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HomeMy Public PortalAbout4940 DOREEN AVE_Electrical__ WGRKERShave PENSATIONo consent to •. „ CE-863 n,61 APPLICATION FOR ELECTRICAL' PERMIT CE-806G lirereby affirm that I have a'certificate of consent to sell insure; or a c�;rtificate of Workers' Compensation Insurance, or a certified. COUNTY OF LOS ANGELES BUILDING AND SAFETY copy,thereof (Sec.3800,Lab..C.) - - Policy No. 580937 ,Company", State Fund - 1_ FOR APPLICANTyTO FILL IN `" _ JOB - ADDRESS ❑, Cerbfietl,copy is hereby forms ad New Residential Bldgs:& Pools EACH NO FEE . . $ — $. , LOCALITY.Teri le Cita ® -Cerbfied^copy is filed wit"e count ding inspection 1 & 2-Family, Sq Ft. p ' " department:, . . - Multi-family Sq.Ft. — NEAREST - .CROSS ST. r" , Date n6—PT-91 APPIic r - " Residential Swimming Pools t - ,OWNER T. ' ' - - 'FIRM NAME Ted Sirene. • CERTIFICATE OF EXEMPTION FROM WORKERS' �' - MAIL Outlets:Rec Light Sw. ,;. COMPENSATION INSURANCE • D ADDRESS 4940 N. Doreen (This section need,not be com leted it the work involved b the First 20,, P Y .:CITY Tel.No. ' permit is for one hundred dollars(S too)or less.) Total No. . . Additional Dl Clt 448-4476 ' I certify that in the performance of the work for.which this permit _ FLAN CHECK - _. is issued, I shalhnot employ any person in any manner so as t6 APPLICANT -become subject to the WorkersCompensation Laws.,." Lighting Fixtures First 20, - ADDRESS - • - Additional - .".. Total No. - - CITY - " - � Tel No „ Date Applicant - Fixed Appliances Not Over 1 HP PERMIT - NOTICE- TO.APPLICANT If; after.making this Certificate of PPLICANT Exemption,you should become su6lecLtothe Workers'Compensation Range_ Healer_ D W. _ provisions of.the Labor Code, you must forthwith comply,with such Oven Dryer_ W.M._ ADDRESS .47 provisions or this permit shall he deemed revoked. Top . EAU W.H. _ - ��,�J/y(�- 6J .ly - _ - CITY Tel t7iC `. 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 ttie Business and Disp.'— Room Air Cond ._ •? Class.- REG.NUMBER Professions Code,and my license is in full force'and effect. DISTRICT NO. PR E ED eV . Power Apparatus&..Large Appliances ,� Size& Type HP,KW,KVA,or KVAR '!/O Q' License un er � Lia U Class C-ZU � � � Up to 11ncL �9•/ a • OC Z Over 1 to 10 Incl. DATE VALIDATION„ Q Contra or Date 6-11—91 Over 10 to 50 Incl. V ❑ FINAL am exempt under Seo, Over 100 Inc.. By . .�� 4. B.&P.C.for this reason-- Over.100 to Services,Swbd..MCC&'Panelboards D - - - - '- Z Date: 0- 200 Amp.Under 600 V Signature - 201,- 1000 Amp.Under 600 V - Over 1060 Amp.or Over 600 V Exemption for Reg.Maint.Elect. SINGLE FAMILY-, - Temp.Power Pole& Appurtenances _ _I .HOME OWNER-BUILDER DECLARATION - Sign with One Branch Circuit A a I hereby affirm that I am exempt from the Contractor's License Law - C -h.a foP the following reason(Section 7031.5, Business and=Professions -Adtli[iona6 Sign Branch Circuits - Code): , .7i'.Q 1' y,,. f L Misc.Conduits&Conductors- El .I,as owner of theproperty;will do the work and the structure i i i I _ - is,not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). • © i tE I nL -,3 ®;v 1.1 CONSTRUCTION'LENDING AGENCY - • - - CHECK, P hereoy affirm that there is a:construction lending agency for theUl performance of the work for'which this permit is issued(Sec.3097, PERMIT FEE - - (Sub-Total) Q Q - Civ. C.). PLAN CHECKING FEE- ' - Lender's Name •. - . i III II: 313111 ' 6111 91 Lender's Address .PERMIT ISSUING FEE _ �_ 7r Q p r 1't44 AM "} -cz °. - °+r' I certify that I have read this applicationandstate'thaf the,above TOTAL FEE ma - , ,infortion.is correct. I agree to comply,with all County ordinances 'and State laws regulating Electrical wiring, andhereby authorize - representatives of this County to enter upon the above-mentioned - - - • - - - - - property for inspection purposes. . - . , I ` - SEE REVERSE FOR EXPLANATORY LANGUAGE ,. Signal Permittee Dale - WORKER S'COMPENSATION DECLARATION CE-8Q6G (2-80.). APPLICATION FOR ELECTRICAL PERMIT E-8Q6 I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.) FOR APPLICANT TO FILL IN ,JOB r Policy No. ADDRESS /1 J✓ o I Company G i3 � New Residential Bldgs.&Pools EACH NO. FEE Ba� �%Pi_ Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY -<'Y' Multi-family Sq. Ft. — NEAREST p, r Certified copy is filed with the county building inspection Residential Swimming Pools CROSS ST department. OWNER OR ,J, FIRM NAME l/f/ZG4;V €�'Oa' Date Applicant Outlets: Rec.—Light—Sw. MAIL First 20 ADDRESS Y/o 1I` 11261`"- CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY,/�- Tel No. 41Vf'1y7� COMPENSATION INSURANCE 2' L/� Ci %Y PLAN CHECK CL (This section need not be completed if the work involved APPLICANT O by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS Total No. Additional I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. permit is issued, I shall not employ any person in any manner PERMIT ✓ / W so as to become subject to the Workers' Compensation Laws. Range—Heater D.W. APPLICANT Ys UJ f / �� c Oven _ Dryer_W.M. ADDRESS Cn Date 9G//��Applicant Top _ FAU _W.H.. Z Hood Fan _Other_ CITY Tel No. NOTICE TO APPLICANT: If, after making this Ce rtteorkers Disp. Room Air Cond.— LICENSE OR Exemption, you should become subject to .the' REG.NUMBER 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 deemed revoked. Up to 1 Incl. rK "- ��• Over 1 to 10 Incl. FINAL „��s LICENSED CONTRACTORS DECLARATION DATE Over 10 to 50 Incl 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 =x ness and Professions,Code, and my license is in full force and 1r 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 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 ness and Professions Code): Misc.Conduits&Conductors 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 ,r �!'5 2 t P 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 PERMIT FEE (Sub-Total) issued(Sec.3097,Civ.C.)- Lender's Name - PLAN CHECKING FEE (One-Fourth Permit Fee) �� _ ° ° r L% 'v Lender's Address PERMIT ISSUING FEE 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 of this County to enter upon the above-mentioned property for inspection purposes SEE'REVERSE FOR EXPLANATORY LANGUAGE �� Signature of Permittee ate