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HomeMy Public PortalAbout6133-6135 GOLDEN WEST AVE_Electrical__ WORKERS'COMPENSATION DECLARATION CE 86 6G (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.) FOR APPLICANT TO FILL IN ,JOB �Ifeeltifted yN . CompanyT'r��=� ��� EACH NO. FEE ADDRESS �i�t�l! New Residential Bldgs.&Pools copy is he eby furnis ed. 1 &2-Family,Sq. Ft. $ — $ LOCALITY F-1Certified Sq. Ft. — NEAREST ..,, Certified copy is filed with t c ty building inspection CROSS ST 0 department. Residential Swimming Pools OWNER OR 01 FIRM NAM Date.l(4��' ?—Applicant Outlets: Rec._Light Sw. MAIL First 20 ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITYTel No. COMPENSATION INSURANCE } PLAN CHECd 9 (This section need not be.completed if the work involved APPLICANT 0 Lighting Fixtures First by the permit is for one hundred dollars ($100) or less.) Total No. o ADDRESS .� cc Additional cc I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CI Tel No. 0 permit is issued, I shall not employ any person in any manner PERMIT so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICAN . W Oven Dryer_W.M. ADDRESS Date Applicant Top FAU _W.H.. �1 Z Hood Fan _Other_ CITY Tel No. NOTICE TO APPLICANT: If, after making this Certificate of Disp. —Room Air Cond.— LICENSE OR Exemption, you should become 'subject to the Workers' REG. NUMBE Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PRO S ED Y with comply with such provisions or this permit shall be oe Size&Type HP,KW, KVA,or KVAR deemed revoked. Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE LICENSED CONTRACTORS DECLARATION VALIDATION Over 10 to 50 Incl. V I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL eY 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 r ness and Professions Code, and my license is in full force and effect. A. � � Services 11121-2. V 1Z 0-200 Amp. Under 600 V �`�" ` Licens�ember Z Lia Class ��+��EA � 201-1000 Amp. Under 600 V � ��a- Contract Date t —I tO'IN C- Over 1000 Amp.or Over 600 V DECLARATION Temp. Power Pole& Appurtenances I hereb affirm that I am exempt from the Contractor's Sign with One Branch Circuit License Law for the following reason (Section 7031.5, SusiAdditional Sign Branch Ci - _. rcuitse ' ness and Professions Code): �� Misc.Conduits&Conductors -P 4 6 1 $A EJ 1, 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 # 0 0 0 0 0 2 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 2 0 0 2 Q I hereby affirm that there is a construction lending agency . 5 0 for the performance of the work for which this permit is PERMIT FEE (Sub-Total) . t�0 0 0 0 2 Q 6 Q= issued (Sec. 3097,Civ.C.): 5 Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) 06.28.-82 Lender's Address PERMIT ISSUING FEE I certify that I have read this application and state that the, TOTAL FEEQ 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 above-mention d prope y for'nspec ion purposes. SEE-REVERSE FOR EXPLANATORY LANGUAGE nature of Permit a Date WORKERS'COMPENSATION DECLARATION CE-806G (2-80) CAPPLICATION FOR ELECTRICAL PERMIT CE-806 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.) FOR APPLICANT TO FILL IN JOB Policy No Company i _ EACH NO. FEE ADDRESS New Residential Bldgs.&Pools rtified copy is hereby furnished. 1 &2-Family,Sq. Ft.. e,2 7 $ — $ LOCALITY y Multi-family Sq. Ft. — NEAREST 19_ e ified copy is'filed with the county building inspection CROSS ST a department. Residential Swimming Pools OWNER OR g ,irq FIRM NAME 14 — Dat Applicant `'�� 9 C Outlets: Rec.—Light—First MAIL qq / First 20 ADDRESS/�w A,1 ' CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY Tel No. COMPENSATION INSURANCE d " PLAN CHECKO APPLICANT (This section need not be completed if the work involved U Additional by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First ADDRESS Additional W I certify that in the performance of the work for which this Total No. CITY Tel No. o Fixed Appliances Not Over 1 HP permit is.issued, I shall not employ any personin any manner PERMIT /'" LU so as to become subject to the Workers' Compensation Laws: Range_ Heater_D.W. APPLICANT C� p_ Oven _ Dryer_W.M. ADDRESS Date Applicant Top _ FAU _W.H.. Hood _ Fan —Other_ CITY el No. NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond._ LICENSE OR q /� Exemption, you should become subject to the Workers' REG.NUMBER WO Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY with comply with such provisions or this permit shall be' Size&Type HP,KW, KVA,or KVAR C--� deemed revoked. `J Up to 1 Incl FINAL Over 1 to 101nc1. DATE IfM ,gam VALIDATION LICENSED CONTRACTORS DECLARATION (f Over 10 to 50 Incl. I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINALBY r 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 ness and Professions.Code, and my license is in full force and r effect. Services License Number146 Lic.Class © 0-200 Amp. Under 600 V r 201-1000 Amp. Under 600 V Contractor X-EDateOver 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATIO 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 P i� G ness and Professions Code): Misc.Conduits&Conductors # 0 0 0 0.2' a � 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 7044, Business and Professions Code). 1,Je 0 CONSTRUCTION LENDING AGENCY ° o ° 9 7 5 Q= I hereby affirm that there is a construction lending agency c1 for the performance of the work for which this permit is PERMIT FEE (Sub-Total) issued (Sec. 3097,Civ.C.). t/ 8.2 3 82 Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE ) O ° N I certify that I have read this application and state that the TOTAL FEE �o ° o o No above information is correct. I agree to comply with all County N o . o ° CrI ordinances and State laws regulating Electrical wiring, and 04-0 ,O' ' ° Oo hereby authorize representatives of this County to enter upon 1 J _4 the abov mentioned property for inspe tion purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE 00o ° C, 3CH j N Si ature o ermi tee. Dat