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HomeMy Public PortalAbout9449 LAS TUNAS DR_Electrical__ WORKERS' COMPENSATION DECLARATION 'zo-ooroDPwaie� APPLICATION FOR ELECTRICAL PERMIT O ;CE-806� " I hereby tb;at I have a certificate of consent tot self cE-eoe , insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC'M S or a certified copy thereof (Sec. 3800, Lab. C.) i .L Policy No. Company FOR APPLICANT TO FILL IN TOB. N4gq L}qS —FUIU45 3LV D ❑Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS a $ — $ LOCALITY TF PLC- G�TY Cid I?�' G? ❑Certified copy is filed with the county building inspec- 1 & 2 Family, Sq. Ft. — tion department. Multi-family Sq. Ft. NEAREST CROSS Residential Swimming Pools OWNER OR T.Date Applicant �J tt -� J FIRM NAME I n'rT! I'�/y •1�,��I�f7�- CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL ADD COMPENSATION INSURANCE ADDRESS S st 20 Fir (This section need not be completed if the;work-involved by Total No. Additional CITY Tel. No.,2�s..,(��`� the permit is for one hundred dollcirs ($100)or less.) PLAN 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 Lighting Fixtures First 20 ADDRESS so as to become subject to the Workers'Compensation Laws. Additional Total No. CITY Tel. No. DateApplicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION ' 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.shal l-be TopFAU —W.H. — y deemed revoked: - CITY f Tel. No. Hood — Fan —Other— LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions Disp. — Room Air Cond.of Chapter REG. NUMBER Class. (commencing with Section 7000)of.Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO.' P O SSED BY >_ and'Professions Code,and my license is in full force and effect. 8 a Size &Type HP, KW, KVA, or KVAR ,( d �� 0 License Number Lic. Class Up to 1 Incl. FINAL U cc Contractor' Date'' Overt to 10 Incl. DATE �ir VALIDATION O El - I 10 to 50 Incl FINAL _ I am exempt under Sec. Over 50 to 100 Inc. BY C) W B.&P.C..for this reason Over 100 d ® Services, Sw6d., MCC & Ponelboards Z Date: Z' 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 SINGLE FAMILY Temp. Power Pole &Appurtenances 'HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License` Sign with One Branch circuit _ Law for the following reason (Section 7031.5; Business and Additional Sign Branch Circuits _! ,. .: Professions Code): •-- ❑ I, as owner of the property, will,do-the work and.the Misc. Conduits&Conductors structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ , .x 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) \. (Sec. 3097, Civ. C.). PLAN'CHECKING FEE Lender's Name 1i,1 s ' PERMIT ISSUING FEE Lender's Address 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 property for.inspection purposes: SEE REVERSE FOR EXPLANATORY LANGUAGE ell d4 gs-z Signature ofrmittee Date ©s WORKERS'COMPENSATION DECLARATION A66_6aoPw.3ia7 APPLI-CATION FOR ELECTRICAL PERMIT Q I hereby affirr�•tha"f'I have a certificate of consent to self 7CE-806Ginsure,, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS ' or a certified copy thereof (Sec. 3800 Lab. C.) Policy No. Am Company FOR APPLICANT TO FILL IN JOB ❑Certified copy is hereby furnished New Residential Bldgs. & Pools EACH NO. FEE ADDRESS L O•f TV114y I� nCertified.copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ $ LOCALITY tion'deportment. Multi-family Sq. Ft. NEAREST CROSS S Residential Swimming Pools- O ' Date Applicant - OWNER OR FIRM NAME - T 4. 0W.S CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec `LightSw._ MAIL COMPENSATION INSURANCE ADDRESS (This section'rieed not be completed if the work.involved by First 20 Toto l.No Additional CITY —^ �Z e Tel. No. -2 t-.6 D3 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 permit is issued, I shall not employ any person ih any manner so as tobecome`subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional'. Total No. CITYTel. No.� Date �2 (16Applicant Fixed Appliances Not Over.1 HP PERMIT NOTICE TO_-APPLI ANT:-If, after ma ting this Certificate of APPLICATION 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, ' _N-)" Tel No LICENSED CONTRACTORS DECLARATION- LICENSEDisp., — Room Arr Cond. OR Class. I herebyaffiim.that I am licensed under provisions of Chapter 9 REG. NUMBER commencin with Section 7000 of Division 3 of the Business ' ( 9 )- Power Apparatus& Large Appliancesr �;+ DISTRICT NO. P ESSED BY �. and Professions Code,and my license is in full force and effect. YP y : �+ O Size &Type HP, KW KVk or KVAR License Number 6 Z Lic. Class G� Up to 1 Incl,<' } 1 FINAL V U'Rl r�Cy,� i`j �L/( Over 1 to t0.lncl. DATE VALIDATION cc Contractor Date❑ Over 10 to 50 Incl. r. I am exempt under Sec. Over 50 to 100 Inc. FINALBY W B.&P.C. for this reason Over 100 t1 Z Date: Services, Swbd., MCC& Panelboards Z - 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 , SINGLE FAMILY Temp. Power Pole&Appurtenances a HOME OWNER-BUILDER DECLARATION • I hereby affirm that I am exempt from the Contractor's License Sign with'One Branch Circuit' a Low for the following reason (Section 7031:5, Business and Additional Sign Branch Circuits I�l•ti•�sv Professions Code): C�7 20.510 ❑ 1, as owner of the property, will do the work and the Misc. Conduits&Conductors - 1 ITEMS structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ Business and Professions Code). , TOTAL 20.50 CONSTRUCTION LENDING AGENCY CHECK 20.50 1 hereby affirm that there.is a construction lending agency for _ CHANGE �LI the performance.of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097,.Ciy. C.). PLAN CHECKING FEE y�-` �y 12/14/89 Lender' s Name /l D )3000`0001., PERMIT ISSUING FEE 0 r Lender's Address O� i 7524 1 AM iQ.re.'.1 I certify that I have read this application and estate 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- ntioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signot0fe of Perm ttee Date ©s RKERS'COMPENSATION DECLARATION 76A663 10%81 CE-$o6G APPLICATION.FOR ELECTRICAL- PERMIT z hat I have a certificate of consent to,self insure; e of Workers':Compensation lhsurance, or a certified COUNTY OF LOS ANGELES`� BUILDING'AND SAFETY c ut S c.38p0t�0 Lab.C) @�'• Policy.No:. .��. T Company c. S 'att� JOB o - OR AP CAN ADDRESS + O Certified copy is h reby furnished , , New,Residential Bldgs:&FPools PLI T' TO FILL IN EACH NO. FEE Certified` copy is:filed with the coup y b iding inspection .1 & 2 family Sq.'Ft., $ LO CALITY' .• j .department.- Multi-family Sq Ft' — _,:M.a. J'. �,�^� • ROSS ST. .- : NEAREST � Date. O APPlicant -tel Swimming Residential•Sw in Pools ER OR . :NAME /. CERTIFICATE OF EXEMPTION FROM,N70RKERS;, MAIL Outlets.Rec— Light Sw. yy COMPENSATION INSURANCE. ADDRES&-, r 1� (This section need not be completed if,the wo&involved'by theFirst 20 - Total No. - Additional :permit'Is.for one;hundred dollars($100)or less.),. . < PLAN CHECK Tel No� r s I certify,that m the performance'of.'the work.for which this'permit APPLICANT is issued;,) shall,not employ any'person,m.,any manner,,so:as'to ° become subject to_ the.W60kers',Compensation'Laws: Lighting Fixtures First 20 "ADDRESS` Additional Date Applicant Tota , o. ' r I N CITY,'•' N Fixed Appliances Not,OVer 1 HP PERMIT 6Yl '..,NOTICE,.•TO APPLICANT;.If, 'after:,. making''this Certificate of ' - Exemption,you should become'subject to•the Workers'Compensation •.-- Range' APPLICANT , — Heate,r_ D.W. � `: provisions of,the Labor Code;:you must,forthwith comply with such;c, ;Oven Dryer _ ;W.M.'_ ADDRESS provisions or,this permit shall be•deemed revoked.. ;, Top FAU•• W.H. r CITY Tel.No D✓Q., LICENSED CONTRACTORS DECLARATION, Hood— Fan _ Other_ (.,hereby ,affirm.that I am licensed._under provisions of Chapter 9 - Disp. Room Air Cond: ' ;Class:"e LICENSE OR '(commencing with Section.7000) of,Division 3 of,the Business and REG.NUMBERe� Code,and myJicense'is in full force grid effect. DISTRICT NO. PROCESSE BY Professions. -Power Apparatus&-Large Appliances w % C' 'Size&Type HP,KW,KVA,or.KVAR License Number�3 ( Lic.Class Up to 1 Incl FINAL --f S� Yl Z _-, Over 1 to.10 Incl DATE` VALIDATION+.. Q Contractor ,)_ Date Over 10 to 50 Incl. FINAL' " U -.I am exempf'under Sec. ` 'Over.50-to 100 Inc:• LU B.&'P.C.for this reason— 200 c- 0 BY Services,Swbd.,�.MCC& Panelboards. Date: 0- 200 Amp Under 600 V rll l r, 1 t� lY Signature; 2017,1- 000 Amp::Under1600 Over 1000 Amp or Over 600 V•., Exemption'for Reg.Maint.Elect, SINGLE FAMILY Tefnp.,Power.Pole&.Appurtenances HOME OWNER-BUILDER DECLARATION.' ACCT .. Sign with.One Branch-Circuit - t�k i• I_hereb':affirm#hat-I'am exempt from the Contractor's License Law 1•aIr y p Additional Sign Branch:Circuits,, for.the following reason,(Section 7031..5, Business and Professions' Code)'_ �.�,� .. v 45 Misc Conduits & Conductors - 1 �1 EN _ El I;as owner of the property,will do the work'and the,structure s not intended or•offered for §ale'(Section 7044;Business •. . Other(See Complete Fee ScheduleHECK ). :and Professions Code). , CONSTRUCTION LENDING AGENCY (.hereby affirm that there is a construction lending;agency,for the ", C'I'A 3E r ..` performance of the work for which this permit:is issued(Sec..3097, PER (S6 (Sub-Total) Civ.C.), i -Lender's Name PLAN CHECKING FEE I PERMIT-ISSUING FEE- o - Lender's,Address 1 certify that I have read this application and,state'that'the above TOTAL FEE,_,; -information is correct )'agree,to comply'with•all County ordinances and State laws regulating Electricalwiring,",and hereby authorize _. :representatives:of this County Ito'enter,'upon,the above-mentioned propertyfoyrskection purposes. : .. - " , SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee' ate i> 'WORKERS' COMPENSATION DECLARATION 76-663 10/61 .CE-806G APPLICATION FOR ELECTRICAL PERMIT n hereby affirm that 1•have a certificate,of consent to self insure, or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF-LOS-ANGELES BUILDING AND SAFETY copy thereof'(Sec. 3800,Lab;Cs) " Policy No. Company ' " FOR APPLICANT TO FILL IN JOB " ❑. Certified copy is hereby.furnished. New Residential Bldgs.& Pools - r EACH ; NO. FEE- ADDRESS ❑ 1 & 2-Family,Sq.Ft. $ _ .$ LOCALITY. Certified copy is,filed With the,county;building inspection department.'., ,Multi-family Sq.Ft. NEAREST,. Residential Swimming Pools 'CROSS ST. Date Applicant - - .. .,OWNER OR. . .,.. -FIRM NAME.- r 'CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL ' Light Sw, L/ 'COMPENSATION INSURANCE - Outlets.Rec' ADDRESS 'lam� ESS .(This section need not'be completed if the work involved b thi First 20 Y CITY Tel.No. permit.is for one hundred dollars($100)or less.) Total No. E O Additional • PLAN CHEC I certify.that in the performance:ofe the work for which this permit APPLICANT K ,is issued, I shall not employ, any,person in any manner so as to become subject-to,the'Workers'Compensation Laws. fighting Fixtures First 20 ,' ADDRESS; Additional. " Total No. CITY,' , Tel.No.. Date Applicant` Fixed Appliances Not-Over 1 HP PERMIT ....�p NOTICE TO "APPLICANT: 'If, 'after, making this$. Certificate of APPLICANT U `, Ix, Exemption,you,should become subject to the Workers'.Compensation Range_ Heater= ,.provisions of the Labor Code,you,must.forthwith comply with such Oven_ Dryer'_L W.M._ ADDRESS ,provisions or this permit shall be.,deemed revoked. Top- --FAU W.H. CITY V }�( y,� Tel.No. 3W Z LICENSED,CONTRACTORS DECLARATION" Hood Fan Other_" -" " v` _ J hereby.affirm that.1 am licensed under provisions,of Chapter 9 LICENSE OR Disp. Room:Air Cond. Class. (commencing with Section 7000) of Division 3 of the Business and REG.NUMBER `C. Professions Code,and my license is in full force and effect. Power-Apparatus.& Large as DISTRICT N0. PR�BY 0 CV Size&Type HP,KW,KVA,.o,KVAR O License Number Lic.Class •�`� Up to 1 incl. FINAL U 3— O . a - Over 1 to 10 Incl. 0 DAT Contractor Date VALIDATION.. 7°� Over 90 to 50 Incl FINA O �J-.,..1 am exempt under Sec. Over 50 to 100 Inc. -. B' - LLJ Over 100 B.&P.C. for this reason Cn Services,Swbd.,MCC&Panelboar_ds Z Date: '1' 0-200 Amp 'Under 600 V Signature G'G°�-Q ��L� 201 -1000 Amp.Under 600 V ❑ � Over 1000 Amp.or Over,600 V Exemption for Reg.Maint.Elect. ` T SINGLE FAMILY ..Temp:Power.Pole &,Appurtenances M HOME OWNER-BUILDER DECLARATION, - Sign with One Branch Circuit I hereby.affirm that•I am exempt from the Contractor's License.Law Additional Sign Branch Circuits for the following reason(Section-7031:5,Business and Professions: F -�^ n Mr , Code): I,as owner of the property,^will do the work and the structure, Misc'Conduits & Conductors ws ' is not Other(See Complete'Fee Schedule)intended or offered for sale (Section 7044, Business _ s FE;^ and Professions Code). CONSTRUCTION'LENDING AGENCY" f� I hereby affirm that there is a construction lending agency for theri (: - performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) t )`� _. . Civ. C.). PLAN CHECKING'FEE -° .. ' ,., r s .t t f Ji G ' Lender's Name PERMIT ISSUING:FEE (J - 1 _a_,t. Lender's Address ` Q � •t � t 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 EXPLANATORV'LANGUAGE - - n Signature:of Permittee Date WORKERS COMPENSATION DECLARATION 76A883 10/81 fl ® ' CE-806G. TION. FOR"ELE.CTR.ICAL�.PE�.RM.IT - -hereby affirm that 11 have a certificate of`consent to self insure, ora certificate of Workers'.Compensation Insurance, or a certified D SAFETY ._copy thereof(Sec.3800,Lab:.C:) 'y COUNTY.OF LOS ANGELES ;BUILDING AN / Policy NOGOmp8ny` "" o'G/ e W FOR APPLICANT TO FILL IN JOB �y •D 'Certified co EACH NO.`' FEE ADRe DRESSW. /.�/� py is hereby,furnished New Residential Bldgs.& Pools;. c•�` r. t.., ., ' : •.LOCALITY Certified "copy is.filed with the'county building inspection & 2 F S F — �^ 1 amity q. t '.department' ' , , " ' , Multi-family Sq:Ft' CROSSSS .' .t ;`,77 Residential Swimming Pools'; DOWNER OR• Date Applicant_•- . f` ' OF EXEMPTION FROM WORKERS'--'7 WAIL- CERTIFICATE, - Outlets.Ree— Light —,Sw a . , .,,, E:. •.L...i 'ADDRESS ki. COMP,ENSATION'INSURANC - First 20- -•(This section need not be completed''if the workinvolved by the, CITY Tel No. . - perkt;is.for,one hundred dollars,($100)or less.)• Total No: AdditionalPLA 1,certify_that.,in the'performance of,;the,work,,for,.which,this:permit ". APPtLICANT, ZA is issued, I shall not employ'any,person in;any mannerk so as to,. become.subject to the Workers'Compensation Laws. Lighting Fixtures First 20 'ADDRESS;' 3 N Additional i LCZ� % Total o.' :.'CITY= �� ",Tel No. Date Applicant - - Fized Appliances Not'Over 1`HP NOTICE,TO, AP,PLICAafter ,making this Certificate of-' 7- PERMIT- IN - / Exemption,you.sh ecpmAsubject to the'Workers Compensation' .`' Range_ Heater= D:W. APPLICANT i ltfi provisions:_ e 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. 58 LICENSED CONTRACTORS DECLARATION,. Hood Fan Other -CITY Tel No !,hereby..affirm that I am licensed under provisions;of,Chapter 9 Disp. Room',Air'Cond., Class.e., ( ommencmg,with.Section'7000) of Division 3 of the'Business and -. 'DIS R.. 'LICENSE OR G NUMBER Professions Code,and m license is in full force and effect. TRICT No. C SSED eY y Power;Apparatus& Large Appliances lr,Y Size& Type HP,KW'KVA,or KVAR, License Number `c Lic Class Up,to,1 Incl FINA Over 1-to 1'0 Incl a DATEL --�1/ .VALIDATION, � Contractor Date' '' Over 10 to,50 Incl , U 0 I"am:exempt under Sec. Over'50 to"'1,00 Inc a Over 100 FINAL ., . 6.8P:C.�for this reason � r : 'N Services, Swbd:,MCC& Pane lboards t?', F , Z BY >' Date,. rrip,U ` 0 200 A rider 600 V Signature: Amp:Under 600 V ' �` 20]-. 1000 ' Over 1000 Amp.•or Over`600 V Exemption for,,Re nt.Elect. `;'SINGLE FAMILY Temp.Po, e& Pole& Appurtenances. HOME OWNER-BUILDER DECLARATION t ` a , r Sign wdh One Branch Circuit.' I hereby affirm that l am,exempt from the Contractor's License Law Adddional.Si n Branch Circuit for the following reason(Section 7031.5, Business'and Professions, $ � Code) Circuits, " Misc.Conduits&Conductors _ �-•� cl Ej ,,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 b-. — i hereby affirm thi t fhere'•is.a construction lending:agency for the _ j x. W. � � $ performance of the-work for.which.this permit is issued(Sec.3097,,p_- . -PERMIT FEE �. (Sub-Totap' Civ.C) i 4-tip a y PLAN GHECKING.F,EE Lend F er's.Name 1= , PERMIT ISSUING FEE„ ,• • AN ESE Address • l (?t lf^ Ef }, x•;,76' 1 certify'that ave.r"ead this application and state that the above (~TOTAL FEE B; o information is correctt?I agree do comply with all County ordinances' ' " _ A and State.,laws.regulating Electrical wiring,,and'hereby authorize. representatives of'this County to enter upon the above-mentioned v - property,f nspection purposes. SEE;REVERSE FOR EXPLANATORY:LANGUAGE, „ Signatur of Permit e.- ., Date