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Home My Public Portal About4964 MCCLINTOCK AVE_Electrical__ ORKERS'- OMPENSATION DECLARATION 764663. 10/81 r F.h .e. ffirri, that I 'have a ertificate of consent to self CE-'806G APPLICATION FOR ELECTRICAL PERMIT `:.Asu i yna'certiftcat4of Work"ers'Compensation Insurance,. COUNTY OF LOS ANGELES BUILDING AND SAFETY 'ror a cer,Sfied copy,thereof(Sec. 3800, Lab. C.) Policy .FOR APPLICANT TO FILL IN JOBG. Certified copy is hereby furnished. New Residential Bldgs..&'PPoo Is EACH' NO. FEE ADDRESS 9- � ( G G Ft. $ " — $ LOCALITY �L i tRrCertlfted'copy is filed with the county building tnspec1 8 2=Famil- ' y. Sq _ _ NEAREST tion department. Multi-family Sq. Ft. .Q r CROSS ST: Date Applicant L- P%'6Lf+� T Residential Swimming Pools OWNER OR CC9 r FIRM NAME °2 K CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL COMPENSATION INSURANCE Outlets: Rec Light Sw._ ADDRESS (This section need not be completed if the work Involved by First CITY Tel. No. the permit is for one hundred dollars($100)or.less.) Total Na. Addittional • PLAN CHECK 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 Frxed.•Applionces Not Over 1 HP PERMIT 9 APPLICANT JKVL r / v p NOTICE TO APPLICANT: If,-after making this Certificate of Exemption, you should become subject t6 the Workers' Range_ Heater_D.W. / 'Compensation.provisions of the Labor Code,,you must forth- Oven ^Dryer —W.M.— ADDRESS JZ (Ni 6' �✓ with comply with such provisions or this permit shall be Top FAU W.H. — f deemed revoked. ' ' CITY G ,o d✓ Tel. No: I Hood•_ Fan _Other_ LICENSED CONTRACTORS DECLARATION LICENSE OR �— ,. !(commencing affirm that I am.licensed under.provisions 6f Chapter 9 Disp. — Room Air Cond. REG. NUMBER Class. C_–J.& (commencing with Section 7000)of Division 3 of the Business DISTRICT NO. PROCE SE ,BY Power Apparatus&,,Large Appliances and Professions Code,and my license is,ih full force and effect. �'� /.)� ®; �. Size&Type HP, KW, KVA,or KVAR` v O License Number 7 Q ,� Ltc. Class G� FINAL,. - ; tJ Over r 1 Incl. DATE r�� ✓" Over'1 to 10 Incl _ ;7 VALIDATI N ,�r � Contracto Date 1– Over-10 to'S0 Incl. ❑ FINAL ,. V • I am exempt under Sec. Over 50 to..100 Inc:• ,BY r`' UA B:,&P.C. for this reason Over 100 CA Services, Svi bd.,MCC&Panelboards .p Dat . 0 -200 Amp. Under 600 V , 1 L. f #0 1 3:a'4' Stgneture' 20.1 - 1000 Amp. Under 600 V ( o o 0.3 Over 1000 Amp. or Over 600 V / a . Exemption:for Reg. Maint. Elect. js/ ,_ SINGLE FAMILY " 0.' 8 3 3 4 L HOME OWNER-BUILDER DECLARATION Temp: Power Pole•&Appurtenances Sign with One Branch Circuit `f1,04.-84 I hereby affirm that I am exempt fr6m'the Contract'or's License Additional Sign Branch Circuits Law for the following reason (Section'7031:5, Business and 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 Other(See Complete'Fee Schedule)_... 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 issued PERMIT FEE (Sub-Total) (Sec. 3097,.Civ. C.). • - PLAN CHECKING-FEE , Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application•and state that the TOTAL FEE g 31 above information is correct. I•agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby.auth rt representatives of this County to enter upon the above- 'e ion d property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ign iture'of Permittee- Date Cal ,y�WORKERk-,.COMPENSATION DECLARATION 76A663 10/81 o firm thahl have a:certificate.of consent to self CE-806G APPLICATION FOR ,ELECTRICAL PERMIT a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a ccdtified copy thereof(Sec. 3800, Lab. C y� aicy C Company' / FOR.APPLICANT TO PILL IN JOB ADDRESS Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO: FEE 1 &2-Famil S. Ft. $ $ LOCALITY ��f� ' 51- Certified copy is filed with the county building inspec- Y� q• NEAREST tion department. / Multi-family Sq. Ft. CROSS ST. Date/%�`�'/�pplicanf[ �l.�9s� Residential Swimming Pools OWNER OR FIRM NAME 1007 CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE ADDRESS (This not be completed If the work involved b First � s section neep Y Total No.. Addittional � CIN - may.,, Tel. N the permit is for one hundred dollars($100.)or less.) PLAN CHECK 1 certify that in the performance of the work for which this APPLICANT . per mit'is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First ADDRESS Total No. Additional' CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of PERMIT 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. — CITY Tel. No. deemed revoked. Hood _ Fan _Other_ LICENSED CONTRACTORS DECLARATION LICENSE OR [, �j I hereby affirm that I am licensed.under provisions of-Chapter 9 Disp. _ Room Air,Cond. REG.'NUMBER 7 L 73 48 Class. (commencing with Section 7000.)of Division 3 of the Business DISTRICT NO. PRO E ED BY Power Apparatus&Large Appliances `r >° and Professions Code,-and my license is in full force.and effect. V A. Size&Type HP, KW, KVA, or KVAR' l V U 0 License Number ��P Lic. ClassUp to 1 Incl. FINAL W � /� Over 1 to 10 Incl. DATE VAL ION O Contract4aiz�'7 �- �VS�Date��3 r� Over 10 to'S0 Incl. � ❑ F.1 NAY su m:e I axempt under Sec. Over 50 to 100 Inc. BY � Over 100 BAP.C. for this reason Date: Services, Swbd., MCC&Panelboords 0 -200 Amp. Under 600 V :21 0 6,6 A Signature 201 -1000 Amp. Under 600 V Over 1000 Amp. or Over 600 V # 0 0 o b o '2 Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole&Appurtenances I o o 2 S 5 0 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit o o 0 I hereby affirm that I am exempt from the Contractor's.License 2 5 5 0 Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and Professions Code): 1 1.13-84. ElI, as owner of the property; will do the work.and the Misc. Conduits&Conductors 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) (Sec. 3097, Civ. C.). PLAN CHECKING FEE U Lender's Name S PERMIT ISSUING FEE .Lender's AddressT/� �- 1 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 mElectrical wiring, and hereby authorize representatives is County to enter upon the above-mentioned rt. or inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 10 ignature of Permit Date ` WORKER S'COMPENSATION DECLARATION c63 10/81 APPLICATION FOR ELECTRICAL PERMIT f,rm'that-4 have a,certificate of consent to self ,r o a certificat& of Workers'Compensation Insurance; COUNTY OF'LOS ANGELES BUILDING AND SAFETY r a certified cop •t reof (Sec. 38,000,, Laab. C.) Po icy No. Company/" �T FOR APPLICANT TO.FILL IN JOB Certified.copy is hereby furnished. New Residential,Bldgs. &Pools . EACH rNO. FEE ADDRESS �v g gall. NEAREST_ .Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $� tion department. Multi-family Sq. Ft. CROSS ST. 00, NEAREST ) Residential Swimming Pools OWNER OR Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec. Light Sw._ MAIL COMPENSATION INSURANCE ADDRESS S This section need not be completed If the work involved b First 20 ( P - Y Total No.. . Additional •`''�• 'CITY � Tel, No�7s- 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 Additional Total No. CITY Tel. Nom?s-osa3 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.A— ADDRESS -7 with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. CITY Z Z Tel. N 6583 Hood _ Fan _Other_ LICENSED CONTRACTORS DECLARATION LICENSE OR 7S I hereby affirm that I am licensed under provisions of Chapter 9 Disp: _ Room Air Cond. REG.NUMBER 7 Classzog (commencing with Section 7000)of Division 3 of the BusinessDISTRICT NO. PRO S .D BY and Professions Code;and my license is in full force and effect. Power Apparatus&Large Appliances Size&Type HP, KW, KVA, or KVAR' r O License'Number ��7��Lic. Class FINAL 119 Up to 1 Incl. 119 Over 1 to 10.lncl. DATE, .. VALE ION 0 Contractor Date Sy Over 10 to 50 Incl. FIN tt; Ell am exempt under Sec. Over 50 to 100 Inc. BY LEA I&Zzjw�, IL B.&P.C. for this reason 'Over 100 Services, Swbd.,,MCC&Panelboards Date: 0 -'200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V �'� 2 4 A ❑ Over 1000 Amp. or Over 600 V # 0,0 0 0.'-0 2 Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole&Appurtenances ),o,o 8 a 3 4 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I herdby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits o -'o 8 3.3 4 5 Law for the following reason (Section 7031.5, Business.and Professions Code): J A 0 7-8 4 0 I, as owner of the property„will do the work and the Misc. Conduits&Conductors 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) (Sec.. 3097, Civ. C.). A/Q PLAN CHECKING FEE Lender's Name �(/�J 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 authorizer re antatives of this County to enter upon the above-.men' perty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 'Sig-nature of er ttee Date