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HomeMy Public PortalAbout6275 IVAR AVE_Electrical__ WORKERS' COMPENSATION DECLARATION 76A663 DPW 3/87 n nn���n���nn �O� ���������n ��^��� I hereby affirm-that I have a certificate of-consent to self CE 806G G�1lT IT A NJ�f (� PER NT or 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 �7(' A� T Q� r` /r C Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS 2'/J !V YViJI� l G K O Certified,copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ — $ LOCALITY tion department. -family Sq. Ft. — NEAREST Residential SwimmingPoolCROSS S T. Date Applicant s O OWNER OR S I T FIRM NAME 'V CERTIFICATE OF EXEMPTION FROM WORKERS' 3 � MAIL COMPENSATION INSURANCE OutRec Light Sw._ ADDRESS First 20 (This section,need not be completed if the work involved by Total No. Additional CITY CT C4 I. No. - the permit is for one hundred dollars ($100)or less.) 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 3 Additional Date Applicant Total No. CITY Tel. No. NOTICE TO APPLICANT: If, after.making this Certificate of Fixed Appliances Not Overt HP PERMIT Exemption, you should become subject to,the Workers' Range_ Heater—D.W. _ APPLICATION 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 l 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 DISTRIQ bI0. PSSED Y >- and Professions Code,and my license is in full force and effect. d Size &Type HP, KW, KVA, or KVAR i Q License Number Lic. Class Up to 1 Incl. FINAL U J Over 1 to 10 Incl. DATE VALIDATIONcc❑ Contractor Date ! 0•Over 10 to 50 Incl. FINAL I am exempt under Sec. Over 50 to 100 Inc. BY U Over 100 t /1 / LU B.&P.C. for this reason n- D Services, Swbd., MCC& Panelboards Z Date: Z 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. :•S SINGLE FAMILY Temp. Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION - - fs s I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Ar•i1 eT Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits JJ i �'.SJ a i•. Professions Code): a ITS I, as owner of the property, will do the work and the Misc. Conduits&Conductors ` Other See Complete Fee Schedule ( 5 structure is not intended or offered for sale(Section 7044, ( P )— D T.�TFfL_ ��ca �- t Business and Professions Code). ��G�i �Lo�C CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for CHANGE .011 {11 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEEi •I Lender's Name11�- luUl t��lr 7 PERMIT ISSUING FEE O 778'1 1 AM 8:"� ! Lender's Address I certify that I have read this application and state that the TOTAL FEE above information is correct.1 agree to comply with all County ordinances and State laws regulating Electrical wiring, and ° hereby authorize representatives of this County to enter upon th ae�w-mentio d property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ©s Signature of Permittee Date WORKERS' COMPENSATION DECLARATION 76A663 10/81 Ppl� �((��MN FOR ELECY 1p�CAL Il EUAl1 T I hereby affirm that I have a certificate of consent to self CE-806G. ALL `v-G U insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or•a certified copy thereof (Sec. 3800, Lab. C.) N Policy No. Company FOR APPLICANT TO FILL IN JOB ' Certified co is hereby furnished. EACH NO. FEE ADDRESS (/ PY Y New Residential Bldgs. & Pools _ Certified copy is filed'with the county building.inspec- y, Sq. Ft.' LOCALITY 1 & 2-Famil $ — $ NEAREST lion department. Multi-family Sq. ,11 3 Ft. CROSS ST. U /y Date Applicant Residential Swimming Pools OWNER OR _ FIRM,NAME O CERTIFICATE OF EXEMPTION FROM WORKERS' — ' MAIL COMPENSATION INSURANCE Outlets: Rec Li ht Sw. ADDRESS /31 f - This section need not be com leted if the work involved b First 20 ( P Y Total No. CITY TJs Tel. No the permit is for one hundred dollars($100)or less.) Additional C ._: I certify that in the performance of the work for which this PLAN CHECK / Y P � APPLICANT". permit is issued,I shall not employ any pe son in an manner so as to become.,subject to Jhe Work e on Laws Lighting Fixtures First 20 ADDRESS _ Additional Total No._.y� CITY Tel. No. Date _ Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, aft,6r making his ertific.t. of ee Exemption, you should become subject to the'Workers, Range_ Heater–LD.W. APPLICANT Compensation provisions of the Labor.Code; you must forth- Oven _ Dryer W.M.— ADDRE with comply with such provisions or' this permit shall be Top ._ FAU —W.H. — deemed revoked. Hood Fan _Other— CITY XAIJA - Tel. N�� ` LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that.l am licenseDisp. Room Air Cold. REG. NUMBER ClassC-_ d under provisions of Chapter 9 '� (commencing with Section=7000) of Division 3 of the Business DISTRICT NO. PROCESSED BY and Professions Code, and my license is in full force and effect. Power Apparatus & Large Appliances .-/ Siie &Type HP, KW KVA, or KVAR' O License Number.: / ic. Class ��� /r UP t�j•� �% FINAL � _, –/__ _ Im Over 1 to 10 Incl. DATE VALIDATION Contractor /l Date O El Over 10 to 50 Incl. FINAL u I am exempt under Sec. Over 50 to 100 Inc.- BY �� a B-&P.C. for this reason Over 100 h 'Services, Swbd., MCC & Panelboards. �� D z Date: 0 - 200 Amp. Under 600 V Signature" 201 - 1000 Amp. Under 600 V ' Over,1000 p. or Over 600 V Exemption for Reg. Maint. Elect. 45 ! � SINGLE FAMILY Te p. Power Pole" &Appurtenances HOME OWNER-BUILDER DECLARATION � Sign with One.Branch Circuit 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. 'a 2 2. A Professions Code): , ❑ I.,'.as owner of the property,'will do the work and the Misc-. Conduits.&Conductors , ! o''0 0 0`0 2 structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ 7044, Business and Professions Code). D ] o;o 6 IL-2 5 CONSTRUCTION'LENDING AGENCY 0.0 or J S I hereby affirm that there is a construction lending agency for . 6 G the performance of the work for which this permit is issued_ PERMIT FEE (Sub-Total) 0 3.07_83 (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE 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 a d State laws regulating Electrical wiring, and hereby t, o ze representati this County to enter upon the ab ,' entioned� o v u SEE REVERSE FOR EXPLANATORY LANGUAGE 40 ignature of Permit a Date De D-A A-.0 10« APPLICATION FOR PERS oa DEPARTMENT OF BUILDIivG. AND SAFETY COUNTY OF LOS ANGELES ,ECC WM. J. FOX, CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GF' ! Z NE . PERMIT 'rw. WIRING FIXTURE9 BERVICQ RIICICIpp. iC READY FOR DATI13GSUQD RANGE HEATER I POWER 1 FIRS IN8P. ION A �. 91CN8 MISCELLANEOUS ' ' APPLICANT DILL IN HEAVILY OUTLINED PORTION ONLY �oB / ec-,rs '� NAM¢ ]� AOOR E69 6 �`J�yT� 4,ks U ADDRESS { LOCALITY / A yyKK-- fT � NZAREST CITY �(,?'�-..� TEL No..�•'s / CRO's 67. L/ CERT. NO. D C' EXPIRE-5 I--$ j t1� I NAMQ DESCRIPTION OF WORK i MAIL NUMBER OP OUT'LETH ON CIRCUITS ! 3 AODR.EDO LOCATION ICY ROOMS O Z ' TEL No. J LIGHT OUTLETS I SW.I PLUGS lrorr. I 'AM TH6 LEGAL POSSESSOR JpF THE ABOVE LOS CIRCUIT I A 6 ( C C E F G HANGELES COUNTY CE IF CAT <VMMCA LIVING ROOM I - ¢11iC7R9C2An. 1 AM T'Hq LE6¢!OWNER OF THQ PROPQRTY DMOCRIDED DINING ROOM i ASOVQ. BRTST. RM. BATH I I I i —�— CORRECTIONS ENT. MALL I I. HALL NO. FRONT PORCH } '� I �- OUTSfD[ KITCHEN 1 DERV. PCH. I _—_— •` d DORM. Ka. Q CLOSET BonM. No. CLOSET TOTAL NO. OF OUTLETS 0 ''11 APPROVALS NO. OF FIXTURES (J B �. tJ DATQ Insveero�rD eus� i NO. OF :fOTORD 31. P. S CONDUIT- NO. OF SIGNS TRANS. 0 WIRING _.:. NO. OF RANGES OR HEATERS FIXTURED M'8CE L O II � ;fi POWER 1.96!19 to i fo # _ PERMIT FGQUTILITY CO.NOTIRIQO r: TOTAL PIMQ F!NAL oe >, aIM APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY � � COUNTY OF LOS ANGELES WM..J. FOX CHIEF ENGINEER : NATURE F"INSTAI.LATION DISTRICT NO. GROUP ZONE PERMIT No. WIRING FIXTURES SERVICE 1 READY FOR. RECEIVED BY DATAIIIBUED .RANGE I HEATER I. I POWER FIRST INSPECTION SIGNS MISCELLANEOUS AFVLICCANT FILL INHEAVILYHEAVILY OUTLINED PORTION ONLY NAME r :f'�- `l/�i t� 'Lb't �/'•' DR E88 .. • U ADDRESS J,L- S ci „n,.e.� �tt C'T Q..•c LOCALITY NEAREST r y Iv CITY -!�, -•1�►"!l�TEL Il6T� •J ,CRUSSST. GUI n .4--s._.�___. y. W REG-. NO. C-J�� .EXPIRES ri-G-7!' �� Ir NAME 7, vi i VC-'CJ✓��.. DESCRIPTION OF WORK 1 i MAIL V _ NUMBER OF OUTLETS ON CIRCUITS 3 ADDRESS O LOCATION BY ROOMS CITY TPL No. I LIGHT OUTLETS I SW.I PLUGS�..I%*• CORRECTIONS - CIRCUIT i_A I D_I C D .E I p I G I H I LIVING ROOM ! DINING ROOM ! / I II UID BRFST. RM. BATH ENT. HALL i ! I_ _-`j_ I� _I J FRONT PORCH OUTSIDE KITCHEN / I61.� FF _.— SERV. PCH. i CLOSET II BORM. NO. _i ^'� �6�• CLOSET I I I APPROVALS DATE IMYPHCYOR•6 MAM4 ti I I J CON9UIT �rr �] II WIRING t / TOTAL_ . I I`�1 IT i FIXTURES' 8 NO. CI' CUTLETS POWER NO. OF FIXTURES II _E UTILITYCO.NOTIFIED 4 i:. NO. OF MOTORS H. P. ''II. 1 FINAL rte' NO. OF SIGNS TRANS. II 1 AM THE LEGAL OP�/NER,,OF THE ABOVE LOO ARGRA ED .±� COUNTY REGISTRATION NUMr NO. OF RANGES OR- HEAYERS� II •� MISCELLANEOUS ELECTRICI M. II I AM THE LEGAL OWNMR OF THff PROPERTY D¢IICRID9n x' PERMIT FEE 0. &0 ABOVE.. .. N: TOTAL` FEE - :fl 'f:' ♦ �. ti.0-+:ire f l L .r r �• t ti . jp ',i . � �. . .rte ,` f'•.�...,�,� � -� a• c �-.. ZON IE / I s a,� � _, ,:- "..-•_ •' ..,..,.... r -"�.�.� gyp"•""'!�ti x . •5 k• :; _-ate__. ._ T... x x �' r���, 1 � 1 �_ � .,.. � f � P .�.��ryrr �"� �`°� mow• r: RAW • .f i P; 4 • • p r�,� VIC y. �t � ISI .� M'i I• �i i� } 1-• ,. I __ - � 1 +kP f�•'�Jr`�� r aMm no . +'s �r �= ice:C:::■.. P .� �.. 1. �_ �o� ON It M MINE A. c, r ? -ter_�K � _. `ps;. • .L i iTr-�;- 1- 1 +N,� ♦ G• f :-t . L _ J .