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HomeMy Public PortalAbout9327 BLACKLEY ST_Electrical__ CE-806G (2-80)KR_K R6'COMPENSATIONDECLARATION APPLICATION FOR ELECTRICAL PERMIT CE-806 I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab. C.) �/�W($G) 30 Seo -9(-Qi/O 64 FOR APPLICANT TO FILL IN JOB Q `'J Policy No Company ff! EACH NO. FEE ADDRESS 93Z 7 L1�CI&ZI T New Residential Bldgs.&Pools Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY yLery/nL� �1/�r c Multi-family Sq. Ft. NEAREST. ® Certified copy is filed with the county building inspection CROSS ST 472,1 department. rj Residential Swimming Pools Q a Q S31 T CoP RM N ME B Date ,Applicant ` AlleL S Outlets: Rec.2—Light_Z Sw. MAIL Q First 20 ADDRESS 3 Z .BG,4GA-G�� CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY''"�m L� G7' Y Tel No. COMPENSATION INSURANCE PLAN CHECK d (This section need not be completed if the work involved APPLICANT 0 Additional by the permit is for one hundred dollars (5100) or less.) Lighting Fixtures First ADDRESS 0 Additional Total No.- ?_ Ir I certify that in the performance of the work/for which this Fixed Appliances Not Over.1 HP CITY Tel No. 0 permit is issued, I shall not employ any person in any manner PERMIT so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. _ APPLICANT VLrG W Oven _ Dryer I W.M. ADDRESS t1 Top — FAU W.H. Date Applicant Hood _ Fan ,Other_ CITY Tel No. NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond. 1 LICENSE OR L C_! Exemption, you should become subject to the Workers' REG. N41.Z:5-2 UMBER TZs2 'LClass Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PRO C S D BY with comply with such provisions or this permit shall be Size&Type HP, KW, KVA,or KVAR deemed revoked. ✓` v Up to 1 Incl. FINAL w Over 1 to 10 Incl. DATE fG LICENSED CONTRACTORS DECLARATIONOver 10 to 50 Incl: ✓ ' VALID TION I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FIN L 9 (commencing with Section 7000 of Division 3 of the Busi- BY ( g ) Over 100 i ness and Professions.Code, and my license is in full force and effect. Services 100A S 6,CV, License Number Lic.Class 0-200 Amp. Under 600 V S 201-1000 Amp. Under 600 V Contractor Date Over 1000 Amp.or Over 600 V 2 2 1 76 A HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances # o o o 0 0 2 I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits o 0 3 7.00 ness and Professions Code): Misc.Conduits&Conductors 0 0 0 3 7.0 0 60 I, as owner of the property, will do the work and the Other (See Cgmplete Fee Schedule)— structure is not intended or offered for sale (Section l) Jc,7J 1 -8 5 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 PERMIT FEE (Sub-Total) issued (Sec. 30,97,Civ.C.). Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE I certify that I have read-this application and state that the TOTAL FEE V / above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above-mentionedd,prop�rty for inspection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE f ��,�e� s� es Signature of Permittee Date WORKERS' COMPENSATION DECLARATION - 10/81 APPLICATION FOR ELECTRICAL PERMIT •- f I hereby 'affirm that I C have a certificate of consent to self insure, CE-806G or a'Itificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY •copy thereof(Sec.3800,Lab.C.) �cTa , �/ Pdlicy No.�4 389'6 Company���"u '- 00 FOR APPLICANT TO FILL IN JOB ❑ Certified copy is hereby furnished. EACH NO. FEE ADDRESS Y New Residential Bldgs.& Pools 7�ZZ — Certified copy is filed with the county building inspection 1 & 2-Family, q S Ft. $ $ LOCALITNEARESTY d partment. y Multi-family Sq. Ft, CROSS STQ� Date — Applicant ©✓u P`—� w^'� Residential Swimming Po I OWNER OR �f�5 FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec LightSw. "' MAIL ` COMPENSATION INSURANCE ADDRESS S (This section need not be completed if the work involved by the /05— CITY 20 permit is for one hundred dollars($100)or less.) Total No.1 Additional CITY P�sQel.No. s��6 I certify that in the performance of the work for which this permit. PLAN CHECK r APPLICANT 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 Total No. Additional CITY.! rr Tel.No. Date Applicant ' W427 NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not 17 1 HP PERMIT Exemption,you should become subject to,the Workers'Compensation Range Heater_r D.W. t APPLICANT provisions of the Labor Code, you must forthwith comply with such Oven Dryer _ W.M. ADDRESS provisions or this permit shall be deemed revoked. Top FAU W.H. CITY Tel.No. LICENSED CONTRACTORS DECLARATION Hood Fan Other_ I hereby affirm that I am licensed under provisions of Chapter 9 Dis LICENSE OR p. Room Air Cond. REG.NUMBER Class (commencing with Section 7000) of Division 3 of the Business and 3� Professions Code,and my license is in full force and effect. DISTRICT NO. PR SSED BY Power Apparatus.& Large Appliances 5 Size& Type HP, KW, KVA, or KVAR41 (� License Number pg Lic. Class r,L� Up to 1 Incl. FINAL Contractors 0`� Date �U Q Over 1 to 10 Incl. DATE VALIDATION ❑ UUU Over 10 to 50 Incl. U FINAL I am exempt under Sec. Over 50 to 100 Inc. BY W Over 100 B,&P.C.for this reason Cn Services,Swbd.,MCC & Panelboards Date: eA00- 200 Amp.Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. n c� O SINGLE FAMILY Temp.Power Pole& Appurtenances 3307 819.:+0 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 1 ITEMS hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5,Business and Professions Additional Sign Branch Circuits TOTAL 19® 0 Code): I,as owner of the property,will do the work and the structure Misc. Conduits & Conductors CHECK 8019o30 is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) ® CHAKE 000 and Professions Code). CONSTRUCTION LENDING AGENCY h n I hereby affirm that there is a construction lending agency for the =—OW1 9/22/89 performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) Civ.C.). 5851 1 AM 90042 PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the above TOTAL FEE information is correct. I agree to comply with all Coufity ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above-mentioned propert nspection rp seS. C SEE REVERSE FOR EXPLANATORY LANGUAGE Si nature of ermi e Date WORKERS'COMPENSATION DECLARATION CE-806G 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby;4fi6 that I have a certificate of consent to self insure, or•a,ce;tii?L;ate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof ((SSe��cc.. 3800,Lab. C.) j� �y�f� .Po❑licy•No.Gb9Z Company 1� 1� •GZA�-D FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE ADDRESS ertified copy is filed with the county building inspection 1 & 2-Family, Sq.Ft. $ — $ LOCALITY department. Multi-family Sq.Ft. — NEAREST � /��, CROSS ST. Date o Applicant7&1 a c'�+Q,� Residential Swimming Pools OWNER OR ' FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec_ Light Sw. MAIL COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work involved by the First 20 permit is for one hundred dollars($100) or less.) Total No. Additional CITY Tel.No. I certify that in the performance of the work for which this permit PLAN CHECK APPLICANT 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 Additional Total No. CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of PERMIT Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APPLICANT provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer W.M._ ADDRESS provisions or this permit shall be deemed revoked. Top _ FAU W.H. _ CITY Tel. No. LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR Disp. — Room Air Cond. REG.NUMBER Class(commencing with Section 7000) of Division 3 of the Business and Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO PRIbUsSED B / Size& Type HP,KW,KVA,or KVAR O� 4 License Number Lic.Class Up to 1 Incl. FINAL Q .—/ Over 1 to 10 Incl. DATE i � 00 Contractor Date — VALIDATION 0 ❑ Over 10 to 50 Incl. . FINAL I am.exempt under Sec. Over 50 to 100 Inc. BY B.&P.C. for this reason Over 100 IL Services, Swbd.,MCC& Panelboards ® q Z Date: 0- 200 Amp.Under 600 V ` ®' Signature 201 - 1000 Amp.Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole& Appurtenances 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit AMA' I hereby affirm that I am exempt from the Contractor's License Law P9ov' i h C B l Si i itonaSign Branch Circuits for the following reason (Section 7031.5,Business and Professions Add Code): 30��;ly 25.50 ❑ I,as owner of tl e property,will do the work and the structure Misc.Conduits& Conductors 1 is not intended or offered for sale (Section 7044, Business Other (See Complete Fee Schedule) _ and Professions Code). TOTAL,' J MILK MIL CONSTRUCTION LENDING AGENCY K 25.50 1 hereby affirm that there is a construction lending agency for the C j 6E o00 performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) Civ.C.). PLAN CHECKING FEE nfVL1i!iflO,,.ryyfUVu�t0d 9`/22/89 Lender's Name PERMIT ISSUING FEE I AM 9 03 46 Lender's Address I certify that I have read this application and state that the above TOTAL FEE information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE . Signature-of Permittee Date