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HomeMy Public PortalAbout5708 OAK AVE_Electrical_8/24/1994_WORKER'S COMPENSATION DECLARATI I hereby affirm th,4t I have a certificate of sent to self insure, or a cemAcate of Worker's Comports n Insurance, or a certified copy thereof (Sec. 3800 Lab. C. Policy No. Company ❑ �d.partm�cntpy hereby furnished. ❑ filed with the county building inspection t. 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 becomebje/yt to the Workers' Compons���then Laws. Date / o Applicant ��i_r, � 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 forthwith 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 ❑ I am exempt under Sec / B.&P.C. for this r on pate: ature Exemption for Reg. Mainl. Elect. SINGLE FAMILY HOME OWNERBUILDERDECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the ollovvmg reason (Section 7031.5, Business and Professions Cod 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). I 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 097, Civ. C.) Lender's Nam= / Lender's Address I certify that I have read t ' ppiication and under penalty of purjury state that the above inior on is correct. I agree to comply with all County ordlnancesand5 Taws regulating Electrical wiring, and hereby authorize representativ of this County to enter upon the above-mentioned property for in a((�tyy�1ll��n((purposes. SIGNA �EOIAERMITTEE 2 DATE 20.00176A569DPW (,2-9„ APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. FOR APPLICANT TO FILL IN New Residential Bldgs. & Pools''�� r ANO. EACH 1 & 2 -Family, Sq. Ft. (i �— $ Multi -family /) Residential Swimming Pools I Outlets: Rec.42LigIn tt 'O / 4P0u��'�/ l First 20 -ly6 Total No. Additional l Lighting Fixtures First 20 Total No. Additional 6NCE RESIDE�GNTI OTHER APPLIANCES NOT OVER 3 HP. Power Apparatus & Large Appliances Size & Type HP, KW, KVA, or KVAR Over 3 to 10 Inc], Over 10 to 50 Incl. Over 50 to too Incl Over 100 Services, Swbd., MCC & Panelboards 0 - 399 Amp. Under 600 V 400 - 1000 Amp. Under 600 V Over 1000 Amp. or Over 600 V BRANCH CIRCUIT FEES 15A, or 20A, 120V, Lighting or Recept. 1 To 10 Branch Circuits 11 To 40 Branch Circuits 41 Or More Branch Circuit - 15A, 20A, 208V To 277V Ughting Br. Circuits Temp. Power Pale & Appurtenances Sign with One Branch Circuit Additional Sign Branch Circuits Misc. Conduits & Conductors Other (See Complete Fee Schedule) PERMIT FEE PLAN CHECKING FEE (Sub -Total) ADDRESS I 1 )Q ---Q �j' FEE LOCALITY t'I(%1,. NEAREST Uj U SST. ASSESSOR .I ASSESSOR MAP BOOK G/( I PARCEL I E OWNER OR FIRM NAME cA ( ^ MAIL ADDRESS IN Tel. No. w I PCLAN CHIC II APPLICANT ADDRESS /D tCITY T.I. No. PERMIT ISSUING FEE TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE PERMIT APPLICANT ADDRESS CITY LICENSE OR L REG. NUMBER 1 DISTRICT NO. Tel. No. Ciess. P SSED� FINAL DATE FINBY /) (� VALIDATION tri i.� •a O3 L1 r_n3: 1 ;.TE M,'i T OTA.L 76 _ 35 i:MC } a O U cc Q U W a Z slJlr Ul.;i_ "`•I i. Frill 7eq`. O32 a y. cn o m o Z O o :13 7;. m =n N t . � n o a o NZ 9n } r '` a W • o- 3 cD o m m A c CDN cr a m i y �. a ,tD, 0 to cr p O ' � y m ? � N ..- � ' y . C) a,G p%. m tn n © W CT < m a tib � t0 G _ C N m 43 to W 'O 0 . Q. W C7 "0 �, C. p CL N m 3' -D t0 C o C7 C� m o m W a c m m 3 0 lb fl o c -I " 3 m tD y 0 Q a m 3. m a -� c" W •„„ la 13 z 3 my O p W .tU to (n C - b o. m iD 5 m m. N •.n N CLm m 3 Ab 'v ° �. .'3 . e a Ao 3 3 R1 ..ti . CD NN O Q" C Qty f] N Zy O � M N n Nm fl N W fl m W m 4i 3 NN. n -i cTt C m W Q CD Q. C y fl O 'a m y 0 N O W i� OL G y fl• 5. W :p 10 N O p, ? a ..'tea c. W.cpy $5 10 a'ov,^o mc3m0 p a' tD :J i ' tp Q N r.�i k. C) to a U) .. -«. CX - 303 - CLy �.�(D +c. • � o � cNo` � t) o. � m � '�''' o cb � -+ o �'m - c f acr G C,�. r m Q m fl G 3 m .... N r- CD -a