HomeMy Public PortalAbout9018 RANCHO REAL RD_Electrical_6/23/1986_outlets and lighting fixtures It ;✓ �:
V. Y i �.
l '�vfirm that
COMPENSATION DECLARATION CE-806 10/81 APPLICATION 'FOR' ELECTRICAL PERMIT
I hereby, affirm that I have a certificate of consent to self ICE-8066
insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a,certified,copy thereof(Sec. 3800, Lob, C.)
Policy No. Company FOR APPLICANT TO FILL IN ' :JOB
Certified copy is hereby furnished. . New Residential Bldgs. &Pools
EACH NO. FEE i ADDRESS Q
❑ Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ I—Is LOCALITY 014,
tion department. Multi-family Sq. Ft. — NEAREST
Residential Swimming Pools CROSS ST.
Date Applicant. ' OWNER OR
n .� .FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light 2 Sw ,MAIL
COMPENSATION INSURANCE ! ADDRESS
section need not be completed if the work involved b First 20
(This p 1l Total No.� Additional CITY ! Tel. No.
the permit is for one hundred dollars($100)or lass:) PLAN CHECK
I certify that in the performance of the work for which this (APPLICANT at:
permit is issued, I shall not employ any person in any manner
so-as to become subject to the Workers'Compensation Laws. Lighting'Fixtures
n First 20 ADDRESS
' Total No.-- Additional
s. - � CITY Tel. No.
Date —o Applicant Fixed Appliances Not O r 1 HP PERMIT
NOTICE TO APPLICANT: If, after making 'this Cert'..cafe of / /ye
Exemption,. you should become- subject,to the Workers' Ranger H te� .W'. — ;APPLICANT
Compensation provisions of the Labor Code, you must forth- I Oven _Dir 1 W.M.— ADDRESS
with comply with such provisions or this permit shall be 1 Top _ FAU —W.H. —
deemed revoked. .CITY Tel. IVa.
LICENSED CONTRACTORS DECLARATION 'Hood' _ Fan _Other_
LICENSE OR
1 hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG.NUMBER Class.
(commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PROCE ED BY
and Professions Code,,and my license is in full force and effect. Type O
Size&T e HP, KW, KVA, or KVAR'
License Number Lie. Class Up to 1 Incl. FINAL
Over 1 to 1:0 Incl: DATEV DATION
Contractor Date Over 10 to 50 Incl. FINAL L,�j
❑ I am exempt under Sec. Over 50 to 100 Inc.
Over 100
B.&P.C. for this reason
Z
Date: Services, Swbd., MCC&Panelboards -
0 -200 Amp. Under 600.V E I .
Signature 201 - 1000 Amp. Under 600 V
❑ Over 1000 Amp. or Over 600 V 2 4 8 7.2 2
Exemption for, Reg. Maint. Elect. # 0 0 0 0 0
SINGLE FAMILY Temp. Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ) 6 . 3500
1 hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
Law for the following reason (Section,7031,.5, Business and g 0 0 0 3!i 0 0 x'
Professions Code): r
I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors o&23 -86
structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ ►
7044, Business and Professions Code).
6 r
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_ h�el
f .
PERMIT ISSUING FEE
Lender's Address
I certify that I have read this application and state-that the TOTAL FEE
above ihformation is correct.t.agree to comply with all County i
ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
th above-mentioned property for inspection purposes. SEEREVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date