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Home My Public Portal About9417 OLIVE ST_Electrical__ fIKEBS'COMPENSATION DECLARATION 76A663 10/81 y a that I have a certificate of consent to self insure, CE-806G APPLICATION FOR ELECTRICAL PERMIT r q certifiCAYte ?f'+V�rkers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY e tpbf(5ec+3800,Lab.C.). Pcficy,No: Company FOR APPLICANT TO FILL IN JOB CC ❑ Sertified copy is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE ADDRESS v� a �' p — LOCALITY $ Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft.�-�� — $ �� department. Multi-family Sq.Ft. NEARESTCROSS ST. Date Applicant Residential Swimming Pools OWNER OR p FIRM NAME T Li CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Re i ht� Sw.� MAIL t COMPENSATION INSURANCE g - / ADDRESS �) I First 20 _ (This section need not be completed if the work involved by the CITY ^ Tel.No. permit is for one hundred dollars($100)or less.) Total No. _ Additional L r , y I certify that in the performance of the work for which this permit PLAN PLANCHET CHECK is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First ADDRESS Addition Total No. CITY Tel.No. i Date Applicant J NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliance Not O r 1 HP h PERMIT Exemption,you should become subject to the Workers'Compensation Range Heater_ D.W. APPLICANT V� provisions of the Labor Code, you must forthwith comply with such Oven Dryer M._ ADDRESS t i provisions or this permit shall be deemed revoked. W. I LICENSED CONTRACTORS DECLARATION Hood ;Fan � Othe CITY t� Tel.No. t OR I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE (commencing with Section 7000) of Division 3 of the Business and Disp. —J Room Air Cond. REGNUMBER ER Class. Professions Code,and my license is in full force and effect. Power ApparatjLjs&Large Appliance I 7 DISTRICT NO. PRO SE BY t Size& Ty pQ HP,KW,KVA,or pCVAR Q ■i1 0 License Number Lic.Class Up to 1 Ind. / f' FINAL 0 Over 1 to 10 Incl. = DATE �� VALIDATION Contractor Date Over 10 to 50 In 0 FINAL c V ❑ I am exempt under Sec. Over 50,to 100 nc. BY 0 Over 1.00 l et B.&P.C.for this reason � Services,Swbd.,MPC&PayJellboards I / Z Date: 0- 200'ArOp.Under/-00 V , ^` Signature 201 - 100'OiAmp.U er 600 V ❑ Over 1000 Amp. or Over 600 V i Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One B nch Circuit I hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 7031.5,Business and Professions Additional Sig ranch Circuits Code): Misc.Conduits& Conductors �I I,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). 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 information is correct. I agree to comply with all County ordinances -O and State laws regulating Electrical wiring, and hereby authorize l d r representatives of this County to enter upon the above-mentioned propert for inspection purpose SEE REVERSE FOR EXPLANATORY LANGUAGE CC x- 13��5 Signature APerttee Date WORKERS'COMPENSATION DECLARATION CE-80B 1U�91 E-6APPLICATION FOR ELECTRICAL PERMIT ' I hereby affirm that I. have a certificate of consent to self Insure, CI or a certificate of Workers.Gotiipensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY ;"dtfpmlevof(Sec.3800,Lab.C.) Policy No. Company I FOR APPLICANT TO FILL IN JOB ❑ Certified copy is hereby furnished. I EACH NO. FEE ADDRESS ` New Residential Bldgs.&Pools ❑ 1 &2-Family, — LOCALITY Certified copy is filed with the county building inspection y,Sq.Ft. $ — $ �- - department. "Multi-family Sq.Ft. NEAREST CROSS Residential Swimming Pools O Date Applicant OWNER OR FIRM NAME C)Iiw CERTIFICATE OF EXEMPTION FROM WORKERS'' MAID e Outlets:.Rec_Light_Sw.— J - COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work Involved Liy the First 20 permit is,for one hundred dollars($100)or less.) -I Total No. Additional CITY Tel:No. i PLAN CHECK I certify that in the performance of the work for which this permit { APPLICANT is issued,-.1 shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS is Additional - Total No. CITY Tel.No. Date �0 Applicant Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making, th ;Certificate of PERIAIT Exemption,you should become.subject to the Workers'Compensation i Range_ Heater D.W. _ APPLICANT provisions of the Labor Code,you must forthwith comply with such ,� Oven Dryer_ W.M._ ADDRESS provisions or this permit.shall be deemed revoked. Top FAU W.H. L•I.CENSED CONTRACTORS DECLARATIONCITY Tel.No.- Hood _ Fan Other_ I hereby affirm .that I am licensed under provisions of.Chapter 9 uCENSE OR ' +I Disp. — Room Air Cond. Class. (commencing with Section 7000)of DDivision.3 of the Business and REG.NUMBER Professions Code,and my licenseis in full force and effect.. DISTRICT NO:. M. EED.BYPower Apparatus&Large Appliances+ Size&TypeHP,KW KVA,or KVARi icense Number Lic.Class �� Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE /y a Contractor Date ! 4 VALIDATIO Over 10 to 50 Incl. FI ' El am.exempt under Sec. Over 50 to 100 Inc. LLI ' B.&P.C.for this reason ,( Over 100 Cl- Cl) Services,Swbd.,MCC&Panelboards ► Z Date: `1 0-200 Amp.Under 600 V Signature 201 - 1000.Amp.Under 600 V j. j9 0 7.8 A' i Over 100O.Amp. r,.O mp.over 6.00 V ❑ Exemption for Reg.Maint.Elect. o 0 0 0 02• SINGLE.FAMILY -temp.Rower Pole&.Appurtenances 9- 2550 HOME.OWNER-BUILDER DECLARATION' Sign.with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law o 0 0,2:S 5 657 for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits Code): 03.01 -88 Misc.Conduits•&Conductors r ' I,as owner of the property,will do the work and the structure is not intended or offered for sale (Section 7044, Bdsiness Other(See Complete Fee Schedule) _ 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(sec.3097, Civ.C.), bERMIT FEE (Sub Total) � PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE' Lenders Address I certify that I have read this application and state :that the above TOTAL FEE S .s information is correct.I agree to comply with all County ordinances t� and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above-mentioned WSEE REVERSE FOR EXPLANATORY LANGUAGE f ittee Date i� ' 'WORKERS'COMPENSATION DECLARATION 74603 1081 CE-800G APPLICATION FOR ELECTRICAL PERMIT k hefeby affljn that I have a cgrtificate bt•consefit to self'Insure, or,a certificate gl,Workers' Compensation Insurance, ora certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy,t hereof(Seca 3800,Lab.C:) Policyxb: r Company FOR APPLICANT TO FILL IN JOB CIL,1-7 .0 ❑ Certified copy is hereby furnished. EACH NO. FEE ADDRESS New Residential Bldgs.&Pools ❑ Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. $ — $ LOCALITY department. Multi-family Sq.Ft, — NEAREST v L CROSS ST. 11 Residential Swimming Pools OWNER OR " Date .Applicant ' I a 1 FIRM NAME CERTIFICATE OF EXEMPTION.FROM WORKERS' Outlets:Rao Light�Sw:� '• MAIL COMPENSATION INSURANCE ADDRESS ` yS (This section need not be completed If•the work Involved by the First 20 permit is for one hundred dollars($100)or less.) Total No.__ 19_. Additional CITY, Tel.No. I certify that in the:performance of the work for which this permit APPLICANT K 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 ''�` Applicants vrr NOTICE TO APPLICANT: If, after making t s Certificate of Fixed Appliances Not Over 1 HP PERMIT' Exemption,you 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 5&40a 2- provisions or this permit shall be deemed.revoked. Top _ FAU —•W.H: LICENSED CONTRACTORS DECLARATION CITY Tel:No. , Hood _ Fan ._ Other._ I hereby affirm that I am licensed under provisions'of Chapter 9 LICENSE OR. Disp. — Room Air Cond. REG.NUMBER' Class°. (commencing with Section 7000)of Division 3 of the Business and Professions Code;and my license is in full force and effect. DISTRICT NO. P SSE Y Power Apparatus&Large Appliances �Q� Size&Type HP,KW,KVA,or KVAR License Number Lic.Class Up to 1.Incl. FINAL 10 Incl. DATE; � � VALIDATION Contractor Date .Over 1 WOver 10 to 50 Incl. V FINAL j p ❑ I am exempt under Sec. Over 50 to 100 Inc. BY '• �/7��)'f W B.,&P:C.for this reason Over 100 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 n Exemption for Reg.Maint.Elect. ; SINGLE FAMILY Temp.Power Pole&Appurtenances 2 HOME OWNER.-BUILDER..DECLARATIONa I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit R�� o s for the following reason(Section 7031.5,Business•and Professions Additional Sign Branch Circuits bode):Code): . as owner of'the property,will do the work and the structure 1;XMisc.Conduits&Conductors 1 ITEMS is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) _ TOTAL o � • and Professions Code).. • ► CECK 27.755 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction Lending agency for the- n - CHANE .00 performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) 1 Civ.C.), ; PLAN CHECKING FEE 0000-0001 q� �89 Lender's Name PERMIT ISSUING FEE 558 1 An 9!23 Lender's Address ', 1 certify that I have read this application and.state that the above TOTAL FEE r a� 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 property for inspection purposes., SEE REVERSE FOR EXPLANATORY LANGUAGE Signa re of Permgee Date I i