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Home My Public Portal About10626 DAINES DR_Electrical__ WORKER S'COMPENSATION DECLARATION 76(3� CE 806G (:t801 APPLICATION FOR. ELECTRICAL PERMIT {� ' J LJ 1 heresy affirm that 1 have a certificate ofconsent to-self COUNTY OF LOS ANGELES BUILDING AND SAFETY v - insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec:3800, Lab.C.) FOR APPLICANT TO FILL IN JOB Policy No. Company _ ADDRESS Qty ❑ � - New Residential Bldgs.&Pools EACH NO. "FEE Certified copy is hereby.furnished. 1 &-2-Family,Sq. Ft. $ $ LOCALITY F! Ft.- NEAREST L , Certified copy is filed with the county building inspection Multi-family Sq. CROSS ST department. , Residential Swimming Pools OWNER OR ''/I FIRM NAME Datr Applicant Outlets' Re. Light Sw.'S MAIL Fi,st 20 ADDRESS ✓/p at-(a L(h < CE RTI FICAT&OF'EXEMPTION FROM WORKERS' Total No. Additional T<T< pn� Tel No. v ' COMPENSATION INSURANCE (:. PLAN CHE K Cl- APPLICANT `0 (This section need not be completed if the work involved by the permit is for one hundred dollars Fixtures First 20 s ($100) or less.) ADDRESS Additional O ' Total No. , I certify that in the performance of'the work'for which this - CITY Tel No. Fixed Appliances Not Over 1 HE permit is issued, I shalPnot employ any person in any manner PERMIT W so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT d Oven Dryer_W.M. ADDRESS to Z Date Applicant Top FAU '_W.H., CITY Tel No. Hood Fan —Other— NOTICE TO APPLICANT: If,after making this Certificate of Disp. _ Room Air Cond-_ LICENSE OR Exemption, you should become subject to the Workers' REG, NUMBER d Class " Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY with comply with such provisions or this permit shall be Size& Type HP,KW, KVA,or KVAR C� deemed revoked. - - Up to 1 Incl. Over 1 to 101nc1. FINADATE L LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl O V VALIDATION I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 BY ness and Professions.Code, and my license is in full force and effect. - Services - - License Number Lic.Class 0-200 Amp. Under 600 V - 201-1000 Amp. Under 600 V Contractor Date Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances .. 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 :A6 3 3.1 A ness and.Professions Code): I Misc.Conduits&Conductors 4 . e e e 2 ❑ I, as owner of the property, will do the work and the Other (See Complete.Fee Schedule)-- ' structure is not intended or offered for sale (Section Z,•I'^ 20 ,90 7044, Business and Ptofessicns Code). CONSTRUCTION LENDING AGENCY o'-'- 2 Q9, O H - I hereby affirm that there' is a construction lending agency for the performance of the. work for which this permit is PERMIT FEE U(Sub-Total) 09,2O_8 z issued (Sec.3097,Civ.C.). Lender's Name PLAN CHECKINGFEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE I certify that 1 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� ove-mentioonned pro ert y for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE r ignature of P r i�.fee Date - Teweas.csaoe T-BB APPLICATION .FOR ELECTRIC ERNIIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER woo eN /IVES BUILDING AND SAFETY DIVISION zgr JOHN A. LAMBIE, COUNTY ENGINEER CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY V FOR APPLICANT L TO Flit!': IN NEAREST cRoss s g6L -A4O 4.,M MINUT FEES I T E M NUMBER EACH FEE OWNER OUTLETS: $ 4 MAIL RECEIPT.RECEF. SW. .10 ADDRESS, E LIGHTING FIXTURES .10 CITY TEL. NO. ELEC. RANGES o. D6YERs ELECTRICIAN - / ["p WATER HEATERS .50 D ADDRESS ELEC.SPACE HTRS. DISHWASHERS q r GARBAGE DISPOSERS AUTO.- .CITY M TEL. NO. ].2. If STATE WASHERS STA. COOKING UNITS .25 LICENSE NO. bpt� S e MOTORS: OVER INC. H.P. DISTRICT NO. I GROUPI zf! P - SSED BY 0— 1/ .25 v— z .5o INSPECTION RECORD z— s 1.00 5— 15 1.50 15— 50 2.50 50-200 5.00 SIGNS: NO. TRANS. NO. LAMPS SERVICE 0-600V 1.00 SERVICE OVER 600V 5.00 - MISC. WIRING PERMIT 1.00 FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT .50 TOTAL FEE s ' APPROVALS IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING 1 'SIJ�io a� GCfl.� I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR - LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE 1) DESCRIBED RESIDENTIAL PROPERTY. POWER SIGNATURE (((111 / � UTILITY CO. NOTIFIED �3/ Q. ry/,J/,® . .-�• !• OF PERMITTEE FINAL N 1 y.AUVATION ARTHUR C. VEIT, c j No CASHSUPERVISING ELECTRICAL ENGINEER IAC07024m NOV z6 2 A 2.50 n WORKERS'COMPENSATION,DECLARATION 63 CE806G (2-80) APPLICATION PpLICpTION FOR ELECTRICAL PERMIT n I ' I hereby affirm that I have a certificate of consent to self. COUNTY OF LOS ANGELES BUILDING AND SAFETY u insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab. C.) q/- Policy No. Company FOR APPLICANT TO FILL IN ADDRESS Q a�f �. /'. New Residential Bldgs.&Pools EACH NO. FEE .Certified copy is hereby furnished. w 1 & 2-Family"Sq. Ft. S '— $ LOCALITY QMulti-family Sq. Ft. — NEAREST Certified copy is filed with the county building inspection CROSS ST department. - Res ideniial Swimming Pools OWNER OR FIRM NAME i. 1;A, Date Applicant 'Outlets: Rec_Light_Sw._ MAIL - J •First 20 ADDRESS- ^- f CERTIFICATE OF EXEMPTION FROM WORKERS' ,Total No. Additional .CITY /' Tel No. -y _ (�� y COMPENSATION INSURANCE - PLAN CHECK I IL APPLICANT - 0 (This section need not be completed if the work involved Lighting Fixtures First 20 ADDRESS U by the permit is for one hundred dollars ($I00) or less.) Total No. Additional I certify that in the performance of the work for which this CITY Te F permit is issued, 1'shall not employ any person in any manner Fixed Appliances Not Over 1 HP PERMIT U so,as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. LLI APPLICANT d y Oven _ Dryer_W.M._ ADDRESS z 'Dated —V�Applica _ ' LAG Top — FAU —W.H CITY Tel No. _ Hood — Fan _Other_ NOTICE TO APPLICANT: If, after eking this Certific to of Disp. _ Room Air Cond.— LICENSE OR :Exemption, you should become subject to the Workers' REG. NUMBE Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCE ED &Y with comply with such provisions or this permit shall be r l ✓ deemed revoked. Size&Type HP,KW; KVA,or KVAR aV Up to"l Inc]. FINAL LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATE VALIDATION Over 10 to 50 Incl -, I hereby affirm that Into licensed under provisions of Chapter 'Over 50 to 100 Inc. FINAL 9 (commencing with Section 7000) iDivision 3 the Busi- , ness and Professions,Code, and my license is in fullll Over 100 BY force and � r effect. Services ' 0-200 Amp. Under 600 V ' License Number Lic. Class- 201-1000 Amp. Under 600 V Contractor Date Over 1000 Amp.or Over 600 V, HOME OWNER-BUILDER DECLARATION - Temp. Power Pole&Appurtenances, P 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 ness'and Professions Code): -, Misc.Conduits-& Conductors I, as ure is no the property, will re [for work and the Other (See Complete Fee Schedulel— �2 8 7.7'A - structure is not intended or offered forsale (Section • - 7044, Business and Professions Code). ' CONSTRUCTION LENDING AGENCY o'2 II hereby affirm that there is a construction lending agency /for the performance.uf the work for which this permit is e'e issued (See. 3097,Civ.C.). PERMIT FEE (Sub-Total) J 2 ) 2 3..5 8 Lender's Name PLAN CHECKING FEE (One-Fourth Permit-Fee) 'Z 3 rj 0;r� Lender's Address ` PERMIT ISSUING FEE .S� 0 2 0'5:-82 I certify that I have read this application and state that the TOTAL FEE ibove 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 Rove-mentioned prpperty for inspection purposes./' SEE E-REVERSFOR EXPLANATORY LANGUAGE ��/JI°A�i/,.2'A✓ Signature f Permittee �� Date ' WORKERS' COMPENSATION DECLARATION _ CIE 106 APPLICATION ID ISA IC p TION FOR ELECTRICAL 1®12RMITf I hereby affirm that I have,a certificate of consent io self CE-BObG /'Y It"Ir IL YY 0 Ytl If' II'l PERMIT p'(9V0 p insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certif' d op thereof (Sec. 3800 Lab. C.) Co Pat cy No. X59 YCompany �cFOR APPLICANT.TO-fILL IN JOB O _ Certified copy is hereby furnished: New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS ,� ❑ Certified copy is filed with the county buil ing inspec- 1 8 2-Family, Sq. Ft. $ — $ LOCAUT L, tion department. Multi-family Sq. Ft. — 'NEAREST 22 � Residential Swimming Pools CROSS ST. OWNER OR Date '�r Applicant L FIRM NAME VAI CERTIFICATE OF EXEMPTION FR WORKERS' - 2 COMPENSATION MSU ANCE Outlets: Rec_ ightSw. (�T ADDRESS This t bcompleted if the work involved First 20 ( s section neenoe com P b T Total No. Additional CITY - Tel. No. the permit is for one hundred dollars ($100)or less.) PLAN CHEC 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 G so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Al Total No. Z.- Additional Date Applicant CITY Tel. No. �O NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the. Workers' Range_ Heater—D.W. APPLICANT Compensation provisions of the Labor Code, you must forth- Oven _ Dryer _ W.M._ ADDRESS with comply with suchprovisions or this permit shall be Top FAU —W.H. CITY Tel. No. deemed revoked. Hood _ Fan — Other— Disc. Room Air Cond LICENSED CONTRACTORS DECLARATION LICENSE OR 2 p-Z�s Class. I hereby affirm that I am licensed under provisions of Chapter 9 — . REG. NUMBER J O (commencing with Section 7000) of Division 3 of.the Business DISTRICT NO. PROCESSED BY and Professions Code,and m license is in full force and effect. Power Apparatus 8 Large Appliances y Q y Size 8 Type HP, KW, KVA, or KVAR' 1�— 0 License Number �V Lic Class Up to I Ind. V FINAL ^j � •z L Over 1 to 101nd. DATE '6i( ' VALIDATION W Contractor Date -3 8 / Over 10 to 50 Inc(. - F- ❑ FINAL I am exemptun r Sea Over 50 to 100 Inc. BY Over 100 IL B:BP.C. for this reason Services, Swbd., MCC 8 Panelboards - D v 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 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 sole (Section Other (See Complete Fee Schedule)_ D 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY' - z 0.7.3&A I hereby affirm that there is a construction lending agency fore . e the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) 1eE e 'Z (Sec. 3097, Civ. C.). s'e PLAN CHECKING FEE ,2, % 650 Lender's Name °o•la'o 1 6,5 0 ' PERMIT ISSUING P - Lender's Address 0 4,,2 5"-a 4 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 t ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon - the above-mentioned property or ins titan purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE _ A' 9-Z3-8Y S gnature of Permittee Dote