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Home My Public Portal About10136 LA ROSA DR_Electrical__ WCIRKERS'COMPENSATION DECLARATION 63 CE806G (2-801 APPLICATION FOR ELECTRICAL PERMIT {� CE 806G (J 1 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.) ' FOR APPLICANT TO FILL IN 306 Policy No. Company New Residential Bldgs.&Pools EACH NO. FEE ADDRESS ra 3G Z Z A i3 0)s a b R Certified copy is hereby furnished. 1 & 2-Family,Sq. F[. $ — $ LOCALITY TeN G0 T i ❑ Certified copy is filed with the county buildinglinspection Multi-family Sq. Ft. NEARESTCROSS ST department. Residential Swimming Pools OWNER OR ) (' ��77 FIRM NAME .SA D Date Applicant Outlets: Rec.L Light Sw.� Q MAIL n [[ / ) First 20 ADDRESS V D n� (� DS" CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY ` T el No. COMPENSATION INSURANCE PLAN CHECK d (This section need not be completed if the work involved r �0 C1 APPLICANT L) by the permit is for one hundred dollars (5100) or less.) Lighting Fixtures First 20 ADDRESS Total No,—.-I--- Additional _ O 1 certify that in the performance of the work for which this CITY at No. F Fixed Appliances Not Over 1 His 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 a Oven _ Dryer_W.M. ADDRESS N Date Applicant Top FAU _W.H. _ Z 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 Nfi. /� PROCES ED BV with comply with such provisions or this permit shall be ,,�� Q deemed revoked. Size&Type HP,KW,KVA,or KVAR Up to 1 Incl. FINAL LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATE //S VALIDATION Over 10 to 50 Incl. 1 hereby affirm that 1 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 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 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 3/7 9,7 A - ness and Professions Code): # o s o 2 Misc.Conduits&Conductors as owner of the property, will do the work and the Other (See Complete Fee Schedulel— structure is not intended or offered for sale (Section b 5 O 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY o Q S O Ft 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) 3 � ' ' 19-81 , issued (Sec. 3097,Civ.C.). Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE O o N O I certify that I have read this application and state that the TOTAL FEE _, o o ' above information is correct.I agree to comply with all County /3 �, o o CWordinances and State laws regulating Electrical wiring, and '-' a CW hereby authorize representatives of this County to enter upon I SN (.N o the /aqbJv\e-m�enMtionned prop y for ie\]ap tion purposes. Q SEE'REVERSE FOR EXPLANATORY LANGUAGE O ° 00 1� I V I TL N' D n ure of Permittee Date WORKERS'COMPENSATIONDECLARATION EB6306G (2-801 CAPPLICATION FOR ELECTRICAL PERMIT E8 + 1 hereby affirm that 'I Isave 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. 3900, Lab. C.) FOR APPLICANT TO FILL IN JOB Policy No. Company EACHINC. FEE ADDRESS '�� New Residential Bldgs.&Pools LA A03A Certified copy is hereby furnished. 1 &2-Family.Sq. Ft. $ — $ LOCALITY 7EHPLEC ❑ — A Certified is filed with the county building inspection. CROSSREST ST W 1 department.nt. Multi-family Sq. Ft. NE Residential Swimming Pools OWNER OR •1 FIRM NAME L Date Applicant Outlets. Rea Light.i{�Sw SWAIL • First 20 ADDRESS Q /y 6 E• � R03A CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY LL ri-Ty Tel No. .2 n COMPENSATION INSURANCE } PLAN CHECK 1 (This section need not be completed if the work involved v O APPLICANT O 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. 0 permit is issued. 1 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 Oven _ Dryer_W.M. CL _ ADDRESS to Date Applicant Top _ FAU _W.H. Z Hood — Fan _Other_ CITY Tel No. NOTICE TO APPLICANT: If, after making this Certificate of Oisp. _ 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. PROCESS D BV with comply with such provisions or this permit shall be - Size&Type HP,KW, KVA,or KVAR deemed revoked. Up to 1 Incl. FINAL LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATE // -7�� VALIDATION Over 10 to 50 Incl. 1 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 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 DECLARATION Temp. Power Pole&Appurtenances I I hereby affirm that 1 am exempt from the Contractor's Sign with One Branch Circuit Additional Sign.Branch Circuits License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): Misc.Conduits&Conductors _r Jr 2A 1 A' F1 1_as owner of the property, will do the work and the Other-(See Complete Fee Scheduler tt o 0 a 0 0.'2 structure is not intended or offered for sale (Section 7044, Business and Professions Code). ' CONSTRUCTION LENDING AGENCY 2 ° ° 1,1.50 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) QO o a 0 1,1.5 05 issued (Sec. 3097,Civ.C.). ' Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) 07.28-82 Lender's Address PERMIT ISSUING FEE 1 certifv 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 t above-mention proper[ for nspection purposes. C� � � SEE REVERSE FOR EXPLANATORY LANGUAGE _am Z 72$ 82 Signature of Permittee Date WO R KER S'COMPENSATION DECLARATION CE-8066 (280) APPLICATION FOR ELECTRICAL PERMIT CE-806 / LJ 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.) v FOR.APPLICANT TO FILL IN JOB 1� Policy No. Company EACH NO. FEE ADDRESS i s DR New Residential Bldgs.&Pools n Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY TF M L 78' — N EJCertified Sq. Ft. EAREST Certified copy is filed with the county building inspection CROSS ST 'department. Residential Swimming Pools OWNER OR }r- .FIRM NAME• G L Date Applicant Outlets: Rec.—Light— Sw._ MAIL First 20 /, CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY Tel No.�7-�/ COMPENSATION INSURANCE �. PLAN CHECK O. (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 0 Total No. Additional cc I certify that in the performance of the work for which this CITY Tel No. 0 U Fixed Appliances permit is issued, I shall not employ any person in any manner PERMIT I– so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT W Oven _ Dryer_W.M. ADDRESS y lla[e Applicant Top _ FAD _W.H., Z Hood — Fan '_Other— CITY To 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. PRO C SED BY with comply with such provisions or this permit shall be deemed revoked. Size&Type HP,KW, KVA,or KVAR Up to 1 had. Y/ Over 1 to 10 Ind. FINALDATE C? VALIDATION LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. , fGf _494- 1 herebyaffirm that 1 am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL 9 (commencing with Section 7000) Division 3 the Busi- BY Over 100 ' "�–��Q�/ ness and Professions.Code, and my license is in fullll 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 25 9 8 5 A HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances # o o 0 o e 2 I hereby affirm that I am exempt from'the Contractor's Sign with One Branch Circuit a"o License Law for the following reason (Section 70 31.5, Busi- Additional Sign Branch Circuits 2, z 350 ness and Professions Code): 0 0 0 2 a 5 O H– Misc.Conduits& Conductors nI, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— 09,01 -82 structure is not intended or offered for sale (Section , 7044, Business and Professions Code). CONSTRUCTION LENDING AOENCY 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 r 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 Cit [ionRd grope [yy r inspectio�urposes�� SEE REVERSE FOR EXPLANATORY LANGUAGE ISrgnature of Per'/lmittee Date