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Home My Public Portal About4935 ENCINITA AVE_Electrical__ r WORKERS'COMPENSATION DECLARATION CE-806 I0/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-806G insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. PC 97711 m an REPUBLIC INT. FOR APPLICANT TO FILL IN JOB n C t Q Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS 4735 ENCINITA AVB. ❑ 1 & 2-Famil S Ft.- $ _ $ LOCALITY TEMPLE CITY Certified copy is filed with the county building ' pec- y- q• NEAREST �ERRTIFICATE ent. Multi-family Sq. Ft. CROSS ST, IVER AZ jS Residential Swimming Pools Date APPlicPT, FFIIRM NME�,�iVWNER OR TI RY1 S INJECTION FOLD OF EXEMPT IO FROM WORKERS' Outlets: Rec Light Sw. nooaess 4035 ENCINITA AVE COMPENSATION INSURANCE This section need not be completed if the work involved b First 20 ( ip y Total No. Additional CITY TALE CITY CA. Tel. No. 2$8-5002 fhe permit is for one hundred dollars ($100)or less.) PLAN CHECK 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 so as to become subject to the Workers'Compensation Laws, Lighting Fixtures First ADDRESS Total No. Additional CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT AP14STRONG ELECTRIC INC. 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.— ADDRESS177 SOU'TIa DEL AVE. with comply with such provisions or this permit shall be Top _ FAU —W.H. — CITY TelNo deemed revoked. Hood _ Fan _Other_ SAN GAERIEL CA . . 572-0000 LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER 357983 Class. C-10 (commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NQ,_ PROCESS and Professions Code,and my license is in full force and effect. �i 1 0� U Size &Type HP, KW, KVA, or KVAR' lJ License Number 357983 Lic. Class C-10 Up to 1 Incl. FINAL ti= ARMSTRONG ETEC;. Date —� Over 1 to 10 Incl. V . DATE VALIDATION Contractor 11/1385 1 Over 10 to 50 Ind. S18.00 1 0 F1 w. ❑ I am exempt under Sec. Over 50 to 100 Inc. B Over 100 �- B.&P.C. for this reason �ry Z Date: Services, Swbd., MCC& Panelboards L V 2-349.8 A 0 - 200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V n # o 0 0 0 0 2 ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V .1 o - 7250 SINGLE FAMILY Temp. Power Pole&Appurtenances o o 0 72505 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit :,1 1. 19-85 1 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 t'Fe 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). 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) $62 00 (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE $l0 5 Lender's Address I certify that I have read this application and state that the TOTAL FEE $72.5 above information is correct. I agree to comply with all County ordinances and State laws egulating Electrical wiring, and hereby authorize prese tive of this County to enter upon the a v - enti ned erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 11/13/85 Sig ature of Permittee Date WORKERS'COMPENSATION DECLARATION -663 ,DAB, CE-806G APPLICATION FOR ELECTRICAL PERMIT I hereby,af:irm'that I.have a certificate of consent to self insure, CE 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 JOBM� El Certified NO. FEE ADDRESS 4V3-s- �AAal A/,,7-,9 pyres Certified copy is hereby furnished. New Residential Bldgs.& Pools ❑ _ Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft. $ $ LOCALITY department. Multi-family Sq.Ft. NEAREST CROSS ST. CvA�/✓/�Y. Date Applicant Residential Swimming Pools OWNER OR FIRM NAME V�I r eu CERTIFICATE OF EXEMPTION FROM WORKERSOutlets:Rec—Light — Sw. — MAIL COMPENSATION INSURANCE ADDRESS— 1 -9 1RsHRJeCO& (This section need not be completed if the work involved by the First 20 Total No permit is for one hundred dollars($100)or less.) . Additional CITY �. �L /fgD�tlT� Tel.No. STS' PLAN CHECK I certify that in the performance of the work for which this permit 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 /''may/�j Total No. Additional CITY l'I./N . Date Applicant Fixed Appliances Not Over 1 HIP NOTICE TO APPLICANT: If, after making this Certificate of 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._ 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 Disp. — Room Air Cond. LICENSE Class. (commencing with Section 7000)of Division 3 of the Business and REG.NUMBB ER Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PROCES p Size& Type HP,KW,KVA,or KVAR �J` O JB � 0 License Number Lic.Class Up to 1 Incl. FINAL U Over 1 to 10 Incl. DATE/,/ ,�� Contractor Date G_ VALI -TION Over 10 to 50 Incl. FINA ❑ I am exempt under Sec. Over 50 to 100 Inc. BY Q. B.&P.C.for this reason Over 100 N Date: Services,Swbd.,MCC& Panelboards , Z 0-200 Amp.Under 600 V i Signature 201 - 1000 Amp.Under 600 V * / ;2 8,3 a 7 A ❑ Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. # 000002 SINGLE FAMILY Temp.Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ' o o255.0 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 o 25500. Code): r-w Misc.Conduits& Conductors I Al 8—8 7 IA 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 S/S I certify that I have read this application and state that the above TOTAL FEE CJJ 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 f .fa ection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE e 6l l� Sign rmrttee Date Vv�ORKERS4COMPENSATION DECLARATION 76-806 10/81 APPLICATION FOR ELECTRICAL PERMIT I�hereby-affirm that I Piave a certificate of consent to self insure, CE-8o6G 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 / r�' _• A. ,✓.,.y M n�. Certified copy is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE ADDRESSr-- Certified copy is filed with the county building inspection 1 & 2-Family,Sq. Ft. $ — $ LOCALITY S &(_ A1,0M i F department. Multi-family Sq. Ft. — NEAREST /� CROSS ST. 0�,o5'"446.4-0 16LV-D Date Applicant Residential Swimming Pools OWNER OR n FIRM NAME jeca9M CERTIFICATE CO COMPENSATION INSURANCE N FROM WORKERS' Outlets:Rec— Light — ADDRESS GSIS �Asd/Q�OOK A4li This section need not be completedFirstt 2 20 ( if the work involved by the Total No. Additional CITY �` � �� Tel.No. permit is for one hundred dollars ($100)or less.) 5�� 7 t\ I certify that in the performance of the work for which this permit PLAN CHECK V 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 /U �� pP ��z,�' �� Additional Total No. CITY No. Date � � Applicant Fixed Appliances Not Over 1 HP PERMIT f NOTICE TO APP ICANT: If, after making 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 Disp. — Room Air Cond. LICENSE B ER Class. (commencing with Section 7000) of Division 3 of the Business and REG.NUMB Professions Code,and my license is in full force and effect. .DISTRICT NOPROCESS B Power Apparatus& Large Appliances � Size& Type HP,KW,KVA,or KVAR License Number Lic.Class Up to 1 Incl. FINAL U Over 1 to 10 Incl. DATE (� VALID ION Contractor Date. Over 10 to 50 Incl. z C, 0 l ❑ FI V I am exempt under Sec. Over 50 to 100 Inc. g ' ol B.&P.C. for this reason Over 100 N Services,Swbd.,MCC& Panelboards , 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 ;2 8 23.8 A HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit # 0,o 0 0,0 2 1 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): I -.6 2S 5 0 I,as owner of the property,will do the work and the structure Misc.Conduits& Conductors o!'6',0 2 5 5 0,9 is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) I Q29-';87 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) ff 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 grope -4or pspection puCpwoses. ` SEE REVERSE FOR EX LANATORY LANGUAGE -4 Cr�_� _ \ Sivffature of Permittee Date