HomeMy Public PortalAbout5708 OAK AVE_Electrical_1/13/1982_WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self
insure, or a certificate of Workers' Compensation Insurance, or
a cer%ifi d copy th/e�re pecell00, Lab. C.)
Policy gi ' �mpanv JC4- LZ a—' Ll
Certified copy is hereby furnished.
Certified copy is filed with the county building inspection
department. D .{�
Date�yApplican✓ " t-4.
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.
Date 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 Busi-
ness and,Professions Code, and my license is in full force and
effect.
(
License Number Lic. Clasp
Contractor Date
HOME OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's
License Law for the following reason (Section 7031.5, Busi-
ness an 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 Name
Lender's Address
I certify that I have read this application and state that the
above information is correct. 1 agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
the bove-mentioned property for inspection purposes.
Signat a of Permittee Date
CE -806G (2-80) APPLICATION FOR ELECTRICAL PERMIT
76A6 6
UNTY OF LOS ANGELES 'r �. BUILDING AND SAFETY
I
FlldgEPools
PPLICANT TO FILL IN
New Residentia2I EACH NO. FEE
1 & 2-Family,Sq. J i) ! $ • 3 — I$
Multi -family Sq. Ft. —
Residential Swimming Pools ,
Outlets: Reclr„Light_ Sw. .Ls'
First 20
Total No. Additional
Lighting -Fixtures First 20
Total No./ Additional
Fixed Appliances Not Over 1 HP
Range_ Heater D.W.
Oven _ Dryer _ W.M.
Top _ FAU _ W.H.
Hood _ Fan —Other —
Disp. _Room Air Cond._
Power Apparatus & Large Appliances
Size & Type HP, KW, KVA, or KVAR
Up to 1 Incl.
Over 1 to 10 Incl.
Over 10 to 50 Incl.
Over 50 to 100 Inc.
Over 100
Services
_0-200 Amp Ude 600 V 1s
201-1000 Amp. Under 600 V
Over 1000 Amp. or Over 600 V
AD % /
1 ADDRESS
LOCALITY
I NEAREST '� P 41 A,<
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1 OWNER OR
FIRM NAME
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ADDRESS ��✓/?/TTS
CITY C Tel No.
PLAN C ECK
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APPLICANT
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ADDRESS
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CITY Tel No.
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PERMIT
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APPLICANT
ADDRESS
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to to
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LICENSE OR
REG. NUMBER
DISTRICT NO, PROCES
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FINAL
DATE
I I FINAL
I I BY
Temp. Power Pole & Appurtenances
Sign with One Branch Circuit
Additional Sign Branch Circuits I
Misc. Conduits & Conductors
Other (See Complete Fee Schedule)
PERMIT FEE (Sub -Total)
PLAN CHECKING FEE (One -Fourth Permit Feel
PERMIT ISSUING FEE _LSO
TOTAL FEE
SEE REVERSE FOR EXPLANATORY LANGUAGE
VALIDATION
'260
APPROVALS
DATE INSPECTOR'S
SIGNATURE
TEMP. POWER POLE
UNDERSLAI WORK
ROUGH CONDUIT
FIXTURES
POWER AUTHORIZED
UTILITY CO. N09'IFIEDp
3�3 �//%/�rZ
FINAL `
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NOTES
M
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am ecempt from the Contractor's
License Law for the following reason (Section 7031..5,
Business and Professions Code): Any ciry or county
which requires a permit to construct, alter, improve,
demolish, or repair any stnicnure, prior to its issuance.
also requires the applicant for such permit to file a
signed statement 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 Professions Code) or that he is exempt
therefrom and the basis for the alleged exemption. Anv
violation of Section 7031.5 by ani, applicant for a permit
subjects the applicant to a civil penalty of nor more than
free hutyred dollars (S500).:
as nwner of the property will do the work. and
the structure is not intended or offered for sale.
(.Sec 7044, Business and Professions Code: The Con-
tractors License !aw does nor 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 praying that he did not build or improve for the
purpose of sale.)
1 am exempt under Se,
B & P.C. for this reason
Dat, tie 13,198 v
i
Owner