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Home My Public Portal About5632 MCCULLOCH AVE_Electrical__ if WORKERS' WORKERS'OOMPENsaTION DECLARATION 76063 10/81 APPLICATION FOR ELECTRI AL .PERMIT {� I her? ;affkm •that I have aycert�cate of consent to self•.insure, cE'-SosG / IJ nor a'ce�tificQte of Workers'Compensation Insurance, or a cbrtified COUNTY OF LOS ANGELES BUILDING AND SAFETY • copy thereof(Sec.3800,Lab.C.) P� ; Policy No. Company '°'i 4Tr C�0 fOR APPLICANT TO FILL IN JOB r r� C ❑ Certified copy is hereby furnished. EACH NO. FEE ADDRESS J G.. e G New Residential Bldgs.& LOCALITY / 1.&2-Family,$q.Ft. L' $ — $ 1' `� Certified copy is filed with the c unty buildinginspection NEAREST t (, epartment. Multi-family Sq.Ft. bv_^f � /M Date L� � Applicant CROSS ST.Residential Swimming Pools OWNER OR �� FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Red—Light_Sw. MAIL — COMPENSATION INSURANCE ADDRESS (This seFirst 20 section need not be completed if the work involved-by the CITY 'T61.No. permit Is for one hundred dollars($100)or less.) Total No; Additional l certify that in the performance of the work for which this permitPLAN CHECK I APPLICANT is issued, I-shall not employ any person.in any manner so as to becomesubject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional CITY Tei.No. Date Applicant Fixed Appliances Not Over 1 HP PERMITIf �. NOTICE TO APPLICANT: .If, after making this Certificate of -C eTa Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W.. APPLICANT provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer WA._ ADDRESS 740 'S f provisions or this permit shall be deemed revoked. Top _ FAU W.H. _ 7 M LICENSED CONTRACTORS DECLARATIONCITY v Tel.No. Z V Hood — Fan Other_ I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REG.ICENUMBER Class (commencing with Section 7.000)of Division 3 of the Business and REG.Nd Professions Code,and my license is In full force and effectDISTRICT NO. P D BY 'Power Apparatus&Large Appliances � Q r, 'l Size&'Type HP,KW,KVA,or KVAR d p w Q License Number. 41'3 Lid.Class C /V Up to 1 Incl. FINAL + V Contractor Date 6�� / Over 1 to 10 Incl. DATE VALIDATION �. Over 10 to 5.0 Incl. FINA ❑ I am exempt under Sec, Over 50 to 100 Inc. EV a B.&P.C.'for this reason Over 100 fn Services,Swbd.,MCC&Panelboards Z 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 Additional Sign Branch Circuits for the following reason(Section 7031.5,Business and Professions Code): ❑ I,asn Other(See Complete Fee Schedule)owner of.the property,will do the work and the structure Misc.Conduits&Conductors _. is not intended or offered for sale (Section 7044, Business - ► and Professions,Code). 2 7 3 7,O A CONSTRUCTION LENDING AGENCY ri I hereby affirm that there is a construction leading agency for the # 0,0 0 0.0 2 performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub Total) Civ.-C.): I 'o 8,1L 6 6 PLAN CHECKING FEE o -'o 8A 6 6 5 Lender's Name PERMIT ISSUING FEE 19 5rb 063G-87 Lender's Address 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. p SEE REVERSE FOR EXPLANATORY LANGUAGE Si ature of Per flee Date J i WORKERS'COMPENSATION DECLARATION I76A663 ,10/81 APPLICATION FOR Et�ECTRICAL PERMIT 1 hereby affirm that I have a certificate of consent to self CE-8066 insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES I BUILDING AND SAFETY or a certified ctopy thereof(Sec. 3800, L C.) P Policy '��_! r any FOR APPLICANT TO FILL IN ! JOB ❑, Certified copy is hereby.furnished. New Residential Bldgs..&Pools EACH NO. . FEE ADDRESS ' Certified copy is filed with the county building inspec 1 &2-Family, Sq. Ft. $ — $ 1 LOCALITY tion department. Multi-family Sq. Ft. — NEAREST I Residential Swimming Pools CROSS OWNER T. Date � licant OW NAME ®� CERTIFICATE OF EXEMPTION FROM WORKERS' ', Outlets: Rec Light Sw._ AMAIL DDRESS COMPENSATION INSURANCE First 20 (This section need not be completed if the work involved-by Total No. Additional CITY ® Tel. No. the permit is for one hundred dollars($100)or less.) I certifythat in the performance of the work for which this PLAN CWET P ..APPLICANT permit is issued,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT ,��yy�� NOTICE TO APPLICANT: If, offer making this . 2 (sem. Certificate of APPLIC T Exemption, you should become subject to the Workers' Range= Heater—D.W. — Compensation provisions of the Labor Code, you.must forth- Oven —Dryer —W.M.— ADDRES with'comply with such provisions or. this permit shall be Top _ FAU —W.H. — CITY Tel. No. deemed revoked. Hood _ Fan —Other_ LICENSED CONTRACTORS DECLARATION 'LICENSE OR 610 I hereby affirm that I am licensed under provisions of Chapter 9. Disp. _ Room Air Cond. REG.NUMBER Class. (commencing with Section 7000)of Division 3 of the Business DISTRICT NO. PROC ED BY and Professions Code,and my license is in full force and effect. Power Apparatus$Large Appliances Size&Type HP, KW, KVA, or KVAR J i V License Num r Lic.. Class Li Up to 1 Incl: FINAL / / 'J Over 1 to 10 Incl.' I' DATE J ^ 20 .—Q VALI TION Contracto Date�/ 5,.-®F. Over 10 to 50 Incl. FIN (cJJ 0 El I am exempt under Sec. Over 50 to 100 Inc. B !16 B.&P.C. for this reason r Over 100 Services, Swbd.., MCC&Ponelboards Date: 0 -200 Amp. Under.600 V Signature 201. - 1000 Amp. Under 600 V ❑ Over 1 . or Oyer 600 V Exemption for Reg. Maint. Elect. Zp AZO,;3;1 ®aL� SINGLE.FAMILY Temp.;Power Pole&Appurten nces HOME OWNER-BUILDER DECLARATION Sign with One Branch-Circuit �/ V ;2-6 8 a 0 A I hereby affirm that I am exempt from the Contractor's-License Additional Sign Branch Circuits V # 0 0 0 0 0 2 Law for the following reason (Section 7031.5, Business,and Professions Code): Misc. Conduits&Conductors I, as owner of the property, will.do the work and the, ) b o 2 5,5 0 I., is not intended or offered for sale (Secfion: Other(See Complete Fee Schedule)_ ► 7044, Business and Professions Code). 0 0 o2 505' CONSTRUCTION LENDING AGENCY � 2.0-87 1 hereby affirm that there is a construction lending agency for' C the performance of the work for which this permit is issued,. PERMIT FEE (SubrTotal) (Sec..3097, Civ. C.). j PLAN CHECKING FEE Lender's Name F PERMIT ISSUING FEE Lender's Address I certify I have read this application and state that the; TOTAL FEE Gc� above' oi is rrect. I agree to comply with all County; ordin c nd Sta laws regulating Electrical wiring, and. her y thorize r presentatives of this County to enter upon) th. a ve-menfl ne property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur f Permittee Date 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, or o'certificate.of Workers'Compensation Insurance, { COUNTY OF LOS ANGELESBUILDING AND-SAFETY or a certified copy thereef(Sec. 3B Lab. C.) Policy No. Compan ' 1I FOR APPLICANT TO FILL IN JOB �+ �^ tee/ EACH NO. FEE ADDRESS Ro Q/&6,&L.q `Certified copy is hereby furnished. New Residential Bldgs. &Pools $ —is LOCALITY Certified'c py is filed with the county building irispec- � 1 &2-Family, Sq. Ft- tio a 'Pent. Multi-familyS Ft. — NEAREST P /1 /� q' CROSS ST. CC�(�' VA— P Date Applican;?�� GA j Residential Swimming Pools OWNER OR �y FIRM NAME CE IF.I.CATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ( Outlets: Rec Light Sw._ ADDRESS =;b First 20 h ' (This section need not be completed If the work involved by I Total No.. Additional CITY {V Tel. No. 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 'APPLICANT l��i� � L�/�,aT• .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 f�� Tel. oo.,55�3 at/ Hood _ Fan _Other_ LICENSED CONTRACTORS DECLARATION LICENSE OR J Z c / � f,( I:hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. T t� Class. MEG.IREGNUMBER commencin with Section 7000 of Division 3 of the Business 'DISTRICT NO. PROCES BY '(commencing ) Power Apparatus&Large Appliances p L and Professions Code,and my license is in full force and effect. I �� Size&Type HP, KW, KVA, or KVAR' O License Number Lia. Class I- Up to 1 Incl. FINAL V � .WPJOver 1 to 10 Incl. DATE S— — VALIDA ON ContractorDate 7 I Over 10 to 50 Incl. FINAL 1�_ ❑ I am exempt under Sec: j Over 50•to 100 Inc. BY W Over 100 B.&P.C. for this reason Services, Swbd.,MCC&Ponelboards Date: 0 -200 Amp. Under 600 V ► 2697.3 A Si.gnaturb - I 201 - 1000 Amp. Under 600 V 2 ❑ Over 1000 Amp. or Over 600 V ` # 0 0 0 01 Exemption.for Reg. Maint. Elect. 0 SINGLE FAMILY Temp: ZPOL e: Appurtenances ( 0 0 25.5 Q HOME OWNER-BUILDER DECLARATION ranch Circuit o 0 o 25 5,0 I hereby affirm that I am exempt from the Contractor's License I Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and 5 Q 6+8 7 Professions Code): ❑ I, as owner of the property; will do the work.and the I Misc. Conduits&Conductors ' structure is not intended or offered for sale (Section I Other(See Complete Fee Schedule)_ 7044, Business and Professions Code,). CONSTRUCTION LENDING AGENCY i I hereby affirm that there is a construction lending agency for I 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 S - Lender's Address 1 certify th t I have read this application and state that the TOTAL FEE J(/ above in motion is correct. I agree to comply with all County ordina a t to laws regulating Electrical wiring, and hereb orize epresentatives of this County to enter upon I the v -merit' ne property for inspection purp es. ,I SEE REVERSE FOR EXPLANATORY LANGUAGE , 5 � 9nature ermittee ate f