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Home My Public Portal About9940 LA ROSA DR_Electrical__ WORKERS'that I have a certificate DECLARATION toofconsent CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-8066 insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELESBUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB EACH NO. FEE ADDRESS / 7(�j LT /L Certified copy is hereby furnished. New Residential Bldgs. 8 Pools /J Certified copy is filed wish the county building inspec- 18 2-Family, Sq. Ft. $ — $ LOCALITY / �/•7 �� !y tion department. Multi-family Sq. Ft. — NEAREST Residential Swimming Pools CROSS ST. LIJ I✓L Date Applicant OWNER OR FIRM NAME ('^^ CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec—LightMAIL q� COMPENSATION INSURANCE First 20 ADDRESS (This section need not be completed if the work involved by Total No. Additional CITY IG �r Tel. No.yY3-c��j the permit is for one hundred dollars ($100)or less.) onal Pa-. PLAN CHECK certify that in the performance f t e work for which this APPLICANT permit is issued, shall not emplo a person in any manner o as to become subject to the W k s'C cation La�r+s. Lighting Fixtures First 20 ADDRESS •> Additional / '-7,Q•+�j '+ �. Total No. CITY Tel. No. Datey Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, afte making this ernficote of APPLICANT Exemption, you should become subject to he 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 Card. REG. NUMBER Class. (commencing with Section 7090)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. PROCESSED BY Y and Professions Code, and my license is in full force and effect. 7y� y Size 8 Type HP, KW, KVA, or KVAR 2r 7^ h /��9a O License Number Lic. Class- - FINAL W Up to 1 Ind. �J Over I to 10 Incl DATE �'t' /Q - J T� VALIDATION O Contractor Date ❑ Over 10 to 50 Incl. FINAL (~j I am exempt under Sec. Over 50 to 100 Inc. BY CLB.BP.C. for this reason Over 100 Z Date: Services-Swbd.,-MCC 8 Panelboards -, �-200 Amp. Under 600 V— Signature 201 - 1000 Amp. Under 600 v ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maine. Elect, 709 G P. SINGLE FAMILY Temp. Power Pole 8 Appurtenances r c c c 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 1 hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits ° 2 S Q Law for the following reason (Section 7031.5, Business and cions Code): a ProfVhe work and the Misc. Conduits 8 Conductors 2 E 0 structure nsr not of r intendedrtor offered y, will do tfor ate (SectionOther (See P Com tete Fee Schedule) Poo 2 n _ `0 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) /L� (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name _ PERMIT ISSUING FEE Lender's Address _ I certify that I hove read this application and state that the TOTAL FEE above information is correct. I agree to comply with all County ordinVnce, nd State laws regulating Electrical wiring, and herenze relures falives of this County to enter upon the enf r perry for inspection urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE '�nPerml rte Dote ' WORKERS'COMPENSATION DECLARATION CE-863 10181 APPLICATION FOR ELECTRICAL PERMIT {� CE-806G LJ I hereby alf'm that I have 2 certificate of consent to self insure, or a-certificate of Worker-'Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy, there9f(3ec.3800.Lab.C.) '•olicy'No. Company FOR APPLICANT TO FILL IN JOB A��D ❑ New Residential Bldgs.8 Pools Certified copy is hereby furnished. EACH NO. FEE ADDRESS (•, V7 ❑ Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft. S — $ LOCALITY EST /�I , department. Multi-family Sq. FL NEARCROSS ST �f-0 / Date Applicant Residential Swimming Pools OWNER OR 11,, // , \\ 1 PP HRM NAME N d _5po i _-.1 CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Hal Light � Sw. S IL COMPENSATION INSURANCE ADDRESS `YV (This section need not be completed if the work involved by the //ma�y ' First,20 Total No.� Additional CITY L� Tel.No.44�3- I NI permit is for one hundred dollars($100) or less.) � I certify that in the performance of the work for which this permit PLAN APPLICANT CHECK 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 �7 ) ) Total No. Additional CITY Tel. Date 5-l ' Applicants GG.>�1.V✓IA/ 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 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 9LICENSE OR (commencing with Section 7000) of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER Class. Professions Code,and my license is in full force and effect. DISTRICT NO. PROCESS BV Power Apparatus& Large Appliances Size& Type HP,KW,KVA,or KVAR �L 0 License Number Lic.Class Up to 1 Incl. FINAL �/ /� U Over I to 10 Ind. DATE ., / r(/} ALIDATION Contractor Date FI �/ U O ❑ Over f0 to 50 Incl. I am exempt under Sec. Over 50 to 100 Inc. gV W B&P.C.for this reason Over 700 d N Services,Swbd.,MCC& Panelboards Date: 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 R 9 6 1.4 A SINGLE FAMILY Temp.Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit • herebyaffirm that am exempt from the Contractor's License Law Cit for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits Code): 0 51 6�8 8 Misc.Conduits& Conductors 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) , 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 'V U �Jt"j PERMIT ISSUING FEE 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 for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sigriature of Permittee Date