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Home My Public Portal About9450 BROADWAY_Electrical__ WORKERS' COMPENSATION DECLARATION CE-W& 10/8I APPLICATION ImP IC p TION FOR ELECTRICAL Ir ERMIT 1 hereby affirm that I have a certificate of consent to self CE-8066 i"i lrrlL '>,riW 0�1 NV9 insure, or o certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES C BUILDING AND SAFETY ora certified copy thereof (Sec. 3000, Lab. C.) \ t ohc NolA b-�/ fSCompony J'i'��- FOR APPLICANT TO FILL IN JOB EACH copy is hereby furnished. New Residential Bldgs. 8 Po Is EACH NO. FEE ADDRESS nn krE Certified copy is filed with the county building inspec- 18 2-Family, Sq. Ft. $ — $ LOCALITY tyL{' L,P lam! tion department. Multi-family Sq. Ft. — 'NEAREST r L Residentiat Swimming�Pools CROSS ST. 1j-fi WNER OR Dote �� /`��Applicant FFIIRM NAME - L CERTIFICATE OF EXEMP ON FR&M WORKERS' .MAIL Outlets: Rec_Light_Sw._ COMPENSATION INSURANCE - ADDRESS First 20 9 (Thissectionneed not be completed if the work involved by Total No. CITU I. No. the permit is for one hundred dollars ($100)or less.) Additional / I certify that in the performance of the work for which this PLAN CHET permit is issued, I shall not employ an APPLICANT p p y y person in any manner /soos . to become subject to the Workers'Compensation Laws. lighting Fixtures First 20 ADDRESS Total No. Additional Date Applicant CITY Tel. No. Fixed Appliances Not Over 1 HP PERMIT _ NOTICE TO APPLICANT: If, often making this Certificate of APPLICANT —Fxeatption, you should become subject to the Workers' Range_ Heoter_D.W. - Compensation provisions of the Labor Code, you must forth- Oven — Dryer W.M._ ADDRESS with comply with such provisions or this permit shall be Top FAU —W.H. — deemed revoked. Hood Fan OtherCITY Tel. No. LICENSED CONTRACTORS DECLARATION _ _ _ LICENSE R I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER 14 Clas / (commencing with Section 7000)of Division 3 of the Business power Apparatus 8 Large Appliances DISTRICT NO. O C� PROCE ED BY_ and Professions Code, and my license is in full force and effect. n Size 8 Type HP, KW, KVA, or KVAR' s O License Number �S��7 Lic. Class ` 1 - V Up to 1 Incl FINAL g ,� "� Date /,rl•/4'S� Over I to 101nd. DATE �� U r VALIDATION Q Contractor Over 10 to 50 Incl. H FINAL I am exempt under Sec Over 50 l0 100 Inc. BY B.BP.C. for this reason Over 100 Services, Swbd., MCC 8 Panelboards ? D 0 -200 Amp, Under 600 V D �� Signature _3::142�K o 201 - 1000 Amp. Under 600 V ^ F-1Exemptionfor Reg. MaiOver 1000 Amp. or Over 600 V / Maim. Elect. SINGLE FAMILY Temp. Power Pole 8 Appurtenances p p HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 'ff p®x I hereby affirm that I am exempt from the Contractor's License additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and Professions Code): ❑ 1, as owner of the property, will do the work and the Misc. Conduits 8 Conductors f � structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ D OY Vol-, 7044, Business and Professions Code). . •2 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 PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE t C� Lender's Name - 1 PERMIT ISSUING FEE �(�; �J r ��/S- ,Lender's Address 1 certify that I have read this application and state that the TOTAL FEE 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-mentioned property for inspection purposes. .SEE REVERSE FOR EXPLANATORY LANGUAGE nature Permittee Date WORKERS' COMPENSATION DECLARATION I]6A663 10ie1 APPLICATION ID Imp IC p 1TION FOR ELECTRICAL IL•�I TRIC p A PER IT I hereby affirm that I have a certificate of consent. to self j CE806Ir IL 'L/"i 0 Iltl FOR IL IL IG 4. II Y'l YYIL I�L�II'(9V9 Y insure, or{��a certif�ic,1aie of Workers' Compensation Insurance, + COUNTY OF LOS ANGELES BUILDING AND SAFETY or a cg.Nfreh"41Y69il of (Sec. 3800, Lab. C.). Policy No. 4' fl CompanyMlSSIOn. Ins- (`h_ FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. &.Pools EACH NO. .FEE ADDRESS 9450 'E-. Broadway ® Certified copy is filed with the county building inspec- I & 2-Family, Sq. Ft. - $ _ $ LOCALITY Temple City tion department. Multi-family Sq. Ft. 'NEAREST p I7 4/1/84 Applicant �j�/ C� Residential Swimming Pools CROSS ST. L� �L 6 y7 L�ti` Date OWNER OR MAiL - r 7S. FIRM NAME A. Constantino CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec 2 Light 2 Sw. - ADDRESS a5 Ob COMPENSATION INSURANCE First 20 4 3 J (This section need not be completed if the workinvolvedby Total No., Additional CITY BUSTeI. No. 792-2236 the permit is for one hundred dollars ($100)or less.) that in the performance of the work for which this PLAN CHECK I certify P APPLICANT permitis issued, I shall not employ any person in any manner -so as to become subject to the Workers'Compensation Laws. Lighting Fixtures first 20, 2 - 1 O ADDRESS Total No. ' 2 Additional I CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of - APPLICANT Cob i ne leetr i e C.O. Inc. 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 1607 'Chestnut St. With comply with such provisions or this permit. shall be Top FAU —W.H. — deemed revoked. rHood Fan _Other— Alhambra - Tel. No'28 — LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. REG NUMBER -229847 Class. C 1 O (commencing with Section 7000) of Division 3 of the Businessy� DISTRICT NO. PROCESSED BY and Professions Code,and my license.is in full force and effect.-` Power Apparatus 8 Large Appliances T V [/ 6 t Size &Type HP, KW, KVA, or KVAR' �j - O License Number— �229/j8�47 Lic{lass C1 O 1 Up to 1 Incl. - 1 4. )0 FINAL /7 / - 1 to 10 DATE ad Of VALIDATION 0 Contractors r-%e"sr"•^-+-� Data 11 /30/85Over 10 to 50 1 cal. CL FINAL ❑. I am exempt under Sec. Over 50 to 100 Inc. BY ¢„•, d B.&P.C. for this reason Over 100 ' Z Date: - Services, Swbd., MCC & Ponelboards D 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V - ❑ Over.1000 Amp. or Over 600 V2,95 1,2 A Exemption for Reg. Mainz. Elect. SINGLE FAMILY Temp. Power Pole& Appurtenances ,1{'•o e o e e 'Z HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit j'e je 1 �..7 5 I hereby affirm that I am exempt the Contractor's License additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and Pic, 1 8756 Professions Code): , ❑ I, as owner of theP P ert ro will do the work and the Misc. Conduits &Conductors or - 0308—SG structure is not intended or offered for sole (Section Other (See Complete Fee Schedule)_ D ' 704 Business and Professions Code). CONSTRUCTION LENDING AGENCY -- I hereby affirm that there is a construction lending agency for (Sec. 3097, Civ. C.). the performance of the work for which this permit is issued PERMIT FEE (Sub-Totol) - .- PLAN CHECKING FEE - Lender's Name I 0 ' PERMIT ISSUING FEE f/ Lender's Address - `,, 17 certify that I hove read this application and'state that the TOTAL FEE y5 F !S' above information is correct. I agree to comply with all County - 1 ordinances and State laws regulating Electrical wiring, and , hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. - iEE REVERSE FOR EXPLANATORY LANGUAGE _. W e 3/7/84. Signature of Permittee Date ,r WORKER'S hveacertificate COMPENSATION DECLARATION 76l DPW(12-91) .APPLICATION FOR ELECTRICAL PERMIT IJ 0-01 I hereby 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 there- (Sec.3.800 Lab.C.) Policy N 52�Company FOR APPLICANT TO FILL IN - JAODO �y r_1B RE56 W / Certified copy is hereby furnished New Residential Bldgs.8 Pools NO. EACH FEE $ $ LOCALITY 'Certified copy is filed with the county building insp Dun 1 $2 Family.Sq.Ft. _ NEAREST epar ent Multi-family Sq.Ft. CROSS ST. Date rJ Applicants "" � 3' Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER OR A c 011(1015:RCC Light SW._ FIRM NAME COMPENSATION INSURANCE First 20 (This section needo..not be completed If the work involved by the MAIL Total NAdditional ADDRESS permit is for one hundred dollars(5100)or less.) , I certify that in the performance of the work for which this permit _ CITY T.I.No. is issued, I shall not employ any person in any manner so as to Lighting Fixtures First 20 PLAN CHECK become subject to the Workers' Compensation Lawsr 9 9 APPLICANT Total No. Additional If JA 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 forthwith comply with such PERMIT provisions or this permit shall be deemed revoked. ' Power Apparatus 8 Large Appliances APPLICANT YP LICENSED CONTRACTORS DECLARATION Size 8 T e HP,KW,KVA,or KVAR ADDRESS Q ' I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 101nc1. (commencing with Section 7000) of Division'3of the Business and CITYTel. o. Professions Code, and my license is in full force and effect Over 10 to 50 Incl. LICENSE OR } Class. ///� Over 50 t0 100 Incl. REG.NUMBER Q. License N ber I Lic.Clas�(� Over 100 DISTRICT NO. MESSED BY O , Services,Swbd.,MCC&Panelboards Q� -{cif?�d�t Conirac�� 1"Vw� Date /-r)•�l / 0-399 Amp.Under 600 V FINALO ATE❑ F I am exempt under Sec. 400-1000 Amp.Under 600 V VALIDATION Over 1000 Amp,or Over 600 V FINAL W e.&P.C.for this reasonBRANCH CIRCUIT FEES BY Data: 15A,.or 20A, 120V,Lighting or Recept. - Z 1 TO 10 Branch Circuits Signature II To'40 Branch Circuits - - ❑ 41 Or More Branch Circuits Exemption for Reg. Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits r SINGLE FAMILY Temp.Power Pala 8 Appurtenances .` HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit AGGT_s- I 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 `711t7z {.� ifc: Code): ❑ I, as owner of the property, will do the work and the structure Misc.Conduits 8 Conductors is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) ® [I)TAL 65 - 85 fessions and ProCode). f HEt_r� (-r°, CONSTRUCTION LENDING AGENCY r4 C I hereby affirm that there is a construction lending agency for the t.Njvl.�.. performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ. C.) PLAN )^1- CHECKING FEE Aill]Q11-iill!)j / ,iz rf�_� Lender's Name - - —�Er PERMIT ISSUING FEE p� / tl-`' ! A"I 5 4-1 Lender's Atldress p ' I certify that I have read this application and under penalty of purjury state TOTAL FEE �� D that the above information is correct. I agree to comply with all County - - ordinances and State laws regulating Electrical wiring,and hereby authorize repr 'ntatives of this County Io enter upon the above-mentioned property - for pecti n purposo . SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF PERMITTEE DATE I WORKERS'COMPENSADECLARATION76-669 to/BI I hereby affirm that I have a certificate of consent to self ICE-110613 APPLICATION rOR ELECTRICAL PERMIT _ insure, or o certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY coy the or a certified copy thereof (Sec. 38QO,s, L b. C.) � doo"' JtiS. Lponl/� . Policy No.-Company _ FOR APPLICANT TO FILL IN JOB j�//5-O O O owm Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS 0 T r> ❑ Certified copy is filed with the county building inspec- 1 8 2-Family, Sq. Ft. E — E LOCALITYrny* GG do dep Iment. �/I�s xt .,,r�.r�) Multi-family Sq. Ft. — NEAREST .x Q 3i & 3 •-J'hiys-F Residential Swimming Pools OWNER OR CROSS ST. G Liz UE: LV Dale Applicant��A!! / lets: Rec_Liht FIRM NAME Sw ` 7L Fci✓/IncTa CERT ICATEOF EXEMPTION FROM WORKERS' OutEMAIL ` COMPENSATION INSURANCE � g First 200 ADDRESS A�.,`3' (This section need not be completed If the work Involved by Total No. Additional CITY y yyG �.� IF'�r�j. Tel. No.��a (S the permit is for one hundred dollars ($100)or less.) PLAN CHECK I certify that in the performance of the work for which this 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 - Total No. Additional CITY Tel. No. Date Applicant Fired Appliances Not Over I HP PERMIT _ NOTICE TO APPLICANT: 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 with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. CITY - Tel. No. LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other— G '? Class. hereby affirm that Disc. _ Room Air Cord. LICENSE OR am licensed under provisions of Chapter 9 REG. NUMBER J (commencing with Section 7000) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. PROCESSED BY Y and Professions Code,and my license is in full force and effect. m z_� Size 8 Type HP, KW, KVA, or KVAR' } OLTF—Cz—A OS License Number Lic. Class Up to 1 Incl. FINAL U Contractor Date Over 1 to 1 50 In DATE VALIDATION Q El Over 10 to SO Incl. V FINAL am exempt under Sec Over 50 to 100 Inc. BY 4 Pi 9, 1 A W — G 8.8P.C. for this reason Over 100 ( 2 Z Dale: - Services, Swbd., MCC 8 Ponelboards ' 0 - 200 Amp. Under 600 V D ) o•° L5 j0 Signature - 201 - 1000 Amp. UndeF 600 V F-1Exemption 1000 Amp. or Over 600 V ° P e Z•�;Jr C_v Exemption for Reg. Mains. Elect. SINGLE FAMILY Temp. Power Pole 8 Appurtenances I - HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit _ I hereby affirm that I am exempt from the Contractor's License Additional-Sign Branch Circuits Law for the following reason (Section 7031.5, Business and - Professions Code): ❑ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors "- structure is not intended or'offered for sale (Section Other (See Complete Fee Schedule)_ D 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 PERMIT FEE' (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE - o Lender's Name _ PERMIT ISSUING FEE Z Lender's Address I certify that I have read this application and state that the TOTAL FEE above information is correct. I agree to comply with all County ' Ord inon as and $tate lows regulating Electrical wiring, and hereby authorize representatives oft is County to enter upon - ' th 66 v mention` rty for spection pu pose . SEE REVERSE FOR EXPLANATORY LANGUAGE r S, 0 t r f e mi Dote -