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Home My Public Portal About4949 FIESTA AVE_Electrical__ WORKERS' COMPENSATION DECLARATION .20-0019 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self -ce e06G insure, or d certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or-.a certified cop thereof (Sec. 3800, La C ) Policy NoI 16�+I � I Company a I FOR APPLICANT TO FILL IN JOB r' ❑Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS 61 �t�S 1ertified copy is filed with the c y.buildi g inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY (-rem �o Ct Al LuLLJJJ tion department. ! � Multi-family Sq. Ft. g — NEAREST L CROSS ST. Date qZ Applicant Residential Pools OWNER OR CERTIFICATE OF EXEMPTION FROM WORKERS' Z , '4 /y' FIRM NAME e e r Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE �� ADDRESS c-� First 20 (This section need not be completed if the work involved by . the No. Additional �/3 CITY TelNo. �$�Z 2 3 the permit is for one hundred dollars ($100)or less.) PLAN CHECK I certify that in the performance of the work for which this APPLICANT 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 Additional 1,70 Total No. �— CITY Tel. No. Date Applicant Fixed Appliances Not ver 1 HP PERMIT / NOTICE TO APPLICANT: If, after making this Certificate of or APPLICATION 7 LS LOnS Exemption, you should become subject to the Workers' Range— Heate D.W. — 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. — Q deemed revoked. Hood — FanOther— �v �C� CITY �, L-Tel. No. LICENSED CONTRACTORS DECLARATION / LICE REG.NSE OR p S C� I hereby affirm that 1 am licensed under provisions of Chapter 9 Disp. — Room Air Cond. — NUMBER Class. (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PR SED BY ?- and Professions Code,and my license is in full force and effect. �� 11 pp r Size&Type HP, KW, KVA, or KVAR 0 License N r ill b�`J S Lic. Class f' Up to 1 Incl. FINAL q U Contractor Date 2 2 Z Over 1 to 10 Incl. DATE 7. /� /Z VALIDATION Er ❑ Over 10 to 50 Incl. FINAL F— I am exempt under Sec. Over 50 to 100 Inc. BY /(! W B.&P.C. for this reason Over 100 d Services, Swbd., MCC& Ponelboards Z Date: 0-200 Amp. Under 600 V Z Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Mainz. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole &Appurtenances x. HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits T'fir'}'; Professions Code): Misc. Conduits&Conductors ❑ 1, as owner of the property, will do the work and theti:-� structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ , Business and Professions Code). CONSTRUCTION LENDING AGENCY 41 r- I hereby affirm that there is a construction lending agency for ••;;ri;-•,ate u the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE ii Lender's Name '` _ J. PERMIT ISSUING FEET 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 "nature tate laws regulating Electrical wiring, and representatives of this County to enter upon d property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ittee Dat WORKER'S COMPENSATION DECLARATION 9 DPW 9/89 APPLICATION FOR ELECTRICAL PERMIT 76A66 I hereby affi�m�that I have a certificate of consent to self insure, 76A663 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.38800 Lab. C.) 7/�O Policy No.L� (70 ifCompany !Vn/e h Cll� FOR APPLICANT TO FILL IN JOB U(� ADDRESS / 7 �/Pi�j•�y Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE _ � /� �•, IILJ Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. $ $ LOCALITY NEAREST a ent. Multi-family Sq.Ft. CROSS ST. Residential Swimming Pools ASSESSOR Date ' Applicant MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER OR COMPENSATION INSURANCE Outlets:Rec._Light Sw. FIRM NAME Cr e tCI� First 20 (This section need not be completed if the work involved by the MAIL Total No. Additional ADDRESS permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITY Tel.No. 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 PLAN CHECK APPLICANT Total No. Additional ADDRESS Date Applicant 15 OR 20A,120V BRANCH CIRCUITS NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers'Compensation 1 TO 10 INCLUSIVE EACH provisions of the Labor Code, you must forthwith comply with such 11 TO 40 INCLUSIVE EACH PERMIT d /( e provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH APPLICANT J f / LICENSED CONTRACTORS DECLARATION 15 OR 20A,208V TO 277V LIGHTING EACH ADDRESS 3-70 �J�d•� e / 11 I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3'of the Business and CITY Gyl Tel.No.�1y�3 0 Professions Code,and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP 4REG. ENSE OR �c Pj, L 2 Power Apparatus&Large Appliances NUMBER C 7 Class/ License Number Lic.Class- Size&Type HP,KW,KVA,or KVAR TRICT NO. PROCESSED BY O Up to 3 Incl. �L`pj� L�LI /�A']//, Over 3 to 10 Incl. AL M Contractor•t'r'�CS ��5�( Date / Over 10 to 50 Incl. E /jam' U) ❑ 1 am exempt under Sec. Over 50 to 100 Incl. VALIDATION 100 FINAL B.&P.C.for this reason Over By 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. .7 SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit Ihereby 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 -i,' .;i,'�?,r Code): _ ❑ i3' ; 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) , ,J T AL and Professions Code). . , CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the %JI, ' F_ _' '•? performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ. C.) PLAN CHECKING FEEt rj j_jj_—{s N;'} 4"! Lender's Name _ PERMIT ISSUING FEE aY 75' ir+ =i r: u j S i Lender's Address I certify that 1 have read this application and state that the above TOTAL FEE a information is correct. I agree to comply with all County ordinances ttt e laws regulating Electrical wiring, and hereby authorize native of his County to enter upon the above-mentioned y for in c n urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE E OF APPLICA OR AGE DATE WORKERS'COMPENSATION DECLARATION CE 806G (2.80) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab. C.) /,5 71,Y FOR APPLICANT TO FILL IN JOB of Policy No. Company EACH NO. FEE ADDRESS New Residential Bldgs.&Pools Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY Multi-family Sq. Ft. — NEAREST Certified copy is filed with the county building inspection CROSS ST department. Residential Swimming Pools OWNER OR off FIRM NAME Date Applicant Outlets: Rec.—Light—Sw. MAIL First 20 ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY Tel No. COMPENSATION INSURANCEO PLAN C HEC ?4 0 (This section need not be completed if the work involved APPLICANTP U by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS Additional cc Total No. Additional 1 certify that in the performance of the work for which thisCITY Tel No. Fixed Appliances Not Over 1 HP U permit is issued, I shall not employ any person in any manner PERMITLU so as to become subject to the W ers'_Compensation Laws. Range_ Heater_D.W. APPLICANT ` Oven'_ Dryer_W.M._ ADDRESS z Date+ ,� plicant Top FAU _W.H.. CITY Tel No. Hood Fan _.Other_ NOTICE TO APPLICANT: If, after making this Certificate of Disp. — Room Air Cond._ LICENSE OR Exemption, I REG.NUMBE Class p you should become subject to the Workers' . Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NOPROCSED BY with comply with such provisions or this permit shall be Size&Type HP,KW, KVA,or KVAR. / deemed revoked. �c G, - G �V Up to 1 Incl. FINAL ZZ LICENSED CONTRACTORS DECLARATION - Over 1 to 10 Incl. DATE /� VALIDAL-PIOON Over 10 to 50 Incl. v I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL /79 (commencing with Section 7000) of Division 3 of the Busi- Over 100 ness and Professions.Code, and my license is in full force and effect. Services 1,01F License Numb ' 2011 Lic.Class 0 -200 Amp. Under 600 V �� -1000 Amp. Under 600 V �r Contractor / Date Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp. Power Pole& Appurtenances I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits 3.1,5 ness and Professions Code): e-9 4 Misc.Conduits&Conductors ;4 0 0' 0 0 0 2 I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— structure is not intended or offered for sale (Section 2 ° ° 1 9.5 0 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency ° ° ° 1 9,5 0 x 3 for the performance of the work for which this permit is PERMIT FEE (Sub-Total) �t ) 0 a Q 9-8 1 issued (Sec. 3097,Civ.C.). Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE 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 hereby authorize representatives of this County to enter upon the ve- ti a property r inspection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE / Signature of Permittee bate