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Home My Public Portal About9238 OLIVE ST_Electrical__ C;01- AQRKERS"bOMPEN8PT19N DECLARATION ti CEAe06G 10/81 APPLICATION FOR ELECTRICAL PERMIT 14he�eby firr that I he ,certificatA of consent to self unsure, r,d�'a certific'ate of Workers'Compensation Insurance, or a certified COUNTY OF LOS ANGELES ' BUILDING AND SAFETY copy thereof(Sec.3800,1 ah. •err t�{9 f,3S pwwi�" (nL(crtnc�-� •Policy N Company \ FOR APPLICANT TO FILL IN JOB Q ❑ Certified copy is hereby furnished. 9��j/��/� EACH NO. FE ADDRESS 9 2 8 d L U e. New Residential Bldgs.&Pp�.�y: $ — $ LOCALITY TPiM lwr= Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft department. AA,�, I Multi-family Sq.Ft. NEAREST CROSS ST. 40 e. d- S Date 9—0�V7 Applicant 6w (A �-y ?�'� Residential Swimming Pools OWNER OR l FIRM NAME W"1-CSO w a mc, CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL COMPENSATION INSURANCE Outlets:Ree—Light—SW.— ADDRESS (This section need not be completed-If the work involved by the First 20 CITY Tel.No. permit is for one hundred dollars($100)or less.) Total No. Additional 1 certify that in the performance of the work foe Which this permit PLAN CHECK APPLICANT 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 NOTICE,TQ APPLICANT: If, after making this Certificate .of PERMIT Exemption,you should become subject to the Workers'Compensation Range._. H.eater•_.. D.W. ._ APPLICANT O f a �L �T2L G. provisions.of the Labor Code;you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS (tilt' provisions or this permit shall be deemed revoked. Top FAIJ •_ W.H: _ CITY r Tel.'Nd.. LICENSED CONTRACTORS DECLARATION Hood _ .Fan _ Other_ (4 .'7 5 I hereby affirm that I am licensed under provisions of Chapter 9Dis . — Room Air Cond. LICENSE`OR (commencing with Section 7000)of Division 3 of the Business and p REG.NUMBER "�f3� Class•G Professions Code,and my license'is.in full force and effect. DISTRICT NO. PROCESSE Power.Apparatus.&Large.Appliances C/`]�'/ Size&Type HP,KW;KVA,or KVAR 'l 8 O License Number 3 b 8 b Lic.Class Up to 1 Incl. FINAL Over 1 to 10 Incl. DAY-Ar. VALIDATION -0 W Contractor AIO'6%rd r9" tGFi I Date Over 10 to 50 Inc[. F ❑ I am:exempt under Sec. .Over 60 to 100 Inc. IL B.&P.C.for this reason Over 1.00 Services,Swbd.,MCC&Panelboards Z Date: 0-200 Amp.Under•600 V Signature 201 - 1000 Amp.Under 600 V ❑ Over 1000 Amp.or Over 600 V 7 8 b 8A Exemption for Reg.Maint:Elect. SINGLE FAMILY Temp.Power Pole'&Appurtenances ) 0'0;0 0 0 .2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ° ° 9 S 5 0 I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits for the following reason(Section 7031.5,Business and Professions Code): o P - 9&5 0 5 Misc.Conduits&Conductors 0 1,as owner of the property,will do the work-and the structure is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule)._ and Professions Code). , 9,0 8—.8 7 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.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the above TOTAL FEE f S 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 proper for inspe ion Pur s. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 11 CE-806 I0/81 APPLICATION FOR ELECTRICAL PERMIT ,�,!:..heBfiy'affirin that I have a certificate .of consent to self! CE-806G 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 I FOR APPLICANT TO FILL IN I JOB Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO.. FEE ADDRESS ;a Certified copy is filed with the county building inspec- 9 &2-Family, $ LOCALITY Sq. Ft. _ � . tion department. Multifamily Sq. Ft. I NEAREST Residential Swimming Pools I CROSS ST. Date ApOWNER OR plican I. FIRM NAME CERTIFICATE OF EXEMPTION F WO E Outlets: Rec Li ht Sw._ I� MAIL A COMPENSATION INSU ANCE g ADDRESS (This section need not be completed if the work involved b r First 20 y Total No. Additional CITY Tel. No.z�3� the permit is for one hundred dollars($100)or less.) . � �� PLAN CHECK I certify that in the performance of the work for which thl'. 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 j Additional I Total No. CITY 7e1. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate df APPLICANT '� �� /E6��✓� 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.— f ADDRESS -,0FZ-_5-- with comply with such provisions or this permit shall be Top — FAU —W.H. —HoodFanFan _Other_ CITY Tel. IVo. deemed revoked. _ LICENSED CONTRACTORS DECLARATION I LICENSE OR p 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 NO. PROCESSED BY and Professions Code,and m license,is•in full force and effect. Power Apparatus&Large Appliances y Size&.Type HP, KW, KVA, or KVAR• �t l License Number LI c. Class Up to'1 Incl. FINAL j Over 1 to 10 Incl. i DATE VALI ATION Contractor Date l ❑ Over 10 to 50 Inc. kFINVI am exempt under Sec. Over 50 to 100 Inc. U B.&P.C. for this reason. Over 100 H Services, Swbd., MCC&Panelboards + Date' 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 60.0 V ❑ I Over 1000 Amp. or Over 600 V j Exemption for Reg. Maint. Elect, j SINGLE FAMILY i Temp. Power Pole.&Appurtenances t 7 5 2 4.A 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 I o 0 0 0.0 2 Law for the following reason (Section 7031.5, Business and Professions Code): 0 o25.50 L� I, as owner of-the property, will do the work and the Misc. Conduits 8 Conductors , x structure is not intended or offered for sale (Section Other(See Complete Fee j Schedule)_ ® - C•p0 2 S 5.0; U 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.). Q 7.2 4 "$7 �f I PLAN CHECKING FEE Lender's Nam //, �'A PERMIT ISSUING FEE Lender's Address_ 0 4�1 I certify that I have read this application avid state that,the TOTAL FEE 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 above=mentioroperty for inspection.purposes. t SEE REVERSE FOR EXPLANATORY LANGUAGE /. 7i Sign of P,7fn itfe Date ); s