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Home My Public Portal About10526 FREER ST_Electrical__ WORKERS'COMPENSATION DECLARATION CE-663 10/81 APPLICATION FOR ELECTRICAL PERMIT _ , I hereby affirm that I have a certificate'of cpnsent fo•,.self insure,, CE. . - or a certificate of Workers` Compensation Insury a�e;�a Certified COUNTY OF LOS ANGELES BUILDING AND SAFETY : _ ,fl ` p thereof(Se 13 0 ,Lab.C) 64i4 � • . O ICY-No ,�, 0.3 `Company � ^ d • FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished o—A EACH NO. FEE ADDRESS rI , New Residential Bldgs & Pools ❑ a,6#10 — $ LOCALITY �f Certified copy is filed•with.the county building inspection 1 & 2-Family,'Sq-Ft $• 5 department., t Multi-family Sq Ft — NEAREST _ CROSS ST Date Applicant Residential Swimming Pools FIRWNER OR M NAME J CERTIFICATE OF,EXEMPTI FROM WORKERS' Outlets Rec Light — Sw A_ MAIL , • . COMPENSATION INSURANCE ADDRESS (This section need-not be completed if the work involved by the First 20 Total.No. Additional -•CITY Tel.No -permit is for one hundred dollars($,100)or less.) ' • I certifythat in the erformance of the.work for which this permit PLAN CHECK P- ,i 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 '' a 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_ DW APPLICANT provisions of the Labor Code, you•must forthwith comply with such Oven Dryer WM._ ADDRESS provisions or this permit shall be deemed revoked Top, FAU W.H. _ CITY Tel N LICENSED CONTRACTORS DECLARATION Hood Fan Other_ I hereby affirm that I am licensed under provisions of Chapter 9 Disp Room Air Cond. LICENSE OR / (commencing with Sechon•7000) of Division 3-of the Business and y,l , REG NUMBER lD Cuss•!-'/d Professions Code,and micense,6'ih full force and effect - - - DISTRICT NO PROCESSED BY Power Apparatus& Large Appliances ��q Size& Type HP,KW,KVA,or KVAR r O U License Number Lic.Class 1—16 Up to 1 Incl. FINAL - ��➢y Over 1 to 10 Incl DATE10 Wff -VALIDATION Contractor Date p.��9D Over 10 to 50 Incl - U FINAL I am exempt under Sec Over 50 to 100 Inc. gY„ , 1 W / � B&P C for this reason Over•100 C/) Services,Swbd,MCC,& Panelboards , R 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•o'le & Appurtenances. HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit a I hereby affirm that I am exempt from the Contractor's License LawAdddional: ACCT.T for the following reason (Section 703t5, Business and Professions'- Sign Branc h .Circuits Code) 3307. 130.00 " Misc.Conduits & Conductors 1 ITEMS 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) , ( VITAL 130®DO and Professions Code) � CHECK 130 a OI.I CONSTRUCTION LENDING AGENCY - I hereby affirm that there is a construction lending agency for the CHANGE .00 performance of the work for which this permit is issued(Sec�3097, ,.. PERMIT FEE ' (Sub-Total) ` Civ.C:) t•�n .. n PLAN:CHECKING.FEE �Ct0�1_0001 5�18/9G Lender's Name ". UtJV PERMIT ISSUING FEE /3. 0 0777 1 Al MIit}1V 13 'L'enders 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 property form ction purposes SEE REVERSE FOR,EXPLANATORY LANGUAGE na ure of Permittee Date WORKERS'COMPENSATION DECLARATION. 76A663CE-806 10/81 APPI�@GATO®� ®� ELECTRICAL PERMIT.-!. ' I hereby affirm that I have a certificate of consent tc `self•insure, CE-Bose 9 or ayy certifxate;ofrWork'ers'.Compensation'lnssurra(ce,•or a'certified COUNTY,OF LOS ANGELES BUILDING AND SAFETY 1t✓CPvthereof( 11 3,Lab C.) CRu tor�/U'iH - Policy • 'Company 0AJUA�7l/ FOR APPLICANT TO FILL IN JOB Certified copy is hereby,furnished. New Residential Bldgs & Pools EACH NO FEE ADDRESS $ LOCALITY '. ❑"' Certified, copy 'is filed'&th •t&i county building inspection 1 &"2,=Famdy,;Sq Ft �� , $'� -department t,' - '.r� _ NEAREST , = .,�^ Multi-family�Sq Ft'' .p' CROSS;ST Date -Applicant .`r.' Residential Swimming Pools OWNER OR .:' f ,. r' FIRM NAME ` �r.4✓. CERTIFICATE OF EXEMPTI N FROM WORKERS' .: . MAIL Outlets�Rec Light SW • D , , '.'COMPENSATION INSURANCE t W ;ADDRESS , f ; Thrs�section need not be com leted'if"the work involved b the i- First 20,• ( P_ y', CITY Tel Total No Additional r1 ' :permit is for one.hundred dollars•.($J00)or less.), - U -- � �si�/ • (,certify,that m the performance,of-the work for.•which this,permit PLAN CHECK'_ is"issued, I shall'not employ APPLICANT p y any person;m any manner„so as.•to - become subject.to the Workers'Compensation Laws. . .. Lig_6ng Fixtures First 20 ADDRESS r . f Additional ?. Total'No. CITY ” Tel No r Date Applicant -a Fixed,Appliances Not Over 1 HP PER NOTICE`TO APPLICANT If, after,•making: this..°Certificate of, Exemption,you should become sublect.t0 the-Workers'Compensation . Range_ Heater_ D W. APPLICANT i provisions of the,Labor,Code, you•must forthwith comply,,,with"such Oven, Dryer W M ADDRESS' �; ' provisions or this permitshall be deemed revoked; ,, " top FAU -_-WH v LICENSED CONTRACTORS DECLARATION, CIT&' �- Tel o Hood' Fan Other I hereby_,affirm that I•am lice nsedunder'provlsions of Chapter 9 LICENSE OR _ • Disp Room'Air COnd. REG'NUMBER 'Class - (coinmencing with Section 7000) of Diwsion'3•of the Business and' Professions Code,and my'hcense is in full force and effect DISTRICT• PROCESSED BY' Power Apparatus& Large Appliances ' Size& Type HP,KW, KVA,or,KVARM1 J ' O License Number sm"��3 Lic Class 1-1/d U Up to V1 Incl. DATE (illei�G��l/ �Ge/G �,"�� Oygr 1 to 10 Incl - Contractor - Date VALIDATION. Over,10 to 50 Incl' I am exempt-under Sec FINAL ! U Over,50.,to 100 Inc BY _ LLJ B&P,C for tfiis reason Over 100, i �" a Services,Swba'MCC& Parielboards /r7 U Z Date: 0-•200 Amp Under 600 V Signature 201 -'1000'Amp Under"600 V r Over 1000 Amp;or Over,600'V _ Exemption for Reg'Mamt Elect, SINGLE FAMILY• Temp. Power^Pole;& Appurtenances' HOME OWNER-BUILDER DECLARATION 1' .,'• r • Sign with One.Branch Circuit - - I hereby'affirm.that I am exempt from:the Contractor's'License Law O ` - Additional Sign.Branch Circuits � �O P for the following,reason (Section 7031 5, Business and;Professions ' - -��ry Code). 1 � M IJV 0.10, MS - - • i c Conduits& Conductors 1 �TrO _ 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)• TOTAL-; i�D'.i 1E�., F , pop-, CHEC 1M 10 CONSTRUCTION LENDING AGENCY P hereby affirm that, there is;a construction lending agency for the 'CHANGE °00 performance of the•work for which thispermd is issued'(Sec'3097, PERMIT'FEE" ` (Sub-Total) - - Civ"C') j, ' PLAN-CHECKING FEE JI1IS+0 L'ender's Name yy•7�} n (` a' PERMIT ISSUING FEE V!/ani 1', AM 10:1, _-Lender's Address JOT AL certify that I have read'this application and state that'the above AL 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 purposes SEE REVERSE-FOR EXPLANATORY LANGUAGE _ ,.. °was-9a - - - . •. - ' • na uure of Permitf6 e Date