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HomeMy Public PortalAbout9944 DAINES DR_Electrical__ WORKERS'COMPENSATION DECLARATION 76A663 10/81 ` APPLICATION FOR ELECTRICAL PERMIT hereb affirm that :.' 'I have a certificate of consent to>self CE-806G r%Dre,'ca . -certificdte of Workers' Compensation Insurance, . or a cer14fied copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY P.ohi y,,No >. Company FOR APPLICANT TO FILL IN JOB \� F-1 \?Certified ertified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE' ADDRESS ❑ Certified-copy is filed with the county building mspec- 1 & 2-Family, Sq Ft 3N143 $ — $ LOCALITY tion department Multi-family Sq Ft 'NEAREST CROSS ST \ Residential Svlimming Pools Date Applicant' - WNER OR FFIIRM NAME e l CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec (Iy Light�Sw SIL COMPENSATION INSURANCE First 20 is b ADDRESS "1 (This section need not be completed if the work involved by 'Total NoAdditional CITY \� ` Tel No 2 6 (4 the permit is'for one hundred dollars,($100)or less.) certify that in the performance of the work for which this PLAN CHECK 't " permit is-issued, I shall not employ any person in any manner APPLICANT- so as to become subject to the Wo r rs'Compensation 'aws Lighting Fixture First 20 ADDRESS q q Total No _ Additional Date Applicant G �K CITY 1 ��„� Q �' Tel No 214 y21, Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT If, after making,this Certificate of 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 q ! (4 with comply with such provisions- or this permit shall be Top FAU W H — r_ t � deemed revoked Hood 1 Fan O(ther— `-1 CITY w 8 Tel No 2 G ZZ LICENSED CONTRACTORS DECLARATION Disp Room•Air Cond LICENSE Class I hereby affirm that I am licensed under provisions of Chapter 9 REG NUMM BER (commencing with Section 7000) of Division 3 of the Business Power Aaratus & Large Appliances, DISTRICT NO PROCESSED BY and Professions Code, and my license is in full force anpp and.effect SL OV d Size &Type HP, KW, KVA, or KVAR O License Number Lic Class Up FINAL to 1 Incl l V Over 1 to 10 Incl DATE VAL ATION Contractor Date❑ Over 10 to 50 Incl 0 FINAL I am exempt under Sec Over 50 to 100 Inc BY LU B&P C for this reason Over 100 ' 3 0 8 2 A 4A Services, Swbd , MCC &"Panelboards Date- 0 -200 Am Under 600 V ► #,o o a o • 2' Signature 2 1 - 1000 Amp Under 600 V 1 0 116200 Exemption for Reg Mamt Elect Over 1000 Amp or Over 600 V SINGLE FAMILY Temp Power Pole & Appurtenances _ HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 0,0-7 4 7 j hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuitss Law for the following reason (Section 7031 5, Business and Professions Code) j, as owner of the property, will do the work and the Misc Conduits& Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule.)- 7044, Business and Professions Code) c - CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for R 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 /00 Lender's Address Icertify 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 jaws regulating,Electrical wiring, and hereby authorize representatives of this County to enter upon t above-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY_ LANGUAGE 1 :y Signature of PermitteeDate ` ♦ c-� ... `'rt.„+_`.. -_ , . ..k r. - Af �� — �•',^+r 1...r ....+ diY«.'y"+�'+... ...'(r i,a' < • �`•J•� :t"'.•'�'S 76A663.-d-806-j(1 I /78) APPLICi4Tl'ON FORIL-ECTRICALYPERMIT COUNTY OF LOS ANGELES ,- ' :_.BUILDING AND SAFETY - FOR APPLICANT TO FILL•IN ,r JOB s' EACH -NO ,•t- FEE ADDRESS New Residential Bldgs &Pools �� �• ,',.4 1 &;2-Family,Sq .Ft $ 025y — $ LOC ALbTYTe { 91!1'8 ?� Nlulf"family Sq Ft ,•s`.�`'r -' -02 IN - --- -- - rl Residze am Swimmmg`P 25 00 CROSS ST•" L,0 4,J/�`'•t"• ools OWNER OR .¢z i4 /GAry ,r FIRM NAME /Q ` Y;d, 4 Outlets Rec' Light, Sw - MAIL'- , ADDRESS' G ��"D,e First.20 >. Total No CITY - a30 ' PLAN CHECK• - f ,..�'k-„ «? i'. .._• ` y APPLICANT Lighting Fixtures.', q r'Fir'st 20 . . 50 ADDRESS Total NoF �» r ,Additional, 30 - -r, ` r-- '; ; k, CITY+ r ' „Tel No. ; F.ix6d'Applionces.Ndt•Over.l-HP,_ ,,, PERMIT-�» Range'• Hedter_"D W p �, APPLICANT f �I r -Ove'n` _',Dra 61rr._W M Top _FAU• — W'H,_ CITY Hood—Fan-,_Othe- 2'5' r_ :, LICENSE OR Class _ Dgp =Room_Air Cond_ — 2 50_ _ REG NUMBER_ ' I HEREBY ACKNOWLEDGE THAT I HAVE-READ THIS APPLICA- �^ Power Apparatus&Large Appliances - TION AND STATE THAT•THE'ABOVE IS CORRECT AND AGREE,TO- "' COMPLY'WITH''ALL-COUNTY-ORDINANCES`AND'STATE-.L`AWS' Size&Type HP, KW,KVA,or KVAR REGULATING ELECTRICAL WIRING Up to l Incl 2 50 } i , ` 5 00• HEREBY'CERTIFY'THAT'I'AM'PROP,ERLY"REGISTERED`AND7OR ^(� Over;1 to 10 Incl LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND,STATE'OF �g -Over-1 Orto.50,lncl 1,2 50 _ _ CALIFORNIA_OR THAT AM THE _LEGAL OV/NER OF=-THE ABOVE ®' Over 50 ro 100 Inc 25 00, DESCRIBED RESIDEN OPER p• ,,--• - - Over,100 - `40'00 PERMITEE. " SIGNATURE dl,� Services _... ..:, ..t DISTRIC Ofp' p - 't 1`2 50 ,i G+ CES 0-•200 A'mp Under'b00 V, �. --20,1-'.1.000 Amp Under+600 V "� 25 00 M. --- Y• „- -, -•- - Over 1000 Amp or Over 500.V 50 00- ^r '�• y n Temp Power;Pole'&Appurtenances'+ s `1000 �• - . Q �� Sign viith One Branch Circuit'V '10 00 Additional Sign'Bronch Circuits ` 2 00„ INSP,EI Th +L> O,N. Misc''conduits&Con'ductors'. ' ' t'0'00 INFORMATION,- =- a ONREVERSE,­ 6,5, ,3-A Other(SeeComplete Fee Schedule)• , r4 '•1, ,2 ^A-SIDE 19. , OZ a :J n ou- PERMIT FEE , , rk _ (Sub=Total) h ry *t ,o 9,'0'6- *9' >f.yr ,PLAN CHECKI'N'G' 'FEE' ,_ (One Fouhh'Permlt'Fee) _ a� o� 'o� O PERMIT ISSUING FEE _, � o, - �� '$7 00 �`• ;o •se4ii i G TOTAL,41 O ,�.;3� l- > .aY, INSPECTION FINALED ,date By �� r J' I ©s