z Date: Z 0-200 Amp. Under 600 V Signature "'i 201 - 1000 Amp.'Under 600 V Over 1000 Amp. or Over 600 V Exemption for'Reg. Maint. Elect.. SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp. Power Pole &Appurtenances 2 .I hereby affirm that I am exempt from the Contractor's,License Sign with One Branch Circuit A)CT°v a Sign Additional Si Branch Circuits Law for The following reason (Section 7031.5, Business and g „� ' e�y� Professions Code): , 7 29.05 I, as owner of the property, will do the work and the Misc. Conduits&Conductors structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ �,2��. Business and.Professions Code). D T TTL ' 29 o: CONSTRUCTION LENDING AGENCY CHEM 29.25 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) CE"'" "' °00 (Sec. 3097, Civ. C.). I f PLAN CHECKING FEEry �y��y 1 Lender's Name l VVV`�������' 1CC VV -0101011 ,7/ 9/8 PERMIT ISSUING FEE �. v Lender's Address 30865 1 1M 9:01 1 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 h by authorize represen atives ofthis County to ente upon b e-*ention pro cty for inspectio purpose . SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Permittee Doti. ©s