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Home My Public Portal About6031 & 6035 ENCINITA AVE_Electrical__ WORKERS' COMPENSATION DECLARATION 63 ID/B, OF 8066 APPLICATION FOR (ELECTRICAL PERMIT I`hereby oiflrm that I have a certificate of consent to self OF 806G insure, or o certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS 6037 ENCIN ITA AVE ❑ Certified copy is filed with the county building inspec- I & 2-Family, Sq. Ft. $ — $ LOCALITY TE9MFL6 r,-9T tion department. Multi-family Sq. Ft. — NEAREST Residential Swimming Pools , CROSS ST. GARIaAL0 1 Date Applicant . . ,OWNER OR t ` (�,�• FIRM NAME LARRY 1aAY'NES CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec 40 Light 5 Sw. 1O " t -• 'MAIL COMPENSATION INSURANCE First 20 'r O ''0 ADDRESS x035 E14GIN ITA AVE This section need not be completed if the work involved by Total No. qp the permit is For one hundred dollars ($100)or less.) Additional CITY' 'j ENI�� 1'�'Y Tel. No. GOT—y C5 that in the performance of the work for which this PLAN CHECK I certify P APPLICANT permit is issued, I shall not the loy Work r person in any manner25 so as to become subject to the Work rs' Compensati - laws. Lighting Fixtures First 20 ADDRESS / Additional �,,///j' Total No. _ CITY Tel. No, Dote 1 O SLD pIf, aft ""� Fixed Appliances Not Over 1 HP PERMIT ?{ NOTICE TO APPLICANT: If, after ski this . ert' irate of '{. APPLICANT t,l0�J11'I At1G i�.�', Exemption, you should beco subject to th Workers' Range— Heater—D.W. pp�1� Compensation provisions of Labor Code, you must forth- Oven — Dryer — W.M. ADDRESS .`J'STT [`i Vi STA with comply with such or visions or this permit shall be Top _ FAU —W.H. — 'Z85-5111 deemed revoked. 1 CITY SAN E,A0RIEL Tel. No. Hood Fan _Other_ LICENSED CONTRACTORS DECLARATION Disc, D LICENSE OR �s 1B I hereby affirm that I am licensed under provisions of Chapter 9 J— Room Air Cond. REG, NUMBER 317 1 3 95 Class r (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PRO S D BY a Power Apparatus 8 Large Appliances y and Professions Code, and my license is in full force and effect. Fj F�,L � Size 8 Type HP, KW, KVA, or K%AR' ../ f! f� License Number 3513 t�5 Lic. Class Up to 1 Incl. FINAL ^ ,,, O ,JOSEPH A AUGUST 1 �o Over 1 to 10 Ind. DATE �G �usf/�/' VA ATION k- Contractor DateINAL W ��( Over 10 to 50 Inc).l 2 I am exempt under Sec. Over 50 to 100 Inc. BY / N B.BP.C. for this reason ' NO F—MMO 9`5 Over 100 / ` 3 8 4 9 A z Date: 1 13 E>6 Services, SWli MCC 8 Panelboards 0 -200 Amp, Under 600 V D '# e e e e e 2 Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V .I e * 47.25 Exemption for Reg. Mainz. Elect. SINGLE FAMILY Temp. Power Pole 8 Appurtenances ° • e 4 7..2 5 6 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 0 1, 1 51 8 6 1 hereby affirm that t 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 &Conductors structure is not intended or offered for sale (Section Other (See.Complete Fee Schedule)— D 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) (Sec. 3097, Civ. CJ PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address _ I certify that I have read this application and state that the TOTAL FEE s above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and eebuthorize representatives of this County to enter upon 9't.h�e',abie'v e-mentioned roperty forinspectionpurposes. SEE REVERSE FOR EXPLANATORY LANGUAGE o-/ 1 '13/Pio gat re of P utee Date VJGrm that COMPENSATION have DECLARATION CE 869 10/8I APPLICATION .FOR ELECTRICAL PERMIT I hereby.affirm Ihal � have a certificate of consent to sell CE806G insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or o certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB Ol?C/ �� Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS J 'f 71 Certified copy is filed with the county building inspec- I & 2-Fomily, Sq. Ft. $ — 8 LOCALITY / tion deportment. Multi-family Sq. Ft. - — NEAREST `nf, Residential Swimming Pools 't CROSS ST. G/ . iYI Date—Applicant I OWNER RM N M ,ii CERTIFICATE OF EXEMPTION FROM WORKERS' L tri Q V PNI ADI NAME L/Or�K�K Outlets: Rec ` Light Sw. ) v� 6 COMPENSATION INSURANCE / �U ADDRESS This section need not be completed if the work involved b First 20 ( P T Total No. 6 Additional CITY Tel. No. the permit is for one hundred dollars ($100)or less.) I certify that in the performance of the work for.which this PLAN CHECK`permit is issued, I Shall not employ any person in any mon r APPLICANT so as to become subject to the Workers' mpensation S. Lighting Fixtures First 20 ADDRESS /. �J gj Total No. 4 Additional CITY Tel Date fc App::: t !N' Fixed Appliances Not Over I HE PERMIT NOTICE TO APPLICANT: If, after making rtiiat of ' Exemption, you should become subje _ c o the Workers' Range_ Heater—D.W. APPLICANT , J. Compensation provisions-of the Labor Code, you must forth- Oven —Dryer _W.M.— ADDRESS with comply with such provisions or this permit shall be Top FAU —W.H. n — deemed revoked. CITY Tel. No. LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other— Disp. _ Room Air Cond. LICENSE Class. I hereby affirm that I am licensed under provisions of Chapter 9 � REG. NUMBER } (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCESS dL and Professions Code, and my license is in full force and effect. Power Apparatus 8 Large Appliances L�s 7`y 0 Size 8 Type HP, KW, KVA, or KVAR' (f a License Number bc. Class— FINALUp to 1 Ind. . �7 Over I to 101ncl. DATE �v i- 0 Contractor Date U VALIDAT U ❑ Over 10 to 50 Incl. FINA 1. am exempt under Sec. Over 50 to 100 Inc. BY lD BAP.C. for this reason Over 100 z Date: - Services, Swbd., MCC 8 Ponelboards 0 -200 Amp. Under 600 V D Signature 201 - I000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect, Over 1000 Amp, or Over 600 V 4 9 3 0 A SINGLE FAMILY Temp. Power Pole 8 Appurtenances kie • e e 2 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 S( T e 5 0,5 0 Law for the following reason (Section 7031.5, Business and - ' Professions Code): e e e 5 0 5 0 5 I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)— D 0 0.7 1 7 8 6 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) (Sec, 3097, 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 TOTAL FEE 3 r� above information is correct. I agree to comply with all County ordinances and State la s regulating Electrical wiring, and hereby aut orize rapre ntatives of this County to enter upon the ab -mention roperty for inspection p rp es. SEE REVERSE FOR EXPLANATORY LANGUAGE Sig na Nr f er ute ate -