HomeMy Public PortalAbout9445 LAS TUNAS DR_Electrical_6/2/1988_temp power pole - void WORKERS'.COMPENSATION DECLARATION 76A663. 1041
CE-806G
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APPLICATION, FOR PER
I hereby 'affirm that have, a certificate-of consent.to self insure,. ELECTRICAL`
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or a ce'rtificatcrof Workers' Compensation Insurance; or a certified
;COUNTY OF LOS ANGELES ;`BUILDING AND SAFETY
copy thereof(Seca 3800:Lab:C.) `. =
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ton.2; �� -� /�5
y o. v� ;/ ,- FOR,APPLICANT;TO FILL.IN b �.' •' JOB
E Certifiecl.copy,is hereby,furnished . New Residential Bldgs &Pool's .EACH c NO:• FEE
- LOCALITY +'
r, ',1 & 2-Family,Sq.Ft:" •.. "`. ,t" :.,
Certified:copy is filed` with:-t ,Inspect on
,',departmen 4 = Multi.-family S4.Ft: * {`
,.
1.
NEAREST'
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Residential'Sm
wimin 'CROSS ST `®�
Pools
Date Applicant ...
NAME
CERTIFICATE'OF'EXEMPT,ION'FROM
WORKERS';,',".' Outlets:'f3ec--Light' Sw. - MAIL ; • :.,
.. ADDRESS• O ,
•.
INSURANCE
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This section.need.not be com feted�if.,,the work;involved'b the ;.
first 20 -+
( COMPENSATIO p INt U ) > Y Total No. Additional.,-,.' w h -CITY y Tel Ne:
ztless.) T Fa
permit is for.one Hundred,dollars. $.100 or I � 4 4, ~PLAN CHECK
I cert fy that in,the performance,of,.the,work for which this permit '� i= 1 ?�{ 'APPLICANT •
is'issued, I-'shall not.employ any person m,':a6y manner so-as to
become;subject too-.the.Workers'Compensation'Laws. ., „ ,, Lighting Fixtures First 20 ' t ADDRESS y
ti
„. .
Total:No . CITY' Tel NoA o
Additional. - _ �
Date Applicant " Fixed Appliances Not Over 1.HP PERMIT
':NOTICE,,TO.APPLICANT: 'If, after. making.'this Certificate of
Exemption„you should become subject-to the-Workers'Compensation J,, Range Heater D.N! APPLICANT
provision's of,the Labor Code, you must forthwith comply.with such Oven'_ Dryer._jW.M ADDRESS' 9i 76' •� .jos �ff/7
rovisions or`this ermit shall be.deemed revoked.
P P.. *Top t- FAU W.H. - ��
CITY< Tel.No:
LICENSED CONTRACTORS DECLARATION. Hood.'- Fan Other_ �� �'� .��7 ' �' 3.
I,hereby affirm That I,am licensed under provisions of,Chapter 9 •Disp: Room Air Cond LICENSE OR
(coinmencing-with Section 7000)`of'Division 3 of.the Business and REG.NUMBER�7� Class.
Professions Code,and my license is in full force and effect. DISTRICT NO PROCE ED BY
Power Apparatus DISTRICT
Size&Type HP.KW KVA,or KVAR :
License'Numoer 7� Q. Llc.°Class 1 Up to 1 Incl: a. FINAL ' V
G'.I�G GXJi7 �0 2 .�p• 1 { ALIDATION ,o
Over 1 to 10'Incl DATE
Contractor Date,. Over. 0 to 50 Inc
r FINAL
Q I am exempt under Sec. -Over 50 to"100 Inc BY. LU
B.&P.C.for'this reason i.
"Over 100
Services Swbd:,MCC&Panelboards`- Z
,
0.-'200 p. 600 V
Signature 201'-;1000 Amp'.:Under'.600.V
r
Over,1000 Amp:or Over 600.V 1
Exemption.fo Reg Maint.,Elect: t= t
,SINGLE FAMILY; Temp.Power Pole&.Appurtenances
'HOME'OWNER;BUILDE9 DECLARATION Sign with One Branch,Circuit' >;,.
I hereby affirm that,I am exempt from the Contractors License Law,-,,;.:'
for the followin .reason (Section 7031:5,Business:and',Professions•`''` Additional.Sign Branch•Circuits ,9 7
,,Code):' 9 -' # o,o 0 0
I,as owner of the property,will'do the work'and the structure,
Misc.Conduits&.Conductors fi: o
is not intended or offered for',sale,(Section 7044, Busir @ss s ;, ,Other,.(See Complete Tee Schedule) .
and Professions Code). o
CONSTRUCTION LENDING AGENCY
0 6`0 8
I hereby affirm that there is a construction lending agency for the
performance of•the�:work for which this permit is issued(Sec;3097, ; - pERMITFEE (Sub Total)
CiV
• PLAN CHECKING FEE �.
Lender's Name
t
:
. 976,4 A
PERMIT ISSUING FEE
Lenders-AddresS-
I certify"that I.have read this application and'state that the above TOTAL:FEE., �
nformatibn is'correct. I agree,to comply with all•County':ordinances „
5t5
0 2 0
and,:State laws„regulating Electrical wiring„ and'tiereby authorize
representatives-of this'County to_ent'r upon the above-mentioned °`2 5,
5,0
Property for inspection Pur ses:
SEE REVERSE FOR EXPLANATORY LANGUAGE Q (�+Q 2 88 .
t
Si ature of Per ee ate