HomeMy Public PortalAbout5720 OAK AVE_Electrical_6/10/1985_��. b l i - y W W F r m t 1 h o C O M P E N S A T I O N D E C L A R A T I O N C E - 8 0 6 , D , B t A P P L I C A T I O N F O R E L E C T R I C A L P E R M I T
J h e r e b y a f f i r m t l y p t I h a v e a , c C r t i f t c o t e b f c o n s e n t t o s e l f C E - 8 0 6 G
i n s u r e , o n a w e r t i f i s a t e o f W o r k e r s ' C o m p e n s a t i o n I n s u r a n c e , C O U N T Y O F L O S A N G E L E S B U I L D I N G A N D S A F E T Y
o r a c e r t i f i e d c o p y t h e r e o f ( S e c . 3 8 0 0 , L a b . C . )
P o l i c y N o . C o m p a n y
C e r t i f i e d c o p y i s h e r e b y f u r n i s h e d .
Q' C e r t i f i e d c o p y i s f i l e d w i t h t h e c o u n t y b u i l d i n g i n s p e c -
t i o n d e p a r t m e n t .
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C E R T I F I C A T E O F E X E M P T I O N F R O M W O R K E R S '
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( T h i s s e c t i o n n e e d n o t b e c o m p l e t e d i f t h e w o r k i n v o l v e d b y
t h e p e r m i t i s f o r o n e h u n d r e d d o l l a r s ( $ 1 0 0 ) o r l e s s . )
I c e r t i f y t h a t i n t h e p e r f o r m a n c e o f t h e w o r k f o r w h i c h t h i s
p e r m i t i s i s s u e d , I s h a l l n o t e m p l o y a n y p e r s o n i n a n y m a n n e r
s o a s t o b e c o m e s u b j e c t t o t h e W o r k e r s ' C o m p e n s a t i o n L a w s .
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N O T I C I ` T O A P P L I C A N T : I f , a f t e r m a k i n g t h i s C e r t i f i c a t e o f
E x e m p t i o n , y o u s h o u l d b e c o m e s u b j e c t t o t h e W o r k e r s '
C o m p e n s a t i o n p r o v i s i o n s o f t h e L a b o r C o d e , y o u m u s t f o r t h -
w i t h c o m p l y w i t h s u c h p r o v i s i o n s o r t h i s p e r m i t s h a l l b e
d e e m e d r e v o k e d .
L I C E N S E D C O N T R A C T O R S D E C L A R A T I O N
I h e r e b y a f f i r m t h a t I a m l i c e n s e d u n d e r p r o v i s i o n s o f C h a p t e r 9
( c o m m e n c i n g w i t h S e c t i o n 7 0 0 0 ) o f D i v i s i o n 3 o f t h e B u s i n e s s
a n d P r o f e s s i o n s C o d e , a n d m y l i c e n s e i s i n f u l l f o r c e a n d e f f e c t .
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C o n t r a c t o r n o t e
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n o t e :
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S I N G L E F A M I L Y
H O M E O W N E R - B U I L D E R D E C L A R A T I O N
1 h e r e b y a f f i r m t h a t I a m e x e m p t f r o m t h e C o n t r a c t o r ' s L i c e n s e
L a w f o r t h e f o l l o w i n g r e a s o n ( S e c t i o n 7 0 3 1 . 5 , B u s i n e s s a n d
_ P r o f e s s i o n s C o d e ) :
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s t r u c t u r e i s n o t i n t e n d e d o r o f f e r e d f o r s a l e ( S e c t i o n
7 0 4 4 , B u s i n e s s a n d P r o f e s s i o n s C o d e ) .
C O N S T R U C T I O N L E N D I N G A G E N C Y
I h e r e b y a f f i r m t h a t t h e r e i s a c o n s t r u c t i o n l e n d i n g a g e n c y f o r
t h e p e r f o r m a n c e o f t h e w o r k f o r w h i c h t h i s . p e r m i t i s i s s u e d
( S e c . 3 0 9 7 , C i v . C . ) .
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a b o v e i n f o r m a t i o n i s c o r r e c t . I a g r e e t o c o m p l y w i t h a l l C o u n t y
o r d i n a n c e s a n d S t a t e l a w s r e g u l a t i n g E l e c t r i c a l w i r i n g , a n d
h e r e b y a u t h o r i z e r e p r e s e n t a t i v e s o f t h i s C o u n t y t o e n t e r u p o n
t h b o v e - m e n t i o n e d p r o p e r t y f o r i n s p e c t i o n p u r p o s e s .
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S i z e 8 T y p e H P , K W , K V A , o r K V A R
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A d d i t i o n a l S i g n B r a n c h C i r c u i t s
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UNDERSLAB WORK
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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): Any city or.county which
requires a permit to construct, alter, improve, demolish,
or repair any structure, prior to, its issuance, also re-
quires the applicant for such permdtto file a signed state-
ment that he is licensed pursuanf,tashe provisions of the
Contractor's License Law (Chapter 1:(commencing with
Section 7000) of Division.3 a/ the Business and Profes-•
stens 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).: ,
❑ 1, as owner of.*,g property will do the work, and
the structure Is not intend+ad'v_.r offered for sale.
(Sec. 7044, Business and Profslons 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 Sec.
B & P.C. for this reason
Date
Owner