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Home My Public Portal About6000 OAK AVE_Electrical__ r wthsCOMPENSATION DECLARATION -663 ,D,a, APPLICATION FOR ELECTRICAL PERMIT I�herebyraffirm thre4 e I have a certificate of coneer)t to self insure E�oeQ o �crerti c+jt�of Workers Compensation Insurance or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY py tihe (Sec 3800 Lab C) AQ'No--i�Company FOR APPLICANT TO FILL IN JOB ❑ CerMied copy re hereby furnished New Resxferitial Bldgs &Pcols EACH NO FEE ADDRESS ❑ Certified copy re filed with the county wilding inspection 1 &2 Family Sq Ft $ '— $ LOCALITY deparbnerR C Multi family Sq Ft — -REST R038 8T Residential Swimming Pools OWNER OR Datar Aj7plrnetrt ; FIRM NAME CERTIFICATE OF CO MPENSATION NEURFROM WORKERS Outlets Res�Light�Sw j L Eas (This section geed not be completed If the work Involved-by the 40 First 20 permit Is for one hundred dollars($100)or less) Total No Additional CITY Tel No I certify that in the performance of the worts for which this permit PLAN CHECK APPLICANT re issued I shall not employ any person iiiany manner so as to + become subject to the Workers Compensation Laws Lighting Fixtures First 20 ADDRESS Total No _ AdddKmW CITY Tel No Date Applicanrt Fused Appliances Not Over 1 HP N TO P CANT If after making this Certificate of PERMIT Exe on should become subject to the Workers Compensation Range— Heater D W APPLICANT provisions of the Labor Code you must forthwith comply with such Oven — Dryer— W M — ADDRESS r provisions or this permit shah be deemed revoked Top FAU — WH — CITY Tel No LICENSED CONTRACTORS DECLARATION Hood ✓—Fan — Other._ / I Jleroby affirm that I am licensed under provisions of Chapter 9 Drep vRoom Arr Cond — LICENSE OR Cor (commencing with Becton 7Q00)Of Division 3 of the Business and REQ NUMBER Professions Code and my losnse re m Tull force and effect Power Apparatus&Large Appliances DISTRICT ED Size&Type NP KW KVA or KVAR 5r 0 License Number Lie Class Up to 1 Incl FINAL /fin CoAtractor Date Over 1 to 10 Incl DATE ��f V$LIDATION ❑ Over 10 to 50 Incl ' I am exempt under Sec ,tyO�vee�"�r 50 to 100 Inc y� B&P C for this reason —,�AA " 100 Dais Z Services Swbd MCC&Panelboards ► 0 200 Amp Under 500 V Signature 201 1000 Amp Under 600 V ❑ ExemptOver 1000 Amp or Over 600 V Exemption for Reg Marrit Elect .f SINGLE FAMILY Temp Power Pole&Appurtenances 6 HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit r L�aa �ry` I hereby affirm that I am exempt from the Contractors Licerin Law Additional Sign. Circuits 3W ifw•W for the following reason(Section 70315 Business and Professions C°de) Tp'IS ❑ I as owner of the property will do this work and the structure Mrs( Conduits&Conductors is not intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule) +rtY!— ► AL 69S 0 50 and Professions Code) 064K 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) p�p PIAN CHECKING FEE W9/vT Lenders Name PERMIT ISSUING FEE Y Lender a 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 to enter upon the above mentioned jxcpert for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature ct Permit e WORKERS COMPENSATION DECLARATION 2MI9 MUM DPW APPLICATION FOR ELECTRICAL PERMIT 1 hereby affirm phot I have a certificate of cogent to self a.806G insure gr gWLcerhficate of Workers Con1pensation Insurance COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS &a SerflfW copy thereof(Sec 3800 Lab C) PAc"y No Company FOR APPLICANT TO FILL IN JOB G `�V Certified copy is hereby furnished New Residential Bldgsl &Pools EACH NO NE ADDRESS if F1Certified copy is filed with the county building inspec 1 &2 Family Sq Ft $ —" S LOCALITY �[ tion department Multi family Sq Ft NEAREST CROSS ST— Dd Residential Swimming Pools � Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec Light Sw_ DDRESS b 3 COMPENSATION INSURANCE First 20 (This section need not be completed 0 the work Involved by Total No Additional CITY sl No the permit Is for one hundred dollars(=100)or less) PIAN ECK I certify that in he performance of the work for which this APPLICANT permit is issued I shall not employ any person in any manner so as to be me sublecI to the Werke Compensate n Laws Lighting Fixtures First 20 ADDRESS Additional Date Applicant AL Total No CITY Tel No NOTICE O APPLICANT If after making his Certificat f Fixed Appliances Not Over i HP PERMIT Exemption you should become suble to the Workers Range— Heater—D W — APPLICATION 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 —WH _ deemed revoked Hood — Fan —Other_ CITY Tel No LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that 1 am licensed under provisions of Chapter 9 Disp _ Room Air Cored — REG NUMBER Class (commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT / B a and Professions Code and my license is in full force and effect Q( Size 8 Type HP KW KVA or KVAR r U License Number Lic Class Up to 1 Inci FINAL Contractor -----Date Over 1 to 10 Incl DATE VALIDATION 0 ❑ Over 10 to 50 Incl FINAL U I am exempt under Sec Over 50 to 100 Inc BY / W B 8P C for this reason Over 100 Y.Ia Services Swbd MCC&Ponelboards , W Date Z 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&Appurtenances 'no. 2 HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit a I hereby affirm that I am exempt from the Contractor s License Additional Sign Branch Circuits �T■* Law for the following reason (Section 7031 5 Business and g Professions Code) 3W 25■501 ❑ I as owner of the property will do the work and the Misc Conduits&Conductors 1 ITEMS structure is not intended or offered for sale(Section 7044 Other(See Complete Fee Schedule)_ , TOTAL 25. 50 Business and Professions Code) CONSTRUCTION LENDING AGENCY `(, X 25.50 1 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) awa ■ 00 (Sec 3097 Civ C) PLAN CHECKING FEE Lender s Name 0000-Ml 11/20/89 PERMIT ISSUING FEE 10 VA Lender s Address e 1 AN 8:58 1 certify that I have read this application and state that the TOTAL FEE s� 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 Wthealbve mentioned pr perty for inspection rposes SEE REVERSE FOR EXPLANATORY LANGUAGE e rmiftee Date ®s