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Home My Public Portal About9826 LEMON AVE_Electrical__ - WORKERS' COMPENSATION DECLARATION 10/81 APPLICATION FOR ELECTRICAL PERMIT =1 hereby CE-806G affirm that I have a certificate of consent to self CE-BO6G insuGe, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec 3800, Lab C ) Policy No Company FOR APPLICANT TO FILL IN JOB r, Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS d — Certified copy is filed with the county building m1 & 2-Familspec- Y, Sal Ft $ $ LOCALIT tion department Multi-family Sq Ft NEAREST Residential Swimming Pools CROSS ST Date Applicant OWNE R CERTIFICATE OF EXEMPTION FROM WORKERS' l MAIL Outlets Rec FIRM NAME' COMPENSATION INSURANCE Light—/_ —Sw LN S ADDRESS 11�4Q (This section need not be completed if the work involved by First 20 16 the permit is for one hundred dollars (:100)or less.) Total No Additional'r CITY Tel N � - P N 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 L, , I — Additional CITY I Date / plicant ZV— Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT 'If, after making 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 DISTRICT NO l� FIR E BY D_ and Professions Code,and my license is in full force and effect /✓� Q Size &Type HP, KW, KVA, or KVAR ' U O License Number Lic Class Up to 1 Incl FINAL DATE � Over I to 10 Incl (i �� VALID ION Contractor Date ❑ Over 10 to 50 Incl F711� d 1 am exempt under Sec Over 50 to 100 Inc B B &P C for this reason Over 100 a w t Z Date Services, Swbd , MCC& Ponelboards ► 0 -200 Amp Under 600 V Signature 201 - 1000 Amp Under 600 V :2 3 8 2 4 A Over 1000 Amp or Over 600 V Exemption for Reg Mamt Elect # o o o a o 2 SINGLE FAMILY Temp Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit "� o o l 650 1 hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits x Law for the following reason (Section 7031 5, Business and g o,o o 1 b 5 0 5 Professions Code) 1, as owner of the property, will do the work and the Misc Conduits &Conductors 0114-86 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) o (Sec 3097, Civ C ) PLAN CHECKING FEE Lender's Name Lender's Address PERMIT ISSUING FEE u 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 repre ntatives of this County to enter upon t ab _mentj2no p perty for inspects purposes 1` J SEE REVERSE FOR EXPLANATORY LANGUAGE igna re of Permittee Date t t -� .3"WORKERS' COMPENSATION DECLARATION CI-806 10/81 APPLICATION FOR ELECTRICAL PERMIT _ I hereklY 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 3800, Lab C ) Policy No Company FOR APPLICANT TO FILL IN" JOB Certified copy is hereby furnishedNew Residential Bldgs & Pools EACH, NO FEE ADDRES — Certified copy is filed with the county building inspec- 1 & 2-Family, S 9 Ft $ $ LOCALI tion department Multi-family Sq Ft — NEAREST CROSS Residential Swimming Pools ST r Date Applicant OWNE ZOR FIRM NAME 1I7 'CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets RecLLight/-Sw� MAIL COMPENSATION INSURANCE First ADDR SS 4-a (This section need not be completed if the work involved by tClT n Tel N the permit is for one hundred dollars ($100)or less.) Total No Additional 1— I certifythat in the performance of the work for which this PIAN CHECK P APPLICANT permit is issued, I shall not employ any person in any manner so as to com subject to the Wor s'Com sation"Laws fighting Fixtures First 20 ADDRESS n If hlTotal No Additional Date7 pplica CITY Tel No NOTI TO PPLICANT if, offer making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exem tion, 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 — ADDRES with comply with such provisions or this permit shall be Top _ FAU _WH _ deemed;revokedHood Fan _Other_ IT Tel LICENSED CONTRACTORS DECLARATION LTUM�E ON 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 DISTRICT NO PROCES ED Y and Professions Code,and my license is in full force and effect Power Apparatus& Large Appliances n y. Size &Type HP, KW, KVA, or KVAR �t'� 0 License Number-- —Lic Class Up to 1 Incl FINAL ! •- U Over i to 10 Incl DATE r/ZQ VALID TION '0 ❑ Over 10 to 50 Incl � Contractor Date FINAL I am'exempt under Sec Over 50 to 100 Inc BY LU CL B &P C for this reason Over 100 W Vf Services, Swbd , MCC& Ponelboards Date 0 - 200 Amp Under 600 V { Signature 201 - 1000'Amp Under 600 V -- 0 for Reg Maint Eject Over 1000 Amp or Over 600 V '•� SINGLE FAMILY Temp Power Pole& Appurtenances X256, 1 A HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit #,o a o,o o 2 1 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 o °'1 2 7 5 Professions Code) Misc Conduits 8'Conductors o 0 0 1 2 7 5 5 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ 7044, Business and Professions Code) 0 7'2 9-8 5. I 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-Totol) (Sec 3097, Civ C ) PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE TO Lender's Address I certify that I have read this application and state that the TOTAL FEE a 7 above information is correct I agree to comply with all County ordinances and State law regulating Electrical wiring, and hereby authorize repre ntatives of this County to enter upon the above-menti ne roperty for insp ction pur oses - _ SEE REVERSE FOR EXPLANATORY LANGUAGE Sign ure of ermittee Date v WORKERS' COMPENSATION DECLARATION 76A663 10/81 -8066 APPLICATION FOR ELECTRICAL PERMIT 4 I hereby,affirm that I have a certificate of consent to self CE 1 insure, or a,certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec 3800, Lab C ) Policy No' Company FOR APPLICANT TO,FILL IN JOB Certified copy is hereby furnished New Residential BldgsEACH NO FEE ADDRESS & Pools t LOCALIT ❑ Certified copy is filed with the county building inspec- tion departme t Multi-family Sq Ft 'NEAREST LV Residential Swimming Pools OWNER OR Date 7 ApplicantCROSS S •• FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL Outlets Rec Light Sw_ �Q COMPENSATION INSURANCE ` First 20 - ADDRESS (This section need not be completed•if the work involved by Total No Additional CI • Tel No f;flj the permit is for one hundred dollars($100)or less.) I certify that in the performance of'the work for which this 'APPLICANTK permit is issued, I shall not employ any person-in any manner so as to become subject to the Wo rs' pensation Laws Lighting Fixtures First 20 ADDRESS Total No Additional CITY Tel No Date Appl c Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT If, after making this Certificate of APPLICANT Y(/ 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 _ ADDRESSP71vG with comply with such provisions or this permit shall be Top FAU —W H —. � �� - deemed revoked Hood _ Fan _Other— 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 DISTRICT NO PROCE D BY and Professions Code, and my license,is in full force and effect Power Apparatus 8 Large Appliances y. o( Size &Type HP, KW, KVA, or KVAIR 0 License Number Lic Class Up to 1 Incl FINAL / - V Over 1 to 10 Ind DATE C1124A V DATION Q Contractor Date Over 10 to 50 Incl 1— FINAL ❑ 1 am exempt under Sec Over 50 to 100 Inc BY d B&P C for this reason Over 100 lG H Services, Swbd , MCC& Panelboards _ Date 0 - 200Amp Under 600V2785A Signature 201 - 1000 Amp Under 600 V Over 1000 Amp or Over 600 V # o•o,o a c 2, ❑- Exemption for Reg Maint Elect 1) o 0 2 5 0 SINGLE FAMILY Temp Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATIONSign with One Branch Circuit o 0 0 2 5,5 0 6 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Business and -Additional-Sign Branch Circuits Professions Code) Misc Conduits&Conductors 1, as owner of the property, will-do the work and the . 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 o'construction lending agency for the performance of the-work for which this permit is issued PERMIT FEE (Sub-Total) . (Sec 300, Civ C ) PLAN CHECKING FEE T Lender's Name 1 1 PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the TOTAL FEE ,SQ above information is correct I agree to comply with all County ordinances and State jaws 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 y Si nature of Permittee Date o