HomeMy Public PortalAbout5734 KAUFFMAN AVE_Electrical__ I
,r hat I haveCOMPENSATION
certificate
oEcon entlOto self insure, CE-806 10i81 APPLICATION FOR ELECTRICAL PERMIT
GE-806G
y;r
Csv a c rtffiCBte of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec. 3800,Lab. C.)
Policy -V 21�Company FOR APPLICANT TO FILL IN' JOB
ADDRESS
Certified
Certified copy is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE
❑ 1 & 2-Family,Sq.Ft. $ — $ 'LOCALITY t
ertifi d copy is filed with the county building inspection
a ment. Multi-family Sq.Ft. NEAREST
CROSS.ST. U
Cj' e Applicant
Residential Swimming Pools OWNER OR
- ,FIRM NAME
C RTIFI AT OF EXEMPTION FROM WORKERS' . MAIL
Outlets:Rec— Light _ Sw.
COMPENSATION INSURANCE First 20 -ADDRESS
(This if the work involved b the n
(This section need not be completed Y
Permit is for one hundred dollars CLTY Tel.No. b
($100) or less.) Total No. Additional - �
I certify that in the performance of the work for which this permit PLAN CHECK --A.
�, yV
is issued, I shall not employ any person in any manner so as to APPLC T fV� i�
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRE S
Total No. Additional CITYTel.No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of APPLICA a
Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _
provisions of.the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M. ADDRESS -7,-0
provisions or this permit shall be deemed revoked. Top _ FAU _ W.H. CITY Tel.No.
LICENSED CONTRACTORS DECLARATIONHood — Fan _ Other_
I.hereby affirm that.I am licensed,under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR Class.
(commencing with Section 7000) of Division 3 of the Business and REG.NUMBER
Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. '` 0 PROC BY
Size& Type HP, KW,KVA,or KVARi V p
License Number Lic.Class Up to 1 Incl FINAL 0
Over 1 to 10 Incl. DATE
Contractor �(/� Date ✓ VALIDATION
Over 10 to 50 Incl. U
FINAL
❑ I am exempt under Sec. Over 50 to 100 Inc. BY j LJ!
B.&P.C. for this reason Over 100
Services, Swbd., MCC& Panelboards Z
Date: 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.
SINGLE FAMILY T�.rP.leurtenancesHOME OWNER-BUILDER DECLARATION rcuit
I hereby affirm that I am exempt from the Contractor's License Law Additional.,Sign Branch Circuits - =c
for the following reason (Section 7031.5, Business and Professions ,_�0 ILI5 I i
Code):
ElMisc.Conduits & Conductors
I,as owner of the property,will do the work and the structure
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) ® i i T AL 2 w 501
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(Sec.3097, PERMIT FEE (Sub-Total)
Civ. C.).
PLAN CHECKING FEE ¢`Stiff — '!+ �' in
Lender's Name
PERMIT ISSUING FEE (�
Lender's A re _
I certify at I ave r i application and state that the above TOTAL FEE
informat' n i corr . I agre to comply with all County ordinances
and St to ws egulating lectrical wiring, and hereby authorize
repre nt Ives f this C my t nter upon the above me tinned
Cp r rinspe on rpose
z SEE REVERSE FOR EXPLANATORY LANGUAGE
Stature of Per tee D e