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Home My Public Portal About6027 KAUFFMAN AVE_Electrical__ WORKERS' COMPENSATION DECLARATION 76A663 10/81 APPUCATION FOR ELECTRICAL PERMIT I.he'eby affirm that I have a certificate of consent to self insure, CE-806G or a certif,;cate of Workers' Compensation lAsurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB /-O�� / ,I�/^/�/J� / ❑ Certified copy is hereby furnished. EACH ' 'NO. FEE ADDRESS & (` (� F_ ��J New Residential Bldgs.& Pools ❑ Certified copy is filed with the county building inspection 1 & 2-Family,Sq. Ft. $ — $ LOCALITY department. Multi-family Sq.Ft. NEAREST CROSS o(9 evr� CROSS ST. (/1/ r Date Applicant Residential Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' A MAIL COMPENSATION INSURANCE Outlets:Rec Light t 2 ADDRESS (This section need not be completed if the work involved b the Firs! 20 permit is for one hundred dollars($100)or less.) y Total No. Additional CITY Tel.No. PLAN CHECK 11 certify that in the performance 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'Comp ti Laws. / Lighting Fixtures First 20 ADDRESS �A Total No Additional CITY Tel.No. his. Date •--�I Applicant V� Fixed Appliances Not Over 1 HP PERMIT NOTICE -TO APPLICANT: •If, after making tCerrtificate APPLICANT Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. 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. CITY Tel.No. LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ I hereby.affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. LICENSE Class. (commencing with Section 7000) of Division 3 of the Business and REG.NUMBB ER Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT No. GP�C�po�EESSS_ED BY Size& Type HP,KW,KVA,or KVAR �s G 0 License Number Lic.Class Up to 1 Incl. FINAL 0 DATE Ix Over 1 to 10 Incl. Contractor Date � VALIDATION 0 Over 10 to 50 Incl. FINAL I— ❑ I am exempt under Sec. Over 50 to 100 Inc. BY U W Over 100 n- BAP.C.for this reason N Date: Services,Swbd.,MCC& Panelboards Poo. 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. .L 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 Additional Sign Branch Circuits 7-1"1'7-1"1' for the following reason (Section 7031.5, Business and Professions Code): i r - ITE) ❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors T '"r•€ is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) )-(1 A^- :•r and Professions Code). h. ► c.;�i,C t,K .56 CONSTRUCTION LENDING AGENCYIi ;;E 5 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 •-j1-(' Lender's Name PERMIT ISSUING FEE ';-'-*' _€ s=_•° 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 up the above-mentioned pro e If inspect' SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKER'S COMPENSATION DECLARATION 9 DPW 9/89 APPLICATION FOR ELECTRICAL PERMIT 76A66 I hereby•affirm that I have a'certificate,of consent to self insure, 76A663 or a certificate; of worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec. 3800 Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB / nA: / U� P � O /�/V, , Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ADDRESS $ _ $ LOCALITY ❑ Certified co Is filed with the count buildinginspection 1 &2-Family,Sq.Ft. department. Y p Multi-family Sq.Ft. CROSS ST. vDRvFF Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec. Li ht Sw. OWNER OR g COMPENSATION INSURANCE FIRM NAMECH _f� OV ZEL- First 20 MAIL /e�� )//lr'�-�^An VC,' (This section need not be completed if the.work involved by the Total No. Additional ADDRESS & (`P V rf �"1 permit is for one hundred dollars($100)or less.) 1 certify that in the performance of the work for which this permit CITY 1 EEA IETel.No. 2 S!L� , is issued, I shall not employ any person in any manner so as to PLAN CHECK C, become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date Applicant 15 OR 20A,120V BRANCH CIRCUITS NOTICE TO APPLICANT: If, after making this Certificate of CITY TeL No. Exemption,you should become subject to the Workers'Compensation 1 TO 10 INCLUSIVE EACH provisions of the Labor Code, you must forthwith comply with such - 11 TO 40 INCLUSIVE EACH PERMIT /J p y p y APPLICANT provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH LICENSED CONTRACTORS DECLARATION ADDRESS d I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH O (commencing with Section 7000) of Division 3 of the Business and CITY Tel.No. U Professions Code,and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR Power Apparatus&Large Appliances REG.NUMBER class. License Number Lic.Class Size&Type HP,KW,KVA,or KVAR DISTRICT NO. A PROCESSED BY F- Up to 3 Incl. �� bJ'®U �2��2.-t. W ❑ Contractor Date Over 3 to 10 Incl. DATE CIL Over 10 to 50 Incl. / _'7�/1 I am exempt under Sec. Over 50 to 100 Incl. VALIDATION FINAL B.&P.C.for this reason Over 100 BY Services,Swbd.,MCC&Panelboards 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. y SINGLE FAMILY Temp.Power Pole&Appurtenances A r• HOME OWNER-BUILDER DECLARATION - t.f,.,4 I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit - for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits 41* Code): 't .. �i Code): - Misc.Conduits&Conductors T'r'H'C 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) , j i 25 =• � •y 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) 147 Civ. C.) PLAN CHECKING FEE I'!?iw;Li--;iia€ "µ Lender's Name PERMIT ISSUING FEE p( 42/1" Lender's Address 1 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 propWWyf inspect61-ZES, SEE REVERSE FOR EXPLANATORY LANGUAGE 9 �- SIGNATURE F APPLICANT OR AGENT DA WORKERS'COMPENSATION DECLARATION 76A663 10/81 hereby'gffirm that I have a certificate of consent to self CE-806G APPLICATION FOR ELECTRICAL PERMIT .F'in5uitf"i�r a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB FF�/1 R` ' ❑ Certified co is hereby furnished. EACH NO. FEE ADDRESS �1�11 ►TN copy Y New Residential Bldgs. & Pools ❑ 1 & 2-Family, S Ft. $ — $ LOCALITY Certified copy is filed with the county building inspec- Y. q tion department. Multi-family Sq. Ft. NEAREST I0 D ^u FF CROSS ST. '< Residential Swimming Pools OWNER OR Date Applicant FIRM NAME ICL A(2D 4EQ7Z CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec39Light ] 3,Sw.23 MAIL q COMPENSATION INSURANCE First 20 20 ADDRESS rC � (This section need not be completed if the work involved by Total No. Additional ICITY Tel. 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 PLICANT permit is issued, I shall not employ any person in any manner so as to become subject to the Worke o ,pensation Laws. hting Fixtures First 20 ADDRESS p Total No. Additional CITY Tel. Date `Zs a Applicant a 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. — Compensation provisions of the Labor Code, you must forth- Oven _ DryerW.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 and Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances 5c !,� Size' .Type HP, KW, KVA, or KVAR' U S BY O License Number Lic. Class Up to 1 Incl. O FINAL U Over 1 to 10 Incl. DATE VALI ION Contractor Date Over 10 to 50 Incl. FINAL ❑ I am exempt under Sec. Over 50 to 100 Inc. BY B.&P.C. for this reason Over 100 Date: Services, Swbd., MCC& Panelboards c0U ® 2 0 2 A 0 - 200 Amp. Under 600 V U Signature 201 - 1000 Amp. Under 600 V # 0,0 "0 0 0 ❑ Over 1000 Amp. or Over 600 V Exemption for Reg., Maint. Elect. 0 8 SINGLE FAMILY Temp. Power Pole&Appurtenances 0 A8 5 cis 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 7,25-88 Law for the following reason (Section 7031.5, Business and Pro essions Code): I, as owner of the property, will do the work and the Misc. Conduits &Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)- 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY ;20267A 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) # o o,o o o 2 (Sec. 3097, Civ. C.). ( o 0 8 a 7 5 PLAN CHECKING FEE Lender's Name 0.0 6 8&7 5 PERMIT ISSUING FEE Lender's Address 07.25788 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 thea e- entioned roperty for ins ction purposes. —�1�� J`� ��j SEE REVERSE FOR EXPLANATORY LANGUAGE ul• 7-2,S"-'F1' Signature of Permittee Date WORKER S'COMPENSATION DECLARATION CE-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT I hereby,affirm that I have 'a certificate of consent to self COUNTY OF LOS ANGELES r /� BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab. C.) "`✓✓✓✓ JOB Policy No. Company EACH . FEE ADDRESS FOR APPLICANT TO N NO7 / 41 New Residential Bldgs.&Pools �� U l: Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. 6r$ — $ LOCALITY •2pte � C i" QMulti-family Sq. Ft. — NEAREST QV G Certified copy is filed with the county building inspection CROSS ST department. Residential Swimming Pools OWNER OR f� FIRM NAME NJ Date Applicant Outlets: Rec gLight , rJ��_ Sw. If Z First 20 /5 ADDRESS wc� CERTIFICATE OF EXEMPTION FROM WORKERS' Total No._—VOL-A2—Additional - CITY 11f ,Ie%Q,TeI No. COMPENSATION INSURANCE PLAN CHECK f3 APPLICANT O (This section need not be completed if the work involved OC�,. �. by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS U Total No. Additional 1 certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. O permit is issued, I shall not employ any person in any manner PERMIT ~ W so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT Oven _ Dryer_W.M. ADDRESS N Date Applicant Top _ FAU _W.H.. Z Hood _ Fan —Other _ CITY o. 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 Appliances DISTRICT�"q�,�� V;6��VV, with comply with such provisions or this permit shall be Size&Type HP, KKVA,or KVAR , f � deemed revoked. Up to 1 Incl. 11 FINAL Over 1 to 10 Incl. DATE -� VALIDATION LICENSED.CONTRACTORS DECLARATION Over 10 to 50 Incl. 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 �.f' ness and Professions.Code, and my license is in full force and effect. Services License Number Lic.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 DECLARATION5 A Temp. Power Pole&Appurtenances f 2 4;7, , I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit #'0 0 0 0 0 2Additional Sign Branch Circuits � License Law for the following reason (Section 7031.5, Busi- ' ness and Professions Code): 2*0'o 3 1, 10 Misc.Conduits&Conductor s I as owner of the property, will do the work and the• Other (See Complete Fee Schedule)— ,o'0 0 3 1, 1 0 structure is not intended or offered for sale (Section 7044, Business and Professions Code). ( i- CONSTRUCTION LENDING AGENCY 2 3 81 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) issued(Sec. 3097,Civ.C.). .Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE 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 thea ove-mentioned propert9;W/.3_b ' purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE i/ r0 Signature of Permittee ate WORKERS'COMPENSATION DECLARATION 10181 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to seCE-806G.CE-806G. insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELESy BUILDING AND SAFETY or a certified copy ff thereof (Sec. 3800, Lob. C.) / �•-� Policy N482 V7S-7) Company_f A f FOR APPLICANT TO FILL IN JOB ❑ Certified co is hereby furnished. EACH NO. FEE ADDRESS V2 / PY Y New Residential Bldgs. & Pools $ — $ LOCALITY � Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. T�''1 ��- t-t NEAREST tion department. � Multi-family Sq. Ft. — tom. Residential Swimming Pools CROSS ST. Date ( `-� Applicant OWNER OR pp y� pp -�— FIRM NAME t� �. , \l S l�e✓1nZe_ CERTIFICATE OF EXEMPTIO F KERS' MAIL Outlets: Rec Light Sw._ ) COMPENSATION INSU ANCE l ADDRESS rA-VL, _ (This section need not be completed if the work involved by First 20 the permit is for one hundred dollars ($100)or less.) Total No. Additional CITY ��M,� `� (_ Tel. No. I certify that in the performance of the work for which this PLAN CHECK APPLICANT K, cem" 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 I ; S(f JYt 2. Total No.� Additional �` Date Applicant CITY T�{�, Tel. No. NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range_ Heater.-D.W. — APPLICANT S 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. i CITY Tel. No. LICENSED CONTRACTORS DECLARATION Hood _ Fan -1-Other_ Disp. Room Air Cond. e g� °� LICENSE _5' Class. ^^1 I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBERZZ-. (commencing with Section 7000) of Division 3 of the Business DISTRICT PROCESSE BY and Professions Code, and my license is in full force and effect. Power Apparatus& Large Appliances �y qq _4 Size &Type HP, KW, KVA, or KVAR' C� License NumberLL Lic. Class - t Up to 1 Incl. FINAL ST,C< �� „y C ��)y Q y Over 1 to 10 Incl. VALIDATION Contractor a -I-_L Over 10 to 50 Incl. ` �� V FINAL ❑ I am exempt under Sec. Over 50 to 100 Inc. BY p :.•?G -c �,. B.&P.C. for this reason Over 100 Date: /�c ch Services, Swbd., MCC & Panelboards ► A, X, 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V 11.3 3 ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Moint. Elect. ”2 5 1, 1 A SINGLE FAMILY Temp. Power Pole & Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit o o 0 o o2 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 2 0 o 1 9 00 Professions Code): El1, as owner of the property, will do the work and the Misc. Conduits 8 Conductors o <> o 1 91 O Q X structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ ► 07. 0 5-84 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.). 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 ®V 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 property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signejure of Permitt Date