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Home My Public Portal About6015 MUSCATEL AVE_Electrical__ � WORKERS'COMPENSATION DECLARATION bA� �l3 1D,B, APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self E-806G , insure, or a certificate of Workers'Compensation Insurance, i or a certified copy thereof.(Sec. 3800, Lab. C.) � COUNTY OF I,OS ANGELES BUILDING AND SAFETY y. Policy No. Company FOR APPLICANT TO FILL IN New Residential Bldgs. 8 Pools JOB /,� Certified,copy is hereby furnished. EACH NO. FEE ADDRESS. 404 Ir !/ Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ff.' $ — $ LOCALITY i tiondepartment. Multi-family Sq. Ft.' — NEAREST Residential Swimming Pools CROSS ST. Date -.Applicant OWNER OR + ; ;} CERTIFICATE OF EXEMPTION FROM WORKERS' FIRM NAME ,S O Outlets: Rec Light - Sw: COMPENSATION INSURANCE ADDRE This section need not be completed if the work involVed-b First 20 ( P Y Total No. Additional CITY' l Te. No. �. the permit is for one hundred dollars($100)or less.) I certify.that in the performance of the work for which this PLAN CHEC permit is'issued,'I shall not employ.any person in a'y .manner APPLICANT so-as to become'subje¢t to the Warke Compen Laws. Lighting Fixtures First 20 ADDRESS ,x ' r .a.: Add' Total No. Additional zP?1; I� � CITY Tel. No. Date pp Fixed Appliances Not Over 1 HP PERMIT NOTICE 7O APPLICANT:.If; in this Certificate of APPLICANT ' Exemption, you 'should be omeu lec o e or ers Range_-Heater—D.W. — ' Compensation provisions of abor Code,you must forth- Oven. _Dryer _W.M.— ADDRESS with comply with such provisions• or this permit shall beTop. _ FAU W.H:.— deemecJ revoked. CITY Tel. No. LICENSED CONTRACTORS DECLARATION Hood Fan _•Other_ �r . Dis _ Room Air Gond. Class. I hereby affirm that I am licensed,under provisions of.Chapter 9 � P' LICENSE OR REG.NUMBER (commencing with Section 7000)of Division 3 of the Business. DISTRICT BY and Professions Code,and my license is in full force and effect. Power Apparatus 8 Large Appliances NO. PROCESSED Off. Size&T'yp'e HP, KW, KVA, or KVAR' i `J _K VO License,Nymber. Lic..Closs. Up to 1. I.nci: FINAL V ' Over 1 to 10 Incl.. DATE � � � jam, i VALIDATION O 69 Contractor Date Over 10 to 50 Incl. bs+ FINAL I am exempt under Sec. Over 50 to.100 Inc. BY W BAP.C. for this reason _. Over 100 } Ser vioeS Smibrj Mrr R (boards Date: . _200 Amp Under 600 ► 7.5 A Signature 201.- 1000 Amp. Under 600 V' ' '+l a. o 0 0 0 r, Over 1000 Amp:or Over 600 V '� Exemption for Reg. Maint:Elect, i `' A o 0 2�`v'.(� . SINGLE FAMILY Temp..Power Pole. Appurtenances !L+ ^ HOME OWNER-BUILDER DECLARATION . Sign with One Branch Circuit, o .0 0 2 5 �•0i". I hereby.affirm that I am exempt from the Contractor's License Additional Sign:Branch Circuits Law for the,following reason (Section 7031.5, Business and ..129--F;3 Professions Code): ' i . . " I, as owner of the property, will do the work and the MiscConduits B Conductors' sOucture is not,intended or offered for sale (Section Other(See Complete Fee Schedule:)_ 1' 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 I PERMIT FEE (Sub-Total) f (Sec. 3097, Civ. C.). i PLAN,CHECKiNG FEE Lender's Name PERMIT ISSUING FEE �� 3 I Lender's Address t I certify,that,I have read this application•and state that the TOTAL FEE i9 ' above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical. wiring, and hereby lioriie rep esenfafives of this County to enter upon y` the a -mention roperty fo inspection purposes. r SEE REVERSE FOR EXPLANATORY LANGUAGE Si Pure of ermittee WORKERS'COMPENSATIONDECLARATION' .,1 >$ - APPLIC/4TION FOR ELECTRICAL PERMIT -1,-hereby affirm that. I have,a certificate of consent'to self �,CE-806G insure, or a certificate of Workers'Compensation Insurance, CC COUNTY O.F LOS. ANGELES BUILDING AND SAFETY or a certified copy thereof(See. 3800, Lab.C.) )� Policy No. Company FOR APPLICANTFILLFILL 1N JOB Certified copy is hereby furnishedFEE ADDRESS rD ' New Residential Bldgs, 8 Pools ❑ Certified cd ms filed with the count buildin $ — $ LOCALITY py' y' g inspec- 1.8 2-Family, Sq. Ft. tion department. q Multi-family Sq. Ft — NEAREST Residential'SwimmCROSS ST. Ing Pools ' Date -Applicant I . OWNER • r + FIRM NAME.. CERTIFICATE OF EXEMPTION FROM WORKERS'• Outlets. Rec light Sw._ COMPENSATION INSURANCE ADDRESS, (This section need not be completed if the work Involved by First.20Total No. Additional CITY ,y J '/-Tel. No. ` ' r the permit is for one hundred dollars(:100)'or less:) ✓ I certify that in•the performance"of the work for which this :) PLAN CHECK s permit is issued,I shall not employ-anyerson in an manner APPLICANT. P P Y V r so as to beco e.-ubject to the Worke Corn atibn La s. ; Lighting Fixtures First 20 ADDRESS r AP a Total No. Additional CITY T Dafe APPlica „ / Fixed Appliances Not Over 1 HP PERMIT NOTIC O APPL CANT: If, after making this Certificate of Exemption, you -should become subject' to- the Workers' Range_ Heater—D.W. APPLICANT 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. Hood. —.Fan _Other_ CITY , Tel. No. LICENSED CONTRACTORS.DECLARATION I LICEN R I hereby affirm that I'am licensed under provisions of Chapter 9 Di;p. _ Room Air Cond. R . NUMB.ER Class. (commencing with.Section 7000)of Division 3 of the•Business power Apparatus 8 Large Appliances DISTRICT NO. PROCESSE Y and Professions.Code,and my,license is in full force and effect: I; � Q Size 8 Type HP, KW; KVA, or KVAR' J 10 %. D % .D License Number- Lic. Classl lip.to.1 Incl, FINAL tJ B Over'I to 10 Incl. ATE' Contractor Date P� � VALIDATION, f Over 10 to 50 Incl. o ❑ FINAL I am exempt under Sec. Over 5016 100 Inc. BY (� W B.BP.G. for this reason• Over 100 \ � Date: SeryO -200 Amp. Under.600 s ► Signature 201 - 1,000 Ampe-TT-nder 600 V ' Over 1000 Amp.or Over 600 V + ❑ , Exemption for.Reg:Maint. Elect. SINGLE FAMILY Temp. Power Pole 8 Appurtenances , C 5 2 �A .HOME OWNER=BUILDER DECLARATION} Sign with One Branch Circuit I hereby affirm that I am exempt from'the Contractor's License Additional Sign Branch Circuits. Law for the.following reasorr'(Section 7031.5, Business and Professions Code): +,`o 0 2 5 v O ❑ I, as owner of the'property, will clothe work and the Misc.'Condu ts:8 C6nductors �. structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ u 0 0 2 01 7044, Business and Professions.Code). ► �'; _ fi 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 PERMITTEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE. ' -L'ender's Name _ 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 m ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of.this County to enter upon &h .OV -menti neproper. for inspection p rposes. SEE REVERSE FOR EXPLANATORY LANGUAGE )1 40ate t 'WORKERS'COMPENSATION DECLARATION 176A663 1 hereby affirm that I have a .certificate ofs'consent to self ISE-BDlG -APPLICATION POR ELECTRICAL PERMIT insure, or a certificate of Workers.'Compensation insurance, I. COUNTY OF LOS.ANGELES- BUILDING AND SAFETY o a certified co thereof(Sec. 3800;'Lab. C.) �� .. . c.. . Policy No. Company ®'�'`�5��/� FO.R APPLICANT TO FILL IN' JOB Certified co is hereby furnished. EACH NO. FEE ADDRESS �j g PY Y New Residential Bldgs. 8 Pools ocALITYde Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ — $ %1'J14 e./ tion.deartment. Multi-family Sq. Ft. — NEAREST CROSS ST. .006 Date f . Applic t ` Residential Swimming`Pools OWNER OR t • FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKE - i MAIL Outlets: Reci Light�Sw. .COMPENSATION INSURANCE A 3 ADDRESS . First 20' / (This section need not lie 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 erforrnance'of the work for which.this PLAN'CFIECK P. PPLICANT 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. Dote Applicbrit Fixed Appliances Not Over 1 HP PERMIT NOTICE TO. APPLICANT: Ifo after making'this Certificate of APPLICANT xe.mption,, you should become subject to the Workers' Range_ Heater_D..W. . ompensation provisions of the Labor Code; you must-forth- Oven —Dryer —W.M. ADDRESS y� ith comply with such provisions or this permit shall be Top _FAU W.H. _ - loomed revFan Other_ oked. Hood _ Tel. N . _ -LICENSED CONTRACTORS DECLARATION 'LICENSE OR hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG.NUMBE _.1 Class- L /O commencing with Section 7000).of D.IvIslon 3 of the Business DISTRICT NO. PROCESS BY nd Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances �� < d s�t� �/ Size&Type•HP, KW. ,, KVA, or KVAR" O !cense Number^S /�7'7-.2 Lic.'Class E�� FINAL � ! Up,to 1' Incl. ? -on o Date / �/ 09 Over 1 to 10 Incl. DATE �a ®� VALIDATION c �� 7 Over 10 to 50 Incl. FINAL ~ 1 am exempt under .c. Over 50 to 100 Inc. BY �� d B.&P.C. for this reason Over 160 rA 'Services;.Swbd„ MCC 8 Panelboards Date:...- 0 . 200.Amp. Under 600 V ► (/ �� Signature 201 -•1000 Amp. Under 600 V I Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole&Appurtenances ?,5 7,8 R NOME OWNER-BUILDER DECLARATION Slgn with One Branch Circuit hereby affirm that I am exempt from the.Gontractor s License �, i' c o o 0 o 2 w fbr-the following reason (Section 7031:5,, Business and Additional Sign Branch Circuits , ofessions Code): it o o ( /I c J I, as owner of the property, will do the work and the Mist. Conduits&Conductors structure is not'iritended'or offered for sale (Section Other(See Complete Fee Schedule)_ ► a o`o j Q 7044, Business and Professions Code.'): 1. 2, j 4_87 CONSTRUCTION LENDING AGENCY ereby affirm that there is a construction lending agency for e performance of'the work for which this permit is issued �PERMI.T FEE (Sub-Total) 7S ec. 3097, Civ. C.). PLAN.CHECKING EEE nder's.Nae ` m �ERMIT ISSUING FEE rider's Address ertify that I have read this application and state that the NOTAL FEE t ove information is correct. I agree to comply with all County dinances and State'laws regulating Electrical wiring, and 4 r%l rize representatives this County to enter upon ent'oned'proper r inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE e of Per mitteeDo J I