HomeMy Public PortalAbout5708 OAK AVE_Electrical_3/4/1980_DEC
TION
76A66
WORKERS' that
t I have
a certificate
cafe of corse CE -806 ,D,B, APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self CE -806G
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. Compon•-
Certified copy is hereby furnished.
❑ Certified copy is filed with the county building inspec-
tion department.
Dat- Applicant
CERTIFICATE OF EXEMPTION FROM WORKERS'
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.
Dot- 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 Number. I ic. Class
Contractor Dat=
❑ I am exempt under Sgr
s B.&P.C. for this reason
Date:
Signatum
❑ 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
Prof Bions 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
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 Addr-«
I certify that I have read this application and state that the
above information is correck_tl�gree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
e b
ove-mentioned property for inspection purposes.
Signa ure of Permittee Date
FOR APPLICANT TO FILL IN
j JOB p n y
ADDRESS )V,G' AAA,
New Residential Bldgs. &Pools EACH NO.
1 8 2 -Family, Sq. Ft. $ — $
FEE , aSJUr]
LOCALITY •'-.�G� /�Jjr 9r��:
Multi -family Sq. Ft.
NEAREST
ST.
Residential Swimming Pools
E
FIRM NAMEvF-�c
Outlets: Rec Light 5
First 20
MAIL 33Vg w� A
��. DRESS '✓ Ir
Total No. Additional
CITY�L�' �/z/ Tel. Nob-l�7L�
(
P A C4 k � "�
APPLICANT J
_.4I
Lighting Fixtures First 20
ADDRESS
Total No.L16Additional
I CITY Tel. No.
Fixed Appliances Not Over I HP
PERMIT
Range_ Heater—D.W. _
I APPLICANT
Oven —Dryer — W.M. —
(ADDRESS
Top _ FAU — W.H. —
I CITY Tel. No.
Hood — Fan _ Other_
Dis — Room Air Cond.
P
LICENSE M Class. '
REG. NUMBER
Power Apparatus & Large Appliances
DISTRICT NO. p� PR0E BY
Size & Type HP, KW, KVA, or
Up to 1 Incl.
FINAL /
DATE ¢ -S-
Over 1 to 10 Incl. i
VALIDATION
Over 10 to 50 Incl I
FINAL !
Over 50 to 100 Inc.
BY
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
_
0 < Q (1 A
Sign with One Branch Circuit
Additional Sign Branch Circuits
Misc. Conduits & Conductors I
^) •^. �I ;-'
Other (See Complete Fee Schedule)_
r
IJ
PERMIT FEE (Sub -Total)
rr)
PLAN CHECKING FEE V
PERMIT ISSUING FEE
TOTAL FEE
SEE REVERSE FOR EXPLANATORY LANGUAGE
APPROVALS DATE ISIGNATURE
TEMP. POWER POLE
UNDERSLAB WORK
OWNER -BUILDER DECLARATION
I hereby affirm that am exempt from the Contractor's
License Law for the following reason (Section 7031.5,
Business and Professions Code): Any city or county which
ROUGH CONDUIT
requires o permit to construct, alter, improve, demolish.
or repair any sfruclure, prior to its issuance, also re -
1 WIRING '�
FIXTURES
quires the applicant for such permitto file a signed sfofe-
ment that he Is Itcensed pursuant to the provisions of the
Contractor's License Law (Chapter 9 (commencing with
POWER AUTHORIZED
Section 7000) of Division 3 of the Business and Profes-
sions Code) or that he is exempt therefrom and the basis
UTILITY CO. NOTIFIED
for the alleged exemption. Any violation of Section
FINAL nn c7
7031.5 by any applicant for o permit subjects the appli-
cant to a civil penalty of not more than five hundred
NOTES
dollars (8500).:
❑ 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 Cantroc.
for'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 ora 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 Sec. �.
- 8 & P.C. for this reason
Date_///C%/!_. ��n/9I 7
Owne��1
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