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Home My Public Portal About5703 OAK AVE_Electrical_6/15/1987_WORKERS' COMPENSATION DECLARATION 76A663 10/81 I IIXce6yirk that I♦nave a certificate of consent to self CE -806G rh�i}re, or a dertificate of Worker/ Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company Certified copy is hereby furnished. Certified copy is filed with the county building inspec- tion department. Date Applican CE TIFICATE OF EXEMPTIO FROM W R ER COMPENSATION INSURANCE (This section need not be completed if the work involved by the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws. Dote Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be deemed revoked. LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Numbed rr { 13 a ic. Class Contract �te 1p%lam ❑ I am exempt der Sem B.&P.C. for this reason Date Signatur- ❑ Exemption for Reg. Maint. Elect. SINGLE FAMILY HOME OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Low for the following reason (Section 7031.5, Business and Professions Code): ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044, 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 (Sec. 3097, Civ. C.). Lender's Nam - Lender's Address I certify that I have ead this application and state that the above information' orrect. agree to comply with all County ordinances a e laws regulating Electrical wiring, and hereby auth r presenlatives.� this County to enter upon th e- r a property for mspection purposes. G SignatJrer0 Permitlee Date APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES FOR APPLICANT TO FILL IN New Residential Bldgs. & Pools EACH NO. I & 2 -Family, Sq. F1 $ — $ Multi -family Sq. Ft. Residential Swimming Pools Outlets: Rec_Light_Sw. First 20 Total No. Additional Lighting Fixtures First 20 Additional Total No. Fixed Appliances Not Over I HP Range_ Heater_ D.W. _ Oven —Dryer — W.M. — Top _ FAU W.H. — Hood _ Fan In -1 Other_ Disp. — Room Air Cond. — Power Apparatus & Large Appliances Size & Type HP, KW, KVA, or KVAR' Up to 1 Incl. Over I to 10 Incl. Over 10 to 50 Incl. Over 50 to 100 Inc. Over 100 Services, Swbd., MCC & Ponelboards 0 - 200 Amp. Under 600 V 201 - 1000 Amp. Under 600 V Over 1000 Amp. or Over 600 V Temp. Power Pole & Appurtenances Sign with One Branch Circuit Additional Sign Branch Circuits Misc. Conduits & Conductors I Other (See Complete Fee Schedule)—! BUILDING AND SAFETY � � j JOB � O 3 FEE ADDRE I LOCALITY NEAREST SS ST. OWNER OR (1� FIRM NAMEMAIL ,KYnn'L�YIL DDRESy/ � / /�� r CITY � (-'y^n� �/(G ", Tel. PLAN CCK APPLICANT ADDRESS CITY Tel. No. PERMIT APPLICA ➢C:GG�-scL/J i ADDRE S S f, CITY jYs Tel. No;*2 s-ilp V I REG. NUUMMBBERR -�Zif_r_3 Class. DISTRICT NO PROCESSE%BN r d � (�\ i FINAL DATE C/ VALID ION ' FBy INALJ,//y//�//, 40--e-2 PERMIT FEE (Sub -Total) 5 PLAN CHECKING FEE PERMIT ISSUING FEE } iJ TOTAL FEE �z iV SEE REVERSE FOR EXPLANATORY LANGUAGE 010 I••19.00 •••19006 0615=87 001 •3 APPROVALS DATE MPECIOR'S SIGNATURE •TE11AP:-POWER POLE UNDERSLAB WORK ROUGH CONDUIT -- WIRING FIXTURES POWER AUTHORIZED ' L� UTILITY CO. NOTIFIED FINAL (Enter on 3ront NOTES i a OWNER -BUILDER DECLARATION V I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.Y Business and Professions Code): Any city or county which, regvlres a permit tp construct, alter, ireprove, demolish, " or repairany structure, prior to its Issuance, ' aiso re- quires the applicant for such permit to file a s'lgned state- ment that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and . Profes- sions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the appli- cant to a civil penalty of not .more' than five hundred dollars '($500).: ❑ t, as owner of the property will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Business and Professions Code: The Contrac- tor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion,"the owner -builder will have the burden of proving that he did not build or improve for,the purposp of sale.) I am exempt under Sec. B & P.C. for this reason Date Owner