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HomeMy Public PortalAbout6022-6028 KAUFFMAN AVE_Electrical__ WORKERS'COMPENSATION DECLARATION CE-806G �c/81 APPLICATION FOR ELECTRICAL PERMIT I F,iereby affirm that I have"a certificate of consent to self insure, or-6 certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy therep(SSec.380 0,LLaab� � �/� !� Policy NOPP[[ JJ A Company 3 � " • rr FOR APPLICANT TO FILL IN JOB ❑ Certified co is hereby furnished. EACH NO. FEE ADDRESS copy Y New Residential Bldgs.& Pool OCALITY Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft. L $ — $ — -n department. Multi-family Sq.Ft. — NEAREST —�j� �J CROSS O L d Date/ ? O rApplicantT6c—G�+ `7 Residential Swimming Pools OWNER OR FIRM NAME Q CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec— Light Sw.— MAIL COMPENSATION INSURANCE , ADDRESS completed if the work involved by the First 20 (This section need not be com P permit is for one hundred dollars($100)or less.) Total No. Additional, CITY Tel.No.' I certifythat in the performance of the work for which this permit PLAN CHECK P 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 Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of PERMIT 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 0 7 provisions or this permit shall be deemed revoked. Top — FAU _ W.H. .Tel.No. y CITY •� LL LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ I hereby affirm that I am licensed under provisions of Chapter 9 Dis — Room Air Cond. LICENSE (commencing with Section 7000) of Division 3 of the Business and P REG.NUMBER C7 Class. Professions Code,and my license is in full force and effect. DISTRICT NO. PROCESSED BY Power Apparatus& Large Appliances C^` �)(/� Size& Type HP, KW,KVA,or KVAR J L/J� License Number C7 Lic.Class Up to 1 Incl. FINAL / Over 1 to 10 Incl. DATE ALIDATION o CT t , Date / Over 10 to 50 Incl. ❑ FIN Z. V I.am exempt under c. Over'50 to 100 Inc. gY B.&P.C.for this reason Over 100 I, Services, Swbd.,MCC& Panelboards ► Z te: 0- 200 Amp.Under 600 V -8 6 4.9 A Signature 201 - 1000 Amp.Under 600 V Over 1000 Amp.or Over 600 V # o o o o o 2 ❑ Exemption for Reg.Maint.Elect. I o - 69.02 SINGLE FAMILY Temp.Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATIONSign with One Branch Circuit v o I hereby affirm that I am exempt from the Contractor's License Law o 0 6 9 0 2 • for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): 1223-87 ❑ 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) Poo. Professions Code). 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 PERMIT ISSUING FEE U •S Lender's Address I certify that I have read this application and state that the above TOTAL FEE (q .4 t6 2 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��y for inspection urposes. � SEE REVERSE FOR EXPLANATORY LANGUAGE �` z 3�� Slgnatur f ermittee Date WORKERS' COMPENSATION DECLARATION CE-806 10i81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-806G insure, ora certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Zy I[c1 Compan 4 X FOR APPLICANT TO FILL IN JOB L Certified co is hereby furnished. ADDRESS U PY Y New Residential Bldgs. & Pools EACH rNO. FEE ' ©�ertified copy is filed with the count buildin spe 1 & 2-Family, Sq. Ft. $ $ LOCALITY tion department. Multi-family Sq. Ft. NEAREST /� Residential Swimming Pools CROSS ST. Date 4 Z`5–� Applicant OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE ADDRESS tZS s section neenot completed if the work involved b First t (Thitid t b p y Total No. Additional CITY i 20 Tel. No. q,7 cF " 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 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 Total No. Additional CITY Tel. No. Date Applicant Fixed Appliances 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. _ n, 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. PRO D and Professions Code, and my license is in full force and effect. Power Apparatus& Large Appliances �r � j� Size &Type HP, KW, KVA, or KVAR' I U License Number Lic. Class– W to 1 Incl. FINAL P 2 -��✓�6 / Over 1 to 10 Incl. �,,�.,`' DATE Contractor IMV –�yLC_ Date /ALIDATION ❑ Over 10 to 50 Incl. FINA a tD I am exempt under Sec. Over 50 to 100 Inc. BY LU B.&P.C. for this reason Over 100' Services, Swbd., MCC & Ponelboards 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 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 #90 60 1 Law for the following reason (Section 7031.5, Business and I 0 0 2 5 5 Professions Code): ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors 0 0 o2 5 5 0 5 structureis not intended or offered for sale (Section Other (See Complete Fee Schedule)_ ► 12 13-86 7044, Business and Professions Code). 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.). LZ PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Q Lender's Address I certify that I have read this application and state that the TOTAL FEE above information is correct. agree to comply with all County ardin qes and State la s gulating Electrical wiring, and her y authorize epr a i es of this County to enter upon th above-men one p o e for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date .WORKERS' COMPENSATION DECLARATION - io/si APPLICATION FOR ELECTRICAL PERMIT •„ I herby Cy'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.3800,1-a .J) Policy NoI16566 J-2 Company ,J FOR APPLICANT TO FILL IN JOB _ ❑ Certified copy is hereby furnished. New Residential Bldgs.& Pgg1s� EACH NO. FEE ADDRESS Certified copy is filed with the county building inspection 1 & 2-Family, `��1 $ _ $ , �ij LOCALITY _ NEAREST O department. � � Multi-family Sq.Ft. CROSS ST. L —� Residential Swimming Pools. OWNER OR 'l Date Applicant \` FIRM NAME V CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec— Light Sw. — MAIL COMPENSATION INSURANCE ti -ADDRESS (This section need not be completed if the work involved by the First 2Q , Total No. Additional. CITY Tel.No. permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit PLAN CHECK 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 Fixed Appliances Not Over 1 HPPERMIT NOTICE TO APPLICANT: If, after making this Certificate of /J S ,�'L Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APPLICANT K 1J 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 CITY Hood — Fan Other_ Tel.No. Z I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR L (commencing with Section 7000) of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER L4 O J- Z Class. e-1 Q Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. / PROCES ED BY L' C. Size& Type HP,KW,KVA,or KVAR t o o License Number V Lic.Class Up to 1 Incl. FINAL V 1 I ^ _ C Over 1 to 10 Incl. DATE Con ac or J, `b `� Date 4 �j VALIDATION 0 ❑ Over 10 to 50 Incl. FIN V I am exempt under Sec. Over 50 to 100 Inc. 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 $6 4 8 A Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATION # 0 0 0 0 0 2 Sign with One Branch Circuit 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 7031.5, Business and Professions .Additional Sign Branch Circuits o o70, 1 8 Code): 0 0 0 7 Q 1 cYi El1,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) 1 2 2 3—8 7 and Professions Code). , 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 „ • PERMIT ISSUING FEE U Lender'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 and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above-mentioned property- r inspecti S. -2-- �� `�1 SEE REVERSE FOR EXPLANATORY LANGUAGE Sig ture of P mi ee Date ) It 11 1WOAKERS'-COMPENSATION DECLARATION CE-806G '°'B' APPLICATION FOR ELECTRICAL PERMIT I hereby_affirm that I have 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 -? POIiCy NO % Company � �_ y FOR APPLICANT TO FILL IN JOB O ❑ 5 LJ Certified co is hereby furnished. ADDRESS PY Y New Residential Bldgs.& P �Is EACH NO. FEE LOCALITY "� Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft. j 2- $ — $ 1 Ldepartment. Multi-family Sq.Ft. — NEAREST CROSS ST. O Date Applicant Residential Swimming Pools OWNER OR ] FIRM NAME •.� �s CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL Sw. Firs , COMPENSATION INSURANCE Outlets:Rec— Light — t20— .`1 .ADDRESS , (This section need not be completed if the work involved by the CITY Tel.No. permit is for one hundred dollars($100)or less.) Total No. Additional, I certifythat in the performance of the work for which this permit PLAN CHECK P 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 Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of PERMIT , C`-- Q -Z Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. APPLICANT F' provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M._ ADDRESS (0!5-- '2-72 provisions or this permit shall be deemed revoked. Top — FAU _ W.H. CITY / Tel.N cr OR LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ t"t hereby 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 „j Class. Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO. PROCESSED BY �1 / Size& Type HP,KW,KVA,or KVAR License Number Lr o / UI ic.Class C 4� Up to 1 Incl. FINAL ` 0 a�Q !"[dl- /�Z3 Over 1 to 10 Incl DATE VALI ATION 0 tractor ! Date J Over 10 to 50 Incl. ❑ FIN I am exempt under Sec. Over 50 to 100 Inc. By U LiJ B.&P.C.for this reason Over 100 �. N Services, Swbd., MCC&Panelboards Z:e: 0-200 Amp.Under 600 V "'MSignature 201 - 1000 Amp.Under 600 V Over 1000 Amp.or Over 600 V ❑ # Q h 7 Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit o o 7 Q�1 8 1 hereby affirm that I am exempt from the Contractor's License Law o 0 0 7 Q. 1 8 v for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): 1223-87 ❑ 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). 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 PERMIT ISSUING FEE 1 S Lender's Address I certify that I have read this application and state that the above TOTAL FEE 1 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 inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE nature of Pr itDate WORKERS'COMPENSATION DECLARATION -663 10/81 CE-806G APPLICATION FOR ELECTRICAL PERMIT I•,Sereby'affi6 that I have a cdi'tificate of consent to self insure, CE or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.c3800,1­ab.C Policy No.��� `� Company FOR APPLICANT TO FILL IN JOB O Certified copy is hereby furnished. New Residential Bldgs.&P I A� EACH NO. FEE ADDRESS LOCALITY Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft. $ _ $ ' department. Multi-family Sq.Ft. NEAREST CROSS ST. 55"A'21 Residential Swimming Pools OWNER OR. Date —�3 - icant ��"S FIRM NAME 0—LI /Q O CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec Light — Sw. — MAIL COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work involved by the First 20 * CITY, Tel.No. permit is for one hundred dollars($100)or less.) Total No. Additional I certifythat in the performance of the work for which this permit PLAN CHECK p 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 Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of PERMIT G Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APPLICANTr—ZrZ. G provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M._ ADDRESS Q 2 provisions or this permit shall be deemed revoked. Top — FAU _ W.H. _ �y CITY J be 6- Tel.No. LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ 1'hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. OR REG.N ' / Class. (commencing with Section 7000) of Division 3 of the Business and REG.NUMBER ""7 0 v 3 Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT N ; / PROCESSED e /. Size&Type HP,KW,KVA,or KVAR License Number 4/0 Lic.Class G-, -0 Up to 1 Incl. FINAL /Z:�3— Over 1 to 10 Inc]. DATE _ VA/DATI'ON O ontractor Date❑ Over 10 to 50 Incl. FINAIZ U I am exempt under Sec. Over 50 to 100 Inc. B W Over 100 n- B.&P.C.for this reason N D Services,Swbd.,MCC.& Panelboards , 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. SINGLE FAMILY Temp.Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): ❑ p I,as owner of the property,will do the work and the structure Misc.Conduits & Conductors 8 b 5,.0 A � is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ and Professions Code). , # o 0 0 0 0 2 CONSTRUCTION LENDING AGENCY I o o b 9 0 2 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) ° ° o69, 010 Civ.C.). — 12 2 3 8 7 PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE 5 Lender's Address I certify that I have read this application and state that the above TOTAL FEE �, O 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 inspection purpos . SEE REVERSE FOR EXPLANATORY LANGUAGE Z-Z Si nature of Pe ittee Date