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Home My Public Portal About9501-9503-9505 LONGDEN AVE_Electrical__ WORKERS'COMPEIVSATIONDECLARATION CE-806G (2.80) ,. �• CE-806APPLICATION FOR ELECTRICAL- PERMIT �.,,,_.;. I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY Insure,.or a certificate of Workers'Compensation Insurance,or. + l a certified cop thereof(Sec.3800,Lab. V_ 715 ] FOR APPLICANT TO FILL IN JOB Q�DI vim+ Policy No. ompany ��' www I EACH NO. . FEE ADDRESS f New Residential Bldgs.,&Pools O Cert' led copy is hereby furnished. 7/� I 1 &2-Family,Sq.Ft. $ — $ LOCALITY L Certified co !� Multi-family Sq. Ft. — NEAREST py is filed with the county building inspection CROSS ST 46. (� department. I Residential Swimming Pools FIRM NAME a r Date Applicant Outlets: Rec.—Light Sw. ADDRES First 20 F<< Or CERTIFICATE OF EXEMPTION.FROM WORKERS' Total No. Additional I CITY Tel No. 0 COMPENSATION INSURANCE - PLAN CH CK � a (This section need not:be completed if the work involved APPLICANT 0- Lighting Fixtures First 20 ADDRESS by the permit is for one hundred dollars ($100) or less.) .I OC • Total No. Additional \ O I certify that. in the performance of the work for which this i Fixed Appliances Not Over 1 HP CITY Tel No. V permit is issued, I shall not employ any person in any manner PERMIT so.as to become subject to the Workers'Compensation Laws. Range_Heater_D.W._ APPLICANT og2 Oven Dryer_W.M._ ADDRESS N U) Date Applicant Top _FAU _W.H.._ Hood _Fan _Other_ CITY Tel No. NOTICE TO,APPLICANT: If,after making this Certificate of Disp. _Room Air'CondLICENSE OR Exemption,. you should become subject to the Workers' REG.NUMBER .` 'AClass ,T Compensation provisions of the Labor Code,you must forth- I Power Apparatus&Large Appliances DISTRICT NO: / PROCESSfED BY with comply with such provisions or this permit shall be deemed revoked. Size&Type HP,KW,KVA,.or KVAR Up to 1 Incl. 1 FINAL Over 1 to 10 Incl, DATE �.- LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. VALIDATION I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100•Inc. FINAL. YAL 9 (commencing with Section 7000)of Division 3 of the —Susi-Over 100 'R ness and Professions.Code, and my license is in full force and effect. ��. Services '1-12 License Numbers Class / 0-290 Amp.Under 600 V _ 201-1000 Amp.Under 600 V Contractor. Date Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances r I hereby affirm that..I am exempt from the Contractor's Sign with One Branch Circuit Additional Sign Branch Circuits • License Law for the following reason (Section 7031.5, Busi- "'J 3 b A ness and Professions Code): El Misc.Conduits&.Conductors �+ o '0 0 0 0 2 I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)— struc,ture is not intended or offered for sale (Section 2 0;0 2 Q 6�• 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency •0 0 0 20.5025 for the performance of the work for which this permit is PERMITTEE (Sub-Total) EC'r issued(Sec.,3097,Civ.C.). 3 2'2—8 2 Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE I certify that I have read this application and state that the TOTAL FEE Q �Q above,information is correct.I,agree to comply with all County ordinances and State laws gelating Electrical wiring, and hereby authorize repres nt es of this,County to enter upon thea mentioned. op y for inspection purposes. SEE,REVERSE FOR EXPLANATORY LANGUAGE: /'Q] Ignature. f Permittee Date 4 1VORKERS`COMP,ENSATIONDECLARATION, 76A6)6 APPLICATION 'FOR ELECTRICAL. PERiMIT I CE,806.G (2•BO) hereby affirm that I have a certificate of.consent to'.self COUNT'Y..OF LOS ANGELESBUILDING•AND.SA'FETY. insure,or a certificate of workers'Compensation Insurance,or. , II (02 a cer#fied;copy thereof(Sec.3800,Lab.C.) } f FOR APPLICANT TO'FI'LL' IN JOB � D JD� Policy No. Company I - EACH NO. FEE A'D.DAESS, lj New Residential BI'dgs.& . I Q Certified copy is hereby furnished.. -1 &2-Family.Sq. Ft. — $'' LOCALITY -� . tel G l7 ` Certified'co is filed.with the'count buildin Multi-family Sq. Ft: — NEAREST J 9 n py y g inspection CROSS ST G�G .� ell(/ AV ( department.' t' ResidentiaCSwimmjng POOIs- OWNEROR t \ FIRM NAME': r r / ' Date. Applicant,. Outlets: Rec.._L'ight Sw. MAIL j First 20, ADDRESS CERTIFICATE OF EXEMPTION FROM.WORKERS'. Total No. Additional COMPENSATION INSURANCE CITY + �Z l',' e1:No � t ' PLAN CHECK :0, 'r APPLICANT y ! (This,lseetion need not be -completed if the work involved. V Li htin Fixtures Ficst 20 by the•permit-is for one hundred dollars-($100) or less.) g g ADDRESS Additional Total No. - p )kiY�ertify that in the per.'fbrmance of the work,for which this Fixed Appliances'Not Over 1 IiP 'CITY- -0 CITY Tel Nti. IS ad,is issued, i stjall not employ any'Oersoh in any manner PERMIT //� W so as'to become subject f0 the Workers'Compensation Laws. Ran..ge_'Heater_D.W. _ APPLICANT ; Oven,— Dryer_•W.M.— ADp E S `` CO Date' plicant, Top' .—•FAU' _W.H'. R S f.Y � .1 Z ' Hood _'Fan• _Other CITY Tel No. y �� / NO ICE.TO,APPLICANT: If,•after'making:this Certificate of Disp., _Room Air Cond. LICENSE OR. {Exemption, you shduld become, subject to the. Workers' REG.NUMBER Class i Compensation provisions of the-.Labor Code,.you must forth- Tower.Apparatus&,Large Appliances DISTRICT N.O. PR ES BY i with comply with such provisions or this permit,shall• be �. 'deemed revoked. -Size&Type HP,KW;KVA,'or KYAR, f Up to 1 Incl. C FINAL. _ r Over 1:to.10 Incl. pgTE. �' d iICENSEI)..CONTRACTORS.:DECL.ARATION i " 1 •VALI ATION'" Over f 0 to 50 Incl. / Ir!hereby:affirm-'that.I am'licensed under provisions of Chapter Over 50 to 1001nc.. F'INA'L BY m�9, (cdmmencinp,with Section 7000)of Division 3 of the Busi- Over 100 ess-and Professions;Code,and.my license is do full force,and effect. Services 'License Number ' 0-200 Amp.Under•600 V �!v ;Lic.'•Class '201-1600�Amp:Under 600 V . ,Contractor Date %` Over 1000 Anip..o�Over 600 V' _ :y HOME OWNER-BUILDER DECLARATION Temp..Power Pole&Appurtenances' t y; y�• -.Sign with:One Branch Circuit 1 ' I hereby affirm that I''am exempt from the Contractor's � , - ;• • .,,, � Additional Sign Branch Circuits- ;,,, ,i'.D,O:o n License I aw.for the following reason (Section 7031.S;�.Busi= i _ ness and Professions Code): t, ' Misc.Conduits&Conductors ? ° ° :' :3 I;as owner of the property; will•do the•work and the' 'Other(See Complete Fee Sched'ule)- structure is not intended or offered 'for sale.;(Section ;, r e ° .7044,''Business and Professions Code). .• ,0 ii' `y Y r. CONSTRUCTION LENDING AGENCY r ; I. hereby affirm that 'there is a construction lending agency ; for*.the perfotmarice,of'the work,for which, this..permit-is ;PERMIT FEE '�� issued(Sec.30.97;Civ.C.}. (Sub=Total):-, ,. tier's Name 1' t e° PL'AN't;HE.CKING•FEE ' (One Fourth Permit Fee) I' Lender's Address PERMIT ISSUING FEE' I,certify that.I have.'read this application and state that the TOTAL FEE above information is correct:I agreeto,comply with all County _ f ordinances .an'd"State ,lawi.regulating.Electrical wiring, and I' hereby authorize representatives of-this,County, to'enter upon the abov m Toned ro er'ty fopopectioji purposes: SEE'REVERSE FOR EXPLANATORY LANGUAGE ,. I Date. , WORKERS'COMPENSATIONDECLARATION' 'ICE-B06SG (2-BO) APPLICATION FOR ELECTRICAL PERMIT CE-8 I, reby affirm that I. have' a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY ins re,or a certificate of Workers'Compensation Insurance,or a c rtified copy thereof'(Sec.3800,Lab.C.)- FOR APPLICANT TO FILL IN J DDRESS Po icy No. Company %� ADDRESS J •G �!1 N New Residential Bldgs. PGOIS EACH NO. FEE rl .Certified copy is hereby furnished. 1 &2-Family,Sq.F — $ LOCALITY aMulti-family Sq..Ft. — CROSS ST L • G T/ G D.� , Certified copy is filed with the county building inspection Residential Swimming Pools --�firr C ` department. FIRM NAME/'V G ,p` Date Applicant' Outlets: Rec.—Light—First ADDRESS dY.• 44. 0 `�61 ' First 20 ' CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY C 7 .l No — i �� COMPENSATION INSURANCE PLAN CHECK a - (Thi's section need not be completed. if the work involved APPLICANT V by the. permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS Total No. Additional o I certify that in the performance of the work for which this. Fixed Appliances Not Over 1 HP CITY Tel No. permit is issued, I shall not employ any person in any manner PERMIT so as to become subject.to the Workers' mpensation Laws. Range_.Heater D.W._ APPLICANT /7 C! L � CL . g Oven _, Dryer_W.M.— ADDRESS 41 Date . .Ly Top _ FAU' _W.H. Hood — Fan _Other_ CITY Tel No NOTICE TO APPLICANT: If, after making this Certificate ofLICENSE.OR f Exemption,. you should become subject to the Workers' Disp. _Room.Air Cond,_ REG.NUIGIBE Class G.r Oi Compensation provisions of the Labor Code, you must forth- lPower Apparatus&Large Appliances DISTRICT Nom. �y P ES BY with comply with such provisions or this permit shall be. �/JQy deemed revoked. Size&Type HP,KW,KVA,or KVAR Up to.1 Incl. • FINAL .v Over"! to 10 Incl. DATE - LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. VALIDATION I hereby affirm that-I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL ` 9`(commencing.with Section 7000 of Division 3 of the Busi- BY ( g ) . I Over 100 T ness and Professions:Code,and my-license is in full force and ,°'.I Js�v v effect. Services License Number Lit.Class 0-200 Amp.Under 600 V 201-1000 Amp.Under 600 V Contractor Date Over 1000 Amp.or Over 600 V HOME OWNER BUILDER DECLARATION Temp.Power Pole&Appurtenances I hereby affirm that I am exempt from the Contractor's Sign with One Brarich Circuit License Law for the. following reason (Section 7031:5, Busi- Additional.Sign Branch Circuits ness and Professions Code): I; _ iMisc.Conduits&Conductors I � `' ,J 0 (11 a-I, as'owner-of the..property, will'do the work and the Other(See Complete Fee'Schedule)— F - structure is not intended or offered for sale (Section I I l l 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 ; '.PERMIT FEE (Sub-Total) issued(Sec.3097,Civ.C.). Lender's NamePLAN CHECKING FEE (One-Fourth Permit Fee) ' Lender's Address PERMIT ISSUING FEE I' , 4 certify that I have read 3his 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 N. hereby autho `ze representatWas of this County to enter upon the abo e- tion party f spection Purpo.s. �,• SEE'REVERSE.FOR EXPLANATORY-LANGUAGE Signator er - Da ;i '