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Home My Public Portal About5003 GOLDEN WEST AVE_Electrical__ WORKERS'COMPENSATTO14 DECL4RAT1ON 7eAOW 10,01 APPLICATION FOR ELECTRICAL PERMIT I hereb affYm that I have a cerHflcate d convent to &W lruasure, CE-Bova or a� of Yk6ms' Compermati�on Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY ctfpy thered(Seo.3800.Lade.C.) PW y No, ry FOR APPIJCANT TO FIl1 W JOB ADDRESS -5—c* � �✓ ❑ - C4rfflM copy Is Aeby funrfthed New Reabardid Brigs.S Pools EACH NO. FEE 0-3 'joCertified copy Is flied with the county bufding tnspecdon 1 S 2-Fen y,S4 Ft. $ — $ LOCALITY departrn-t- M -famfy Sq.Ft NEAREST �. J Data / 1 /l Ii uftiResbandei Swtrrvnfnp Poole OWNE aT. /i �f�j t7 F�roi � ria►� lJ� Ci f CERTIFICATE OF EXFJv1PTION FROM WORKERS' Oudeta:Rec�G Light/ 3w.�C— COMPENSATION INSURANCE Flrat 20 D / ADDRESS 'L- -dion need not be completed tf the work Irnotved by the Total No. AddHiorml CffY Tel.No. ..� is for one hundred dol is re($100) or 1e.) PLAN CHECK certify that d the performance d the work for whbh thle permit Is lasued, I shall not employ any- pennon In any manner so ae to become subject to the Workers'Compermatlon Leve. LJg"ng Flxturee Ftrat 20 ADDRESS Total No. Addttiorml CFTY Ted.No. '�'� t Fbred Appliances Not Over 1 HP NOTICE APPLICANT: If, after makIN this Certtfbate of P1�T Exemption,you ehorid become subject to the Wxkere' n Compermetion Range— Heater_ D.W. — APPLICANT provWon6 of the Labor Code, you must forthwith compty with such Oven — Dryer — WIL— ADDRESS provlNons or thio permR ehaR be deemed rewked Top — FAU — WJ-L _ CFTY Tel.No. LICEME0 CONTRACTORIO S DECLARATION Hood — Fan — Other— I hereby affYm that I am ooeneed under provisions of Cimpter 8Dbp. — Room Air Coad. REO-NUMBERORC� (cormnenoing with Section 7000) d Dfviebn 3 d the BLx%IrX s and Pro(eeabne Code,and my lbD n is In hill force and effect P— Apparat�&Large Apdbar— Dt9TFtlCT N6. PROCESSED BY }¢ Size s Type HP,KW,K\4%or KVAR ,"qr7 Llcenw Number L1c.Clew Up to 1 hc1 FINAL Over 1 to 10 k)(-,L DATE All ykam o Date Over 10 to 60 Ind. ElFINAL I am exempt under Sec. Over 60 to 100 Inc. BY RAP.C.for tNa reason Over 100 Cl) Services,Swbd,MCC 8 Panelboards , Z 0-200 Amp.Under 600 V Sip-oature 201 - 1000 Arte.Under 800 V Over 1000 Amp.or Over 600 V ❑ Exempl'bn for Rep.Melnt Elect - SINGLE FAMILY Temp.Power Pole d Appurte� 2 HOME OWNER-BUILDER DECLAFATlON I hereby afftrm that I am exempt from the Coutraotora Llcery Law 'with one Brand,C1rcuH ACCT.i for Hiefolbwing reason (Sect o 7031.6, Busld Proteeeions Addttlonal Sign Branch C=its c.cde): neas an3307 87.10 .� I,as owner of the property,wlII do the work and the structure MI:sQ Conduits h CorxiUotora 1 ITEM to not Intended or offered for sale (Sectbn 7044, Buetueea Other(See Complete Fee Sahediie) — I and Pro(embne Code). TOTAL7 _ 1� CONSTRUCTION LENDING AGENCY CWCv 87.10 I hereby affhm that two le a cormtiKton iending apenoy for the .00 pwformance of the work for which this permit Is issued(Sec.3097, PERMrr FEE (Sub-Total) 0 Clv.C.). PLAN CHECKING FEE 1 10/22/90 Larders Name PERMIT ISSUING FEE J 3424 1 AM 7:�1 Caudata Address y 1 certify that I have read thio appfballon and state that the above TO-DL FEE / •/� information Is oarred.I agree b corrpty wtth all County ardYmnces and State laws regulatlng Electrical wtrtp, and hereby authortze representatives of thio County to enter upon the above-mentioned }Of SEE REVERSE FOR EXPLANATORY LANGUAGE Somture Date tom— T z COMPENSATION DECLARATION " 76Aes3 1' 0/81 APPLICATION FOR ELECTRICAL PERMIT I her y �5ng that I have-a cerf wade d cone *to eef( kw ue OE-8060 or.a d vYbriaers' Compenestlon Inmvurno% or a oerMW- COUNTY OF LOS ANGELES BUILDING AND SAFETY copy therebf(Sec 3800,Lab.C.) Pbficy Na— _. POR 11PPLIG1Afr TD FY1 N JOB ❑ certined Dopy I.hereby fumfetled f,� EACH NO. FEE. Q3 _ _ E L.00A_ffY n Cer11M1ed copy le'Red with the county bLbdtp Inspection 1 d 2-Famay,S4 Ft NEAREST r Y deperin a Mritl-fang y Sq- Ft �7i088 8ti Date . APP�t Reeidentiel Swlmmtnp P00116 bW1ER GR FIRIA NAME FERTFICATE OF EXEMPTION FROM WORKERS' OLdatm Neo— Lightsow.— MALAT COMPENSON NSURANCE. ADDRESS (ThW-"ctlgn need not be cort�irrtrrd It the work Mvohmd by the Ad io Tel.No_ ownilt Is for one hundred dollars(=100)or kmm) Total No. Addttbnel I cwt fy tl-W In the Performance'of the woda for which this,p—rdt r+ t is li es^lj]'shall not entpfoy any person In-arty manner'so as to becofne to the Workers' Laws. L IQhtinp FM-e6 Ffret 20 ADDRESS Total No. " Q Tet Date Fbred Appianoes Not Over 1 HP P� . �tJO-ITCE ff, after meklrp thio d ' EMmp6q should beoolne sub)eat W the Ykdaere' Hasner— DW. C. . proyldone.d the Lith abor Code, you must forthwoprr#y with such Oven Dryer — wM ADD provlafone or this pemNt sane➢be deemed revdaad Top FAU — wi — . LfCENSED-GONTFTACTORS DECLARATION . Hood — Fah — Other— Tel.Nb ary I her�eby',W m alien J am Ilcenebd under provtsione,d Chapter 9 p� — Room Alr Cord.- LCEIM— . pBgR. -. jowvnerictrQ Oft Section 7600) d DM6w 3 of the Badness and desebde,an ns Cod mb y kenee In full force and effect Power APperatup&Larpp Appk noes T PrPROC>=8BED _ Size S Type HP,KW,Kl^or KWgR �L Lloernse'Nymber LIC.Ofasa _�Up to 1 tnoL FINAL Over 1 to 10 Ind. �� Contractor Date Over.10 to 60 hld. ❑ BY AL I em exernp�t aider Seo. ,, Over 60 to 100 hnc By BAP.C,for-this reason Over 100 8ervioee,Swbd,MCC.d fn ' 0-200 Amp,Under 800 V Skpiature 20t- 1000 Amp.Under 600 V a4 Over 1000 Amp.or Over 800 V ❑ Exemption for Peg.Mata Elect ;11 01,2A SWGL E FAMILY Tem.Poww.Pale&Appurtsnanoes #('o 0-'0 0 0 2 HOME OWNER$UILDEA DECLARATION,. Sign with One Branoh Ctrmft I hereby affirm that I em from the Contractor-e License LEW. Additional 84W Branch Ctrcutta I ° ° 2 5 0 for the foRcyl meaon 7031.6,Bushnees and Prote9afons Code): 0 0'0 2S 5 06 ElI,as owner of the property,wig do the,work and the atruohue fdbo Cond<rttii 8 Canductore iq not Interded or offered.for safe (Section 7044-Bushort�iate neee Other(See CFee Sohedule) — and Profeseiona coda). a27 -88 CONSTRUCTION LING AGENCY - I hereby efflrrn that there is a owstrudion bodlnp epenoy for the performanoe d the work for which this permit Is Ismr (Seo.3097, P[yRW FEE ($ub Total) . . -. 131J1N.CHEC4&G FEE L.wxWa Nemo PERWT l RJM FEE Lenders Addrsee I oerttfy thea I have read Vile applbatSon erred state that the abdve TO-17%L FEE Wornurtion IA loorred_J epree to Gon#y wfth a9 Cdurnty ordlnanoes and Sffiie`leve requiatirg Electrical wb.irQ and hereby authortze rep-&-tatI'es d this County to enter upon the mentloned Property for _ SEE REVERSE FOFG EXP1-.ANMDiW LANGUAGE