HomeMy Public PortalAbout9445 1/2 LAS TUNAS DR_Electrical_9/1/1992_circuit for 88 Arcade WORKER'S COMPENSATION DECLARATION 9 DPW 9/89 APPLICATION FOR ELECTRICAL PERMIT
76A66 � '
I hereby affirm that I have a'certificate of consent to self insure, 76A663
or a cia0ificate`of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof-(Sec..3800 Lab!tC.) i• ----_ ,._ _._..
Policy NO Company- - FOR APPLICANTTO FILL'IN '"'` `" _ JOB {"" LA
s.
A
ADDRESS - S f�1
Certified copy IS hereby furnished. New Residential Bldgs.&Pools ; EACH•- NO FEE - ^�
LOCALITY
❑• Certified.copy•is�filed with the county building inspection. - 1 &2-Family,Sq.Ft. i $ — $
department. '.,, RE%!s, Multi-family Sq.Ft. — 's CROSS S7.
o,-
Residential Swimming Pools, ASSESSOR
Date - Applicant I t MAP BOOK
.r ;:�; � r .• :. -,. .. ,. l , i'., •_ '.. _.__ ... .. PAGE PARCEL
CERTIFICATE OF EXEMPTION,FROM WORKERS' Outlets:Rec Light Sw. i A OWNER OR /�s
COMPENSATION INSURANCE .:, Total No. g Additional NAM ( /\ !� i
__ FIRM: E_:.. - • h J
d' First 20 ! •. I -� � -
j ww /nn
(This section need not be completed if the work Involved by the ADDRESS -y l_IST TUI"/T
permit Is for one hundred dollars($100)or less.) g r
I certify that in the performance of the work for which-'this permit r -- - -- -' - �-(� C` �(7 T o.
is issued, I shall not employ any''person'(n'any`manner s`o as to 1 1 CITY
N
Li htin Fixtures. FI(St 20 , PLAN CHECK
become subject to the.Workers'•„Compe atlon Laws 7.t 9 9 - - APPLICANT
Total No. Additional
ADDRESS
Date !'/- �APPlicant '
NOTICE TO.APPLICANT: If, after making,this Certificate of 15 OR 20A,120V BRANCH CIRCUITS CITY Tel.No.
Exemptlon;.yop should become subject to.the-Workers'Compensation 1 TO 10 INCLUSIVE EACH
rovlslons:of the Labor,Code,. ou must forthwith com I with such 11 TO 40'INCLUSIVE EACH--- PERMIT . �e 7-R��
P Y P y• APPLICANT - ( 1 C_rC�• c__
provisions or this permit shall be deemed revoked, 41 OR MORE BRANCH CIRCUITS EACH
LICENSED CONTRACTORS DECLARATION =tt. _.-. _ _ ADDRESS_. �,Lj 4
15 OR 20A, EACa
QZ
1 hereby affirm that'] am licensed under provisions of Chapter 9
208V TO 277V LIGHTING
(commencing with Section 7000) of Division 3 of the'Business'and _ -._ CITY �{}�� Z� jel�(lo. � ��v 4/%
Professions Code, and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR ~_ ..1 [).
7 Power Apparatus&Large Appliances REG.NUMBER �- Class.
License Number `� O Lic.Class U' Size&Type HP,KW,KVA,Or KVAR DISTRICT NO. PROCESSED BY
.,, ..I.
Up to 3 Incl _ _ _ _ LU
�,/J C'� `a /�' �Z Over 3 to 10 Incl FINAL .if U)
Contractor.� j / - aR' :_. .. - _. DATE.. _ .. _
- .. Over 10 t'o 50'1n61.El ! Z
I am exempt under Sec. Over 50 to 100 Incl. VALIDATION
FINAL
B.&P.C.for this-reason - Over 100. By
Services,Swbd„Date: MCC._&-Panelboards_
._ •. _..__ _ _ __.. _ �... - --
_... 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.
n
SINGLE FAMILY Temp.Power Pale&Appurtenances JL
HOME OWNER-BUILDER DECLARATION _ _.� ,.-_ . _ , ,_ _� At,(•Te8 „
I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit
for the following reason Section 7031:5, Business and Professions Additional Sin Bran -,ch Circuit_ _
Code): 0{ 2`
o e: ITEMS
❑ 1,as owner o1 the property,will do the work and the structure Misc.Conduits&Conductors T... .h_�
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ 11tt���T�AL 0>a 18
and Professions Code).
CHECK
40.28
CONSTRUCTION LENDING AGENCY
GE
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. 11000-0001.... _ 9/ 1/92
Lenders Name _
{.
PERMIT ISSUING FEE ...',. .r 5� 9,
.OSI 1 AM eC�t
°
Zi
Lender's Address
I certify that.l have read this application and state that the above TOTAL FEE Q
information is correct. I 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
prop or inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
5 ATURE OF APPLICANT OR AGENT DATE '