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HomeMy Public PortalAbout9662 GARIBALDI AVE_Electrical__ WonnVtsP COMPENSATION DECLAR cons X0019DP1N�m APPLICATION FOR ELECTRICAL PERMIT >. I hereby afflrrtythat I have a certificate of consent to self �-0p,bp Insure, or a cert icote of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified co thereof (Sec. 3800, Lab. C-) Mcy No_ Company FOR APPUCANT TO Fll IN JOB r U Certified copy Is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS Certified copy Is filed with the county building Inspec- 1 8 2-Family, Sq. Ft. $ El LOCALITY tion department. Mulil-family Sq. Ft. t�T CROSS ST. Residential Swimming Pools O R O Date Applicant A NA/NE !rH C CERTIFICATE OF EXEMPTION FROM WORKERS' First 20 MAIL lj COMPENSATION INSURANCE Outlets: Rem Light Sus._ ADDRESS y (This sectbn reed not be completed If the`Mork Involved by Total No. Additional CITY � Tel. No. f�_ 7 the penmFt Is for one hundred dollars(=100)or leu.) PLAN CHECY I certify that In the performance of the work for which this APPLrANT permit Is Issued, I shall not employ any person In any manner Lighting Fixtures First 20 ADDRESS so as to become subject to the Workers Compensation Laws. Additional Total No. CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making This Certificate of APPIJC1T10N D�nGI� Exemption, you should become subject to the Workers' Range— Heater—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. — deemed revoked. Hood — Fan —Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR Dlsp. — Room Air Cond. NUMBER (commencing affirm I hereby arm that I am licensed under provisions of Chapter 9 (comm'encing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. BY d and Professions Code,and my license is In full force and effect. Size 8 Type HP, KW, KVA, or KVAR O License Number Uc. Class Up to 1 Incl. FINAL / `/71✓ CC Over 1 to 10 Incl. DATE VAUDATION 0 Contractor Dot Over 10 to 50 Incl. FINAL U ❑ I am exempt under Sec. Over 50 to 1p0 Inc. BY P W B.BP.C. for this reason Over 100 U.. U) Services, Sbd., MCC 8 Panelboards , w DatZ e: 0-200 Amp. U nder 600 V Signature 201 - 1000 Amp. Urxler 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Malnt. Elect. SINGLE FAMILY Temp. Power Pole 8 Appurtenances i HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Sign with One Branch Clrcultr�Ti .r Low for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits 3301 31.W Professions Code): 1 ITEhS ❑ I, as owner of the property, will do the work and the Mlsa Conduits 8 Conductors structure Is not Intended or offered for sale(Section 7041, Other (See Complete Fee Schedule)_ , TOTAL 31 - 00 Business and Professlons Code). CONSTRUCTION LENDING AGENCY r.�UX u1•�� I hereby affirm that there Is a construction lending agency.for •�41 the performance of the work for which this permit Is Issued PERMIT FEE (Sub-Total) (Sec. 3097, Clv. C.). PLAN CHECKING FEE 010CH3001 12J27/SCJ Lenders Name PERMIT ISSUING FEE �✓ �69 a 1 Pi111:,�r� Lenders Address I certify that I have read this application and state that the TOTAL FEE �/ 0-C 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 bovepentioned operty for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �s gnature of Permittee Date WORKERS coMPENSAT1pN/EG AApT}ON o tae, APPLICATION FORE FECTRICAL PERMIT I hereby effhm that I have a oertlfloate ooneent to 90 Yv",s or a cer8flcate of VObrkere' Insurance, or a certfled COUNTY OF LOS ANGELES BUILDING AND SAFETY Copy thared(sec 3800.Leb.a) PabyNa-P(-991357c—*,,,Y&aublic Indemi y FOB"PPILICA"T 1h FLL INrib 1 d i ❑ Cert[W.copy Ie hereby famished. New Residential Bldgs.& Poole EACH Na FEE AmpEss9662 E.— © CerthW copy b fled with the bLWInp Yiepsation 1 &2-Fam $ $ I_OCALOCALITYEy,S4 Ft N�� " departrnent Muftl-femtRy 54 Ft CFKM 8T. Date 1 /l1/ Applbant Residential swlmming POOfe =1 E pi4ne Harper CERTFICATE OF EXEMPTION FFN M WORKERS' Outlets Rec Light �Sw. — MALCOMPENSATION INS CE _ ADDRESS 9662 Garibaldi• 20 l (This section reed not be compWed C he work Ywolwd by the To4a1 No._ AdditionalCity Tel.No. permK b for one hundred ddtan(i1 )or fess.) I ow tfy that h the performenoa of the for whbh this permit AAFPUC..WT Is leaked, I shell not employany. In arty manner eo as b beoome thWo to e. rkere'OOm Lew& LJghtIng Fixtures First 20 ADDRESS TOtai NO, CFFY Tel.No. Date Applicant I Fbaed AWVances Not Over 1 HP PERWT NOTICE TO APPLICANT: If, of nr m#dTV this CerifM1oete d Fxemp6or> you OKtW beo0me skOct to e Vl des'Cw parnarion Fes— Heeler—�nesor�a D.W. — ALIGwf gryarit Heating proof the Labor Code, you must trmwfth —Vty with such oven — Dryer— WPP M— ADDREss1350 E. Las Tunas prwlebrm or if>fs permit shall be dsemedfrevoked.' TOP — FAU — WJ-L — CfTY Tel.No. LICERAT1oN LICENSED CONTAACTOFIS RECLAHood — Fan — Other— an Gabriel I hereby affirm that I am kwwod undo( pvAelom of Chapter 9 Disp, — Room Air Cond. LICENSE 0R CYrr� (oommenolnp vrfth section 7000) of Division 3 of the Buefr»ee and wa N mim 221751 0 - O Proleeaiam Code,and my kerne Is In full force and effect_ Rover APAP S Large Appilar— DISTRICT ma BY Sue&Type HP,KW,K)^or'KIR v�/ Lioenee Number 721 751 LJ--Clava C-20 1 contractor Bryant iieati nQ DatA .1/4/91. Over 1to 10 Incl. ' FINAL/J/�— �� Mk LDATK). Over 10 to 60 hid L FlfAL — ❑ I am exempt under Seo. Over 60 to 100 ha BY Over 100 BbP.C.for biWts reason Services,Swbd,MCC&PenefboerdsPON. z Date: 0-200 Amp.Under 600 V Slpnature 201 - 1000 Amp.-LJ rider 600 V 2 over 1000 Amp.or Over 600 V ACCT. T F-1Exemption for Reg.Malnt.Elect SINGLE FAMILY Temp.Pbvver Pole& Appurtenances 7 47.60 HOME OWNER-BULDER DECLARATK N Sign with O11e Branoh Circuit I TENS I hereby affirm that I am exempt from the Ccrrtr s License Law s sin TOTAL 47- 60 for the fodowtp reason(Section 7031.6,Business and Professions Code): Mka Condufla&COnduotore CHECK 47.60 D4 as owner of the property,eel do the work and the etruoU other(see Cortpieie Eve schedule) — , I Is not Intended or offered for sale (Section 7044, BuUnesa and Prdeaslons Code). GONSTRUCTION LENDWG AGENCY IJ��O-11 101 1/21/91 1 hereby affirm that there is a cormtrrcbon landlrlQ apenay for ther pen rmanoe of the worK for whish tufa pemnk fs,tsauad(;,ea 3097, PEFiMFr FEE (sutrTotal) �j 5094 1 Ah 10:06 c v.C.). PLAN CHECKING FEE / Larders Name - _ PERM IT iSSl.ffNQ FEE LerxWs Address I owtffy that I have reed thlB epp0carion and state that " above_ TOTAL FEE fnfaTne5an IB oorrect I agree to oompty with all County ordlnar>oea 11�r I and State laws regriattp Electrical wlrtrq, and hereby author s r/ repreeemteUvee of bile Canty to enter upon the above- mentia5ed poPsay for W SEE REVERSE FOR.EXPLANATORY_LAN%k4QE S41aturs Of Permktse Dade