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Home My Public Portal About5302 NOEL DR_Electrical_5/14/1985_ WORKERS CI have cera DECLARATION CE 10,81 APPLICATION FOR ELECTRICAL PERMIT J hereby a�f�rm that I have a certificate of consent to self CE 8060 'insure dr a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof(Sec 3800 Lab C ) 5 31 cy No Company FOR APPLICANT TO FILL IN JOB s' Certified co is hereby furnished EACH NO FEE ADDRESS 5-30'L 1�c9P� PY Y New Residential Bldgs 8 Pools �ertified copy is filed with the county building mspec 1 8 2 Family Sq Ft /S , E s — $ LOCALITY eNEARE G tion department Multi family Sq Ft CROSS ST �LL�de Date-54- (ei Applicant !� £G GT• Residential Swimming Pools OWNER OR FIRM NAME �J ( N CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec Light Sw_ MAIL COMPENSATION INSURANCE + 1\ ADDRESS ZJ 6al(A ► we- Ar_'& r (This section need not be completed if the work involved by Total No AddrtFirst onal t CITY �G, Tel No the permit is for one hundred dollars($100)or less) \ - OWN 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 AQ-1_-AWA- eC-fe-C-M` C- 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 k-L2,5 Kqj( with comply with such provisions or this permit shall be Top _ FAU —W H — deemed revoked CITY �� Tel No4LJ7s7g b LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_ Disp _ Room Air Cond LICENSE M .� Class 40-4D MB 3 �6 (commencing with Section 7000) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO PROCESS Y and Professions Code and my license is in full force and effect d 3�� -td Size 8 Type HP KW KVA or KVAR 0 License Number Lic Class _ Up to 1 Incl FINAL V Contractor A"- �Gr' Date 6f eY I9 Over 1 to 10 Incl DATE v yell ION 0 Over 10 to 50 Incl FINAL 11- U ❑ 1 am exempt under Sec Over 50 to 100 Inc BY LU B 8P C for this reason Over 100 Date Services Swbd MCC 8 Panelboards ► 0 200 Amp Under 600 V Signature 201 - 1000 Amp Under 600 V ❑ Exemption for Reg Maint Elect Over 1000 Amp or Over 600 V SINGLE FAMILY Temp Power Pole 8 Appurtenances ;12022A HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit # • • s • • 2 1 hereby affirm that I am exempt from the Contractor s License Additional Sign Branch Circuits Low for the following reason (Section 7031 5 Business and • • 7,15 0 Professions Code) ❑ I as owner of the property will do the work and the Misc Conduits 8 Conductors • • • 7 3.Jr Q structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ PooLl--8 5 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 PERMIT FEE (Sub Total) (Sec 3097 Civ C ) PLAN CHECKING FEE Lender s Name PERMIT ISSUING FEE 15-6 Lender s Address I certify that I have read this application and state that the TOTAL FEE 3 O 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 ove mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE l _ gl�fltos Signet re of Permittee Date WORKERS COMPENSATION DECLARATION 76A663 l0/et APPLICATION FOR ELECTRICAL PERMIT I,k,�reb}affirm that I have a certificate of consent to self CE 8066 insure orb certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec 3800 Lab C ) Policy No Company FOR APPLICANT TO FILL IN JOB r a Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS J Certified copy is filed with the county building mspec 1 &2 Family Sq Ft $ — $ LOCALITY tion department Multifamily Sq Ft — NEAREST CROSS ST Residential Swimming Pools OWNER OR Dote Applicant FIRM NAME 0. CERTIFICATE OF EXEMPTION FROM WORKERSMAIL COMPENSATION INSURANCE Outlets Rec Light Sw_ ADDRESS This section need not be completed if the work involved b First 20 ( tip y Total No CITY Tel No the permit is for one hundred dollars($100)or less) Additional �ys—e� 3 1 certifythat in the performance of the work for which this PLAN CHECK c P i APPLICANT G 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 Additional Total No CITY Tel No Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT If after making this Certificate of APPLICANT 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 Hood _ Fan _Other_ CITY Tel No LICENSED CONTRACTORS DECLARATION LICENSE OR 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 Power Apparatus&Large Appliances DISTRICT NO� ^' PROCE E BY and Professions Code and m license is in full force and effect O( D. Size&Type HP KW KVA or KVAR 0 License Number Lic Class Up to 1 Incl FINAL V Over 1 to 10 Incl DATE Q VALIDA N 0 Contractor Date Over 10 to 50 Incl FINA ~ 1 am exempt under Sec Over 50 to 100 Inc BY Over 100 B 8P C for this reason Date Services Swbd MCC&Ponelboards 0 200 Amp Under 600 V 16 9.8 A Signature 201 1000 Amp Under 600 V Over 1000 Amp or Over 600 V # • • • • • 2 Exemption for Reg Mainf Elect /YO�) • • SINGLE FAMILY Temp Power Pole&Appurtenances `� f • -2S505 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 1 Law for the following reason (Section 7031 5 Business and Professions Code) JZI as owner of the property will do the work and the Misc Conduits&Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ ► 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 PERMIT FEE (Sub Total) - (Sec 3097 Civ C ) O Ale PLAN CHECKING FEE Lender s Name PERMIT ISSUING FEE Lender s Address c I certify that I have read this application and state that the TOTAL FEE _ J above information is correct I agree to comply with all County ordinances and State jaws 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 r Signature of Permitteb Date