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Home My Public Portal About5708 NOEL DR_Electrical__ WORKERS COMPENSATION DECLARATION l0/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm 866m that I have a certificate of consent to self et>bG insure or a 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 Certified copy is hereby furnished New Residential Bldgs &Pools EACH NO FEE ADDRESS Q M. 40 r ❑ $ _ $ LOCALITY Certified copy is filed with the county budding inspec 1 &2 Family Sq Ft NEAREST tion department Multifamily Sq Ft CROSS ST t L'vie Date Applicant Residential Swimming Pools OWNER OR CERTIFICATE OF EXEMPTION FROM WORKERS FIRIL M NAME ,� OT,�72 COMPENSATION INSURANCE Outlets RecLight5 DRESS B /TYc (This section need not be completed if the work involved by First ti CI Tel No Oil the permit is for one hundred dollars($100)or less) Total No Additional f� ' �� PLAN CHECK I certify that in the performance of the work for which this AfPLICANT 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 A Additional 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 — CITY Tel No deemed revoked Hood _ Fan _Other_ 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 PRO ED BY >- and Professions Code and my license is in full force and effect d Size&Type HP KW KVA or KVAR 0 O License Number Lic Class FINAL 09 Up to 1 Incl A Contractor Date Over 1 to 10 Inst DATE T S 3 VALIDATION Q ❑ Over 10 to 50 Incl FINAL t; I am exempt under Sec Over 50 to 100 Inc BY �r r Over 100 B&P C for this reason fA Z Date Services Swbd MCC&Panelboards pop- 0 0 200 Amp Under 600 V Signature ' 201 1000 Amp Under 600V ❑ _ O Exemption for Reg_Mamt Elect Over 1000 Amp or Over 600 V � f SINGLE FAMILY Temp Power Pole&Appurtenances HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit 2 0 2 0 0 A I hereby affirm that I am exempt from the Contractor s License Additional Sign Branch Circuits Law fo the following reason (Section 7031 5 Business and g # • • • • • 2 profstens Code) r I as owner of the property will do the work and the Misc Conduits 8 Conductors 2 • • 0 0 structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ ► 0 - 180005 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY 0 a 0 4—8 3 j 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 D Lender s Name PERMIT ISSUING FEE Lender s Address It I certify that I have read this application and state that the TOTAL FEE above information is corEact-Kagree to comply with all County ordinances and State laws regulating Electrical wiring and hereby authorize representatives of this County to enter upon e above mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Sign re of Permittee Date DECLA 1 hereby affirm that I haveWORKER certificate of consen Otoo s ure 76AS63 DPW(72 et) APPLICATION FOR ELECTRICAL PERMIT or a certificate of Worker a Compensation Insure r a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof(Sec 3800 Lab C) Policy No COM FOR APPLICANT TO RLL IN JOB ADDRESS ❑ Certified copy is her furnished New Residential Bldgs &Pools NO EACH FEE LOCALITY ❑ Certified co s filed with the county budding inspection 1 &2 Family Sq Ft NEAREST depart Multifamily Sq Ft CROSS ST Date Applicant Residential Swimming Pools ASSESSORj PAGE G�/IO 1 PARCEL CERTIFICATE OF EXEMPTION FROM WORKERSOutlets Roe _Light Sw OWNFIRM NAME COMPENSATION INSURANCE First 20 (This section need not be completed If the work Involved by the ADDRESS permit Is for one hundred dollars($100)or less) Total No Additional I certify that in the performance of the work for which this permit CITY Tel No is issued I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers Compensation ws Lighting Fixtures First 20 APPLICANT " Total No Additional ADDRESS Date Applicant NOTICE TO APPLICANT If after making this Certificate of RESIDENTIAL APPLIANCES NOT OVER 3 HP 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 PERMIT APPLICANT 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 p#oC hapter 9 Over 3 to 10 Incl (commencing with Section 7000)of Division 3 of Business and CITY Tel No Professions Code and my license is in full for nd effect Over 10 to 50 Incl LICENSE OR } Over 50 to 100 Incl REG NUMBER Clews CIL O License Number LIC Class Over 100 DISTRICT NO SED BY 0 Services Swbd MCC&Panelboards - ar Contractor Date 0 399 Amp Under 600 V e2pA� X&Pfor r Sec 400 1000 Amp Under 600 V VALIDATION W Over 1000 Amp or Over 600 V FNAL I L ason BRANCH CIRCUIT FEES BY42r Date 15A or 20A 120V Lighting or Recept Z 1 To 10 Branch Circuits 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Exemption for Reg Maint Elect 15A 2DA 2D8V To 277V Lighting Br Circuits ' SINGLE FAMILY Temp Power Pole&Appurtenances AL,T $s HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit �' 99I hereby affirm that I am exempt from the Contractors License Law 3303 3 for the following reason(Section 7031 5 Business and Professions Addibonal Sign Branch Circuits Code i 7EMS I as owner of the property will do the work and the structure Misc Conduits&Conductors Tr TAL 83.55 is not intended or offered for sale(Section 7044 Business Other(See Complete Fee Schedule) , and Professions Code) 83 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) Civ C) 0000—mol V 1/99 PLAN CHECKING FEE Lender s Name 0230 f F il 4 9 2 PERMIT ISSUING FEE Lender s Address 1 certify that I have read this application and under penalty of puqTOTAL FEE ury state �. that the above information is correct I agree to comply with all County ordinances and State laws regulating Electrical wiring and hereby authorize representatl of this County to enter upon the above mentioned property for in on purposes SEE REVERSE FOR EXPLANATORY LANGUAGE l SIGNS OF ERMITTEE DATE n WORKER S COMPENSATION DECLARAT 200019 DPW(12 91) APPLICATION FOR ELECTRICAL PERMIT 70ABB3 I hereby affirm thj)t I have a certificate of sent to self Insure or a cerfIGcate of Worker s Compena n Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof(Sec 3800 Lab C Polley No Company FOR APPLICANT TO FILL IN JOB E] A ADDRESS (JfA4 4t + CertifiedIs hereby furnished New Residential Bldgs &Pools NO EACH FEE LOCALITY { fled copy Is filed with the county building Inspection 1&2 Family Sq Ft _--1� _ $ $ ❑ ( NEAREST r department Multi family Sq Ft CROSS ST ! Applicant Residential Swimming Pools ASSESSOR to MAP BOOK E' PARCEL OR 1114 CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Roo Light First 20 SW OWNER ME KA COMPENSATION INSURANCE /'PO &AQ FIRM NAME perms section need not be completed the work involved by the MAIL Total No Additional ADDRESS permit Is for one hundred dollars($1000)or leas) I certify that In the performance of the work for which this permit CITY C- Tel No Is Issued I shall not employ any person In any manner so as to PLAN CHEC become§Itbfe t to the Workers Compens tion Laws Lighting Fixtures First 20 APPLICANT R Total No Additional ADDRESS Date Applicant R IDENTIAL ANO ER 3 NOTICE TO APPLICANT If after making this Certificate 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 APPLICANT 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 LICEBE OR Over 50 to 100 Incl REGNNUM ER Class a License NumberLIc Class Over 100 DISTRICT NO P SEED BY 0 Seances Swbd MCC&Panelboards O� Q 0 399 Amp Under 600 V FINAL 0 Contractor a 400 1000 Amp Under()Do V DATE It VALIDATION V ❑ I am exempt under Sec Over 1000 Amp or Over 600 V FINAL d B&P C for this r on BRANCH CIRCUIT FEES BY 07 Date 15A or 20A 120V Lighting or Recept Z 1 To 10 Branch Circuits ..lure 11 To 40 Branch Circuits 41 Or More Branch Circuits Exemption for Reg Mamt Elect 15A 20A 208V To 277V Llghtin Br Circwrts HOME OWNER BUILDERSINGLE ILY DECLARATION Temp Power Pole&Appurtenances H4' TJL ir I hereby affirm that I am exempt from the Contractor s License Law Sign with One Branch Circuit — , � for the ollowing reason (Section 7031 5 Business and Professions Additional Sign Branch Circuits 30-- 1 ITEMS Cod 1 as owner of the property will do the work and the structure Mlsc Conduits&Conductors is not Intended or offered for sale(Section 7044 Business Other(See Complete Fee Schedule) 1 r l TA .35L 76 and Professions Code) , �jC L1 .r 7Li 'q �.T1L�.f CONSTRUCTION LENDING AGENCY rHtu,►7GANGE 0-21 hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued 097 PERMIT FEE (Sub Total) Civ C) PLAN CHECKING FEE 01]W-15001 8/24,C'F Lender s Name PERMIT ISSUING FEE Ar q 4? Lender s Address TOTAL FEE I certify that I have read t ppllcation and under penalty of puqury state r that the above Infor Son is correct I agree to comply with all County ordinances and 5 talt aws regulating Electrical wiring and hereby authorize representativ of this County to enter upon the above mentioned property for In n purposes SEE REVERSE FOR EXPLANATORY LANGUAGE SIGN R PERMITTEE DATE WORKERS COMPENSATION DECLARATION ` CE-806G (2 80) APPLICATION FOR ELECTRICAL PERMIT + i E.806 I hereby affirm that I have a certificate of consent to self LINTY OF LOS ANGELES �, BUILDING AND SAFETY \ insure or a certificate of Workers Compensation Insurance or a cer IV copy�h Qfs//��SSe�e� X3800 Lab C) at, APPLICANT TO FILL IN + JOB Policy No Company - "w' EACH NO FEE ADDRESS New Residentia Idgs &Pools Certified copy is hereby furnished 1 &2 Family SqRLJ S LOCALITY Certified co Multifamily Sq F — OSS T �/ r copy filed with the county building inspection CROSS ST Residential esidential Swimming Pools OWNER OR j� FIRM NAME —� �v Date yAppiica++ Outlets Rec X.Light Sw—I—, MAIL First 20 ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS Total No Additional CITY C Tel No 1 COMPENSATION INSURANCE PLAN CHECK > (This section need not be completed if the work involved APPLICANT CL by the permit is for one hundred dollars ($100) or less) Lighting Fixtures First 20 ADDRESS 8 Total No Additional cc 1 certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No permit is issued I shall not employ any person in any manner PERMIT so as to become subject to the Workers Compensation Laws Range_Heater D W APPLICANT u1 Oven _ Dryer_W M ADDRESS N Date Applicant Top _ FAU _W H CITY Tel No Z Hood _ Fan _Other_ NOTICE TO APPLICANT If after making this Certificate of Disp _Room Air Cond_ LICENSE OR Exemption you should become subject to the Workers REG NUMBER Class Compensation provisions of the Labor Code you must forth Power Apparatus&Large Appliances DISTRICT NO PROCE D BY— with comply with such provisions or this permit shall be deemed revoked Size&Type HP KW KVA or KVA Up to 1 Incl FINAL Over 1 to 10 Incl LICENSED CONTRACTORS DECLARATION DATE r .�� VALIDATION Over 10 to 50 Incl (effect hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc FINAL BY (commencing with Section 7000)of Division 3 of the Busi Over 100 ess and Professions Code and my license is in full force and + Services icense Number Lic Class201 1000 Amp Under 600 V ontractor \ Date Over 1000 Amp or Over 600 V HOME OWNER BUILDER DECLARATION Temp Power Pole&Appurtenances , I hereby affirm that I am exempt from the Contractors Sign with One Branch Circuit License Law for the following reason (Section 7031 5 Busi Additional Sign Branch Circuits nese an Professions Code) Misc Conduits&Conductors I as owner of the property will do the work and the Other(See Complete Fee Schedule)— -92608A structure is not intended or offered for sale (Section 7044 Business and Professions Code) e CONSTRUCTION LENDING AGENCY # Y 2 I hereby affirm that there is a construction lending agency 2,•ie b 5 5 0 for the performance—of the work for which this permit is PERMIT FEE (Sub Total) issued(Sec 3097 Civ C) 0 0 0 65 5 015 Lender s Name PLAN CHECKING FEE (One Fourth Permit Feel 1 Lender s Address PERMIT ISSUING FEE 01 13-82 I certify that I have read this application and state that the TOTAL FEE d 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 bove mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE i i �G p -/ � I'� • Signatute of Permittee IF Date