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Home My Public Portal About6133 AVON AVE_Electrical__ ION WOthat I have a certificate of consent to 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT � 76A663 I hgreby affirm that I have a certificate of consent to self insure, or'a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec. 3800 Lab. C.) "AJ ❑cy No. U 5� t6empanv ,•',` , FOR APPLICANT TO FILL IN JOB 2 1 �^ ` ^, ADDRESS J ,v 1 6Q r OIE Certified copy is hereby furnished. — � New Residential Bldgs.&Pools NO. EACH FEE LOCALITY $ S / Certified copy is filed with the cowbuildl g inspection 1 &2-Family,Sq. Ft. de artment. Multi-famil S Ft. NEAREST P q Y q� CROSS ST. Date �.S^��plicant Residential Swimming Pools ASSESSOR PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Cutlets:Rec. � yOWNER OR COMPENSATION INSURANCE Lighta- r FIRM NAME O (This section need not be completed if the work involved by the MAIL Total NoAdditional ADDRESS permit is for one hundred dollars($100)or less.) .�lZ I certify that in the performance of the work for which this permit CITY Tel.No. is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers' Compensation Laws. Lighting Fixtures First 2077 APPLICANT Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must fortALARAT'ON ply with such PERMIT provisions or this permit shall be deemed rev Power Apparatus&Large Appliances APPLICANT S n.7 LICENSED CONTRACTORS DECSize&Type HP, KW,KVA,or KVAR ADDRESS3—]C vmj I hereby affirm that I am licensed under pof Chapter Over 3 to 10 Incl. `` C (commencing with Section 7000) of DivisionBusiness an CITY Tel.No 7 Professions Code,and my license is in full fofect. Over 10 to 50 Incl. } LICENSE OR D�q Class. Over 50 t0 100 Incl. REG.NUMBER ` a o� Over 100 DISTRICT NO. SSED BY License Number LicU -�� Services,Swbd.,MCC&PanelboardsContractor 1 / � � J�� 0-399 Amp. Under 600 V NAL DIATE❑ 400-1000 Amp. Under 600 V VALIDATION WI am exempt under Sec. Over 1000 Amp.or Over 600 V FINAL LUB.&P.C.for this reasonBRANCH CIRCUIT FEES BY (n Date: 15A,or 20A, 120V,Lighting or Recept. z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits F-141 Or More Branch Circuits Exemption for Reg. Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp, Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License La for the following reason (Section 7031.5, Business and ProfessionsAdditional Sign Branch Circuits Code): El 1, as owner of the property,will do the work and the structure r. Conduits&Conductors is not intended or offered for sale (Section 7044, Business ther(See Complete Fee Schedule) , and Professions Code). (� CONSTRUCTION LENDING AGENCY I hereby affirm that there is a const,uction lending agency for the performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ. C.) A i f PLAN CHECKING FEE Lender's Name I ill PERMIT ISSUING FEE Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE that the above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring,and hereby authorize rep resentives of this County to enter u on the above-mentioned property for inspec n p poses. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE F PERMITTEE DATE \b , that COMPENSATION DECLARATION CE 863 to/Bt APPLICATION FOR ELECTRICAL PERMIT I hereat I have 0 certificate of consent to self CE 8066 insurecate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY or a cthereof (Sec 3800 Lab C )PolicyCompany FOR APPLICANT TO FILL IN ' JOB ADDRESS /3 Certified copy hereby furnished New Residential Bldgs & Pools EACH NO FEE ❑ 1 &2 Family S Ft $ 1 — $ LOCALITY Certified copy is file with the county building mspec � Y q tion department Multi family Sq Ft — NEAREST Residential Swimming Pools CROSS ST OWNER OR Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec Light Sw_ MAIL COMPENSATION INSURANCE ADDRESS 2 r� First 20 (This section need not be completed if the work involved by Total No Additional CITY G Tel No the permit is for one hundred dollars ($100)or less ) I certify that in the performance of the work for which this PLAN CHECK APPLICANT permit is issued I shall not employ any person in any manner so as to become subject to the{Workers Compensation Laws Lighting Fixtures First 20 ADDRESS I Total No Additional CITY Tel No Date e4o Applicant Fixed Appliances Not Over 1 HP PERMIT t NOTICE TO PPLICANT If after making this Certificate of APPLICANT Exemption you should become subject to the Workers Range_ Heater_D W Compensation provisions of the Labor Code you must forth Oven _ Dryer _ W M — ADDRESS r with comply with such provisions or this permit shall be Top — FAU —W H — deemed revokedHood _ Fan _ Other— 1 CITY Tel No LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp _ Room Air Cond REG NUMBER f Class L (commencing with Section 7000) of Division 3 of the Business DISTRICT NO PROCESSE BY Power Apparatus 8 Large Appliances and Professions Code and m license is in full force and effect � -- jj ,,�� Size &Type HP KW KVA or KVAR r (j o 0 License Number Lic Classes A Up to 1 Incl FINAL V DATE Fati,� Over 1 to 10 Incl ��/ 61, VALI TON 0 Contracto Date Over 10 to 50 Incl F— 1 F-1FINAL W I am exempt under Sec Over 50 to 100 Inc BY 61 B &P C for this reason Over 100 d N Services Swbd MCC & Ponelboords Z Date 0 200 Amp Under 600 V Signature 201 1000 Amp Under 600V F_] Over 1000 Amp or Over 600 V 2 7 7,Q 4 A xemption for Reg Maint Elect � # o ° o ° o 2 SINGLE FAMILY Temp Power Pole& Appurtenances HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit I ° ° 3 2 5 0 I hereby of m that I am exempt from the Contractor s License Additional Sign Branch Circuits Law for the Ilowing reason (Section 7031 5 Business and ° ° ° 3 2 5 0 c=� Professions Co ) ❑ I as owner f the property will do the work and the Misc Conduits&Conductors Q al 9-87 structure is no intended or offered for sale (Section Other (See Complete Fee Schedule)_ 7044 Business a Professions Code) Poo CONSTRUCTI LENDING AGENCY ) I hereby affirm that there is construction lending agency for the performance of the work r which this permit is issued PERMIT FEE (Sub Total) (Sec 3097 CGv C ) PLAN CHECKING FEE Lender s Name PERMIT ISSUING FEE Lender s Address — I I certify that I have read this application and state that the TOTAL FEE above information is correct I agree to cam with all County ordinances and State laws regulating Electri I wiring and hereby authorize representatives of this County enter upon above mentio d pr e ty for inspec n pur uses SEE REVERSE FOR EXPLANATORY LANGUAGE gnature of rmi ate