The URL can be used to link to this page

Home My Public Portal About10227 OLIVE ST_Electrical__ .r 1 ,WORKERS'th." I have a TIONcerci DECLARATION CE-806 loiet APPLICATION FOR ELECTRICAL PERMIT ')Thereby,ctiPlrm that I have a certificate of consent to self CE-806G ins,701 or'a certificate of Wor�,k�ers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or d certified,copt fi'ere of (Sec. 3800,'Lab. C.) P�olicy'No. Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS Ion . O WAG s Ls G1 — Certified copy is filed with the county building inspec- 1 &2-Family, S.q• Ft. $ $ 1 LOCALITY tion department. Multi-family Sq. Ft. — NEAREST CROSS Si. Residential Swimming Pools Date Applicant OWNER OR . FIRM NAME 004 . L CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Re Light MAIL '— COMPENSATION.INSURANCE M ADDRESS 02Z C— Ll4 I CI TV his section need not be completed if the work involved b FAdditional CITY Tel. N p Y Total No. 3 the permit'is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this APPLICCANTK 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 ��//)J Total No. Additional CITY Da /te pplicant /VON 5—,We Fixed Applian s Not Over 1 HP PERMIT NOTICE,/TO A PL ANT: If, after making this .Certificate of LAI 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. 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 DISTRICT O. PROCESS BY and Professions Code,and my license-is in full force and effect. Power Apparatus 8 Large Appliances _. Size&Type HP, KW, KVA, or KVAR' no- License Number Lia. Class FINAL. 6J 09 Up to 1 Incl. Over 1 to 10 Incl: DATE ZZ VALI ION Contractor Date. Over 10 to 50 Incl. V FINA I am exempt under Sec. Over 50 to 100 Inc. BYdi � B.&P.C. for this reason Over 100 y Date: Services, Swbd., MCC&Ponelboards ® z 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for,Reg. Maint. Elect.. p SINGLE FAMILY, 7 7 ��9 Q HOME OWNER=BUILDER DECLARATION i Temp. Power Pole 8 Appurtenances Sign with One Branch Circuit 0 0 0 0 0 2 I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits o 0 Law for the following reason (Section.7031.5, Business and ) 2 5 5 O Professions Code): I, as owner-of the property, will do the work and the Misc.. Conduits&Conductors o 0 0 2 5.5 Q structure is not 'intended or offered for sale (Section Other(See Complete Fee Schedule)_ o a 2 1 —87 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 Lender's Address C I certify that I have read this application and state that the TOTAL FEE t J 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 0ih ov -mentioned �foriurposes. � SEE REVERSE'FOR EXPLANATORY LANGUAGE ig ature of Permittee Date WQ RKERS'COMPENSATION DECLARATION 76A60CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT '9hereby�clfffrm that I have a certificate of consent to self CE-806G. ' insafe, or a certificate of Wq.`Gera'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or certified copy`tfiereof-(Sec. 3800, Lab:C.) Policy No. Company FOR APPLICANT TO FILL IN JOB r ( t Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS I`'1 LzCI . ❑ Certified copy is filed with the county building inspec- 1 &2-Family, S Ft. $ — s LOCALITY y q 'NEAREST tion department. Multi-family Sq. Ft. CROSS ST. Date Applicant Residential Swimming Pools OWNER OR FIRM NAME 00461i1c, CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rece.Light Sw. ` N `– COMPENSATION INSURANCE V � ADDRESS O2 c- L14 n I�('E First 20 (This section need not be completed If the work involved by Total N0. Additional CITY Tel. N 3 the permit is for one hundred dollars($100)or less.) PLAN 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 V ADDRESS Additional ��ww Total No. CITY Date pplicant - Fixed Applian s Not Over 1 HP PERMIT NOTIC TO A PL NT: 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 i DISTRICT O. PROCESS BY and Professions Code,and my license is in full force and effect. Power Apparatus.&Large.Appliances 5 I y� �l Size&Type HP, KW, KVA, or KVAR J` (J O License Number Lic.Class Up to 1 Incl. FINAL V Over 1 to 10'Incl. DATE OZ VALI ION O Contractor Date Over 10 to 50 Incl. ❑ .10 FINA I am exempt under Sec. Over 50 to 100 Inc., BY BAP.C. for this reason Over 100 Services, Swbd., MCC'&Panelboards Date: 0 -200 Amp. Under 600 V Signature 1 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp, or Over 600 V Exemption for Reg. Maint. Elect. -27 7 1.9 A SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch.Circuit # 0 0 0 0 'o `Z I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits J - 2550 Law for-the following reason (Section 7031.5, Business and Professions Code): _ ❑ I; as owner of the property, will do the work and the. M.sc. Conduits&.Conductors o 0 0 2 5 5 Q c;. structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ ® !] 2 1 "-87 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 Lenders Name PERMIT ISSUING FEE /001 Lender's Addressr I certify that I have read this application and state that the TOTAL FEE Jt 5 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 th ov -mentioned �Perfor�1 �urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Permittee Date