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Home My Public Portal About9528 LIVE OAK AVE_Electrical__ WORKERS' COMPENSATION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-806G insure;-ar-a"certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof S 3800, L Policy NqI ' any FOR APPLICANT TO FILL IN JOB Certified co s hereby furnished. EACH NO. FEE ADDRESS PY Y New Residential Bldgs. & Pools — Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ $ LOCALITY tion department. Multi-family Sq. Ft. — NEAREST Residential SwimmingPools CROSS ST. Date ` plica n FOIRM NAME CERTIFICATE OF EXEMPTION FM WORKERS' Outlets: Rec�LightI-S. MAIL COMPENSATION INS RANCE First 20 ADDRESS (This section need not be completed if the work involved by Total No. Additional CITY el N�,gs� 37 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 in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No._/ Additional CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICAN 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 r Tel. ,�S LICENSED CONTRACTORS DECLARATION LICENSE OR �> I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REG. NUMBER Class. r (commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PROCESS Y and Professions Code,and my license is in full force a d effect. /ice` �/ U Size& Type HP, KW, KVA, or KVAR (f License Number?JU3f7 Lic. Class Up to 1 Incl. FIN 0� Over 1 to 10 Incl. D � ractor VAL ION Contate ElOver 10 to 50 Incl. FIN 'L W I am ex mpt under Sec. Over 50 to 100 Inc. BY Over 100 B.&P.C. for this reason 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. ;27527A SINGLE FAMILY Temp. Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit # 0,.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 O 1 575 Professions Code): o:O a 5 Misc. Conduits& Conductors I, as owner of the property, will do the work and the o 7 2 4 t '] structureis 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) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address Z have read this application and state that the TOTAL FEE tion is correct. I agree to comply with all County d State laws regulating Electrical wiring, andze representative of this County to enter uponti a perty or inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ittee Date 11 Y�, ° WORKERS'COMPENSATION DECLARATION 76A663 10/81 APPLICATION FOR ELECTRICAL PERMIT �%ereby affirm that 1 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 crcertified'copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB (� (� Certified copy is hereby furnished. New Residential Bldgs. & P` $ $ LOCALITY EACH NO. FEE ADDRESS 1 &2-Family, —\ O �� a S � — Certified copy is filed,with the county building inspec- Y� q• �45� Ft. tion department. Multi-family Sq. Ft. 'NEAREST Residential Swimming PoolsCROSS ST. Date Applicant OR FFIIRM NAME p—ii CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw. MAIL q COMPENSATION INSURANCE ADDRESS lS (This t bFirst 20 ( s section neenoe completed if the work involved b Y Clf: Tel. Total No. the permit is for one hundred dollars ($100)or less.) Additional TY I certifythat in the performance of the work for which this PLAN CHECK P erAPPLICANT 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 Total No. Additional CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT -•cc' 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. CITY Tel. No. LICENSED CONTRACTORS DECLARATION Hood Fan _Other_ Disp. _ Room Air Cond. LICENSE OR Class. I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROLE BY and Professions Code, and my license is in full force and effect. Power Apparatus 8 Large Appliances -. o �/ Size &Type HP, KW, KVA, or KVAR J a License Number9L4Iic. Class Up to 1 Incl. FINAL V ` Over 1 to 10 Incl. DATE//_ Q VALIDAT N ad Contractor to Over 10 to 50 Incl. (([, V FINA ❑ I am exempt under Sec. Over 50 to 100 Inc. B.&P.C. for this reason 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. '21 811.-8'A SINGLE FAMILY Tem Power Pole & Appurtenances HOME OWNER-BUILDER DECLARATION p Ci 0 0 0 0 0 2 Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits ( p o 2 5 5 Q Law for the following reason (Section 7031.5, Business and Professions Code): 'o-o a 2,5505) I, as owner of the property, will do the work and the Misc. Conduits&Conductors structureis not intended or offered for sale (Section Other (See Complete Fee Schedule)_ pop a, O 9"8 5 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) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE <(J Lender's Address � I certify that I have read this application and state that the TOTAL FEE 5j, 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 SINnature Permittee Date ,' WORKER'S COMPENSATION DECLARATION 76A663 9 DPW 9/89 APPLICATION FOR ELECTRICAL PERMIT u, ' 76A66 I hereby affirm that I have a certificate of consent to self insure, ov a..cdrtificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE $ _ $ LOCALIT Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER OR COMPENSATION INSURANCE Outlets:Rec. Light Sw. n (� FIRM NAME First 20 -J i _ MAIL (This section need not be completed if the work involved by the 2 ADDRESSCJ Z, `V ~ permit is for one hundred dollars($100)or less.) Total No. Additional I certify that in the performance of the work for which this permit CITY C`� Tel.N075_3"-' is issued, I shall not employ any erson in any manne so as to Q PLAN CHECK become subject to the Workers'Co a ti ws Lighting Fixtures First 20 3 -22 ( APPLICANT Total No. i Additional ADDRESS Date Applicant �'W NOTICE TO APPLICANT: If, after making this Certific a 15 OR 20A,120V BRANCH CIRCUITS of `` CITY Tel.No. Exemption,you should become subject to the Workers'Compensation 1 TO 10 INCLUSIVE EACH 00od - provisions of the Labor Code, you must forthwith comply with such 11 T040 INCLUSIVE EACH �i.SQ•� PERMITAPPLICANT � provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH LICENSED CONTRACTORS DECLARATION ADDRES ! O I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH Ln, sia&l(commencing with Section 7000) of Division 3 of the Business and CIT Coijillijp, Tel.No. (S. SE3Q U Professions Code,and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR ( � r� 0:• Power Apparatus&Large Appliances REG,NUMBER 5E4, �tD class. 0 5(�57\.11� Size&Type HP,KW,KVA,or KVAR DISTRICT NO. PROC ED BY License Number Lic.Class�L— u (�f� 2 I��1 c Up to 3 Incl. 5. O OW.. Contractor)9/D*1R.it�W3 (SIL+f.)[L�L7ate — � Over 3[0 10 Incl. DATE U) ❑ Over 10 to 50 Incl. Z I am exempt under Sec. Over 50 to 100 Incl. Z VALIDATION FINAL B.&P.C.for this reason Over 100 By Services,Swbd.,MCC&Panelboards Date: 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 Law for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): ❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors '„ J•--_- is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , { and Professions Code). CONSTRUCTION LENDING AGENCY PL -5 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) i 2 Civ.C.) �.;-Ir=..:,.::�• _ .._ PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE -- Lender's Address _ C certify that I have read this application and state that the above TOTAL FEE si. ,• •.- - ,- formation is correct. I agree to comply with all County ordinances If tate laws regulatin Electrical wiring, and hereby authorize r e ent of is C my to enter upon the above-mentioned " p e I ec i n pu oses. SEE REVERSE FOR EXPLANATORY LANGUAGE (GNAT PLI NT OR AGE ATE