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Home My Public Portal About6324 ENCINITA AVE_Electrical__ '1t y I WORKER'S COMPENSATION ate of consent ON 200019 DPW(tB-91) APPLICATIOWFOR ELECTRICAL PERMIT ILjI f ]68663 `hereby,alfirm that 1-have a certificate of consent tq self.insure. 'oi certif(Gate of Work�'s Compensation Insurance,'or a certified •COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Se_\3800 Lab. C.) FWIQ271730-Q1 Golden Ea le JOB P❑O iCy NO. q1 Golden g FOR APPLICANT TO FILL IN ADDRESS 32 En c i n i to Avenue Certified copy is hereby furnished. New Residential Bldg$.&Pools NO. EACH FEE LOCALiTYTemp 1 e City, CA ,91 700 Certified c0 is filed with the cou building Ins tion 1 &2 Family,Sq. Ft. $ $ PY Y 9 NEAREST department. Multi-family Sq.Ft. CROSS ST. Avenue Date O-5/'0-7/Y6 Applicant Residential Swimming Pools MAP BOOK5382 PAGE OI7 PAPCEL 033 CERTIFICATE OF EXEMP I FROM WORKERS' Outlets:Rec.—Light—SA._ OWNER0` lorth Encinita Trust COMPENSATIO NSURANCE FIRM (This section need not be completed It the work Involved by the Total No. AdtlitiFirst o MAIL Snal ADDRESS 6324 Enc i n i to Avenue permit is for one hundred dollars(5100)or less.) I certify that in the performance GI the work for which this permit CITY lemple City, CA Tel.No. is issued, I shall not employ any person in any manner s0 as to PLAN CHE G{ become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 ApPLICANTre rformance Power Systems Date Total No. Additional ADDRIESS'1326'E. Francis NOTICE TO APPLICANT: If, anter making this Certificate of RESIDENTIAL APPLIANCES NOT OVER 3 HP. CITY . Ontario, CA Tel.No. Exemption, you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions Of the Labor Code, you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked. _ Power Apparatus&Large Appliances APPUCANTSame As Above LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRES8S ame I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 101ncl. (commencing with Section ]000) of Division 3 of the Business and CITY Same Tel.No. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR 693087 Class:C-l0 EL Over SO l0 100 Incl. REG.NUMBER OJ O License Number 693087 LIC.Class CC 10. Over 100 DISTRICT NO. // y P$OGBV Q Services, Swbd.,MCC&Panalboards vit06/ 1,e e_ Q Contractor Performance. Powerpale 05/07/96 0-399 Amp.Under 600 V FIATE NAL ❑ 1 am exempt under Sec. 400-1000 Amp. Under 600 V VALIDATION W Over 1000 Amp.or Over 600 V FINAL d B.&P.C,for this reasonBRANCH CIRCUIT FEES BY Data: 15A,or 20A, 120V,Lighting or Recept. Z 1 To 10 Branch Circuits .f Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits ACCT.A Exemption for Reg, Maim. Elect. 15A,20A,208V To 277V Lighting Sr.Circuits 6 SINGLE FAMILY Temp.Power Pale 8 Appurtenances 333303 70.10 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 1 ITEMS I hereby affirm that I am exempt from the Contractor's License Law ft i 1f''f 10 for the following reason (Section 7031.5. Business and Professions Additional Sign Branch Circuits TOTAL 70 m Code): 70.10 ❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors CHECK is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) D CHANGE .OD and Professions Code). CONSTRUCTION LENDING AGENCY - OOOO-DDO1 `/ E196 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) (] 6317 1 PM 5:42 Civ. C.) None. PLAN CHECKING FEE Lender's Name Lender's s - None PERMIT ISSUING FEE Q O G I certify Thaatt I have read this application and under penalty of purjury stale TOTAL FEE that the above information is correct. I agree to comply with ail County ordinances State laws regulating Electrical wiring,and hereby authorize represent v of this County to enter upon the above-mentioned property for inspec pur oses. 05/07/96 SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATUREV_01PETIMMEE DATE Pelf orMuzirl Pnwer Svstem5 WORKER'S haveCOMPENSATION DECLARATION MA663 DPW(12.91) APPLICATION FOR ELECTRICAL PERMIT 20-001 I hereby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.388000 Lab. C.) C n Policy No. �.�49 ! I S?'•ompany J �� Imo/ ldgs. FOR APPLICANT TO FILL IN JOB O 2 y �A/`r , ILJ' Certified copy is hereby furnished. New Residential B &Pools NO. EACH FEE ADDRESS (/LOCALITY ❑ Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. 3'I" $ ' NEAREST department. Multifamily Sq.Ft. CROSS ST, �d Date- 7' 4 Applicant Residential Swimming Pools ASSESSOR �} 2 •'4'L " 1 MAP BOON PAGEv� PARCEL J CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec.—Light OWNEROR Sw. r FIRM NAME f�iC COMPENSATION INSURANCE First 20 (This section need not be completed if the work involved by the MAIL 5 permit is for one hundred dollars(5100)or less.) Total Ni Additional 1 I certify that in the performance of the work for which this permit CITYTel.No. co Z is issued, I shall not employ any person in any manner so as to PLAIN CHECK became subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No Additional ADDRESS Date - Applicant RESIDENTIAL APPLIANCES NOT OVER 3HP. NOTICE TO APPLICANT: If, after making this Certificate of CITY T.I.No. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such - PERMIT ANT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances L G ei 157 >— LICENSED CONTRACTORS DECLARATION Size&Type HP,KW, KVA,or KVAR ADDRESS P. P 1 hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 101nd. (commencing with Section 7000) of Division 3 of the Business and CITY bTel.Ni _ L Professions Code, and my license is in full force and effect. Over 10 to 50 Ind. LICENSE Over 50 to 100 Ind. REG.NUMBB Claw. 64 G - O /ems/O Over 100 DISTRICT N0. P SEO BY O License Number I�T (O V S� Lia Class ( Services,Swbd.,MCC&Panelboards Contractor 7— - 6 0-399 Amp.Under 600 V FINAL ❑ I am exempt under Sec. / 400-1000 Amp. Under 600 V /(_ C Over 1000 Amp.or Over 600 V ✓ __-----_VALIDATION W FINAL OL B.&P.C.for this reason BRANCH CIRCUIT FEES BY U) Dale: 15A,or 20A,120V,Lighting or Recept Z 64 1 To 10 Branch Circuits Signature 1 To 40 Branch Circuits F-141 Or More Branch Circuits t t Exemption( r Reg. Mainz Elect. 15A,20A,20BV To 2T7V Lighting Br.Circuits 3303 403.61 SINGLE FAMILY Temp. Power Pole&Appurtenances i ITEMS HOME OWN R-BUILDER DECLARATION I hereby affirm that I am e mat from the Contractor's License Law Sign with One Branch Circuit TOTAL 403 . 61 for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits tf Code): CHECK 403.61 ❑ I,asowner of the property,will do the work and the structure Misc.Conduits&Conductors CHANGE .00 is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule)_ D and Professions Code). , CONSTRUCTION LENDING AGENCY 0000-0001 7/ 8i96 1 hereby affirm that there is a construction lending agency for the 722, 1 AM 8"13 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 I certify that I have read this application and under penalty of purjury state TOTAL FEE / that the 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 Cfor�in�spp-eection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE fo OaE OFA ��? �