HomeMy Public PortalAbout4818 WILLMONTE AVE_Electrical__ WORKERS'COMPENSATION DECLARATION ?6A663 10/81 �PUPLICATI®hl FOR Ef�C�CTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self ¢
insure, or a certificate of Workers'Compensation Insurance,
COUNTY ®F LOS ANGELES B IDI G AND AFETY _
or a certified copy.thereof(Sec. 3800, Lab. C.) [E-s06G
Policy No. Company FOR APPLICANT TO FILL IN JOB
Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS 4 `
❑ g = g LOCALITY
Certified copy is filed with the county building inspec- 1 8 2-Family, Sq. Ft.
tion department. Multi-family Sq. Ft. NEARECROSSST g . e0qA�
Residential Swimming Pools OWNER OR �a B�
Date Applicant FIRM NAME 9 V1`FD1 01
CERTIFICATE OF EXEMPTION FROM WORKERS' �' �� MAIL
COMPENSATION INSURANCE Outlets: Recce light Sw. C f A-4 d P-16V
First 20 ;: __ ADDRESS
(This section need not be completed if the work Involved by Total No. 5' Additional CITY iTel. No & 2
the permit is for one hundred dollars($100)or less.)
I certifythat in the performance of the work for which this PLAN CH K
P erAPPLICANT
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
Total No.- Additional. CITY Tel. No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT
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
with comply with such provisions or this permit shall be Top _ FAU —W.H. — +
CITY
deemed revoked. Hood _ Fan _Other— l� Tel. No.
CONTRACTORS DECLARATION LICENSE OR
I 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 DISTRICT NO. PROCESSED BY
and Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances
Size&Type HP, KW, KVA, or KVAR- 1
License Number Lic. Class Up to 1 Incl. FINAL V
09
Contractor Date Over 1 to 10 Incl. DATE• 41 VALIDATION
❑ Over 10 to 50 Incl. FINAL t
I am exempt under Sec. Over 50 to 100 Inc. BY L.
B.&P.C. for this reason Over 100
Services, Swbd., MCC&Panelboards
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 Temp. Power Pole&Appurtenances \�
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I 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
Professions Code): �`.7 7 5 .7 A
❑ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors
Other See Com late Fee Schedule 0 0 0 0 0
Oth
structure is not intended or offered for sale (Section. ( P )—
7044, Business and Professions Code). 27. 1
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for ' ° o 2 7 1 v y
the performance of the work.for which this permit is issued PERMIT FEE (Sub-Total)
11,
(Sec. 3097, Civ. C.). 19-82
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE
Lender's Address
I certify that I have read this application and state that the TOTAL FEE U F.
above information is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby a thorize representatives of this County to enter upon
the o -mentioned prop t insp tiosn./�_Peroses. j SEE REVERSE FOR EXPLANATORY LANGUAGE
i ature of Permittee Date ,I
iGASSS-CES0512-SB APPLICATION FOR ELECTRIC PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A.LAMBIE.COUNTY ENGINEER
CASSATT D.GRIFFIN.SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES CROSS ST.
1 T E M NUMBER EACH FEE OWNER
OUTLETS g g MAIL
LIGHTS ECEPT. SW. S .10 ADDRESS
LIGHTING FIXTURES .10 CITY TEL.NO.
ELEC.RANGES CLO.DRYERS ELECTRICIAN
WATER HEATERS .50 ADDRESS
ELEC.SPACE.HTRS. DISHWASHERS
CITY EL.
GARBAGE DISPOSERS AUTO.-
STATE
WASHERS STA.COOKING UNITS .25 LICENSE NO.
MOTORS: OVER INC. H.P. wAva
DISTT O. I GR UP ZONE B
0— 1/$ .25
1/2- 2 .50 INSPECTION RECORD
2- 5 1.00
5— 15 1.50
15— 50 2.50
50—200 5.00
SIGNS: NO.TRANS.
NO.LAMPS
SERVICE 0-600V 1.00 J
•SERVICE OVER 600V 5.00
MISC:
WIRING PERMIT 1.00
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .50
TOTAL FEESAPPROVALS.
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS A LICATION DATE 'INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT
ELECTRICAL WIRING. WIRING G/ `.Z7"�� �✓i• a�``•`��...
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/ORS
LICENSED AREQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES G
CALIFORNIA OR THAT 1 AM Alft LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTI e--AR0)6ERkX, POWER ..P
SIGNATURE UTILITY CO.NOTIFIED `
OF PERMITTE
FINAL
DF ARTHUR ARTHUR C. VETT,
MO CASH SUPERVISING ELECTRICAL ENGINEER
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