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Home My Public Portal About9324 LOWER AZUSA RD_Electrical__ WORKERS'COMPENSATION DECLARATION 78-883 10/81 APPLICATION FOR ELECTRICAL PERMIT hgreby affirm/ y CE-808G that I have a°cert'rficatei.of consent to'self insure, or a certificate of Workers' Compensation Insurance, or a certifiedCOUNTY OF LOS ANGELES BUILDING AND SAFETY- copy thereof(Seo.3800,Lab.C.) i Policy No.J'---;1 3• Company ` FOR APPLICANT TO FILL IN JOB C� 3 4 Certified copy is hereby furnished. - `T�' ! , ADDRESS / New Residential Bldgs.&Pools EACH• NO. FEE ; Certified copy is filed with the county building inspection, 1 &2-Family,Sq.Ft. $.... _ $ ' LOCALITY department. Multifamily Sq.Ft. EST I CRs ST' , Date/-Q Applicant Residential Swimming Pools OWNER OR FIRM NAME CERTIFICATE:OF EXEMPTION FROM WORKERS' Outlets:Rao Light_Sw. . MAIL — COMPENSATION INSURANCE ', ADDRESS .7:j A'i (This section need hot be completed If the work.involved by the,. First 20 permit Is.for one hundred dollars($100)or less.) Total No. Additional, ' CITY �'� Tel.No. I certify that in the performance of the work for which this permit PLAN.CHECK APPLICANT is issued, I shall not.employ. any person in any manner so as to. become subject to the Workers'Compensation Laws. Lighting Fixtures First.20 ADDRESS i, Additional, Total No.� CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT ",, NOTICE-'TO' APPLICANT: If; after making this Certificate. ofAOL Exemption,you should become subject to the'Workers'Compensation Range_ Heater_ D.W. NTa. O t� provisions of the,Labor Code,you must forthwith comply with such Oven Dryer_ W.M._ ADDRESS . g D provisions or this permit shall'be deemed revoked.. Top FAU W.H. _ CITY Tel.No. LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ O I hereby affirm that I am licensed under provisions of Chapter 9' LICENSE' R (commencing with Section'7000)of Division 3 of the Business and Disp. — Room Air Cond, L43214 . Class. REG.NUMBER O�} Z+$ Professions Code,and my license is in full force'.and affect. Power Apparatus&Large Appliances DISTRICT NO. G P bESSED BY t/ Size&Type HP,KW,KVA,or K'VAR oO ' License Number q C) Lic.Class �–T S ; Up to 1 IncU l, FINAL Over 1 to 10 Inc.. DATE 7 �' VALIDATION Contractor �. Date / `��'q Over 10 to 50 Incf. ` O • : FINAL ❑ I am exempt.under Sec. Over 50 to 1,00.Inc. gY LV BAP.C.for this reason 1 Over i00 I' f�'�-�'g! Services;-Swbd.,MCC&Panelboards Date: , Z 0-200 Amp.Under 600 V Signature 4, RIM Mk,tpRi _ 201 - 1000 Amp.Under 600 V •, ❑ Over 1.000 Amp.or Over 600 V 1 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;, -Ail I".T s A for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits i. Code) ",; C n == –� � I,83 owner.of the property,will do the work and the structure Misc.Conduits&Conductors is not intended or.offered for sale (Section 704.4; Business, Other(See Complete Fee Schedule) '. and Professions Code). ['u Ai r_i9 25 CONSTRUCTION LENDING AGENCY 'AE 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) tnitfGL Civ.C.). PLAN CHECKING FEE Lender's NameI'Ijj 11–I;I�iit _/�.j;�� ' PERMIT ISSUING FEE o7y ' Lender's Address Q "151s `min.z I certify that I have read this application and state that the above TOTAL FEE �9 j 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 ,pronarty for inspection purposes. . ' 1 SEE REVERSE FOR EXPLANATORY LANGUAGE I - Sig ature-6f Permittee Date J1'1 yn•Y: s dffirmERS'cOMP,f1,CSATIOfJ DECLARATION -W6qD3/� •APPLICATION FOR ELECTRICAL PERMIT I"Aereb��dlfirm•thatl#gave certificate of consent to self Cep 'Ir;in'sure, or a certificate.of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS �$ r r Hied'pp.6 f(Sec. 3800, Lab. .) Polic% 0. J�]� Company j FOR APPLICANT TO FILL IN JOB Certified coFSy is hereby furnished. yNew Residential Bldgs. &PoolsEACH NO. FEE ADDRESS ertified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. LOCALITY n tion d partm t. Multi-family Sq. Ft. — NEAREST CResidential Swimmin Pools CROSS ST: Date Applicant J 9 OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS.' MAIL Outlets: Rec Light Sw._ First COMPENSATION INSURANCE I ADDRESS (This section need not be cohipieted if the work involved by I' ) the permit is for one hundred.dollars(:100)or less.) Total No. Additional CITY N onal Q S / I certify that in the performance of the work for which this I PLAN CHECKAPPLICANT permit is issued,:l shall not employ any person in any manner f . so as to-become subject to the Workers'Compensation Laws. (Lighting Fixtures First 20 ADDRESS. Additional Date , Total No. CITY Tel. No. Applicant NOTICE TO APPLICANT: If, after making this Certificate of 6 Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become •subject to the Workers' ! Range— Heater—D.W. — APPLICATION 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. i CITY Tel. No. LICENSED CONTRACTORS DECLARATION I Hood — Fan —Other— Room Air Cond. LICENSE OR M I hereby affirm that I am licensed under provisions 0f Chapter 9 p• REG.NUMBER Class. (commencing with Section 7000).of.Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. P O SSED BY and Professions Code,and my license is.in full force and effect. r t d I Size&Type HP; KW, KVA, or KVAR ` Q License Number Lic. Class i Up to I Incl. FINAL ' U � Over 1 to 10 Incl. f cc Contractor ✓f�stP7 Date I DATE `�— l V� VALIDATION 0 , Over 10 to 50 Incl. FINAL i H' I am exempt under Sec.' - . . ..... Over 50 to 100 Inc. BY U �. Over 100 d B.&P.C. for this reason In Date: ' SerVices, Swbd.., MCC&'Ponelboards ► 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 V1 , SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances 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 'a7 Professions Code): 3L i;{' 33.01.. Wisc. Conduits&Conductors iw C. I, as owner of the property, will do the work and the ! J.I C. L structure is not intended or offered for sale(Section 7,044, Other(See Complete Fee: hedule)_ i ., 3 s Business and Professions Code). ® {:l�I A_ „00 CONSTRUCTION LENDING AGENCYLL (( — 1�11 a I hereby affirm that there is a construction lending agency for trHL�•if 4s the performance.of the work for which this petmit is issued IPERMIT FEE (Sub-Total) C ` i= (Sec. 3097, Civ. C.). .PLAN CHECKING FEE _ _} Lender's Name s 13101 '-1�t 'i_; >1A r�Ffr?i d • PERMIT ISSUING FEE Lender's Address 7692; i 0:'I 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 y ordinances and St ' s reg4.lating Electrical wiring, and I hereby auth res tatives of this County to enter upon the a - tione rope for inspection purposes. ,l SEE REVERSE FOR EXPLANATORY LANGUAGE t Slgnat a Dat' ®' } , J. (PWORKERS'COMPENSATION DECLARATION 20.0,019OPW:3%87 APPLICATION FOR ELECTRICAL. PERMIT " .I .hereby affirm that I have a certificate of consent to self cE O insure, or a certificate of Workers'Compensation Insurance, I COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof(Sec. 3800, Lab. C.)• I Policy No. Company ` FOR APPLICANT TO FILL IN JOB /� ...�✓J .L,�/,s ❑Certified copy is.hereby furnished. New Residential Bldgs. &Pools EACH NO.. FEE ADDRESS Q32o W�'�' o J� ❑Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ — .$ Om LOCALITY'�� .�Ls G IT tion department. Multi-family Sq. Ft. NEAREST CROSS ST. NG�� Date Applicant (Residential Swimming Pools OWNER OR FIRM NAME C4tLPG i" SO'PPl.lE25 CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Z Light Sw._ MAIL A 27• l^,. /fj COMPENSATION'INSURANCE �� ADDRESS �'f'.7 '4 �E. L0ST-A j First 20 (This section.need not be completed if the work involved by Total No. Additional CITYT�*r�p(,EC Tel. No.#49 the permit is for one hundred dollars($100)or less.) PLAN CHECK I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner pp /1 APPLICANT so as to become subject to'the W sat' Laws. Lighting Fixtures First 20 /0 0T O ADDRESS Additional Date �I3 2 Applic 'Total No. Z� CITY Tel. No. NOTICE TO APPLICANT: If, a r ma ing this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range_ Heater—D.W. _ APPLICATION . .— ;Vr �t Compensation provisions of the Labor Code, you must forth- Oven — Dryer _W.M.— ADDRESS;;0 18DZ Q with comply with such provisions or this permit shall be Top — FAU —W.H. — �r deemed revoked. CIT Tel. No. %97-aW LICENSED CONTRACTORS DECLARATION Hood — Fan —Other— Disp: _ Room Air Cond. — LICENSE OR NUMBER. G'D I hereby affirm that I am licensed under provisions of Chapter 9 REG.NUMBER. G O Class. (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PR SED BY and Professions Code,and my license is in full force and effect, f 0_ Size&Type HP, KW, KVA, or KVAR p/=AV Q License Number._�s 3 27� L c.•Class CIO Up to 1 Incl. FINAL V Z+�3•C�2 — Over 1 to.10 Incl. DATE , VALIDATION Contractor Date Over 10 to 50 Incl. 0 FINAL ❑ I am exempt under Sec. I Over 50 to 100 Inc. BY W B.BP:C. for this reason 1 Over 100 IL Date: Services, Swbd., MCC&Parlelboards ; Z 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 HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit r#(;f`,f,T Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): 3307 :, edi•,; Eli, as owner of the property, will.do the work and the Misc. Conduits 8 Conductors structure is not intended or offered for sale(Section 7044, Other.(See Complete Fee Schedule)— =, .111 AL ._� 2 � Business and Professions Code). r CONSTRUCTION LENDING AGENCY `.•i`jt.1:Fi '�aF "'" I hereby affirm that there is a construction lending agency for CHANGE ;r. the performance of the work for which this permit is issued PERMIT FEE (Sub-Total.) (Sec. 3097, Civ. C.). PLAN CHECKING FEE I �il'l –I_j)t i "•i=', Lender's Name •4E tr 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 re y au a re ese of. is County to enter upon the above-me ione op e t insp tion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signa ure of Permit Date ®s t•., Vv®RttERS'�OMPEN 'TION DECLARATION DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT 1 hereby offjrym that"I have a certificate of consent to self 'C10.66 t O inqur'e, ora tertificate of Workers'Compensation Insurance, I COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS (or aaccertrtified coMgr c. 3800, Lab. o'F Ticy No. /��pany .. FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS PY y'building inspec- 1 &2-Family,.Sq. Ft. LOCALITY Certified co is filed with the count $ — $ ion de rNEAREST t ent. Multi-family Sq. Ft. CROSS ST. Residential Swimming Pools Date Applicant OWNER OR FIRM NAME f CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL utlets: Rec Light Sw._ COMPENSATION INSURANCE � + . ADDRESS This section need not be completed if the work involved b First 20 ( P 11 Total No. CITY Tel. No. the permit Is for one hundred dollars($100)or less.) Additional 6 I certify that in the performance of the work for which-this PLAN CHECK permit is issued, I shall not employ an t' 3 i APPLICANT p p y. y person in any manner Li htin Fixtures .-..First 20 so as to become subject to the.Workers'Compensation Laws. I g 9 ADDRESS r i Additional i Date Applicant Total No. CITY Tel. No. NOTICE TO APPLICANT: If, after making this Certificate of (Fixed-Appliances.Not Over I HP PERMIT Exemption, you should become subject to the Workers' f Range— Heater—D.W. _ 'APPLICATION Compensation provisions of the Labor Code, you must forth- f Oven — Dryer —W.M.— ADDRESS with comply with such provisions or this permit shall be Top — FAU —.W:H. — deemed revoked. Hood — Fan —OtherCITY Tel. No. _ LICENSED CONTRACTORS DECLARATION LICENSE OR _ — I hereby affirm that I aDisp. Room Air Cond.m licensed under provisions of Chapter 9 ti REG.NUMBER Class. (commencing with Section 7000)of Division 3 of the BusinessPower Apparatus&Large Appliances DISTRICT NO. PR C ED BY and Professions Code,.and my license is in full force and effect. a Size&Type HP;KW, KVA, or KVAR ,fJ� p License Number Z Lit. Class } U Up to 1 Incl: _ FINAL � Over 1 to 10 Incl. Contractor /7 Date DATE ^C[/ _ "AL117ATION 0 ❑ Over 10 to 50 Incl. FINAL 1" I am exempt under Sec. Over 50 to 100 Inc. FI u B.&P.C. for this reason Over 100 a ► Date: Services, Swbd.,MCC&Panelboards NZ • I 0-200 Amp. Under 600 V — • Signature 1 201.- 1000 Amp.:Under 600 V ❑ Exemption for Reg. Matnt. Elect. 1 Over 1000 Amp.:or Over 600 V SINGLE FAMILY Temp o er P rtenances Q. Q 00 ' HOME OWNER-BUILDER DECLARATION -$$ {_^ s I hereby affirm that I am exempt from the Contractor's License SignTn7ffFle rant intuiti,i: Law for the following reason (Section 7031.5, Business and i4dditional Sign Branch Circuits 7`� Professions Code): Ii-. ,�L•i,1: 5340 ❑ 1, as.towner of the property, will do the work and the mist. Conduits&Conductors IT L1 structure is not intendedoroffered for sale(Section 7044', Other(See Complete Fee Schedule)_ - , ;f t-. 53-0 --„ Business and Professions Code). i I - 3_00 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for CHANGE €_t the performance of the.work for which this permit is issued PERMIT FEE (Sub-Total) ap (Sec. 3097, Civ.C.). PLAN CHECKING FEE Lender's Name 001010-0DO f 7/ 3/01 / ikRMIT ISSUING FEE ff� Lender's.Address / ?8 3 1 Ari 9:512 'I certify that I have read this application and state that the ,TOTAL FEE ��-BSO above information is correct. I agree to comply with all County l ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this-County to enter upon the above- operty for inspection pun os SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur o P D e as „n %YOm RKERS_ COMPENSATION DECLARATION: 20-0019 DPW V87z (•ihereby affirthat I have'a certificate.of consent to self 7E APPLICATION FOR ELECTRICAL C CTRICAL .PERMIT Q V or apcertificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a ce�r ified-copy thereof(Sec. 3800, Lab. C.) Poli IVa + Company 6 FOR APPLICANT TO FILL IN Job Certified.co is hereby furnished. EACH NO. FEE ,. ADDRESS.. PY Y . /tel fZ' New Residential Bldgs. &'Pools LOCALITY . ertified co is,'filed with the count buildin $ , • PY.•� y g.inspe - • 1 &2-Family„ Sq. Ft. _ _ _ - - • tion de rtment. — NEAREST _ PQ Multi-farrlil Sq, Ft. CROSS ST Y �; Date Applican Residential Swimming Pools. PI OWNER OR ,�v q 1 RM NAME C.A) etll - ii;• : CERTIFICATE OF EXEMPTION FROM WORKERS.' r Z / MAIL COMPENSATION INSURANCE Outlets: Rec LI p ADDR p First 20 / �Q �O (This section need not be completed if the'work Involved 4y wn ESS Total No. Additional Q iTY �/ . r the permit is for,one hundred dollars(5100)or less.) PLAN CHECK I certify.that in the performance of 4he work.for which this APPLICANT permit is issued,f.shall not employ any person in any manner r so as to become subject to the Workers'Compensation Laws. Lighting Fixtures 'First 20 0 � ADDRESS i Date., Applicant : N Additional . . Total No. Z� CITY Tel No f NOTICE TO APPLICANT; If, after making th"is Certificate of Fixed Appliances of Over 1 HP PERMIT Exemption:, .you should become subject to the Wotkers' Range— Heater—D.W. — APPLICATION'. Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDREj with comply with such provisions or this permit shall .be Top — FAU W.H. deemed'revoked. �Other_ CITY 'Tel. No � Hood — Fan - LICENSED CONTRACTORS'DECLARATION �p LICENSE OR Disp. — Room Air Cond. — REG.NUMBER � Class. j0 1 hereby affirm that I am.licensed under provisions of Chapter 9'. (commencing,with:Section 7006)of Division.8 of.the'Business Power.Apparatus.&Large Appliances DISTRICT NO. PROCESSED BY and'Professions Code;.and my license is in full.force and effect., t a a Size&Type HP,XW, KVA, or,KVAR ' �'�O �,� � U License NumJbaer fLic. Class Up-to T Incl. FINAL ..: Over 1 to 1-0.Incl: . DATE / t,/ _�/ VALIDATION Contractor Date ' l Y ❑ Over 10.to 50 Inc]. FINAL F- U Iain exempt under Sec. Over SO to t00 Inc. BY SAP.C. for this reason- Over 100 a Date: Services;Swbd..,MCC&Panelboards Z 0-200-Amp. Under 600 V — Signature 201 - 1000 Amp: Under 600 V Exemption far Reg.,Maint. Elect. Over 1000 Ainp. or Over 600 V SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER•BUILDER'DECLARATION a: I hereby affirm that I am exempt'from the Contractor's License Sign with One Branch Circuit t Law.for the following reason (Section 703-1.5, Business and Additional Sign Branch Circuits ACCT. Professions Code):. 3307 +.'.+ I, s ' .t7.�tlS ElMi.sc. Conduits&Conductors I;.as owner of the property,,will do the work and .the. 7� rk Other See Complete.Feb..Schedule. L . structure is not intended'.or offered for sale(Section 704,4; ( Schedule.)-.- Business and Professions Code). ® TOTAL 167 CONSTRUCTION LENDING AGENCY } f=' 'I Hereby affirm that there is a construction lending agency for ' :HECK 167..uL1 the performance of the work for which this permit is.issued PERMIT FEE (Sub-Total) Q CHANGE (Sec. 3097, Civ. C.). PLAN CHECKING-FEE 00 Lender's Name Lza e`-"/14 `?tPERMIT ISSUING-FEE .� t . l� Lender's Address TOTAL FEE 147 �o 8517 1 i "a'PI I certify that I have read:this application and state that the above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby.authorize representgative-s of this County to-enter upon the above- nned por inspection purposes. SEE REVERSE FOR UPLANATORY LANGUAGE Signature of P;yfnittfie Date i ®'