HomeMy Public PortalAbout9441 LAS TUNAS DR_Electrical_12/21/1988_Three Amigos outlets �• tiARKEP�S'COMPENSATION,DECLARATION 76nss3 10/81
C.� �`�
I hereby:urm: l have a certificate of consent to-self insure, CE-806G APPLICATION FOR E LE CTR I CA L PER M
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 - ADDRESSJOB
gqq^ /7f l' w5'
. Certified,copy is hereby furnished „. . New Residential Bldgs.&Pools EACH NO. FEE
/ f
Certified copy'is filed with:the county building inspection - 1 & 2-Family,.Sq: LOCALITY Ft: $ — $ W\' 6Z Ci r
department. Multi-family Sq.Ft. - NEAREST
CROSS ST.
Residential Swimming Pools
Date Applicant_ OWNER
NAME'
F {q/t(r"
CERTIFICATE.OF EXEMPTION FROM WORKERS' 5 f AIL
Outlets:Rec Light Sw —
COMPENSATION INSURANCE ADDRESS
First 20 �
permit is for,one.hundred dollars($100);or:.less.) PLAN CHECK
I certify that in the'performance.bf the.work Jor which•this permit - - - ,APPLICANT ` -
is;issued,-I-shall not employ any person in,any manner'so as to
become subject to the Workers'Compensation taws. Lighting Fixtures -First 20 ADDRESS'- -
Additional
�- 4 Total No: `CITY " Tel.No.
Date Applicant [sL2 J Fixed Appliances Not Over 1 HP
NOTICE .TO'APPLICANT: If: ,after, making this Certificate of Ran PERMIT
Range— HeaterD.W._ APPLICANT
Exemption,,you should become subject to the Workers'Compensation 9- ,.. _... .
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. CITY Tel.No.
LICENSED CONTRACTORS DECLARATION Hood Fan Other_ �' i
;l;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 effe0tDISTRICT NO. PROCESSED
Power Apparatus&,Large Appliances .. (Y/
Size& Type HP,KW KVA,or KVAR v U
License Number y 9 9'�3 Lic.Class Up to 1 Incl: FINAL
�,. Over 1 to 10,Incl. _ DATE, VALI TI N. Ow
Contractor" Over 10 to 50;❑ Incl. V FINAL
I am exempt under Seca Over 50 to 100 Inc. By W
Over 100 t]...
BAP.C.for this reason Z
Services;'Swbd.,'MCC& Pane'lboards ' "
Date: 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_
HOME OWNER-BUILDER DECLARATION
Sign with.One Branch Circuit
I hereby affirm that-I am exempt from the Contractor's License Law .
X13&9A "
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits. -
Code): # o 0 o e -2
Misc.Conduits'& Conductors
1,as owner.of the property'will do.the'.work and the structure I .0-0 1 8.75
is not intended'or offered for sale (Section 7044;Business _ Other (See Complete Fee Schedule)
and Professions Code) , o. P. 6-1 a 7 5 v
CONSTRUCTION LENDING AGENCY <
,I hereby affirm that there is a construction lending,agency for the . 2-2 8
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..
V
I certify that I have read this application and state that the above TOTAL FEE
information is correct,1 agree to'comply with all County ordinances
and State laws regulating Electrical wiring; and hereby'authorize
representatives of this-County to enter upon'the above-mentioned +
property.for inspection urposes.
SEE REVERSE FOR'EXPLANATORY LANGUAGE
Signature of Permittee Date