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Home My Public Portal About5828 BURTON AVE_Electrical__ Wm that I have a COMPENSATION DECLARATION 76-663 107R, APPLICATION FOR ELECTRICAL PERMIT CE-806G I hereby affirm that I have a certificate of consent to self insure, 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 ADDRESS Certified copy is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE 1 & 2-Family,Sq.Ft. $ — $ LOCALITY Certified copy is filed with the county building inspection NEAREST department. Multi-family Sq.Ft. CROSS ST. Residential Swimming Pools OWNER OR Date Applicant 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 Date 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 is issued, I shall not employ any person in any manner so as to APPLICANT become subject the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS r Total No. -- Additional CITY Tel.No, Date Applicant Fixed AppliancAs Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of PERMIT Exemption,you should become subject to the WorkersCompensation 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. LICENSED CONTRACTORS DECLARATION Hood Fan OtherCITY Tel.No. _ I hereby affirm that I am licensed under provisions of Chapter 9LICENSE OR CL (commencing with Section 7000) of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER Class. } Professions Code.and my license is in full force and effect. Power Apparatus 8 Large Appliances DISTRICT NO. PROCESSED BY p U Size& Type HP, KW,kVA,or KVAR W License Number Lic. Class Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE LL Contractor Date VALIDATION ElOver 10 to 50 Incl. Ir FINAL Q am exempt under Sec. Over 50 to 100 Inc. By 10� BAP.C.for this reason Over 100 O a Services, MCC 8 Partls Date: 200 A 600 V 0-200 Amp.Under 600 V H Signature 201 - 1000 Amp.Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole 8 Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 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 Code): Misc.Conduits 8 Conductors I,as owner of the property,will do the work and the structure Other(See Complete Fee Schedule) _ is not intended or offered for sale (Section 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(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 property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS COMPEN�ATION'DECLARATION CE '°'°' -80BG APPLICATION, FOR ELECTRICAL ,PERMIT I hereby•aflir 'that.) have a certificate.of consent to self insure, �J or a.codificat, of Workers CampegsatwnJnsurance, ora certified COUNTY OF LOS ANGELES BUILDING AND"SAFETY- cop�thereof{Sec.3800,Lab.'C.) r' , yPolicy No! '- •x Company FOR APPLICANT TO FILL IN `- JOB El. Certified copy is hereby furnished. .EACH>- NO. FEE ADDRESS r- I - -, 1 New Residential Bldgs & Pools LOCALLY ' '❑,• Certified copy Is filed. with the.county building inspection 'I &'2-Family, Sq Ft:. `• !U. S $ Y - department., Multi-family Sq..Ft. — NEAREST, / '` • '• ""' " •' Residential SwimmingPools CROSS'ST. _ Date ' Apphcamt - OWNER r — CERTIFICATE OF EXEMPTION FROM'WORKERS •,. 1�� pS e, r• .MAIL - ' "COMPENSATION INSURANCE'S - Outlets:Rec Light Y1 Sw 20 V ADDRESS (This section need not be completechi{the'work,lnvolved ti the (� First 20 Y Total No._[.72 Additional` "' V CITY _ Tel.No: •'permit Is9or one,huntlretl dollars:($100)or less.) .•. � - ' e� - �i . . PLAN CHECK--, I cissuee, I h the performa'ary, riuthhe in for manse s permit - - "-I,=; - '� 'APPLICANT Itis„issued I shall"n'Otemploy'ariy,person.in,any manneF so as t0 j/ - , 'become subkct,tolpe+Workers=Compensation.Laws. ghting•Fixtures First 20" - •• �� ADDRESS - Additional,,, _ S - A -Tota6 No.� CITY Tel No Datef , Applicant Appliances Not Over 1 HP• _ NOTICE • A PLICANT - If, after making,this Certificate of PERMIT ,I Exemption,you should become subject too.the Workers'CompensationRange_ Heater_ D.W. APPLICANT - provisiori the Labor Code,youu.must forthwith,comply with'such 'Oven,_ Dryer, W.M._ ADDRESS s or- • '^ provisionthis permit shall be deemed revoked, _ _ Top FAU.. W. -`, • CITY i. �i'Tel.No. LICENSED CONTRACTORS DECLARATION V .t Hood.— Fan Other :'y hereby afhrm;lhat.l am,licensed,under provisions.,of!Chapter 9 . _ uCENSE OR . (commencing with Section 7000),of Division 3 of.the Business and •Disp. _L Room'AirCond' -. r "� '�� 3' '.REO.'NUM6ER •�= ^ Class. Professions COde,'andmy license is in full force and effect: DISTRICT NO PROCES ED BY - -Power Apparatus&,Large Appliances - - - . , - _ } a Size&Type HP KW,KVA;or KVAR _ S• U License Number • '1�SOh J�•. - Ulc Class C l 0 Up to 9lncl... - _ FINAL. I'1 fJl. ti�yr n�Over to 10 Ind _ DATE ,VALIDATION .. M Contractor CkJAI• AI,1;=(V/v dente - - '- O Over 10-to 50 Incl FINAL ) F- ❑ I am exempt under Sec. - �. ': r - - - Over 50 to-100 Inc.' . .._. BY .. - .W Over 100 'n' B&P C'for this reason _ _ - (n _ __ 'Seraces'Swbd.,MCC 8 Panelboards - s�y �' Z Date: te.%,O 200 Amp UntleP 600T- L T7J O -Signature - 201 1000 Amp. Under 600'V , Over 1000 Amp:or Over 600 V ” 0. Exemption for Reg.Malnf.Elect." --- - - SINGLE FAMILY .Sign with On Br &.Appurtenances. I her .. ... - a. ' HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit , he affirm that I am exempt from the Business.an License Law'' _ Additional Sign Branch''Circuits .' for the following.reason (Section 7031.5;Business.antl Professions "- Code): - ' 0 I,,as owner of theproperty,will do the work and the structure' Misc.Conduits'&Conductors ` is not intended or,offered for sale (Section 7044, Business _ : ,.Other(See Complete Fee Schedule) -+ and Professions.Code). CONSTRUCTION LENDING AGENCY r I hereby sffirm that there-is a construction lending'agency'for'the. .performance of the work for which this permit is issued(Sec.3097, "PERMIT FEE u • - '(Sub-Total)' T Civ.C.). - ,• ,. PLAN CHECKING FEE��• .,.'.. , Len_der's Name' - u - IF ISSUING FEE Lender's Address ' I certify that I have read this application and state that the above TOTAL FEE ,.,_ _ _ �`-r•�' Z�,. .- ._ . .. - 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. A SEE REVERSE.FOR EXPLANATORY LANGUAGE +Signature of Permittee pa WORKERS'COMPENSATION,DECLARATION 76A663 10r81. APPLICATION FOR ELECTRICAL PERMIT I hereby affirm•tNat I'have a certificate of consent to self insure, - CE-ease- " or a ce7tificate of Workers' Compensation Insurance, or a certified - COUNTY OF LOS ANGELES BUILDING AND SAFETY - copy thereof(Sec.3800,Lab.C.) - Policy No. I COmpany. FOR APPLICANT TO FILL AN JOB &.2 �U tl aW 17VC ❑ Certified co is hereby furnished - - . EACH., NO. .FEE ADDRESS _ 0 4 r PY Y - 'New,Residential Bldgs.8 Pools I 1 & 2-Family,Sq.Ft. $ $ LOCALITY A hf- G fill L /4 - Certified copy is filed with the county building inspection department. _ Multi-family Sq.FL — NEAReST .� /yl CROSS OR Residential Swimming Pools 'Date Applicant •r - I OWNER O /J /J p 'FIRM NAIVE /C i CERTIFICATE OF EXEMPTION FROM WORKERS' . \ 1 MAIL./ c Outlets:Rae Light Sw v y;. J '+COMPENSATION INSURANCE 1 ; , v ;- i 1 U IAODRESS p f& First 20 , CITY Tel.No. (This section need not be completed if the work involved by the Total No. First 2 nal r - - - permit is for one hundred dollars.($100)or less.) , , , I certify that in the performance of the,work for which thisP ermit '� \- 1 PLAN CHECK• + \ J \, is issued,I Shall not employ any person in any manner'so as to - �• APPLICANT+ ' become subject to the Workers'Compensation La Lighting Fixtures First 20 )ADDRESS - Additional .� Total No.—4 CITY Tel.No. Date 'Applicant NOWE TO APPLICANT: It, after making this. Certificate of Fixed Appliances Not Over 1 HP '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._ 1 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 Disp. Room Air Cond. REG.NUMBER Clazs. ProfessionsCode,and my license is it full force and effect. Power Apparatus& Large Appliances !/�-�DISTRICT NO. p/ PR ESSED BV )V( _ O� Size& Type HP,KW.KVA,or KVAR �J/ b v License Number Lie.Class Up to 1 Incl. " FINAL Over 1 to 10 Ind. DATE C:-- _ VALIDATION Q Contractor - - bate - Over 16 to 50 Incl. Over 50 to 100 Inc. U ' ❑ FINAL - I am exempt under Sec. _ BY - a B.&P.C, for this reason Over 100+ N Services,Swbd.,MCC& Panelboards D 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& Appurtenances313 + v9.UQ HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits 1 ITEMS <the,,f.owing reason(Section 7031:5, Business and,Professions TOTAL $'g _00 Misc:Conduits& Conductors 0 I ownerofthepropty,will do the work and the structure CHECY\- 89.01tintendedorofferedfor sale (Section 7044, Business Other (See Complete Fee Schedule) DProf. .na Codo) CHARGE .�u' CONSTRUCTION LENDING AGENCY , I hereby affirm that there is a construction lending agency for the 0000-0001 6/ 4Y90 performance of the work for which this permit is issued(Sec.3097, PERMIT FEE- (Sub-Total) - Civ.CT. 11386 1 AM10:12 PLAN CHECKING FEE - Lender's Name - - - PERMIT ISSUING FEE + . . Lender's Address O I certify that I have read this application and state that the above.` TOTAL FEE - r ' 01 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 u on the above-mentioned - - property for ins cho purposes. - p'�-/'/) SEE REVERSE FOR EXPLANATORY LANGUAGE. Signature of PermitteeD��