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HomeMy Public PortalAbout9445 LAS TUNAS DR_Electrical_8/29/1988_temp power pole J t WORKERS' COMPENSATION DECLARATION 20-0019 DPW 3/87 2/2- hereby affirm that I F-bve a certificate of consent to self 76A663G APPLICATION FOR ELECTRICAL PERMIT Insure, or a cetYificate of Workers' Compensation Insurance; COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy they f (Sec. 3800, Lob. C..)7Jc�y�/ Polic No. 7 L Company � i v rr-��1 FOR APPLICANT TO FILL IN JOB r ertified 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 partm nt./ Multi-family Sq. Ft. — NEAREST / Q1/ T. Residential Swimming Pools CROSS SO Y Date Appli OWNER OR FIRM NAME v CER I KATE OF EXEM TION F M WORKERS' 1by utlets: Rec Light Sw._ MAIL /Ql COMPENSATION INSURANCE ADDRESS' First 20 (This section need not be completed if the work involvedTotal No. Additional CITY '� ��� Tel. No. — �. the permit is for one hundred dollars ($100)or less.) PLAN CHECK 52 I certify that in the performance of the work for which this APPLICANT fjl 6 /L permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional Total No. CITY r ) h No: Date Applicant Fixed Appliances Not Over 1 HP PERMT NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION 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 ll with comply with such provisions or this permit shall be To — FAU —W.H. — /^� deemed revoked. Hood — Fan —Other— CITY ` r Tel. Noemw LICENSED CONTRACTORS DECLARATION LICENSE OR 1 hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. — REG. NUMBER Clas (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO.... / PRO ED BY >' and Professions Code,and my license is in full force and effect. a / Size &Type HP, KW, KVA, or KVAR `JtLicenseNA�ber,�S2t✓��/� Lic\Class � Up to 1 Incl. FINAL �� Over 1 to 10 Incl. DATE ALIDATION 0 Cant c Over 10 to 50 Incl. ❑ FINAL j U I am ex mpt under Sec. Over 50 to 100 Inc. BY W B.&P.C. for this reason Over 100 0- Services, Swbd., MCC& Panelboards U) Date: Z 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. �O 5 4,9 A SINGLE FAMILY Power Pole& HOME OWNER-BUILDER DECLARATION Temp. Appurtenances #'0:0:0 • 02 I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits A 0 0 2 S 5.0 Professions Code): 0 0,6 2 5 5 0 C5 ❑ 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)— 0 8,2 9, 8'8 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 Q Lender's Addresses i I certify that I have read this application and state that the TOTAL FEE V above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authoriz representatives of this Couty to enter upon the above-men ioned ' erty for inspection urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signa ure of rmi to ©s