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Home My Public Portal About9831 HOWLAND DR_Electrical__ TION 20 WORKERS't I have a certificate of corse 76A '3 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT O hereby affirm that have o certificate of consent to self CEA insure, or o certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lob, C.) Policy No, Company FOR APPLICANT TO FILL IN JOB ❑Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH I NO. FEE ADDRESS O C Certified copy is filed with the county building inspec- I & 2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. — NEAREST CROSS ST. IRM Residential Swimming Pools Q O Date Applicant OWN ER OR NAME I CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec LightSw._ MAIL COMPENSATION INSURANCE first 20 3. ADDRESS �( Es On (This section need not be completed if the work involved by Total No. �" Additional CITY - Q Tel. No. $+ the permit is for one hundred dollars ($100)or less.) PIAN CHECK I certify that in the performance of the work for which this APPLICANT permit 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 Fixed Appliances Not Over I HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION 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 _ deemed revoked. Hood — Fan —Other_ CITY Tel. No. LICENSED CONTRACTORS DECLARATION Disp. _ Room Air Cond. — LICENSE OR Class. I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER (commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. PROCESSED BY Y and Professions Code,and my license is in full force and effect. d Size 8 Type HP, KW, KVA, or KVAR o'�.Q �jl ,=t O License Number Li<. Class Up to 1 Ind. FINAL C..) Contractor Date Over 1 to 10 Incl DATE ��–/ _Q(i VALIDATION M ❑ Over 10 to 50 Ind. FINAL U/� k– I am exempt under Sec. Over 50 to 100 Inc. BY //- `�v Q LU B.&P.C. for this reason Over 100 " d Services, Swbd., MCC 8 Panelboards U3 Date: 0- 200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V _ Exemption for Reg. Mainz. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp. Power Pole &Appurtenances ";f -1 m Sign withOne Branch Circuit I hereby affirm that I am exempt from the Contractor's License _�_(� Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): jy,rt_. Conduits&Conductors s f r - os owner of the property, will o the work and the Misc. _ a" _tv structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ ' _ _ Business and Professions Code). I:',iiC1 �`., �-.-- �- CONSTRUCTION LENDING AGENCY 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) t� (Sec. 3097, Civ. C.). _ PLAN CHECKING FEE �_'jUi)? Lender's Nomen�Ft" PERMIT ISSUING FEE °I'' Lender's Address TOTAL FEE I certify that I have read this application and state that the TO 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 th above-mentioned prop rty r inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 3,3-qa Signature of Permittee Date os WORKERS'COMPENSATION DECLARATION '20 W19 DPW 3/67 O I hereby affirm that I have a certificate of consent to self .76AW3 APPLICATION FOR ELECTRICAL PERMIT insure, ar a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB j I F] 31 Lr Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS (Glad brI', Certified copy is filed with the county building inspec- 1 8 2-Family, Sq. Ft. $ — $ LOCALITY nevi Cl tion department. Multi-family Sq. Ft. — NEAREST- CROSS ST. Len Date Applicant OWNER OR (.JestyR��de Residential Swimming Pools THorS R, l l FIRM NAME E CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec—Light_Sw._ MAIL 'W 3 f C /J_0 Dr. COMPENSATION INSURANCE First 20 ADDRESS (b J L rEU ✓ 'p (This section need not be completed if the work involved by Total No. Additional'- r iT C CITY . le CI Tel. No. ags-SbOI the permit is for one hundred dollars ($100)or less.) s PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit 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 Applicant _ '•- Total No. CITY Tel. No. NOTICE TO APPLICANT: If, after making this Certificateof Fixed Appliances Not Over 1 HP PERMIT Exemption; you should become subject to the Workers' Range— Heater—D.W. APPLICATIONCfxe�� 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 —' AU —W.H. — deemed revoked Hood — Fon —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 Power Apparatus& Large Appliances DISTRICT NO. PRO SED BY > and Professions Code,and my license is in full force and effect. Il Size 8 Type HE, KW, KVA, or KVAR o J Q License Number bc. Class Up to 1 Incl. FINAL L �� U Contractor Date Over I to 10 Incl. DATE n _z� 9 VALIDATION' 0 ❑ Over 10 to 50 Incl. FINAL! Gr _ � am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C. for this reason Over 100 d Date: Services, d., MCC 8 Panelboards Q �` W 0 200 Am- Under 600 V O , — Signature 201 - 1000 Amp. Under 600 V ' Exemption for Reg. Main!. Elect. Over 1000 Amp.'or Over 600 V SINGLE FAMILY Temp. Power Pole &AppurtenancesHOME OWNER-BUILDER DECLARATION �t I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Law for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits •"'= _� Professions Code): 7-a, �'7 -- -_ Conduits &Conductors L(�J I, as owner of the property, will f o the work and the Misc. + i• -j''_; structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)— �� Business and Professions Code). . , i�fe Fi 59 a '.ta-, CONSTRUCTION LENDING AGENCY cr I hereby affirm that there is a construction lending agency for ;" Al _E the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). - .PLAN CHECKING FEE ;-fr(_t`I_ Lender's Name norly PERMIT ISSUING FEE Lender's Address , 1�'fi 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-mentionedpro erI for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date ®s