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Home My Public Portal About6031 KAUFFMAN AVE_Electrical__ 4 � KERS' COMPENSATION DECLARATION CE 806G 10/81 APPLICATION FOR ELECTRICAL PERMIT m that• I hale a certificate of consent to self j (u�r�e cert. if,„Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY .,or-.o cejVifie�ccpy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB f Certified co s hereby furnished. EACH NO.. FEE ADDRESS D / PY Y New Residential Bldgs. & Pools 1 &2-Family, S Ft. $ — $ LOCALITY•�'1 Certified copy is filed with the county building inspec- Y- q tion department. Multi-family Sq. Ft. NEAREST CROSS ST. Residential Swimming Pools OWNER OR + Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light 2— Sw. A MAIL COMPENSATION INSURANCE 4 ADDRESS d First 20 (This section need not be completed if the work involved by Total No. Additional CITY /�', �r el. No. the permit is for one hundred dollars ($100)or less.) PLAN CHECK 1 certify that in the performance of the work for which this I APPLICANT permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'jQompeat ion Laws. Lighting Fixtures First 20 ADDRESS eAM Total No. Additional CITY 1. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after mokF g 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 Power Apparatus& Large Appliances UX DISTRICT N — U` t/ PROCESSED BY >_and Professions Code, and m license is in full force and effect. Size &Type HP, KW, KVA, or KVAR' O License Number Lic. Class Up to 1 Incl. FINAL t; Over 1 to 10 Incl. DATE (g rg Contractor Datef� G VAL ATI O Over 10 to 50 Incl. FIN tJ I am exempt under Sec. Over 50 to 100 Inc. B ? UA B.BP.C. for this reason Over 100 / Date: Services, Swbd., MCC & Panelboards 0 - 200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V 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 Law for the following reason (Section 7031.5, Business and -2 7 6 9.2 A P fessions Code): 1, as owner of the property, will do the work and the Misc. Conduits & Conductors #-o,o'o o.0 2 structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ 7044, Business and Professions Code). ( o o ] 5 CONSTRUCTION LENDING AGENCY 0 0 0 8 7 55 1 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) 0 a l 7-87 (Sec. 3097, Civ. C.), PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address C 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 obo e-me 'oned property for inspection purposes. • SEE REVERSE FOR EXPLANATORY LANGUAGE S16-nouXe of Permittee to 0 I G n - e VC/OR(CERS' COMPENSATION DECLARATION 76A663 10/8t APPLICATION FOR ELECTRICAL PERMIT I fherelJy affirm that I have a certificate of consent to self CE-806G insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 380 k�� Policy No. Compo FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS -13 oa Certified copy is filed with the count ilding inspec- 1 & 2-Family, Sq. Ft. — $ LOCALITY �^ tion depar ent. Multi-family Sq. Ft. NEAREST IF Residential Swimming Pools ;OWNER OR Date ApplicanCROSS ST. t N _ FIRM NAME -.^ CE TIFICATE OF EXEMPTION FOM WORKERS' : ,. MAIL COMPENSATION INSURANCE Outlets: Rec4 LSw. ADDRESS (This section need not be completed if the work involved by First ti Total No.. 20 Additional CITY 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 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 �/ Exemption, you should become subject to the Workers' Range Heater D.W. _ APPLICANT Compensation provisions of the Labor Code, you must forth- Oven _ Dryer W.M.— ADDRESS �e with comply with such provisions or this permit shall be Top FAU —W.H. — deemed revoked. CITY Tel. No. 7 LICENSED CONTRACTORS DECLARATION Hood '✓ Fan _Other_ /} M F • S Disp. y� Room Air Cond. v LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER Class. (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCESSED BY Il' Power Apparatus& Large Appliances and Professions Code, and my license is in full force and effect. ' — O Size &Type HP, KW, KVA, or KVAR V L Q U License Number �� lass Up to 1 Incl. FINAL it t , Over 1 to 10 Incl. DATE — �j Z VALIDATION Contractor Date L/ ❑ Over 10 to 50 Incl. FIN W I am exempt under Sec. Over 50 to 100 Inc. BY B.&P.C. for this reason Over 100 Z Date: Services, Swbd., MCC& Panelboards 0 - 200 Amp. Under 600V �5Q1,9A Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect, Over 1000 Amp. or Over 600 V # o o o o o 2 SINGLE FAMILY Temp. Power Pole & Appurtenances A o - 39,25 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit o 0 0 3 4 2 5 5)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 7, 1 4 ..'8 6 Professions 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 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 D 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 and State laws regulating Electrical wiring, and herebyauth ize representatives of this County to enter upon t e ave entioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee ate i WORKERS'COMPENSATION DECLARATION 76-663 10/$1 APPLICATION FOR ELECTRICAL PERMIT I hereb affirm that I have a certificate of consent to self insure, CE-606G or a certificate of Workers' Compensation Insurance, 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 ❑ Certified copy is herebyfurnished. EACH NO. FEE ADDRESS New Residential Bldgs.& Pools ❑ 1 & 2-Family,Sq.Ft. $ — $ LOCALITY Certified copy is filed with the county building inspection department. Mufti-family Sq.Ft. — NEAREST CROSS ST. Date Applicant Residential Swimming Pools OWNER OR AA ' FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS'. Outlets:Rec Light Sw. MAIL COMPENSATION INSURANCE ADDRESS This section need not be completed if the work involved the First 20 ( p b Y 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 r _ sT Total No. CITY Tel.No. D � Applicant�a? 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. APPLiCA provisions of the.Labor Code, you must forthwith comply with such Oven _ Dryer W.M._ ADDRES provisions or this permit shall be deemed revoked., Top - FA W.H. _ CIT Tel., LICENSED CONTRACTORS DECLARATION Hood Fan Other_ 1 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 Class.(,r Professions Code,and my license is in full force and effect. DISTRICT NO. PROCESSE BY " Power Apparatus& Large Appliances - O ` /' ,y Size& Type HP,KW,KVA,or KVAR 6 License Nume4?/ _� Lia CIasS/, ��[./` �7 Up to 1 Inc[. FINAL J /�� U Over 1 to 10 Incl. DATE c,. VALIDATION 0 Over 10 to 50 Incl. L/ ❑ I am exempt under Sec. Over 50 to 100 Inc. BY FINAL Pjl �U B.&P.C.for this reason Over 100 / Services,Swbd.,MCC&Panelboar'ds ® N Date: 0-200 Amp.Under 600 V ry Signature 201 - 1000 Amp.Under 600 V ❑ Exemption for Reg.Maint.Elect. Over 1000 Amp.or Over 600 V �� SINGLE FAMILY Temp.Power Pole& Appurtenances 8 4 9' HOME OWNER-BUILDER DECLARATION Sign with One'Branch Circuit # 0 O(�O, 2 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 0 1 O Code): X o 0 0 2 ❑ I,as owner of the property,will do the work and the structure Misc.Conduits & Conductors ( Q 3 is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , and Professions Code). CONSTRUCTION LENDING AGENCY ;2 8 5 Q 5 1 herebyaffirm that there is a construction lendingagency for the 0 0 9201.4 o performance of the work for which this permit is isued(Sec.3097, PERMIT FEE (Sub-Total) 1 00 G 1�0Q Civ. C.). PLAN CHECKING FEE o 0 o 2.1.O O 5 Lender's Name • PERMIT ISSUING FEE- 1 203-87 Lender's Address I certify that I have read this application and state that the above TOTAL FEE �1, i„r 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 �gn r inspection purposesSEE REVERSE FOR EXPLANATORY LANGUAGEof Permittee Date WORKER S'COMPENSATION DECLARATION CE-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT CE-806 � I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES }� BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or / , a certified copy thereof(Sec. 3800,Lab.C.) JOB Policy No. EACH NO. FEE D Company FOR APPLICANT TO N DRESS t j New Residential Bldgs.&'Pools 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 "J department. Residential Swimming Pools OWNER OR FIRM NAME Date - Applicant Outlets: Rec._Light Sw. ADDRESS IV First 20 CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY CI CA4 Tel COMPENSATION INSURANCE PLAN CHECK tl (This section need not be completed if the work involved APPLICANT 0 by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS U Total No. Additional cc I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. 0 I . permit is issued, I shall not employ any person in any manner PERMIT so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT W k`, �t _ Oven _ Dryer_W.M._ ADDRESS , � NX Date 'Applin � Top _ FAU _W.H.. 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 Appliances DISTRICT NO. PROCES D BY with comply with such provisions or this permit shall be deemed revoked. Size&Type HP,KW, KVA,or KVAR 1 0 Up to 1 Incl. FINAL LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATE VALIDATION Over 10 to 50 Incl I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc.. FINAL BY f 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 ness and Professions.Code, and my license is in full force and effect. Services 0-200 Amp. Under 600 V License Number Lic.Class 'L 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- Additional Sign Branch Circuits nessan rofessions Code): 0 0 1 5 9 A Misc.Conduits& Conductors I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— _ # o o io o o'2 structure is not intended or offered for sale (Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 2 ° o 1 9.50 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is PERMIT FEE (Sub-Total) 0 0 0 1 9.5 0 P2 issued (Sec. 3097,Civ.C.). d Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Y/ 07.01 —81 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 th ve-mentioned�Eop for inspection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE S I- / signature of Permittee Date