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Home My Public Portal About8752 BURGHARDT RD_Electrical__ 76A663 F R-'WORhat I have a certificate of con DECLARATION CE-806 Aral APPLICATION FOR ELECTRICAL PERMIT GE-66fiG sreby affirm that I have a certificate of consent to self insure, i or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY -copy thereof(Sec.3800.Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB \ Certified copy is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE ADDRESS 8 Pn RD Certified copy is filed with the county building inspection I & 2-Family,Sq.Ft. $ _ $ LOCALITY //,✓ /GA/g,/f/I department. Multi-family Sq.FL NEARECROSSSST W 5 Cl) �✓ Date Applies >�- Residential Swimming Pools OWNER OR of FIRM NAME /V CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets'Rec LL Light Sw. -tb / . .' r MAIL �� COMPENSATION INSURANCE - ADDRESS Q completed if the work involved b the First 20 (This section need not be corn P Y CITN CHECK� / Tel.No,7 permit is for one hundred dollars($100) or less.) Total No. Additional I certifythat'In the performance of the work for which this permit PLAN CHECK P 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 p/ Total Na ( CITY Tel. Date_I/— /a Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, af� makmg this Certificate of 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 (commencing with Section 7000) of Division 3 of the Business and Dlsp. — Room Air Cond. REG.NUMBER Ciass. Professions Code,and my license is in full force and effect. DISTRICT NO. l!/�^D� PR S 8 ev Power Apparatus 8 Large Appliances Size 8 Type HP,KW,KVA,or KVAR t U License Number Lia Class Up to 1 Incl. FINAL Over 1 to 10 IndDATE LIDATION Q Contractor Date Over 10 to 50 Incl. / U INAL Q 1 am exempt under Sec. Over 50 to 100 Inc. By W B.&P.C.for this reason Over 100 7 N Date: Services,Swbd.,MCC&Panelboards Z 0-200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V ❑ Exemption for RegMOver 1000 Amp.or Over 600 V . aint.Elect. SINGLE FAMILY Temp.Power Pole& Appurtenances p HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit # 1 hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits o - 4G50 for the following reason(Section 7031.5,Business and Professions g I Code): 0004G5.003 ❑ 1,as owner of the property,will do the work and the structure Misc.Conduits & Conductors O"1 8 is not 'intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) 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(Sec.3097, PERMIT FEE (Sub-Total) Civ.C.). 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 County ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above-mentioned pro ty fo mnspection our oses. SEE REVERSE FOR EXPLANATORY LANGUAGE Si ature of PErmittee 61 Date WORKERS' COMPENSATION DECLARATION CE-806 10,81 APPLICATION FO ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-8066 insure, or a certificate of Workers;Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified cc y thereof (Sec. 3800, Lob. C.) iOV . -/�S ./J,IS Sid/l� icy o. ampony FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. 8 oo Is EACH NO, FEE ADDRESS 3 r Certified copy is filed with the county bui Id in inspec- I & 2-Family, Sq. , . $ — $ W LOCALITY ' hon departmentMulti-family$q. Ft. NEAREST CROSS ST. T� Date/ov . Appli nt 7/L Residential Swimming Pools OWNER OR - r FIRM NAME CE IFICATE OF EXEMPTION FROM WOMAIL Outlets: RecLight $w. d COMPENSATION INSURANCE ADDRESS ( R Y This section need not be com leted if the work involved b First 20 the permit is for one hundred dollars ($100)or less.) Total No. Additional CITY Tel. No. that in the performance of the work for which this PLAN CHECK I certify P 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 Fixed Appliances Not Over 1 HP PERMITn NOTICE TO APPLICANT: If, after making this Cerlificate of APPLICANT /1( 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 g2 S+� with comply with such provisions or this permit shall be Top — FAU —W.H. — f��A deemed revoked. CITY / Tel. N LICENSED CONTRACTORS DECLARATION Hood — Fan _Other_ LICENSE M p I hereby affirm that I am licensed under provisions o4 Chapter 9 Disp. — Room Air Cond. REG. NUMBER 7 � class.e—/e (commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO, 510 PROCESS BY and Professions Code,and m license is in full force and effect. IL p Size 8 Type HP, KW, KVA, or KVAR' - _ Q License Num6erJ 9`1 Lic. Classy ��Ae Up to 1 Incl. FINAL �t / V Over 1 to IIncl. DATE �y Lp ^Q� VALIDATION Conacto DateLx/ � Q Over 10 to 50 50 Incl. FINAL L U u ❑ 1 am exempt un¢ r Sec. Over 50 to 100 Inc. BY Cf IM B.&P.C. for this reason Over 100 Z Date: Services, Swbd., MCC & Panelboards ► ,� Y� o -200 Amp. Under 600V _ 757,9A Signature 201 - 1000 Amp. Under 600 V }' c e a o oz Over 1000 Amp. or Over 600 V ❑ Exemption for Reg. Moint. Elect Z u o 77_C O SINGLE FAMILY Temp. Power Pole&Appurtenances i HOME OWNER-BUILDER DECLARATION r e Z C n o Sign with One Branch Circuit , 7 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 1 2 1 4 —E3 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 safe (Section Other (See Complete Fee Schedule)_ , 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 Lender's Name PERMIT ISSUING FEE 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 ordinances and State laws regulating Electrical wiring, and hereby authorize representatives oft County to enter upon,tlbe - o -mentioned property f pection purposes. ,t SEE REVERSE FOR EXPLANATORY LANGUAGE a not of Permittee Dte /