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Home My Public Portal About4700 MILLER DR_Electrical__ WORKERS'COMPENSATION DECLARATION 78A883. 10/81 1 hereby affirm that I have a certificate of consent to self insure CE-8000 APPLICATION FOR ELE:cTRICAL PERMIT or a certifie�t�of:'�kers' Compensation Insurance,.or a certifle( COUNTY OF LOS ANGELES i BUILDING AND SAFETY copy-thereof(Sec.3800,Lab.C.) I - Policy No Corfrpany. ! FOR APPLICANT, FILL IN JOB ADDRESS �47D O ` El Certified copy is hereby furnished. New Residential Bldgs.i EACH NO ,� LOCALITY ' �i ❑ Certified copy is filed with the county building inspectio 1 &2=Family,Sq.F . FEE &Pools t. $ _$ department. Multi-family Sq.Ft. NEAREST CROSS ST. w 1"' rJ fa Date Applicant- 'Residential Swimming Pools OWNER OR J FIRM NAME 0"t, Ci C CERTIFICATE OF EXEMPTION FROM WORKERS' L ! Outlets:Rec Light_SW.— COMPENSATION INSURANCE • AD SS (This section need not be.completed if the work involved by th P First ion 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 is issued,.I shall:not employ any person in any manner sd as to APPLICANT become subject to the Workers'Compensation.La Lighting Fixtures First 20' ADDRESS Additional WATotal No. CITY' Tel.No. Date pli ant + NOTICE TO APPLICANT- If, er making a Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption,you should become subject to the V106r re'Compensation Range_ Heater_ D.W. _. I APPLICANT e G f ie provisions of the Labor Code,you must forthwith comply with suce Oven _. Dryer_ W.M.:_ ADDRESS t P �5 e-4� ie I provisions or this permit shall be deemed.revoked. Top FAU W.H. _ 4 LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ CITY Tel.No. D� e-w�.:. .1. . 1 '�Z6 I hereby affirm that I am licensed under provisions. of Chapter 9. LICE EOR y -- _ 4 � Class.Je�D, (commencing.with Section 7000)of Division Disp. Room Air Cond.3 of the Business and REG.NUMBER . Professions Code,and my license is in full force and effect. i DISTRICT NO: PROCESSE Y Power Apparatus&Large Appliances f � 4 Size&Type HP,KW,.KVA,or KVAR 2 .'V License Number ,` 7 KZ—Lic.Class G` O Up to 1 Incl. FINALV / �1--/Y- r AT Over 1 to 10lncl. ". DATE VALIDATION -0 . Contracto Over 10 to 50 Incl. "I FINAL ❑ I am exempt under Sec. Over 50 to'100:Inc. BY W B.&P.Q.for this reason Over 100 I Services,Swbd.,MCC&Panelboards ® Z Date: 0-200 Amp.Under 600 V ... Signature 201 - 10.0.0 Amp.Under 600 V Over 1.000 Amp.or Over 600 V Exemption for Reg.Maint:Elect. SINGLE FAMILY I Temp.Power Pole&Appurtenances i 'HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I:hereby affirm that I am exempt from the Contractor's License-Law s. for the following reason'(Section:7031..5,Business and Professions Additional Sign Branch Circuits AtCT.g Code): I - 10 Misc.Conduits&Conductors 3607 16'I ❑ I,as owner of tie property,.will.do the work.and the structurITEMS is not intended or offered•for sale (Section 7044, Business Other(See Complete Fee'Schedule) and Professions Code). ® TOTAL ' 16.60 CONSTRUCTION LENDING AGENCY I GASH 16a61I I hereby affirm that there,is a construction.lending agency for t performance of the.work for which this.perrriit is issued(Sec.-3097, PERMIT FEE (Sub-Total) 'HANGS' ..00 Civ.C.). PLAN CHECKING FEE` Il' Lender's Name. 000.0-0001 5/14/90 PERMIT ISSUING FEE Lender's Address ! 0646. -1 Ali 9:47 1 certify that-.[ have read.this application and state that the above TOTAL FEE i information is correct.'i•agree to comply with all County ordinances i and State laws regulating Electrical wiring,. and hereby authorize II representatives of this County toe ter upon the above-mention�+d pro for inspe iAJDA. , SEE REVERSE.FOR EXPLANATORY LANGUAGE ignature of Permi. Date `r II w ORKERS'COMPENSATION DECLARATION zo-oot°ePw3ie7gppLICATION FOR ELECTRICAL PERMIT `i'm that I have a certificate of consent to self cEe a[Eertificate of Workel;�_.j:orrsation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS ed copy thereof(Sec. 3800, Lab. C.) �• "^Policy No.•-•8,5501 1 ry ompany-Sf-at-a 'Punct FOR APPLICANT TO FILL IN JOB ❑Certified copy is hereby furnished: New Residential Bldgs. &Pools EACH NO. FEE ADDRESS XnCertified co is filed with the count building LOCALITY PY " y g inspec- 1 $2-Family, Sq. Ft. $ -- $ Temple City tion department. Multi-family Sq. Ft. -- NEAREST Date?—, Residential Swimming Pools CROSS ST. — �-$9—Applicant- @ ;<z�� El ri F OWNER Development CERTIFICATE OF EXEMPTION FROM WORKERS' Out ets: Rec.�Light Sw._ MAIL ' COMPENSATION INSURANCE ' s' O� ADDREss2035 So., Myrtle Ayp -70 First 20 t�S t , (This section need not be completed if the work Involved by Total No. Additional CIN Monrovia Tel. No.3 rj 9_,3 rjj the permit is for one hundred dollars($100)or less.) I-certify that in the performance of the work for which this PLAN CHECK permit is issued, I shall not employ any person in any manner APPLICANT so as to become subject to the Workers'.Compensation Laws. Light'ng Fixtures First 20 ADDRESS Additional Date ' Applicant To�al No. CITY Tel. No. Fixed 'Appliances.Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of. j PERMIT Jerr Exemption, you should become. subject tb the Workers' Range— Heater—D.W. _ APPLICATION y S Electric, Iri,C Compensation provisions of the Labor Code; you must forth- Oven _ Dryer —W.M.— ADDRESS 14923 .Tele hone Ave with comply with such provisions or this permit shall be Top, — FAU —W..H.. deemed revoked. Hood _ Fan —Other— CITY =h J Tel: N LICENSED CONTRACTORS DECLARATION Disp. _ Room Air Cond. _ LICENSE OR I hereby affirm that.I am licensed under provisions of Chapter 9 l REG.NUMBER CIO-259475 Class. C 10 (commencing with Section 7000)of Division 3 of the Business Power,Apparotus&Large Appliances DISTRICT NO. f PROCESSED BY >- and Professions Code,and my license is in full force and.effect. a Sizer&Type HP, KW, KVA, or KVAR �. O License Number C10-25947gic. Class .0 10 Up to 1. Incl. FINAL V Jerry's Elect 7-31-89 --Over 1 to 10 Incl. DATE ✓ VALIDATION OE Contractor 1-89 Over 10 to 50 Incl. f ❑ I am exempt under Sec. Over 50 to 100 Inc: gY AL U W : B.&P:C. for this reason Over 100' 0- a Service , Swbd.;MCC&Panelboards , Date: Z . - 0200 Amp. Uride'r'600 V . UVVV Signature 201 -;1000 Amp. Under 600 V ❑ ', Over- .000 Amp. or Over 600 V Exemption for Reg. Maint. Elect; SINGLE FAMILY Temp. Power Pole&Appurtenances 2 � HOME OWNER-BUILDER DECLARATION .. I hereby affirm that I am exempt from the Contractor's'License Sign with One Branch Circuit a Law for the following reason (Sect ioh,7031.5, Business and Additional Sign Branch Circuits ACCTeg Professions Code): ' 7 27o50 Misc. Conduits Conductors 1 ITEM ❑.I, as owner of the property, will.do the work and the I &' ,I structure is not intended or offered for sale(Section 7044, Other(See Complete'Fee Schedule)_ Business and Professions Code). , TQr& - o0 CONSTRUCTION LENDING AGENCY CHECK 275.50{ I hereby;affirm that there is a construction lending agency for he performance of the work for which this permit is issued PERMIT FEE (Sub-Total) I ,f Sec. 3097, Civ. C.). I ' I PLAN CHECKING FEE j Leder's Name PERMIT ISSUING FEE 0000-0001 S/ 1/ { Lender's Address I 4816 1 AM10248 , I I cegIfy that I have read this application and state that the TOTAL FEE I above information is orrect. I agree fo comply with all County , ordinances and Stat laws regulating Electrical wiring, and hereb,outhoriz a esentativ. of this County to enter upon the abo a-ment property r'inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE y 7-131-89 g ture Date ' 45 Wq�fir, ERS'COMPENSATION DECLARATION 7sAsas ,0,8, APPLICATION FOR ELECTRICAL PERMITat I have a sertificift pf cqn ent to self insure, CE-9086 `-s> w`a c8rtifi.Ste of Workers'Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY co a 00,Lab.C.). 0I o. Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. EACH NO. FEE ADDRESS New Residential Bldgs.&Pools y. q•Ft. 1 &2-Family,S $ _ $. LOCALITY derti•ed co is filed with the county building inspection p ment. Multi-family Sq.Ft. NEAREST CROSS 3T. Date Applicant Residential Swimming Pools OWNER OR FIRM NAME RTIFI ATE OF EXEMPTION FROM WORKERS' Outlets:Rec Ljght_Sw.---- MAIL. COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work invdlved by the First 20 permit.is for one hundred dollars($100)or less.) Total No. Additional CITY i 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 Total No. Additional CITY Tel.No.' Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of - PERMI AN Exemption,you should'become.subject to the Workers'Compensation Range_ Heater D.W. provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS . provisions or this permit shall be deemed revoked: Top _ FAU W.H. CITY B�/l f Tel.No. . LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ I hereby affirm that I 'am licensed under provisions of Chapter 9 - LICENSE OR Disp. _ Room Air Cond. REG.LIMBE Clas (commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO. PROCESSED BY . 7 Size&Type HP,KW,KVA,or KVAR O Q License:Nufnbe Lic.Class ��7 Up to 1 Incl. FINAL * INAL' Q C"� Over 1 to 10 Incl. DATE - VALIDATION 0 Contractor Dat4hAAR Over 10 to.50 Incl. ❑ FIN ' e&� I am exempt under Sec:. y Over 50 to 100 Inc. FI :. a B.&P.C.for this reason Over 100 i Services,Swbd.,MCC&Panelboards a 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. fur�� SINGLE FAMILY Temp.P�P.Ie& nariees2 HOME OWNER-BUILDER DECLARATION A{iCTI hereby affirm that I am exempt from the•Contractor's•License Law• it a L for.the following reason(Section 7031.5,Business.and Professions Additional Sign Branch Circuits Code): 3307 25°50 the. MISc.Conduits&Conductors 1 ITEM I,as owner of the property,will do th .work and the structure is not intended or offered for sale (Section 7044,Business TOTAL 25.50 and Professions Code). Other(See Complete Fee Schedule) CONSTRUCTION LENDING AGENCY -CHECK -25.510 I hereby.affirm that there is a construction lending agency for the CHANGE .011 performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub Total) Civ.C.). PLAN CHECKING FEE , Lender's Name /� OOM-0M1 6/29/89 PERMIT ISSUING FEE ) 42M 1 AM 103'55 Lender's Address I certify that4 have read this..application and state that the above TOTAL FEE Q informatio correct.I comply with all County ordinances and Sta ws reIng ectr' al wiring, and hereby authorize repres t Ives of is Co ty enter upon the above-mention d ' grope or inspec pos SEE REVERSE FOR EXPLANATORY LANGUAGE S• ure-of Farmi a ate