HomeMy Public PortalAbout9441 LAS TUNAS DR_Electrical_12/29/1988_Subway Temp Power Pole °. WORKERS'COMPENSATION DECLARATION CE-806 1q/8t APP.LICATION.:F®R ELE,CTR-ICAL�PERMIT
. ,' CE-806G
I hereby affirm that I•have•a certificate'of consent to„self insure,
or a certificate of Workers'•' n I
Compensationsu ance, or a certified 'COUNTY^OF'LOS, ANGELES "•'WILDING AND SAFETY
copy thereof(Feb.3800 Lab. C.)
POIiCy'NO. �V Company' ' N .FOR APPLICANT;TO FILL IN JOB °' �/p�
„❑ > - .. - - .•ADDRESS' - i' T /�S
-Certified co s hereby furnished. :`'
PY: Y New Residential Bldgs. &'Pools
• , FEE_ ' '
EACH NO. �� ��
Certified co s filed:wdh county.building spection' :'1 & 2-Family,•Sq.Ft.' ' — Y + / f� l,iC.
Py
". i' .department.. * '`" Multifamily Sq.Ft — "NEAREST.
$ $ CROSS ST Q/✓v'f/'�7
' OWNER
Date )
Residential Swimming Pools 1 CROSS' T.
Applicant Y w
„o t s R ,FIRM NAME. p�
CERTIFICATE OF`.EXEM TIO ,FROM•.WORKERS' " � v �` �"MAIL
Outlets:Rec—Light .Sw
e
COMP .1 SURANCE:.. f First 20
ADDR
",(Thls section need not be'completed,if the work involved by the; a :CIT
YES Tel.No.
S .
jpermit'is for one hundred.dollars,($100) or less
Total:No." Additional . .'
PLAN CHECK
I certify that inane performance;of•the work for,which<thlsapermit, gppCICANT K
is issued, I shall•inot{,employ,'any:person in any;,manner so as to
rt'_
become subject,to ,Workers,.Compensation Laws., - Lighting Fixtures -First 20 ADDRESS
' a �.
'`Total No. clrY.sem/✓ e7 Y!� i✓/O r 2:3
Additional
Date Applicant•-
Fixed Appliances Not Over 1 HP
,NOTICE APPLICANT:APPLICANT: If,-,after making ,this Ce"rtificate of PERMIT �/
Exemption,you sHould,become.subject'to the.Workers'Compensation ,_ ' "Range_ Heater_. D.W.
`' APPLICANT /V
O
proyisrons,of the Labor Code, you'mustforthwith comply`with.such Oven Dryer _,,W.M. ADDRESS, /�'f�� G� �
A'pro'vrsions(or,this'pe"rmit shall be deemed revoked tr Top, FAU:.:— W.H.
CITY: Te1.No.
LICENSED CONTRACTORS.DECLARATION t,; ,,. Hood,_ Fan, Other—' ' 21
I,hereby affirm„that,l am'.licensed:under provisions of Chapter.9, e LICENs��
Disp: Room,Air,Gond..',_ EG Clas .
f� /LJ,v,vra
'(commencing with,Section-7606)L,
of Division of the•Business and.' •
Professions;'Code,and'my”license is m full force:and effect' DISTRICTNO'NUMBER PROCESS BY' -
t
Po Large Appliances.
P
Size& Type HP,.KW'KVA,or KVAR.: U
AK
License Number Lic.Class to.1 Incl.
- ry.
p
D TEL
Over 1 to 1011ncl
Contractor�V(/C'�� Nf�O`A� te, Z/ Y
A 'VALIDATION: 'OO
Over,10 to 50 Incl
0 1 am exempt under Sec:' _ Over 50 to 1,00 Inc.
, Uj
;,- Over 100
. ' F
IN L
•
BAP C,for this reason '
a
Ser"vices;'Swbd., MCC &P nelboards
" Date
0
2o6 Amp'.'Under 600 V
Signature „ ' 20,1 ='1000,Amp.Under:600 V # ®'G
g
;:. x.
-
' '` '• Over 1000.Amp.nor Over,600 V �
E-
xempfion for'Reg.,Malnt.Elect; - (�
F, SINGLE,FAMILY _Temp.,Power Pole&.Appurtenances Jo�
HOME OWNER-BUILDER DECLARATION .
.
V.0
I herebySign with Orie Branch Circuit;
affirm that'(,am=exempt•from the,Contractors.License Laws'
Additional Sign.Branch.Circuits-
fior.the following:reason(Section 7031;:5, Business and Professions.
12.'29 88
Code):
..
❑ x
'Misc Conduits'& Conductors.
I,asowner'of,the property,will do,the work and-the structure. h
Other.(See Complete Fee Schedule
,. is not intended or,offered for�sale,(Section,7044, Business,' .:�-, .,•, p ) ,.
and Professions Code):
,
CONSTRUCTION LENDING AGENCY, _
I'hereby`affirm'that there is a construction lending;agency for-the
pecformance 'of the work for,whichthi5 permit is issued'(See.3097,,,.,` PERMIT FEE (Sub:Total)`
Civ,. ,.
• 'PLAN CHECKING fEE ,
Lenders'Name -
i,'
,.- PERMIT ISSUING•FEE „
Lender's Address (_
I`.certify that,( have read•,this application and(state that the,•above TOTAL'FEE
informationas correct. I agree to.comply wrth:all County'ordinances
-,and State laws regulating 'Electrical.wiring, and hereby •authorize
representatives of this County to enter•upon.;the above-mentioned
•.property r inspection purposes. '
/ SEE,REVERSE FOR EXPLANATORY LANGUAGE
:`5igr0ureN,Pprrnittde, Date