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Home My Public Portal About6118 MUSCATEL AVE_Electrical__ 1 WORKERS'COMPENSATION DECLARATION CE-8066 (2.80) APPLICATION. FOR ELECTRICAL PERMIT I her by-affirm that I have, a certificate of consent to self COUNTY. OF LOS ANGELES BUILDINGSAF . AND ETY ins.;ora certificate of Workers'Compensation Insurance;or 7, a certified copy thereof(Sec.3800,Lal C:) ✓' ompJ- sC - - ---- -F-O.:RAPPLICAN_TT_O_FILL I_N _ JOB Policy N Cany New Residential Bldgs.&Pools EACH NO. FEE ADDRESS - Certified copy is hereby furnished. 1 &2-Femily,Sq.Ft. $ —' $ LOCALITY ' Multi-family Sq. Ft. — NEAREST Certified copy is filed with the county building inspection CROSS ST t department. Residential Swimming Pools OWNER OR FIRM NAME Date Applicant A. PUPJO"�_ Outlets:,Rec.- Light Sw. ADDRESS �/ First 20 CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY Tel No. .-� / } COMPENSATION INSURANCE PLAN CHECK tl APPLICANT (This section need not be completed if the work involved V by the permit is for one hundred dollLighting Fixtures First 20 ars ($100) or less.) ADDRESS � Total.No. Additional O I certify that in the performance of the work for which thisCITY Tel No. permit is issued, I shall not employ any person in any manner Fixed Appliances Not Over 1 HP PERMIT LU so as to become.subject•to the Workers'Compensation Laws. Range_Heater_D.W._ I APPLICANT p, Oven ._ Dryer_W.M._ ADDRESS CO) Z 'Date Applicant_ Top _FAU -_W.H. � . . /',, r��f�• Hood Fan _Other_ CITY Tel No .3rJ[J NOTICE TO ?APPLICANT: If,after making this Certificate of Disp. _Room Air Condom LICENSE OR /`�� Exemption, you should become subject to the Workers U REG.NMBS Class Compensation provisions. of the Labor Code,you must forth- power Apparatus&Large Appliances DISTRICT NO. P,ROC SE72rBY with comply with,such provisions' or this permit shall be deemed revoked. Size&Type HP,KW,KVA,or KVAR Up to 1 Incl.. FINAL LICENSED.CONTRACTORS DECLARATION Over 1 to 10 Incl. DATE F//� � VALIDATION Over 10 to 50,Incl. I hereby affirm that lam licensed under provisions of Chapter Over 50 to.100 Inc. FINAL ' 9 (commencing with Section 7.000)of Division 3 of the Busi- BY Over 100 ness and Professions.Code,and my license is in full force and effect. Services '' / Lt �" 0-200 Amp.Under 600 VQ License Num be I Lic.Class / 201-1000 Amp.Under 600 V Contractor d'� 0 Date- �' �/ Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp:Power Pole&Appurtenances Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's Additional Sign Branch Circuits License Law for the following reason (Section 70.31.5, Busi- <01 a'6 A ness and Professions Code): Misc.Conduits&Conductors 0 0 0. 0 o 2 Ell, as owner of the property, will do the work and the- Other. (See Complete Fee Schedule)— structure is not intended or offered for sale (Section 2 00 3 2 0 7044,Business and'Professions-Code). CONSTRUCTION LENDING AGENCY o 0 0 2 0(11 czi I hereby affirm that there is a construction lending agency ` for the peiformance of the work for which this permit is PERMIT FEE (Sub-Total) d20626-81 issued(Sec.13097,Civ.C.). Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's.AddressPERMIT ISSUING FEE I certify that I have read this,application and state that the TOTAL FEE' m above 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 o e-mentionecprop ty for inspection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION C L-663 10/81 APPLICATION AELECTRICAL PERMIT - I.hereby affirm that I have% certificate of consent to self insure, E-606G /'1TION FOR 1l or a certificate of Workers'Compensation Insurance, or a certified- COUNTY–OF-LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800.Lab..C.) ------- Policy No. Com an FOR APPLICANT TO FILL IN JOB p �j p y ❑' Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ADDRESS ❑ 1 &2-Family,Sq.Ft. $ — $ LOCALITY Certified copy is filed with the county building inspection department: Multi-family Sq.Ft. — NEAREST CROSS ST. Date Applicant Residential Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL Outlets:Reo Light Sw.— � COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work involved by the First 20 �� 5 10 permit is for one hundred dollars($100)or less.) Total No. Additional CIT Tel.No. _,g I certify that in the performance of the work for which this permit PLAN CHECK APPLICANT Is Issued, I shallnot employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS i Additional Date �� 4rApplicani0/UV � �L� Total No. CITY Tel.No. NOTICE AP LI ANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT 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 W.M._ / ADDRESS oI jP2? ' provisions or this permit shall be deemed revoked. Top — FAU W.H. _. /�' CIT �y� Tel. �3 a LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ I hereby affirm that I am licensed under provisions of Chapter 9LICENSE OR /y 7 Disp. - Room Air Cond.. REG.NUMBER G" � Clas ;commencing with Section 7000)of Division 3 of the.Business and Professions Code,and my license is in full force and effect. PowerApparatus&Large Appliances DISTRICT NO. SSED BY Size&Type HP,KW,KVA,or KVAR c;,;- U License Number �^ Q 7 lass Over r 1 Incl.. FINAL J 0 Over 1 to 10 Incl. DATE / VALIDATION Q Contractor Over 10 to 50 Incl. ❑ FINAL I am exemp under Sec. Over 50 to 100 Inc. BY W B.&P.C.for this reason Over 100 Z Services, lboards / G+ Ilk- Date: 0-2 O Amp. nde 600 V O Sidnature 201 - 1000 Amp.Under 600 V Over 1000 Amp.or Over 600 V ❑ Exemption for Reg.Maint.Elect. 1 SINGLE FAMILY Temp.Power Pole&Appurtenances ACCT.O HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law 3303 97.70 for the following reason(Section.7031.5,Business and Professions Additional Sign Branch Circuits Code): 1 ITERS El 1,asn Other(See Complete Fee Schedule.)Conduits&Conductors TOTAL 97.70 owner of the property,will do the work and the structure is not intended or offered for sale (Section 7044, Business'' C4{ECK 97.70 and Professions Code). CONSTRUCTION LENDING AGENCY °00 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) 0 Civ.C.). (MOB—Q001 10/2L/95 I PLAN CHECKING FEE 3033 1 AH110-2, Lender's Name PERMIT ISSUING FEE � Q 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 enter upon the ab -mentioned property fof inspection urpos SEE REVERSE FOR EXPLANATORY LANGUAGE ature rmittee at 1) WORKER'S COMPENSATION DECLARATION' f• 7SA663 DPW(12'91>V`,'; APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to,seif Insure, or a.certificate of Worker's Compensation Insurance, or,a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. _copy.ttiePeof(Sec:3800'.L'ab;.C:)-�.=---;._.�_. :�-----=--�---- �---—--�f .., ._- ---•�— - --------- --=----- ------ - - - ------- ---•-------�—/� --- , PoliOB cy No. Company 1 FOR APPLICANT TO FILL IN ADDRESS v Certified copy is hereby furnished. New Residential Bldgs.'&Pools NO. EACH FEE LOCALITY 1&2-Family,Sq.Ft. _ $ $ Certified copy is filed with the county building inspection NEAREST q. Ifo/�! department. i Multi-family Sq.Ft. CROSS.ST. ,) A- '� Date - Applicant Residential Swimming,Pools• Sb MnP BOOK PAGE&10 PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec. Light LoSIN. OR . FIRM NAME, COMPENSATION INSURANCE First 20M AL 'I (This section need not be completed if the work Involved by the Total No. Additional ADDRESS permit Is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permitZ 1 z CITY i Tel.No. is issued, I shall not employ any person In'any manner so as to Q L. lam. PUN CHECK become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT U • Total No.__L4L__ Additional ADDRESS Date �� =940 Applicant "Te, RESIDENTIAL APPLIANCES NOT OVER 3 HP. 1 NOTICE TO APPLICANT: If, after making this C.er ficate of CITY' Tel.No. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. / — ,(� provisions of the Labor Code,you must'forthwith comply with such APPLICCANT {� N provisions or this permit shall be deemed revoked. Power Apparatus'&Large Appliances LICENSED CONTRACTORS DECLARATION Size&Type HP,.KW,KVA,or KVAR. ADDRESS '3>v v L I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000)of Division 3 of the Business and CITY; p� - T. No. Professions Code,and my license Is in full force and effect. Over 10 to 50Jncl. LICENSE " 7_p } Over 50 to 100 Incl. REG.NUMBER }G3 a" Class' a Over 100 DISTRICT NO. PRO E D.Y O License Number Lic.Class (� Services,Swbd.,MCC&Panelboards0 C6 ✓ Contractor Date D$'/3�` i 0-399,Amp.Undef 600 V DATE o ❑ I am exempt under Sec. 1 400-1000 Amp.Under 600 V ,S`� VALIDATION W . Over 1000 Amp,or Over 600 V FINAL, 0. B.&P.C.for this reason BRANCH CIRCUIT FEES BY cc Date: 15A,or 20A, OV,Lighting or Recept. Z 1 To 10 Branch Circuits Signature ' 9 11 To 40 Branch Circuits El Exemption Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Cln u'Its SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION I j�NTA I hereby affirm that I am exempt'from the Contractor's License Law Sign with One Brahch Circuit for the following.reason(Section.7031.5, Business and Professions Additional Sign Branch Circuits 7�F:.sv.+�r Code): ❑ thework and the structure Misc.Conduits&Conductors _ 1 `t I,as owner of the property,will do is not Intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) , 'TOTAL AL 94>a 80 and Professions Code). -FECR .. Cr°4 TV,0 CONSTRUCTION LENDING..AGENCY -.. .._ I hereby affirm that there,is a construction lending agency for the 1 t' 1 pgrformance of the work for which.this permit is issued(Sec. 3097, PERMIT FEE (Sub-Total) i Civ.C.) P,LAN CHECKING FEE ilCl- Ij ,� _ Lender's Name PERMIT ISSUING FEE +�' .i AM , 5 Lender's Address l oertify that I have read this application anti under penalty of purjury state TOTAL FEE o ' that the above information Is correct. I agree to comply with all County ordinances and Siate laws regulating Electrical wiring,and hereby authorize representatives of this County to enter upon the above-mentioned property. for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE fie--'Ua, �� SIGNATURE OF PERMITTEE V DATE.