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HomeMy Public PortalAbout5930 GOLDEN WEST AVE_Electrical__ N16RKERS',COMPENSATI6N DECLARATION 76-663 to/at CE-806G p 'I/`TION,' F'®R ELECTRICAL PERMIT ,,' d'-9 PP ICfL F9 - 1 1 ` I'hereby affirm that I have atrficate �f cpnsent,to self insure,° - or a vertificate of Workers' Co pensation Insurance, Gr"a certified ` =` COUNTY-,OF,LOS•,ANGELES BUILDING:,AND,SAFETYB't'.•a�';, copy Thereof (Sec 38oeLab C), ° Policy,-No Company ` , FOR APPLICANT TO FILL IN "y "JOB /�,'J�� �ft•y + F . , ADDRESS. Y{f .Certified copy is hereby furnished New Residential Bldgs & Pool EACHNO FEE' s r_. • $ — $ LOCALITY -Certified copy is•;filed with' the•county budding inspection 1 & 2-Family, Sq ,Ft — i " department ., 1 f- Multi-family,Sq Ft, _ NEAREST r r.,•J •P ..� �, FY, Y, v CROSS ST •, & v • , •- Residential Swimming Pools OwNER,OR Date Applicant 'n • , ,v., a .n` a, t". ., - ,c •� ' - FIRM NAME �" �• /V �, _ CERTIFICATE'OF EXEMPTION FROM.,WORKERS' ~,i' Outlets Rec, "Light'Sw _ MAIL •7 Z ;'a, n` ,, COMPENSATION INSURANCE r ,, (�' ADDRESS (Th s section'need'riot be completed rf,the work,mvolved by the First 20.' permit-Is for:one hundred dollars-($'100)or less.)-, Total No � Additional. CITY el No _ Q .(P, •,, .P,L'AN CHECK ` k-I'certify that,in'the performance of the work•for,which,this-p' mit ;}, PPLCAN7 ;is issued, Ilshall notPemploy, any person.in any manned-.so to become subject to the Workers'Comp e saton Laws Lighting FixturesFirst 20 �J ADDRESS• r Additional Z Total,Noe s CITY �+ Tel No ate APPI an _ e r :NOT E- TO PL ANT al n i -Certific e _of _ Fixed Appli es'Not,Ow�e""r. 1 HP�y ti PERMIT Exemption,you should beco subte tot Wor rs'Comp s ion+�„ Range—'Heat D W APPLICANT a provisions of rthe�LaboCode,.you mustforthwit comply�w) uch°f.., Oven Dryer °WM'222_ f 3: ADDRESS 3 ; provisions or this-permd shall-be deer ei' revoked' To '_FAU W H' _� - 'r " „ r,r j t'• :r ,Top , ,' CITY : TehNo , L-ICENSE,D CONTRACTORS'DECLARATION Hood �' Fan' "_ Other_" * +�' ` I hereby affirm that I am licensed,unde'r provisions,of Chapter 9•• DTs . J LICENSE OR'p• �-Room Air Cond 4--' V Class (commencing with Section 7000)`of Division'3 of the`Busmess.and, REG NUMBER' ° Professions Code,and" license is.in'fulbforce and effect' DISTRICT No VP�O�EED Y y ,Power Apparatus& Large Appliances ' Size & Type HP,,KW,-KVA,or KVAR V 0 LGcense,Number L'ic•Class '� ; - FINAL r _ ''Up'fo 1 Incl•"-, " U Over 1 to,10 Incl' DATE VALIDATION 0 'Contractor Date A' W_ - r. : .., Q 1 ❑ K Over1O,to 50 Incl " FINAL 1 am exempt under Sec > Over 50 to 100 Inc; BY W 138&PC for this reason Ovcr"100 U-' Sery es;Swbd,MCC & Paneltioards U' t,' N Date 0 - 200-Amp ,Under 600 V Signature 201-- 1000 Amp Under•660 V. 17 - Ove(•1000 Amp or Over 600 V,f El Exemption for Reg Maint Elect ;' £ ' SINGLE FAMILY."' '•t`- ^^ Temp Power Pole& Appurtenances HOMEOWNER-BUILDER DECLARATION • " - IJhereb affirm that I am exempt from the Contractor's License Law Sign with One Branch Circwt' , , ',` , —� , y ° Additional Si n Branch Circuits a ° " "` .9.r' for the following reason (Section 7031 5`, Business and Professions g - j•, Code) ? ; `r ?�,t' r 7t E =k Misc Conduits-& Conductors, - e TZ �- ❑' I,as owner of;the property,will do the work'and.the structure TOTAC" Other(See Complete i �� �� is not intended,or offered for sale (Section 7044, Business :,x,`7,' and Professions,Code)• = ® y, e<'a �-t 2 --,7�.5 - of - - • ' ., ° 'En' - 'd s, - a• - ., ,_ , ,� r .� ` _ - n'L7�( CONSTRUCTION LENDING AGENCY 'I hereby:affirm•that there is a construction lending agency for'the i a _ "s�'.., =- ; performance.of the work'for which this permit is issued(Sec '3097, .PERMIT FEE'- - ;(Sub-Total) Civ C)_ .. ,. 5 t • - - -7. h I'1.G':. .if 'fix! v r' PLAN CHECKING.F,EE r - Lenders Name ' •' �. 3..- ,�. �,A 1, ,.- '°fir' •�,1�'.a•r� A 4,�,Y t'f, ,w:_�� ., PERMIT ISSUING,FEE .l (7 L'ender'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 r and State laws regulating Electnc wiring, and hereby authorize representatives of this County to ter upon the above-mentioned „ prop' y+f ins ri p rpo A�lk •• SEE REVERSE FOR EXPLANATORY LANGUAGE" ; Sid tui of P ee p �� r WORKERS'COMPENSATION DECLARATION 76-663 10/81 CE-806G. APPLICATION FOR ELECTRICAL PERMIT I bsreby a Iti'm that-l h&je 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.) V Policy No. Company FOR APPLICANT TO FILL IN JOB qf 7�v l�f9a�/c:�ll � ❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ADDRESSS9.30 ❑ 1 & 2-Family,Sq.Ft. $ — $ LOCALITY � CC Certified copy is filed with the county building inspection department. Multi-family Sq.Ft.. — NEAREST f a TU_r� CROSS ST. h!T I /V Residential Swimming Pools OWNER OR Date _ Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS'' MAIL Outlets:Rec— Light — Sw. — COMPENSATION INSURANCE ADDRESS -j• (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. —/ �. that in the performance of the work for which this.permit PLAN CHECK I certify 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 Additional Total No. CITY Tel. No. Date Applicant �AL/> tCz cCLfR Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT GA40&6JJ 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 W­ -,09 A05- provisions or.this permit shall be deemed revoked. Top — FAU W.H. s PD/ N 9 (� • LICENSED CONTRACTORS DECLARATION � Hood — Fan — Other_ CITY Tel.No. I•hereby affirm that I am licensed under provisions of Chapter 9LICENSENUMBOR (commencing with Section 7000) of Division 3 of the Business and Disp. — Room Air Cond. Class. REG. ER (p ~✓-(D Professions Code,and my license is in full force and effect. DISTRICT NO. PROCESSED BY Power Apparatus& Large Appliances (/ pp f! ../ Size& Type HP,KW,KVA, or. KVAR O � -cam' 0 License Number ��O�� �T // ,,���Lic.Classsj Q� Up to 1 Incl. FINAL V CACo�ean����cDate J��� Over 1 t0 10lncl. DATE �`�� Q VALIDATION 0 ri tor Over 10 to 50 Incl. l U FINAL am exempt under Sec. Over 50 to100Inc. BY W B.&P.C.for this reason Wit-C- 6e OWWG rk-r Over 100 �- d � c�a, �Y NysFtF Date` 7_3_4/ SY-001 ,Swbd.,MCC& Panelboards �/ _Z _ a�te.�:,, 200 Amp.Under 600 V l0� ,•Signature �"�`"� `I� - 1000 Amp. Under 600 V `fesJ.-- QOver 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 ».9• y I hereby affirm that I am exempt from the Contractor's License Law t4 for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits K'•i.1 Code): 3307 ❑ 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) and Professions Code). ® i 1 I(A?- 2 = ,o CONSTRUCTION LENDING AGENCY -•iir L!'c ' `' I hereby affirm that there is a construction lending agency for the k;y iCIE performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) /(2 lig Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Da - Lender's Address u 8;.4 ��• » �'1 I certify that l 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 pZtYN(i for ir4spection purposes. �� SEE REVERSE FOR EXPLANATORY LANGUAGE •- Signature of Permittee Date 7 WORKERS'COMPENSATION DECLARATION EA683 10/81 APPUC�AM.ON FOR ELECTRICAL PERMIT `I`he:-2hy affirm thaj 1 have a certificate of consent to self insure, CE-806G or a certtcate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof-(Sec. 3800,Lab. C.) I I fl Policy No. Company FOR APPLICANT TO FILL IN JOB, ❑ Certified copy is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE ADDRESS (573o lsG pew r AVF• ❑ 1 & si Family, ldg Ft. $ — $ LOCALITY 45M 9= Certified copy is filed with the county building inspection NEAREST department. Multi-family Sq.Ft. CROSS ST. I-A-4 TuNr4S Date Applicant Residential Swimming Pools OWNER OR `OQ Q M.` FIRM NAME c & CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec— Light — Sw. r MAIL COMPENSATION INSURANCE ADDRESS 3 N, T This section need not be completed if the work involved b the First 20 ( P Y CITY ,+ Tel.No. permit is for one hundred dollars($100)or less.) Total No. Additional �ft�} �f -�is� PLAN CHECK I certify that in the performance of the work for which this permit 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 • ^` •, Additional Date yI—q t! Applicant �%�QG'i P Szec ic, Total No. CITY Tel.No. NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP P PLAIT Exemption,you should become subject to'the Workers'Compensation Range_ Heater_ D.W. ` APPLICANT r re provisions of the Labor Code, you must forthwith comply.with such Oven _ Dryer _ W.M.— ADDRESS .3 W provisions or this permit shall be deemed revoked. Top _ FAU _ W.H. _ _ CITY Tel.No. LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other` �� I In affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR (commencing with Section 7000) of Division 3 of the Business and REG.NUMBER 5ad�� Class.e�d Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PROCESSED ev Size& Type HP,KW,KVA,or KVAR r© CQ License Number�U404/g Lic.Class Up to 1 Incl. FINAL U .i p p„ gyp, 3 ver 1 to 10 Incl. , �Q DATE L VALIDATION Contractors LLf tKi( Date I ! Over 10 to 50 Incl O � may' FINAL U L�1 I am exempt under Sec. Over 50 to 100 Inc. BY L) B.&P.C. for this reason- = QN 4,ywcs. 7N-e Over 100 U)' Date: ����7� Services,Swbd.,MCC&Panelboards 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 Q ;` HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits fH�'f`';-'T for the following reason (Section 7031.5,Business and Professions _ Code): E] Misc.Conduits & Conductors x I,as owner of the property,will do the work and the structure l EI S is not intended or offered, for sale (Section 7044, Business Other (See Complete Fee Schedule) _ and Professions Code)., ® '`_F j fiL:, 55.3 m 0- _ CONSTRUCTION LENDING AGENCY 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 1 f Oil -1 F,E, i C,/,! r'"'t PERMIT ISSUING FEE Lender's Address -' r'-'� e At'• 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 ipspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE GGl t(fiC /+# gna ure of Permittee Date WORKERS'COMPENSATION DECLARATION, - io/ai CE-806G APPLICATION FOR ELECTRICAL PERMIT "I 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(Sec.3800,Lab.C.) PolicY No. Company FOR APPLICANT TO FILL IN JOB p Y ❑ Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS F-1 Certified & 2-Family, Sq.Ft. $ _ $ LOCALITY Certified copy is filed with the county building inspection department. Multi-family Sq.Ft. NEAREST CROSS ST. Date ApplicantResidential Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec Light Sw. MAILJ �� / COMPENSATION INSURANCE ADDRESS O �tP� A (This section need not be completed if the work involved by the First 20 40� CITY 1,C— e' � Tel.No ' permit is for one hundred dollars($100) or less.) Total No. Additional / A I certify that in the performance of the work for which this permit PLAN CHECKAPPLICANT 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 an ADDRESS Total No. C9�1 Additional V CITY Tel.No.� Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of 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^] 7 61H provisions or this permit shall be deemed revoked. Top — FAU W.H. LICENSED CONTRACTORS DECLARATION Hood — Fan - Other_ CITY M . Te Tel. No.�' t�(�/���� I hereby affirm that I am licensed under provisions of Chapter 9LICENSE OR Disp. — Room Air Cond. O ob Class. (commencing with Section 7000) of Division 3 of the Business and REG.NUMBER ��lYJ Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO., PROCES BY Size& Type HP, KW,KVA,or KVAR �f 0 License Number Lic. Class Up to 1 Incl. FINAL V Over 1 to 10 Incl. DATE r Contractor Date VALIDATION 0 El Over 10 to 50 Incl. FINALY ~ I am exempt under Sec. Over 50 to 100 Inc. BW d- B.&P.C.for this reason Over 100 N 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 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law ;�; aY for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits r y Code): Misc.Conduits & Conductors .r�ll� �V s��.) ❑ I,as owner of the property,will do the work and the structure �, ITEMS is not intended or offered for sale (Section 7044, Business Other (See Complete Fee,Schedule) _d—a and Professions Code). ® !!I j��„ .�imp 9,rte CONSTRUCTION LENDING AGENCY CHECK 30.20 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) CHANGE .00 Civ.C.). PLAN CHECKING FEE Lender's Name 00100-00 1 6/ 8/90 PERMIT ISSUING FEE Lender's Address 1178 t Ali 8:31 1 certify that I have read this application and state that the above TOTAL FEE 3 eLQ information is correct. I agree to comply with all County ordinances and State laws regulati Electrical wiring, and hereby authorize representatives of this o my to enter upon the above-mentioned pr rty for insp ction. u oses. SEE REVERSE FOR EXPLANATORY LANGUAGE �0a Si4e 4r D44e