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HomeMy Public PortalAbout5135 FARAGO AVE_Electrical__ 4 WORKERS' COMPENSATION DECLARATION 76-663 10/81 APPLICATION FOR ELECTRICAL PERMIT 1-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(Seek.3A800.Labb. C.) . fl ,.�(/L}}�../� Policy No.10 ..] " -9 ompany _"�"� Y"w" '' FOR APPLICANT TO FILL IN JOB❑ ��EACH NO. . FEEADDRESS Certified copy is hereby furnished. New Residential Bldgs.& Pools Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft. $ — $ LOCALITY f department. Multi-family Sq.Ft. — NEAREST CROSS ST. Date Applicant T /�� e,y• Residential Swimming Pools OWNER OR V �^ FIRM NAME CERTIFICATECOM ENSAT ONI INSURANCE ORKERS' ADDRESS 4 S E �( &Q C)-,k . S 6 f D 6 Outlets:Rec— Light — Sw.— y (This section need not be completed if the work involved by the First 20 permit is for one hundred dollars($100)or less.) Total No. Additional CITY �� � � Tel.NdB gad- �� certify that in the performance of the work for which this permit PLAN CHECK APPLICANT is issued, I shall not employ any person in any manner, so as to IF become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS 9 Additional � Total No. CITY Tel.No. Date✓��'�° _ Applicant i U�p Gj /;a-C Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLkANT: If, after making this Certificate of APPLICANT uQ (2, 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. — ADDRESS 4/)S L/ke &k&• 0,6 provisions or this permit shall be deemed revoked. Top — FAU W.H. CITY r Tel No. �'Zf' p LICENSED CONTRACTORS DECLARATION Hood Fan Other I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR �� 3 �- Class. (commencing with Section 7000) of Division 3 of the Business and REG.NUMBER 13 Professions Code,and my license is in full force and effect. Power Apparatus DISTRICT NO. PR CE 'E Y �p 0 us& Large /j Size& T e HP, KW, KVA, or KVAR J 1 License Number 44/ 3/'7 t• Lic. Class � Up to 1 Inc]. FINAL V /Contractor �.�QAAA Date 91• Over 1 to 10 Incl. DATE Z VALIDATION Over 10 to 50 Incl. e FINAL ❑ I am exempt under Sec. 0 Over 50 to 100 Inc. gY 9 Gil Over 100 ®- B.&P.C.for this reason N Services,Swbd.,MCC& Panelboards 11110. = "' Date: i i •:. '4 0- 200 Amp.Under 600 V �••y, _r Signature 201 - 1000 Amp.Under 600 V ,p_:'_)a' 25.:I'.1 ❑ Over 1000 Amp. or Over 600 V Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit — 50 I hereby affirm that I am exempt from the Contractor's License Law •t".f'_'. •-'•b•= i h Ci B Sign Sgn rancCircuits _ for the following reason(Section 7031.5, Business and Professions Additional ,., f•,r, Code): ❑ I,as owner of the property,will do the work and the structure Misc.Conduits & Conductors is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) n r3 0 ► and Professions Code). �« ,,• CONSTRUCTION LENDING AGENCY ��• �• A�104 1 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) S (7v Civ. C.). 7T"o ,x/ 7`'�-• D /fQ /C PLAN CHECKING FEE Lender's Name ��"' �Y n�ypy'h�U�T,'��1J Lender's Address 4" s. 4 C�Ca^CiA /�cy, PERMIT ISSUING FEE �f 6j I certify that I have read this application and state that the above TOTAL FEE ��,(ju information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this C u y to enter upon the above-mentioned property for inspection oses. ,T p SEE REVERSE FOR EXPLANATORY LANGUAGE naure of Pe mittee �C"U�Dat + ' r� WORKERS'COMPENSATION DECLARATION -'76F66S 10/81 APPLICATION FOR ELECTRICAL PERMIT f%�reby_4ffirm 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 ADDRESS Bldgs.& P�p Is EACH NO. ' FEE ❑ 1 & 2-Family,Sq.Ft. 125 $e — $ LOCALITY Certified copy is filed with the county building inspection department. Multi-family Sq.Ft. — NEAREST CROSS ST. ff'� Date Applicant Residential Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec— Light Sw. MAIL COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work involved by the First 20 CITY Tel.No. permit is for one hundred dollars ($100)or less.) Total No. Additional I certify that in the performance of the work for which this permit PLAN APPLICANT CHECK is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. i Lighting Fixtures First 20 ADDRESS . � Total No. Additional CITY Tel.No. � � Date Applicant ` Fixed Appliances Not Over 1 HP 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 46— provisions or this permit shall be deemed revoked. Top —.FAU W.H. A J LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ CITY Tel.No.33-<--%-7 I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. LICENSE O q (commencing with Section 7000) of Division 3 of the Business and REG.NUMBER P5 Class.01 p Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO, PROCESSED BY n Size& Type HP,KW,KVA,or KVAR O License Number 137 Lic.Class y— Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE 1,0 � VALIDATION O Contractor c�ceCN�/'Li Date Over 10-to 50 Incl. '� FINA 7 17— ❑ I am exempt under Sec. Over 50 to 100 Inc. V � B.&P.C.for this reason Over 100 Z Services,Swbd.,MCC & Panelboards 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 HOME OWNER-BUILDER DECLARATION Sign with One Branch CircuitF5' IL I hereby affirm that I am exempt from the Contractor's License Law >9tP for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): 76� ❑ I,as owner of the property,will do the work and the structure Misc.Conduits& Conductors d is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) ® TOTAL 76.86 �-�t and Professions Code). CONSTRUCTION LENDING AGENCY CHECK HYTIECK 76.86 1 hereby affirm that there is a construction lending agency for the CHIVE 00 performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) Civ. C.). Lender's Name PLAN CHECKING FEE 34" 1 5/24/89 � �� d PERMIT ISSUING,FEE �� �� 1 AM10:50 Lender's Address P99��iV �vVV 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 property for inspection urp ses. i�� SEE REVERSE FOR EXPLANATORY LANGUAGE Sign ture of Perrrlttee Date 4, WORKERS'COMPENSATION DECLARATION 78-863 o10/81 CE-806G �Y�/1 APPLICATION FOR ELECTRICAL PERMIT •I.he`reby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY 'uI copy'thereof (Sec.3800,Lab. C.) Policy No.*- Company FOR APPLICANT TO FILL IN JOB / /— ❑ Certified copy is hereby furnished. EACH NO. FEE ADDRESS New Residential Bldgs. & Pools ❑ 1 & 2-FamilySq.Ft. $ • � — $ LOCALITY Certified copy is filed with the county building inspection , department. Multi-family Sq.Ft. — NEAREST CROSS ST. Date Applicant Residential Swimming Pools OWNER OR FIRM NAME i CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec Light — Sw. MAIL COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work involved by the First 20 Total No. Additional CITY Tel.No. permit is for one hundred dollars($100) or less.) I certifythat in the performance of the work for which this permit PLAN CHECK P P 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 Total No. Additional CITY Tel.No. Date ��� Applicant /' Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of PERMIT Exemption,you should become subject to the Workers'Compensation Range_ HeaterD.W. _ APPLICANT _ provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M. _ ADDRESS C-L-0 J provisions or this permit shall be deemed revoked. Top — FAU _ W.H. _ CITY Tel.No. s��j LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE Class. 6— (commencing with Section 7000) of Division 3 of the'Business and REG.NUMBER Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. Jf 0 PROCESSED BY //jf �-- /l Size& Type HP,KW,KVA, or KVAR 0 License Numbe/r�`-ttL) 7/3� Lic.Class Up to 1 Incl. FINAL U S`1pp G��" ' -- Over 1 to 10 Incl. DATE /r!j 2 D� O ContractorJJ// YYXXQ/ Date J VALIDATION Over 10 to 50 Incl. U ❑ FINAL I am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C.for this reason Over 100 Cf) Services,Swbd.,MCC& Panelboards ® Z Date: 0- 200 Amp. Under 600 V Signature 201 - 1000 Amp.Under 600 V F-1 Exemption 1000 Amp. or Over 600 V Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp. Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 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 _ �g Code): !6© 86 ❑ Misc.Conduits&Conductors a XTM I,as owner of the property,will do the work and the structure is not intended or offered for sale (Section 7044, Business Other (See Complete Fee Schedule) ® ®�� and Professions Code). MAL CONSTRUCTION LENDING AGENCY 76®86 I hereby affirm that there is a construction lending agency for the CFAMEp� performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) f ° oVL� Civ. C.). " ' PLAN CHECKING FEE g� Lender's Name �fJ` 5/24/89 PERMIT ISSUING FEE Lender's Address 34% 1 10150 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 property for in pectio urp ses. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Peknittee Date b, / WORKERS'COMPENSATION DECLARATION CEA80663 6G 10/81 APPLICATION FOR ELECTRICAL PERMIT .I,k�,eYeby affirm that I have a certificate of consent to self insure, 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. EACH NO. FEE ADDRESS�� New Residential Bldgs.& Po s ❑ 1 & 2-Family,Sq.Ft. $ — $ / LOCALITY Certified copy is filed with the county building inspection department. Multi-family Sq.Ft. — NEAREST CROSS ST. Residential Swimming Pools OWNER OR Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec— Light — Sw. MAIL COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work involved by the First 20 CITY Tel.No. N Total Additional permit is for one hundred dollars($100)or less.) To ' 1 certify that in the performance of the work for which this permit PLAN CHECK is issued, I shall not employ any person in any manner so as to APPLICANT become subject to the Workers'Compensation►Laws. �) Lighting Fixtures First 20 ADDRESS a� �n // ,6/ Total No. Additional Date � Applicant �IX.Y hfi� �lL CITY Tel.No. NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APPLICANT provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M._ ADDRESS provisions or this permit shall be deemed revoked. Top — FAU W.H. — LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ CITY Tel.No.`33 ,;''�3 I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR (commencing with Section 7000) of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER 7 Class. Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY Size& Type HP, KW,KVA,or KVAR 0 License Number /37 Lic. Class ��� Up to 1 Incl. FINAL //�—///� ��,,�+, Over 1 to 10 Incl. VALIDATION Contractor 4.1ebk gxi ate 6 -;3146 DATE ) 4 07 O ❑ Over 10 to 50 Incl. FINAL / r// ~ I am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C.for this reason Over 100 Services,Swbd.,MCC& Panelboards ® Z Date: 0-200 Amp.Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp.or Over 600 V " Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp. Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit' I hereby affirm that I am exempt from the Contractor's License Law ��$ for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits e Code): ❑ Misc.Conduits& Conductors I,as owner of the property,will do the work and the structure 9 q is not intended or offered for'sale (Section 7044, Business Other(See Complete Fee Schedule) d1 2S and Professions Code). ® 76 86 CONSTRUCTION LENDING AGENCY 76M 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 5/24/89_ PERMIT ISSUING FEE r � 1®s31 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 propSaW4r inspectio&rp ses. SEE REVERSE FOR EXPLANATORY LANGUAGE ywh;Signature of er ttee Date • {: WORKERS'COMPENSATION DECLARATION -663 ,D,B, C APPLICATION FOR ELECTRICAL PERMIT T ,t hereby affirm that I have a certificate of consent to self insure, E-sosG or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy.thereof(Sec. 3800,Lab. C.) Policy,Ncr Company FOR APPLICANT TO FILL IN. JOB S/�/ ❑ Certified co EACH NO. FEE ADDRESS — /-3/ is hereby furnished. New Residential Bldgs.& Pools ❑ 1 & 2-Family,Sq.Ft. $ — $ G LOCALITY Certified copy is filed with the county building inspection department. Multi-family Sq.Ft. NEAREST CROSS ST. Date Applicant Residential Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec— Light Sw. MAIL COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work involved by the First 20 permit is for one hundred dollars($100) or less.) Total No. Additional CITY Tel.No. I certify that in the performance of the work for which this permit PLAN CHECK 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 ' .� p � � �J ��"_V I Applicant / 1 Total No. Additional CITY Tel.No. Date NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT APPLICANT Exemption,you should become subject to the Workers'Compensation Range_ HeaterD.W. _ _ provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M._ ADDRESS e O 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 (commencing with Section 7000) of Division 3 of the Business and REG.NUMBER ER Class. Professions Code,and my license is in full force and effect. 'Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY O //•� Size& Type HP,KW,KVA,or KVAR 0 License Number. c/)I Lic.Class` Up to 1 Incl. FINAL V Over 1 to 10 Incl. DATE l6 VALIDATION 0 Contractorhd� Date ( Over 10 to 50❑ Incl. I--FINAL I am exempt under Sec. Over 50 to 100 Inc. gY LLI Over 100 BAP.C. for this reason Services,Swbd.,MCC& Panelboards , 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 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit /� n I hereby affirm that I am exempt from the Contractor's License Law '` 4�7 for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits e q� Code): �� 76.86 I;as owner of the property,will do the work and the structure Misc.Conduits & Conductors is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , ®�y and Professions Code). TOTAL 76.4346 CONSTRUCTION LENDING AGENCY 76.86 1 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) , J{f Civ. C.). PLAN CHECKING FEE g 15/24 B Lender's Name .� ,�+ b 49 89 PERMIT ISSUING FEEw /liae Lender's Address 67788!! 50 I certify that I have read this application and state that the above TOTAL FEE 7/ 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 propert for inspection p rposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �"a1 Signature of Per ttee Date