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Home My Public Portal About6351 ENCINITA AVE_Electrical__ DEC TION WORKERS't I have a certificate cafe of corse •, 76A668 10,61 APPLICATION FOR ELECTRICAL PERMIT I hereby aft{4n that I have a certificate of consent to self � CC-e06G insure, ar a izrtifimfe of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lob. C.) Policy NO. Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. &.Pools EACH NO. FEE ADDRESS ❑ Certified copy is filed with the county building inspec- 18 2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. — NEAREST CROSS ST. t7. Residentiol Swimming Pools OWNER OR Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec_Light " Sw. IL ( COMPENSATION INSURANCE ( s sachet, DDRES$ ( 6. (This e completed need not bleted if the work involved First 20 + . No. the permit is for one hundred dollars ($f00)or less.) Total No. Additional CITY.- Gt T Tel -S- 4 I certify that in the performance of the work for which this PLAN CHECK 141 1A permit is issued, shall not employ any person in any manner APPLICANT so as to become subject to the Work Comp 'sari n La Lighting Fixtures First 20 ADDRESS Additional � Total No. CITY Tel. No. j Date -- -v �Pelican ' �� Fixed Appliances Not Over I HP PERMIT �/ NOTICE TO APPL CANT:' If, after maki g this- ertificate of APPLICANT /C Exemption, you should become subject to the Workers' Range_ Heater—D.W. Compensation provisions of the Labor Code, you must forth- Oven _Dryer —WiM.— ADDRESS with. comply with such provisions or .this permit shall be Top FAU —W.H. deemed revoked. CITY r el. No. Hood Fan _ Other - LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. REG. NUAAR& ~AI Class. (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCESS BY and Professions Code, and my license.is in full force and effect. Power Apparatur8 Large Appliances C,_ �^� t R • _ Size 8 Type HP, KW, KVA, or KVAR' �r v0 4 O License Number Lic{lass Up to I Incl. FINAL I V Over 1 to 10 Incl. DATE .r2` VALIDATION Cr Contractor Date Over cl 10 to 50 In . / O FINAL ~ ❑ I amexempt under Sec. Over 50 to 100 Inc. BY _ d B.BP.C. for this reasonOver 100 t Z Date: Services wbd. Iboards D 0 - 200 Amp. Under 600 V Signature 201 - 1000 Amp`. tJ?rder 600 V ❑ Exemption for Reg. Maint, Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole 8 Appurtenances 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 Law for the Following reason (Section 7031.5, Business and ' Professions Code): 19 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 `.3 85' , a I hereby affirm that there is a construction lending agency for # e a s e e 'Z the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). 6 2 5 PLAN CHECKING FEE t ' Lender's Name o o e 4 6 2 5 U PERMIT ISSUING FEE j ' Lender's Address0 8 2 9-8 4 1 certify that I have read this application and state that the TOTAL FEE + r04 above information is correct. I agreeIto comply with all County , ordinances and State laws regulating Electrical wiring, and hereby authorize represent lives of this County to enter upon the abive r3ention d p pert for i spection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE c C Signator of Permi tee // Date / ION Wm that I have a certificate of consent 'l6-806 ,D,B, APPLICATION FOR ELECTRICAL PERMIT � � ' I hereby affirm that I have a certificate of consent to self insure, CE-806G 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 ❑ Certified copy is hereby furnished. _ New Residential Bldgs.8 Pools EACH NO. FEE ADDRESS ❑ S — $ LOCALITY Le ' Certified copy is filed with the county building inspection 1 & 2-Family,Sq'FL department. Multi-family Sq.Ft. — .NEAREST C�O Date _ -CROSS ST. ONr+Applicant Residential Swimming Pools `' OWNER OR - t 1 FIRM NAME DY e r CERTIFICATE OF EXEMPTION FROM WORKERS' J MAIL Outlets:RaeLight — Sw. — - j ADDRESS COMPENSATION INSURANCE First 20 (This section need not be completed if the work involved by the CITY TelNo permit . ..is for one hundred dollars ($100)or less.) Total No. Additional , I certifythat in the performance of the work for which this permit PLAN CHECK - P APPLICANT is issued, I shall not employ any person in any manner o as to - become subject to the WorkersCompens to •Laws. Lighting Fixtures First 20 ADDRESS Additional _ Total No. - CITY - Tel.No. Date APPlican Fixed Appliances Not Over 1 HPPPPLICANT ERMIT m NOTICE TO APPLICANT: If, after. akin A this Certificate of toy e r Exemption,you shouldbecome subject to the WorkersCompensation Range_ Heater_ D.W. _ 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 9LICENSE OR (commencing with Section 7000) of,Division 3 of the Business and Disp. — Roam Air Cond: REG.NUMBER Class, Professions Code,and my license is in full force and effect. -Power Apparatus& Large Appliances DISTRICTT NO. n PROC ED BY Size 8 Type HP,KW,KVA,or KVAR ✓. OC/ C.(�•W 0 License Number Lic.Class - Up to 1 Incl. - FINAL' /�/1 Over 1 to 10 Inc[. DATE VALIDATION O Contractor ✓L✓�e� -0ale Over 10 to 50 111 FINA (~,) ❑' I am exempt under Sec. Over 50 to 100 Inc. BY _ a BAP.C.for this reason Over 100 Services,Swbd:, MCC& Panelboards Z Date: 0- 200 Amp.Under 600 V # l9 } };'Z1,^L r9 Signature 201 - 1000 Amp.Under 600 V Over 1000 Ampp.or Over 00 V I e o 27.50 ❑ Exemption for Reg.Main!.Elect. --- 53rY �w - ' o � 2Z5OF3 ' SINGLE FAMILY - ' Temp._Power Pole 8 Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 1, 4?8 8 1 hereby affirm that I am exempt from the Contractor's License Law Additional Sign,Brarlch Circuits for the following reason(Section 7031.5,Business and Professions ' Code): - Ur1,as owner of the property,will do the work and the structure Mise.-Conduits& Conductors is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) D 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 O PERMIT ISSUING FEE, _ . Lender's Address I certify that I have read this application and state that the above TOTAL FEE _ 1J information is correct.I agree to comply with all County ordinances and State laws regula' g Ee rice! wiring, and hereby authorize representa' as of this ounty t enter upon the above-mentioned - property r, spect oses SEE REVERSE FOR EXPLANATORY LANGUAGE ., S`Igl e ittee Date