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Home My Public Portal About5703 OAK AVE_Electrical_8/12/1987_WORKERS' COMPENSATION DECLARATION 76A663 10/81 I hereby affsrrA that 1 have a certificate of consent to self CE -8066 insutl'or a cera ficate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Compamr - Certified copy is hereby furnished. Certified copy is filed with the county building inspec- ((tiIj /qdepartrment. Date V) 2'�x Applican CERTIFICATE OF EXEMPTIO FROM RKERS' 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. Dat- 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 Nu erl-On I,p-) b ic. Class Contractor�� r r�"r 7�_Date ❑ 1 arrYexempt and er Se, B.&P.C. for this reason nate: Signatur- ❑ Exemption for Reg. Maint. Elect. SINGLE FAMILY HOME OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law 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 sate (Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for theperformance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Nam= . Lender's Address I certify that I have read this application and state that the above inform io is correct. I agree to comply with all County ordinances 'late laws regulating Electrical wiring, and hereby ou a eprese7�s y to enter upon the abov - propec�tioJn%/puurrp/o/grte-�s.. Signa re o4 Permittee to APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN New Residential Bldgs. & Pools EACF 1 & 2 -Family, Sq. Ft $ Multi -family Sq. Ft. Residential (LS/Iwimmin Pools Outlets: Rec„L�LightSw. First 20 Total No. Additional' Lighting Fixtures First 20 Total No. Additional Fixed Appliances Not Over I HP Range_ Heater_ D.W. — Oven —Dryer LOCALITY — W. M. — Top — FAU W.H. — Hood _ Fan J__ Other_ Disp. Room Air Cond. — Power Apparatus & Large Appliances Size & Type HP, KW, KVA, or KVAR Up to 1 Ind. Over 1 to 10 Incl. Over 10 to 50 Incl. Over 50 to 100 Inc. Over 100 Services, Swbd., MCC & Panelboards 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 �I Misc. Conduits & Conductors Other (See Complete Fee Schedule)_ I I PERMIT FEE PLAN CHECKING FEE NO. FEE JOB �p Ja ADDRESS- cP' /� $ LOCALITY _ I NEAREST L% l CROSS ST. OWNER FIRM M MAIL ADDRESS CITY Tel. No. PLAN CHECK APPLICANT ADDRESS CITY Tel. No. PERMIT - APPLICA (ADDRE(((SS 'JAv� �_lA+/�y.%„�/ �Al� T.I. dILICE SE OR .jsj - � � `C> Class. f REG. NUMBER � DISTRICT NO. M PROCE D BY FINAL DATE DATE V ATION FINAL rlef BV / (Sub -Total) II & PERMIT ISSUING FEE TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE 27654A #.....2 '1 e •21,50 21,50Zi 08.1 2"87 APPROVALS DATE INSPECTOR'S OWNER -BUILDER DECLARATION SIGNATURE "TEMP. POWER POLE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, UNDERSLAB WORK If Business and Professions Code): Any city or county which ROUGH CONDUIT requires a permit to consfruct, alter, improve, demolish, �� or repair any structure, prior to Its issuance, also re - WIRING quires the applicant for such permit to file a signed state- ment that he is licensed pursuant to the provisions of the FIXTURES Contractor's License Law (Chapter 9 (commencing with POWER AUTHORIZED Section 7000) of Division 3 of the Business and Profes- t sions Code) or that he is exempt therefrom and the basis UTILITY CO. NOTIFIED for the alleged exemption. Any violation of Section FINAL enter on 5ronf 7031.5 by any applicant for a permit subjects the appli- cant to a civil penalty of not more than five hundred NOTES dollars ($500).: ❑ I, 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 purpose of sale.) I am exempt under Seca , B & P.C. for this reason Date Owner r