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Home My Public Portal About5825 ENCINITA AVE_Electrical__ WORKERS' COMPENSATION cafe of once ,zoamsDPW 3,ez APPLICATION FOR ELECTRICAL PERMIT O I hereby affirm )hot'I have a certificate of consent to self [EAB�ObG .� insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lob.'C.) _ Policy No. - 2 S Company )?.AIRA4PA)T FOR APPLICANT TO FILL IN JOB ' Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRES AVE O Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. LM `T $ — $ LOCALITY l& tion department. Multi-family Sq. Ft. — NEAREST Residential SwimmingPools CROSS ST. Date, - 1 D Applicant �� Hu1A J i� FOI RM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RecLightSw._ MAIL COMPENSATION INSURANCE ADDRESS (This section need not be completed if the workled by First 20 Total No. Additional CITY Tel. No.3n• _ The permit is for one hundred dollars ($100)or less.)ess.) certify that in the performance of the work.for which this PLAN CHECKAPPLICANT 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 20 ADDRESS Total No. Additional CITY Tel. No. Date �'' 15 — V Applicant 1, NLJA LfE NOTICE TO APPLI NT: 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. — APPLICATION Compensation provisions of the Labor Code; you must forth- Oven — Dryer —W.M.— ADDRESS 1. O with comply with such provisions or this.,permit shall be Top —.FAU —W.H. — deemed revoked. Hood _ Fan —Other_ CITY Th No. _ UCENSED CONTRACTORS DECLARATION LICENSE OR hereby affirm that lam licensed under provisions of Chapter Disp., Room Air Cond. REG. NUMBER Class. LI- (commencing with Section 7000)of Division 3 of the Business Power Apparatus & Large Appliances DISTRICT NO. R ED Y t Y and Professions Code, and my license is in full force and effect, 1./ /' d Size &Type HP, KW, KVA, or KVAR U License Nunri rq- Lic. Class G- 1 J Up to I Incl. FINAL U IW U1A f �T Over 1 to 10 Incl DATE '� i VALIDATION 0 Contractor - � Y Date Over 10 to 50 Incl. U ❑ FINAL 0 I am exempt under Sec Over 50 to 100 Inc, gyOver 100 / U LU LU 8.8P.C. for this reason D Z /I T(f)- Services, Swbd., MCC 8 Panelboards Date: 0-200 Amp. Under 600 V Signature 1-MI HU>A 1-Er- 201 -\1000 Amp. Under 600 V ❑ Over 1000 Amp, or Over 600 V Exemption for Reg. Mainz. Elect.- SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp. Power Pole 8 Appurtenances +- •�• + I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit �f`-LT•s Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): - dJU( �L•�'J ❑ I, as owner of the property, red f o the work and the Misc. Conduits& Conductors 1 FENS" structure a not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule) D 1 CITAL ' IJ �� Business and Professions Code). '1'1 III, CONSTRUCTION LENDING AGENCY - CHECK "f 8.211-' I hereby affirm that there is a construction lending agency for CHANGE .I!I_I the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE 010110-DOCt1 L�11.41?r! Lender's Name PERMIT ISSUING FEEGSRC7 .I AN V.•,_„� Lender's Address -�., 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 'p hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE J_= _r _4 L7 _ 1 —i3 ” ' Signature of Permittee Doe �s _ WORKERS"COMPENSATION DECLARATION 7eA683 total CE-806G APPLICATION FOR ELECTRICAL PERMIT hereby {1 -I afSrm,thaf I have a certificate of consent to self insure, LJ or a'certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy l�ereof-(Sec.3800,Lab. C.) Policy N<. Company t�zQIA4JT 'GlJS�.IULF FOR APPLICANT TO FILL IN JOB ' ❑ Certified copy is hereby furnished. New Residential Bldgs.& Pools EACH NO. - FEE ADDRESS S °64—; /e4P, - 1 8 2-Family.Sq.FL ' $ — $ LOCALITY Zu Lx .Certified copy is filed with the county building inspection department. Multi-family Sq.Ft. — NEAREST CROSS ST ois T<!AA Swimming Date e�I I�� Applicant <''-�"a� v CI+T`t� Residential 9 Pools OWNER MR . . FIRM NAME JT CoQ. Tia• , -CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec_ Light _ Sw. — MAIL COMPENSATION INSURANCE ADDRESS 16— fR6 � 490l Of.'First 20 �- (This section need not be completed If the work involved by the permit is.for one hundred dollars ($100)or less.) Tocol No. Additional CITY Sgt7M�c, 648��. (;/# Tel.No. �;aft o)R 7 I certifythat in the performance of the work for which this permit PLAN CHECK �cn APPLICANT K«JG yN�(✓1 is,issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS 1L-0 PTwIv, Qw,.. Additional � - Total No. - CITY H I� 5 Tel.No. if Date Applicant - Fixed Appliances Not Over 1 HP PERMIT �� NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT G S Exemption,you should become subject to the Workers'Compensation Range— Heater— D.W. provisions of the Labor•Code, you must forthwith comply with such Oven _ Dryer — W.M. — ADDRESSV - by (� provisions or this permit shall be deemed revoked. Top — FAU — W.H. CITY SaOM$'S''� Tel.No.W W� nr LICENSED CONTRACTORS DECLARATION Hood —,Fan — Other_ 01 I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Could. LICENSE OR $SoQ - Class. (commencing with Section 7000)of Division 3 of the Business and REG.NUMBER 5 I Professions Code,and my license is m full force and effect. - Appliances - DISTRICT NO. P CES ED BY Power Apparatus 8 Large nn Size& Type HP,KW,KVA,or KVAR 1 �U License Number .53�� l I Lic.Class \S Up ti Rol. FINAL I Over 1 to 10 Incl. DAT VALIDATION Q- ContractorWOW T-m*rDate��1(yP - Over 10 to 501nc1. FINA U ❑ I am exempt under Sec. Over 50 to 100 Inc. BY LLJ O. B.&P.C.for this reason Over 100 K V N Services,Swbtl.,MCC 8 Panelboards Z Date: . 0- 200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V - - - Over 1000 Amp.or Over 600 V El Exemption for Reg.Maint.Elect. -"'••"'-'+" •' SINGLE FAMILY Temp.Power Pole& Appurtenances w2 - HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit rft.CT a I hereby affirm that I am exempt from the Contractor's License Law ' ' A ' for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits• 7 .Ce O Code): . . _ _ Misc.Conduits& Conductors 1 ITUS ❑ Las owner of the property,will do the work and the structure Other(See Complete Fee So edule ,V 25.50 is not intended or offered for sale (Section 7044, Business j D zTl and Professions Code). - .1JL•��1r e1� CCrr CONSTRUCTION LENDING AGENCY 1r11GM L�O`��I�I1 I hereby affirm that there is a construction lending agency for the _ aW performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) Civ. C.). PLAN CHECKING FEE 1 W Jl/89 Lender's Name �( V1/�J (� PERMIT ISSUING FEE U 5438 1 AH11o4E Lender's Address I certify that 1 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 f Perm teeD�