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Home My Public Portal About9674 LAS TUNAS DR_Electrical__ 4, �RKEthat COMPENSATION DECLARATION CE-8061- 10/81 APPLICATION FOR ELECTRICAL PERMIT I herebaj o that I have a certificate of consent to self �j oinsure, or ��,tificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY 'uI or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. EACH NO. FEE ADDRESS New Residential Bldgs. 8 Pools ❑ Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. — NEAREST I Residential Swimming PoolsCROSS ST. Date Applicant OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL Outlets: Rec Light Sw._ COMPENSATION INSURANCE First 20 ADDRESS (This section need not be completed If the work Involved by Total No. •Additional CITY Tel. No. the permit is for one hundred dollars(§1100)or less.) PLAN CHECK t 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 su o ers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional Total No. . CITY Tel. No. Date pplican.t - Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, aft ma 'n this rtificate of APPLICANT Exemption, you should be me-su j t to th Workers' Range_ Heater_D.W. Compensation provisions o he Lobo Co� o nust forth- Oven —Dryer —W.M.— ADDRESS with comply with such p ovisio or this'permit shall be Top _ FAU —W.H:— deemed revoked. CITY Tel. LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_' LICENSE OR Disp. — Room Air Cond. Clas I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMB R (commencing with Section 7000).of Division 3 of the Business DISTRICT NO. PROCES D BY and Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances dam. Size&Type HP, KW, KVA, or KVAR' Licen tuber Lic. Clas� FINAL Up to 1 Incl. DATE ... 0 Over 1 to 10 Incl. `� 91 VALID TION Contractor. Date ,e Over 10 to 50 Incl. ` FI N%� LLI ❑ Za e t unton Sec. Over 50 to 100 Inc. B n . for is Over 100 Date: Services, Swbd., MCC&Panelboards 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 One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits 6 4 8 7 A Law for the following reason (Section 7031.5, Business and Professions Code): # 0'0 0 0 0 2 ❑ I, as owner of thero ert , will do the work and the Misc. Conduits&Conductors structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ ( °;° 2 S 50 7044, Business and Professions Code). 0 0 0 2 5 5 0 63 CONSTRUCTION LENDING AGENCY 0 2 1 O'8 7 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.A/��i, _/ 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 �S above infor ' n is correct. I agree to comply with all County ordinances an laws regulating Electrical wiring, and here y orize r r �entatives ofthis County to enter upon theabove- ntion pr inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur of P rmittee Date I WORKERS'COMPENSATION DECLARATION CE-806G 12.80) APPLICATION FOR ELECTRICAL •PERMIT CE-806 I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING BUILDING AND SAFETY insure,or a certificate of Workers'Compensation Insurance,or r�v a,certified copy thereof(Sec.3800, ab.C.) ,%� FOR APPLICANT TO FILL IN JOB Policy No��Company ADDRESS l-� New Residential Bldgs.&Pools EACH NO. FEE Certified copy is hereby rni had. 1 &2-Family,Sq. Ft. $ � _ $ ��1�� LOCALITY ` ❑ �� —�� Multi-family Sq. Ft. — NEAREST Certified copy is filed with the county building inspection CROSS ST , F — UY1 department. Residential Swimming Pools OWNER OR FIRM NAME Date Applicant Outlets: Rec.—Light Sw. MAIL First 20 1 ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional ,CITY Tel No. COMPENSATION INSURANCE PLAN CHECK APPLICANT d' (This section need not be completed if the work involved' Lighting Fixtures First 20 ADDRESS V by the permit is for one hundred dollars ($100) or less.) Additional Total No. I 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 mannerPERMIT so as to become subject to the Workers'Compensation Laws. Range_ r HeateD.W._ APPLICANT h i W Oven _ Dryer_W.M._ ADDRESS N Date . Applicant Top _ FAU _W.H.•_ Hood _ Fan _Other_ CITY Tel No. O NOTICE TO APPLICANT: If, after making this Certificate of Disp. _Room Air Cond.— LICENSE OR i�soq Exemption, you should become subject to the Workers' REG.NUMBEFL;VJ l.® 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 I deemed revoked. Size&Type HP,KW,KVA,or KVAR l_ , Up to 1 Incl. / ' Over 1 to 10 Incl. FINAL DATE LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl./ 0 7-8 VALI DATIO I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 1 c FINAL BY 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 D O 0.200 Amp.Under 600 License Number Lic.Class 201-1000 Amp.Under 600 V Contractor -4l& 6 Date Over 1000 Amp.or Over 600 V � HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances U 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'bircuits ness and Professions Code): Misc.Conduits&Conductors I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)— structure is not intended or offered for sale (Section I _ ., 7044,Business and Professions Cade). ='G 7 41- A CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency o a o '0'0 C for 'the performance of the work for which this-permit is PERMIT FEE (Sub-Total) tel' issued(Sec.3097,Civ.C.). f 2 o o p E 3 7 Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) c . �: t � •.r ti , Lender's Address PERMIT ISSUING FEE 1 1 -, 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 abo mentioned property r ins ction purposes. SEE'REVERSE FOR EXPLANATORY'LANGUAGE Signature of Permittee Date