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Home My Public Portal About6037 MUSCATEL AVE_Electrical__ WORKERS'COMPENSATION cafe of consent 6A663. 10/e1''N, APPLICATION FOR ELECTRICAL PERMIT .I hereby affirm that I have a certificate of consent fo self E'B insure, or a certificate.of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof(Sec. 3600, Lob. C.) i ' Policy No: Company ��`' rj ' FOR APPLICANT TO FILL IN. JOB Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE t•, ADDRESS �' Certified copy is filed With the county building inspec- 1 &2-Famlly, Sq: Ft. $ — $ LOCALITY 01— C- tion partxnt. -Multi-fainily Sq..Ft. — NEAREST CROSS ST. ' � [��AA/ Residential Swimming Pools OWNER OR ' .. Date Applicant'_ FIRM NAME :I CERTIFICATE OF EXEMPTION,FROM WORKERS' MAIL ti COMPENSATION INSURANCE Outlets: RecLightSw. ADDRESS j'c7/yr (This section need not be completed if the work Involved by /J First 20 y the permit is for one hundred dollars;($100)or less.) Total No. �/f�G . CITY Tel. No, �j Additional . c' 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 fo.the Workers'Compensation Laws. Lighting Fixtures First 20. ADDRESS l Additional Total No._ Date Applicant CITY Tel. No. NOTICE TO"APPLICANT: If,'after making this Certificate of Fixed Appliances Not Over 1 HP ^�g o the Workers' -Range_.Heater_D.W. Exemption, you should become subject'tAPPLICANT .,Compensation,provisions.of the•,Labor.Code,'you;must forth- Oven _Drye'r _W.M._ ADDRESS ev--.d rte. with comply with such 'provisions or this'permit. shall be Top —'FAU W.H. — ' deemed.revoked. ;'• CITY Tel.'No. LICENSED,CONTRACTORS DECLARATION Hood — Fan —Other_ P LICENSE OR �f I hereby affirm that I am licensed-under provisions of Chapter 9 Disp. — Room Air Cond. REG.NUMBER j 5 Class'. (commencing with.Section 7000)of Division 3 of the;Business DISTRICT NO. PROCES ED BY ' and Professions Code,and my license is;in-full force and effect. Power Apparatus.&..Large Appliances �� rSize&Type HP,.KW, KVA;or KVAR` 0 License Number ! Lie.'ClassFINT� V Up to 1' Incl., p, Over 1 to 1.0 Inci. — 'f� VALIDATION OC Contractor Date Over 10 to 56 Incl. FIN V ❑ I am exempt under Sec.- Over 50 to 100 Inc. BY B.&P.C. for this reason• Over 100 ' H Services, Swbd., MCC&Panelboards z �I Date: 0 200,Amp. Under 600 V Signature. 201 -.1006 Amp. Under 600 V ❑ Exemption for Reg.,Maint. Elect. ' Over 1000 Amp. or Over 600 V 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 Additicrial.Sign Branch Circuits , Law for the following reason (Section J63.1.5, Business and 9 0'5 5 6 Professions Code): ❑ M(sc. Conduits&Conductors 1a'0 0 0. o. 0 2 I, as owner of the property,'.wiIL do the work,and the ' structure is not intended or offered for'said (Section. Other(See Complete Fee Schedule.)- 2 7044, Business and Professions Code). ; • CONSTRUCTION LENDING-AGENCY - . - - � ., - • 0. I hereby affirm.that there is-a construction lending agency for r ! _ The performance of the work fowhicb this permit is issued PERMIT FEE (Sub-Total) 0 2 1 7— i 11 (Sec. 3097, Civ. C.). ; i PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE. Lender's Address I certify that f 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 here§y authorize representatives of this County'to enter upon- t ove-me ntio operty for Inspection purposes. t SEE'REVERSE FOR EXPLANATORY LANGUAGE Sign ature of Permitt Date _XORIKER'S COMPENSATION DECLARATION 20.001 APPLICATIDPW(12-91) • I I.I ., LLLIII I hereby affirm that I have a certificate of consent to self insure, 17FOR ELECTRICAL PERMIT or a certificate ofyorke('s Compensation Insurance, or a certified CQPNTY.OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thegaof'(Sec.3800 Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN A DRESS Al, !P[LT h4&L ❑ Certified copy is liereby'turnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY ��✓ G r . C. Z 1 &2-Family,Sq.R. — $ $ ❑ Certified copy is flied with the county building inspection. _ 'NE AREST �� department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools MAP BOOK PAGE PARCEL OWNER OR ` CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets;Rec.41--Light Sw. �� D FIRM NAMEZ.a''A/ COMPENSATION INSURANCE First 20 (This section need not be completed If the work Involved by theO MAIL s .r permit is'.for one hundred dollars(S100)or less.) Total No.� Additional d I I certify that in.the performance of the work for which this permit CITY S Tel.No.z�6, is issued, I shall not employ any person in any manner so as to i PLAN CHECK become subject to the Workers'Compensation Laws. Lighting FixturesFirst 20 1 APPLICANT '' I Total No. — Additional ADDRESS Date Applicant - NOTICE TO APPLICANT: If, after making this Certificate of RESIDENTIAL APPLIANCES NOT OVER 3 HP.- O O CITY Tel.No. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT.OVER 3 HP. provisions of the Labor Code,you must forthwith comply with such APPLICANT ' S provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances LICENSED CONTRACTORS DECLARATION Size&.Type HP,KW,KVA,or KVAR .ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing,with Section 7000).of Division 3 of the,Business and CITY Tel.No. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE C+R >" Over 50 to 100 Incl. REG.NUMBER Class• d DIST7 PROCES X Over 100 License Number Lic.Class V I, Bery es,Sw M C PaYr .Und FINAL 0 Contractor Date O DATE V 400-1 000 Amp.Un0 V 2 f O VA (DATION LU ❑ I am exempt under Sec. Over 1000 Amp.or Over 600 V FINAL d BAP.C,for this reason. BY �/ Z BRANCH CIRCUIT FEES C//f Date: ,® 15AA or 20A 120V,Lighting or Recept. 2AIN Signaturei1,s64i• 1 To 10 Branch Circuits '�,_ +1416'40 Branch'Circuits ❑ 41 Or Marti Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A 208V To 277V Lighting Br.Circuits 2 SINGLE FAMILY Temp.Power Pole&Appurtenances ACCT a a' HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit '� 193.2-5 1 hereby affirm that I am exempt from the Contractor's License Law 3 Q3 for the following reason(Section 7031.5, Business:and Professions., Additional Sign Branch Circuits 1 ITEMS Code) TOTAL :193 ,_ I,as owner of.the property,will-do-the-worfC-and the.structure.. Misc.Conduits.&Conductors a�'•-a is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) , CHECK 193°&5 and Professions Code). CHANGE "�� 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'(Sec. 3097, PERMIT FEE (Sub-Total) 01107/22/96 Civ.C.) no—mi Lender's Name PLAN CHECKING FEE 7570 1 AM 8'-34� PERMIT ISSUING FEE Lender's Address . I certify that I have read this application and under penalty of purjury state TOTAL FEE that the above information Is correct. I agree to comply with all County ordinances and State Iaws.regulating.Electrical wiring,and hereby authorize representatives of this County to enter upon the above-mentioned property for inspectio purp // SEE REVERSE FOR-EXPLANATORY LANGUAGE SIGNATURE OF PER DA