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Home My Public Portal About6202 KAUFFMAN AVE_Electrical__ 314 WORKERS'COMPENSATION DECLARATION 76A663 CE'8p6G (2-80) APPLICATION' FOR ELECTRICAL PERMIT , 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 Insu.kance,or a certified'copy thereof_(Sec. 3800, Lab. C.) FOR APPLICANT TO FILL.IN AD e. Policy No.—Company - - •ADDRESS ' New Residential Bldgs.&Pools EACH NO. FEE T - a;Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY'riTy Multi-family Sq. Ft. r CROSS ST Certified copy,is filed"with the county•building inspection Residential Swimming Pools department.' FIRM NAME Date '•Applicant Outlets Re JZLight� Sw'� _ l� MAIL First 20 i ADDRES CERTIFICATE OF EXEMPTION FROM•WORKERS' " 4 •Total No. Additional' CIT Tel No COMPENSATION INSURANCE "� d PLAN'CHECK' O (This gection need not be completed if the work involved d APPLICANT V by the •permit is'for one hundred 'dollars ($100) or'l-ess.) , Lighting:Fixture Firsf 20. ADDRESS 0 Additional %I" Total No. O I(certify that-in the performance of the work'fo{which this Fixed AppliancesFNot Over 1-4. CITY el No. U, Termit•i&issued, I shaWnot employ any person in any manner PERMIT' W' ; so as to become subject to the••Workers' Compensation,Laws. Range_ Heater=D.W. -APPLICANT 4 Oven Dryer'_W.M ADDRESS Date e6wApplicantl` �� Top FAU _ W.H. '1 ? Hood Fan =Other— CITY A` TeLNo: NOTICE TO APPLICANT: If,,after making this Certificate of Disp. •_ Room Air Cond-_ LICENSE OR Exemption, you should 6ecome`'sub'Iect to the Workers' _ REG.NUMBER Class Compensation'provisions'oUthe'Labor Code, you must forth- Power Apparatus&•Large Appliances' DISTRICT NO., PROCESS D BY with comply with such provisions or this permit.shall be �' deemed revoked. ! Size'&Type HP,KW, KVA,or KVAR r t V Up to.1 Incl.. FINAL Over 1 to 10 Incl. DATE ' LICENSED•CONTRACTORS DECLARATION VALID TION Over'10'to 50'Incl.' I hereby affirm that I am licensed 'under provisions of Chapter Over 50•to 100 Inc; BY 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 s ness and'Professions Code,•and:my licen'se•is in full force and effect. Services License Number' Li' :'Class " 0-200-Amp.Under 600 V 1000 Amp. Under 600 V- 2-7'4 8-A- 2011' Contractor Date Over, Amp,or Over-600 V #.0"o o e 02 HOME•OWNER;BUbLDER•DECLARAT•ION . Temp. Power Pdle&Appurtenances ':;` T o.o 0.0 0 - Sign with One Branch Circuit I hereby affirm that 'I, am exempt, from .the Contractor's ' Additional Sign Branch Circuits . s 'License Law for_the following reason (Section 703,1.5','Busi- g _ °'O -Z Q O O v ness and Professions Code): � Nhsc.Conduits&,Conductors•. O 8 2 048-5 LSJ �, as owner of the property, will do the work and the" Other (See Complete Fee Scfiedule)— structure'is•not intended' or offered 'for sale '(Section 7044, Business and Professions Code). _2 CONSTRUCTION LENDING AGENCY o I hereby affirm that there is-,a construction lending agency! `," f for .the performance of`the' work for which .this permit is PERMIT'FEE (Sub-Total) issued (Sec, 3097:Cw.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"/ r' above information is correct. I agree to comply with all County f ordinances and State••laws regulating Electrical wiring,'and , hereby authorize,representatives of this County,to enter upon the above-mentioned proper for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATIONDECLARATION 76-663 CE-806G (2:80) App'LICi4TI.ON F®R ELECTRICAL PERMIT • - � ''� I hereby affirm that I have a'certificate of consent to self I COUNTY'OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab. C.) ` 11 . -, ' FOR APPLICANT TO FILL IN jOB /'^ � � Policy No'. Company ' t ADDRESS 2. ft0 New Residential Bldgs.&Pools' EACH NO: FEE. 42D Certified copy is hereby'furnished.-, 1 &2-Family,Sq. Ft. $ — $ •• LOCALITY.p'�114rj��TG/ Multi-family Sq. Ft.' — NEAREST ''� O. Certified copy is filed with the county building inspection CROSS ST' ; ��w�Gww dV'',, A�J� department Residential Swimming Pools, OWNER OR FIRM NAMEt Date Applicant Outlets Rec=Light_.Sw' MAIL -First 20• ADDRESS 649:114— CERTIFICATE OF.EXEMPTION•FROM WORKERS' Total No Additional' CITY (� Tel Nod, 2�p+ - >_COMPENSATION INSURANCE,., PLAN CHECK 4 a' (This section need not be completed if the work involved' ; APPLICANT " �. by the pertnit is,for one hundred dollars ($,100) or,less.) ' ' Lighting Fixtures First 20 ADDRESS' Additional Total No. I certify,that in the performance of the work for which this CITY Tel No: Fixed Appliances Not Over 1 HP permit is issued, I•shall nod employ any`person in any manner ., _ PERMIT - W so-as to'become'subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT �� t1 Oven. _ Dryer _WU .M, � ADDRESS Z -Date Applicant Top, — FAU _W.HGIN .. r - 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. PROCESSED BY- with comply with such:-provisions or this 'perinit shall be i deemed•revoked. Size&Type HP, KW, KVA,or KV-AR ,. ` Up to 1 Incl. - FINAL Over 1 to 10 Incl. DATE .� LICENSED`CONTRACTORS DECLARATION�� VALIDATION Over 10 to 50 Incl. I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINALBY j- 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 " License Number Lica Class 0-200 Amp. Under 600 V 201-1000 Amp. Under 600'V Contractor Date Over 1000 Amp or Over 600 V �ir �i ife HOME OWNER-BUILDER DECLARATION- Temp.Power=Pole&Appurtenances ee�vq�� Sign with One Branch Circuit I hereby affirm that I am- exempt from' the Contractor's License Law for•theJollowh g reason,-(Section 7031.5, Busi- Additional Sign Branch CirL'wts n;�nProfessions Code): Misc.'Conduits& Conductors j2'5:6 3 0 A s owner of the property, will do the work and the 'Other (See Complete Fee Schedule)— oy ' structure, is' not intended or offered for, sale (Section _ +, 7044, Business and Professions Code'). ° J CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction dendmg agency for the performance `of the work fog which this permit is:• •PERMIT FEE (Sub-Total) issued (Sec..3097,Civ:C.). Lender's Name .2 ' PLAN"CHECKING FEE (One-Fourth'Permit Fee) Lender's Address PERMIT ISSUING FEE 2'0 0 2 3.5' 5 0 ,.• I certify that.I have read this,application and state that the, TOTAL FEE : ° 2150 v above information is.correct.I agree to comply with all County "t ordinances and State laws regulating Electrical wiring, and hereby,authorize representatives.of this County to enter upon the above-mentioned property f inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE.,,, Signature of Permittee Date " l WORKERS'COMPENSATION DECLARAT;ON •76-60 ,10/81 CE-8066G APPLICATION FOR ELECTRICAL' PERMIT I hereby affirm that I have a certificate of-consent to self insure' or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING'AND SAFETY or a certified copy`thereof(Sec 36,00, Lab. C. - Policy-No •` Company FOR APPLICANT TO FILL IN.. JOB ,'• ,..,. L Certified copy is hereby furnished New Residential Bldgs• & Pools EACH NO. FEE ADDRESS fp�.02.. �r'V�104&ki Axpe.006 1 & 2-Family, S Ft. $ —is •LOCALITY/ Certified copy is filed with the county building inspec- Y q• tion department. "' Multi-family Sq.Ft. — NEAREST Residential Swimming Pools CROSS ST OWNER OR *401411 I Date Applicant FIRM NAMES CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets � MAIL �Lht p..e►wr-�8�h{�Os� ' COMPENSATION INSURANCE Outlet CE ig � Firstirst20O ADDRESS 40M_ (This section need'not be completed if the`work Involved by Total No. 12-- Additional CITY QL .Tel. No.2&a_S 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 .0LUI�d�L 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 �" "(��Z licant ^ Total No. \ CITY Tel. No Date App , 1''H*ARQ-%S Fixed Appliances Not Over 1 HP PERMIT v` NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT OU�1�C-12. 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. CITY, Tel. No deemed revoked. Hood- Fan _Othe 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 BusinessDISTRICT NO PROCESSED BY and Professions Code, and my license is-in.full•force•and effect' Power Apparatus& Large'Appuances d Size &Type HP, KW,.KVA, or KVAR' Q License Number Lic ClassUp To 1 Incl DATE FINALOC' Contractor Date Over Lto 10 Incl. VALIDATION 0, ElOver 10 to,50 Incl FINAL v U I am exempt under Sec. .OLer 50 to 100 Inc. BY C� tr,/ d B,&P C for this reason Over 100 Z Services,-Swbd , MCC & Panelboa7ds t — 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 On'e Branch G�cuit• I hereby affirm"that I am'exempt from the Contractor's License - Add0lonal Sign.Branch Circuits Law for the following.reason (Section 7031 5, Business and, PP ff ons Code) LJ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule) 7. — r 7044,,Business and Professions Code). -2,52 66 CONSTRUCTION LENDING AGENCY' ' I hereby affirm that there is a construction lending agency for -2 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total)' K (Sec 3097, Civ C. -PLAN CHECKING FEE Lender's'Name - , a o 4 0,,2.5 PERMIT.ISSUING-FEE C' - Lender's Address � �° �� 0�9, 1 5 • =8,3 _ 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-mentioned pro rty for inspection purposes ` ` SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permitte . Date