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Home My Public Portal About6116 HART AVE_Electrical__ WORKERS'COMPENSATION DECLARATION a 7CE-806(G (2-80) n T P CACFOR E 2CTICAL PET I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES , BUILDING AND SAFETY insure, or. a certificate of Wog"kers'Compbnsation Insurance,or - a certified copy thereof(Sec. 3800,Lab. C.) FOR APPLICANT TO FILL IN JOB J Policy No. Company. ADDRESS New Residential Bldgs.&Pools EACH, NO. FEE ❑ Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY Multi-family Sq. Ft. — NEAREST ❑ Certified copy''is filed with the county building inspection CROSS ST Residential Swimming Pools department. OWNER OR y yyr FIRM NAME I OL. (3� IVt { {4 !� Date 'Applicant Outlets: ReO" Light 7 Sw. MAIL dd /�+ I, •First 20 ADDRESS C U lY & IJ CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY v�dl L.I r"�fel Nod j7a j r } COMPENSATION INSURANCE "' d PLAN CHECK O (This section need not be completed if the work involve d �y �d ADDRESS APPLICANT U by the permit is.,for one-hundredLighting Fixtures First 20 F&O:dollars ($100) or less.) � pC Total No. Additional I certify that in the performance.of the work for.which this Fixed Appliances Not Over 1 HP CITY Tel No. permit is issued, I shall not employ any person in any manner PERMIT soas to become subject to the.Workers' Com ensati Laws. Range_ Heater=D.W:i APPLICANT a ' Oven Dryer—W.M._ ADDRESS F Z /Date Applicant Top — FAU _W.H. — Z T 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. NUMBER Class Compensation provisions of the Labor Code,'you must forth- Power Apparatus& Large.AppliancesDISTRICT NO. PROCE ED BY with comply with such provisions or this permit shall be Size&Type'H P;KW, KVA,or KVAR '— deemed revoked. Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE LICENSED CONTRACTORS DECLARATION 'Over 10 to 50 Incl. VALIDATION —eq- I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL 9 (commencing with Section 7000) of Division.3 of the Busi- Over 100 BY ness and Professions.Code,'and my license is in•full force and effect. Services License Number Lia Class 0-200 Amp:Under 600 V 201-1000 Amp: Under 600,V Contractor Date Over_1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION 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- nessand Professions Code): Misc.Conduits&Conductors ;U'4 4 A h d k th ill d h f 1, as owner othe property, will e work anthe n • ❑ Other (See Complete Fee Schedule)— �# o;o 0 0 o G structure is not intended•or offered for sale (Section 7044, Business and Professions Code). 20 60 7 O CONSTRUCTION LENDING AGENCY' . I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is PERMIT FEE (Sub Total) �� o 0': 0 1 7 -jissued (Sec. 3097,Civ.C.). Lender's Name PLAN CHECKING FEE (One-Fourth Permit Feel 61 8 2 Lender's Address PERMIT ISSUING FEE y �Q I certify that I have read this application and state that the TOTAL FEE �zJ 'v L7 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-mentioned pro erty for' spection purposes. ' u SEE'REVERSE FOR EXPLANATORY LANGUAGE Signatureof Permittee Date WORKERS'COMPENSATION DECLARATION 76A663 10i81 �,ppdOC�la��01�1 FOR C ��C��Q�C�ad p�Q�� 1-hereby affirm that I have a certificate of consent to self CE-806G tistrc .or•a'certificote of'Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or o-certified copy thereof (Sec. 3800, Lab. C..) Policy No. Company FOR APPLICANT.TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ 1 LOCALITY {� tion department. Multi-family Sq. Ft. — 'NEAREST CROSS ST. Date Applicant Residential Swimming Pools OW ERR o �q FIRM NAME � 1T iYi CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Lfght Sw. MAIL 0 COMPENSATION INSURANCE ADDRESS / 4/4 This section need not be completed if the work involved First 20 (7� ( p b Y Total No. Additional CITY r Tel. No. b f O the permit is for one hundred dollars ($100),or less.) I certifythat in the performance of the-work for which this PLAN CHECK p APPLICANT 3:d permit is issued, I shall not employ any person in any manner 66 so as to become subject to,the Workers'Compensation Law Lighting Fixtures First 20 ADDRESS Total No. • ' Additional o. D-ate 9' Applicanto - ` � Fixed Appliances CITY Not Over 1 HP PERMIT 'NOTICE TO APPLICANT: 'If, after making this Certificate of APPLICANT 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 I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REG. NUMBER Class. (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCE D BY and Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances �. Size&Type HP, KW, KVA, or KVAR' License Number Lic. Class Up to 1 InclV FINAL Over 1 to 1.O Incl. DATE ) �� VALI ATION Contractor Date❑ Over 10 to 50 Incl. I-FINAL I am exempt under Sec. Over 50 to 100 Inc. BY LU B.&P.C. for this reason Over 100 rA DateServices, Swbd., MCC & Panelboards D : 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 &Appurtenances2 1 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit #,0 0 0 0 0 11 I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and . ( o o 21.7 5 ProfBions Code): Misc. Conduits&Conductors LTJ I, as owner of the property, will do the work and the o o o 2 1.7 5 structure'is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ D 7044, Business and Professions Code). 0603785 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 PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE U Lender's Address I certify that I have read this application and state that the TOTAL FEE 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-menti ne:�,f perty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �fp� 314,�1"'� Signature of Permittee Date f�p FOR 2 PERMIT[�I��I FJ WORKERS`COMPENSATION DECLARATION' CE-806G lora i APPLICATION A R9 IP p I C/ANTI O �1 Ir®Ifs E p E CTR I CA IT'LL Ifs M I T tl hereby.`affirm that I have a certificate of consent to self insure, CE-6o6G I��I�L� �o/tU L� L� or acertific i of Workers' Compensation Insurance, or a certified COUNTY OF'LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,LaI5. C.) Policy No.' Company FOR APPLICANT TO FILL IN, ' JOB0 s(•t!' •� ❑ Certified copy is hereby furnished.• New Residential Bldgs. & Pools EACH NO. FEE ADDRESS , 1 & 2-Family,Sq.Ft. $ — $ LOCALITY 8 ` Certified copy is filed-with the county building inspection — department. Multi-family Sq. Ft. NEAREST CROSS ST. Residential Swimming Pools OWNER OR Date Applicant FIRM NAME �'C CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec Z Light -L Sw. MAIL COMPENSATION INSURANCE a ADDRESS ( C'I y Thin section need not be completedthe First 20 if the work involved b Y Total No. Additional CITY "' J l Tel.No. _P!� •.permit;is,for one hundred dollars ($100) or less.) -- PLAN H CK s; • I certify that in the'performahce 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 i � ^ /((��fq lI Total No. 2 Additional CITY Date Applicant U1 G(a fi 69 1/1 M PRIVNe 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 provisions or this permit shall be deemed revoked. Top ..— FAU W.H. . LICENSED CONTRACTORS DECLARATION Hood Fan OtherCITY' Tel.'No. _ I hereby affirm that I am licensed under.provisions;of.Chapter 9LICENSE OR Disp: ROOM Air Cond. REG.NUMBER Glass. (commencing with Section 7000)'of Division 3 of the Business'and Professions Code,and my license'is in frill force and effect. Power.Apparatus..& Large Appliances_ DISTRICT N PROCESSED BY Size&Type HP,KW,•KVA,or KVAR —( 0 License Number Lic.Class Up to 1 Incl FINAL U Over 1 to 10 Incl. DATE VALID TI N Contractor Date _ Over 10 to 50 Incl. 0 FINAL,:. V ❑ !am exempt under.Sec. Over.50 to 100 Inc.;, gyfit C. BAP.C.for this reason Over 100 - N " Services,Swdd.,MCC& Panelboards' Z. Date, 0-200 Amp.Under 600 V D Signature 201 -'1000 Amp.Under 600 V '• 8 3 CO A Ti Exemption 1000 Amp.or'Over 600 V 0 0 0 0 0 2. Exemption for Reg.Maint.Elect. . SINGLE FAMILY Temp.Power Pole.& Appurtenances ,1 65D HOME OWNER-BUILDER DECLARATION. - Sign'with One Branch Circuit o ° ° 1 6500 I hereby affirm that I am exempt from Contractor's License Law for the followingreason Section 7031:5, Business and Professions Additional Signn-Branch Circuits . ( 11, 1 2687 Code): ® Misc.Conduits-&'Conductors " 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) D 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 FEB (Sub-Total) ~ � Civ.C.). PLAN CHECKING FEE Lender's Name, PERMIT ISSUING FEE ' Lender's Address l I certify that I have read this application and state that the above. TOTAL FEE ' U 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 ins ction urposes. -•• SEE REVERSE FOR EXPLANATORY LANGUAGE _ ignature of Permittee Date ' WORKERS'COMPENSATION DECLARATI0 fy .. 76A663% 10/81 /�(� p �n �, p 2 ,("hereby„ifirm thflr at I Have . cersificate of consent to'self Insure, CE-806G .6L'UI�PL��CL�U��ON FOR ELEC p MAL PERp�gp� or7a ceFtifi-ii:6 of�Workers',Compensation Insurance, or a certified COUNTY,OF LOS ANGELES BUILDING AND`SAFETY 'copy thereof(Sec--�3&00;L'' . C.) ,• . Policy No", r 'Company ^ FOR APPLICANT N TO FI LC IN e JOB ' , Certified copy,is hereby,furnished New Residentlal;,Bldgs.&Pools EACH NO.. FEE ADDRESS Certified copy Is filed' whlhhhe county-building,inspection 1 & 2-Family,Sq.Ft. $ $ ❑ ,., y LOCALITY' department. Multi-famil Sq.Ft, GROSS ST. NEAREST / Date Applicant Residential Swimming Pools OWN R OR' r. i FIRM NAME CERTIFICATE OF EXEMPTION FROM•WORKERS`' MAIL Outlets:Rec Light-'Sw ' COMPENSATION`INSURANCE ADDRESS ° This section need not be completed if the,work involved by them First 20 ( P - permit is for one hundred dollars,($100).orless) Total No. Addltlonal - CITN - -1 certify that in the'performance of the work for.whdW this permit APPLICANT K v Tel.No isc,issued, I'shall riot employ any•.person in.any manner'•so,as.to ns ^ ., 'ADDRESS become subject to the Workers Compensation ws Lightmg Fixtures First 20 DAdditional- d Total No. CITY Tel,No Date Applicant�V�w Fixed Appliances Not Over THP PERMIT' NOTICE; TO APPLICANT: If,,.after making this Certificate 'of APPLICANT (✓ Exemption;you shbuld become,subject,to the Workers'Compensation Range_ Heater_.:D.W. - provisions of the Labor Code,,you:must•forthwiih comply-with such 'Oven' Dryer W.M. ADDRESS provisions or this permit-shall be;deemed revoked Top -•FAU W.H. CITY TeI,No:' LICENSED'CONTRACTORS.DECLARATION Hood - Fan Other_ I:hereby affirm Ahat I'am licensed-under-provisions of Chapter 9 Disp. Room Air Cond.' UCEN EOR (commencing'with,Section 7000),of,Division,3;of the Business and REG.NUMBER Class. Professions Code and my license is in full force.and effect. � DISTRICT NO. - PROLE ED BY ,. Power Apparatus&Large Appliances< Size&Type HP;KW KVA,or KVAR •- License Number Lid.Class Up to 1.'Incl.' FINAL ' U .-.Over,1 to 10•lncl " `� Contractor Date O DATE' VALIDATION Over 10 to 50 Incl. F IN ❑. I am exempt under Sec:. Over:50 to-100 Inca, g tLIU B.&P, C.for this reason Over 100 Services;Swbd.,MCC 8 Panelboards 0. Date. 0 200 Amp.Under 600 V, �D �` Signature 201 - 1000 Amp.Undef.600 V Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect.+ � 59Q SINGLE FAMILY Temp.Power Pole& Appurtenances HOME,OWNER-BUILDER DECLARATION. - Sign-ovith One'Branch Circui4 I o'o 2 I hereby,afWm that I am`exempt,from'•the-Contractor•License Law for the following,reason(Section.7031.5;,Business and Professions Additional Sign Branch'Circuits - 0 Aaaiti �5 0 Code)' C Mi sc Conduits'&Conductors 4- '8 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) - 121 • , 7 ,arid Professions Code). CONSTRUCTION LENDING AGENCY. ; I hereby'affirm that-there.is a construction.lending agency for the performance of the work-foe.which this permit'is issued(Sec.3097, PERMIT'FEE (Sub-Total)' , Civ.CJ. PLAWCHECKING FEE Lender's Name PERMIT ISSUING FEE;. ender's Address' certify .that I.have read this application and state that the above T.OTAU FEE formation is correct.I agree to comply with all County ordinances' nd State laws regulating Electrical,wiring, and hereby authorize _. presentatives of this�.County to enter upon the above-mentioned operty for ins p tion pu oses. ' SEE REVERSE FOR EXPLANATORY LANGUAGE nature of Permittee Date WORKERS'COMPENSATION DECLARATION CE-806G 10/81 ��IP CAMON FOR �II 2 pe��,��p �E(�f,�,T I;-reby'affirm that I have a certificate of consent to self insure, CE-aosG I�L� IIYI Ir L�IS�o Lt� ERNT „- 'a certifftate of WorkersCompensation Insurance,•or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY. Fcpy thereof,(Sec.3800,Lab. C.) • Policy No. - Company FOR APPLICANT,TO FILL IN - JOB /� . ❑ EACH, .NO. FEE 'ADDRESS / I Certified copy is hereby furnished. New Residential Bldgs.& Pools filed 1 & 2-Family, Sq.Ft. _ $ LOCALITY Certified'copy is ed with=the county building inspection department.,: - : - Multi-family Sq.Ft. NEAREST CROSS ST. Date '' Applicant Residential Swimming Pools' OWNER OR .FIRM NAME 6 40 - i Z ,P .. ''; - .. CERTIFICATE OF EXEMPTION FROM WORKERS' � MAIL Outlets:Rec Light Sw L /[ II COMPENSATION INSURANCE a `."/� •ADDRESS I if 1I .1T y (This section need not be completed if the work involved by the / 1 First 20 permit is for.one.hundred dollars ($100)-or.less.) Total No.JAL_ Additional CITY hC. k T Tel No. I certify,that in the performance of:the work for which this permit PLAN CHECK Y' P P ,• APPLICANT _ is issued, I shall not employ, any person,in any manner so as to t LN me subject to th&Ppl, orkers'Co ensation Laws. Lighting Fixtures First 20„ ADDRESS r /}��,(�'�/�• y � ��j Additional�� -��" Total No. CITY Tel.No.c n Fixed Appliances Not.Over 1 HP, OTICE TO APPLICANT: If, after making this Certificate of PERMIT // / �. '� O R r/1�Q[r Exemption,you should become subject to the Workers'Compensation „Range—,.Heater_ R.W. APPLICANT �f 1. V -provisions of the,Labor Code,yo-u'must forthwith comply with such Oven Dryer — W.M._ ADDRESS fw d /.4 provisions or this permit shall be deemed revoked. Top — FAU W.H. LICENSED CONTRACTORS DECLARATION "Hood Fan Other_ CITY Lam. G V' Tel.No. — _ 1 hereby affi'rm,.that I'am licensed under provisions of Chapter 9 LICENSE OR (commencing_with Section 7000) of Division 3 of the Business and Disp. Room Air Cond. Class. ' REG.NUMBER Professions.Code,,and my license is in full force and effect." Power Apparatus& Large Appliances DISTRICT No. PROCESSED BY Size&Type HP,KW,KVA,or KVAR C1 E Q License Number Lia Class Up to 1 Incl. FINAL V Over 1 to 10 Incl. DATE !n VALIDATION Q Contractor Date Over 10 to 50 Incl. FINAL CCCJJJ C/ U ❑ . lam exempt under Sec. Over 50 to 100.Inc. BY W G. B.&P.C.for this`reason Over 100 Services,'Swbd.;'MCC&Pan'elboards Z Date: 0- 200 Amp.Under 600 V D 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 : 8 I hereby affirm that I am exempt from the Contractor's License Law .Additional Sign Branch Circuits ACCT. for the following reason(Section 7031.5, Business and Professions Code) .3307 15.00 ❑ Misc.Conduits&ConductorsITEMS 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) 'TOTAL � ,f-d and Professions Code). 'f C)i AL� 15. �..-p0 CONSTRUCTION LENDING AGENCY CASH lcol I hereby affirm that there is a construction lending agency for the ✓ HANGE Ce performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) ntt VG Civ.C.). PLAN CHECKING FEE 0000-0001 5/16/89 Lender's Name VU U _ PERMIT ISSUING FEE -s Lender's Address , 5290 1 AM 8:09 1 I certify that I have read this application and state that the above TOTAL FEE �J_0 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 pr perty for inspection.pur�ses. SEE REVERSE FOR EXPLANATORY LANGUAGE Y/ nature o Permittee Date