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Home My Public Portal About5445 PARMERTON AVE_Electrical__ WORKERS COMPENSATION DECLARATION 100019 DR43/B) 801 I APPLICATION FOR ELECTRICAL)PERMIT O h eby affirm that I have a cenifimse of consent to self 7F ensu or a certificate of Workers Compensation Ins ronce COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS or a certified cop fya (Sec r;'pan 00 La�� Polis sNo {,�,` om n FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished New Residential Bldgs 8 Pools EACH NO FEE ADDRESS _ ertified copy is filed with•the c my budding mspec 18 2-Family, Sq Ft $ — S LOCALITY hronn de a mens Mull, family Sq Ft — NEAREST Dote rS � Applicant Residential Swimming Pools OWNERSOR ( FIRM NAME ' CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec_Ught_Sw_1_ 'WAIL COMPENSATION INSURANCE First 20 ADDRESS (Thu section need not be completed d the work Involved by Total No 2 gddnionol CITY Tel No the permit is for one hundred dollars ($100)or less ) PLAN CHECK I certify shat 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 become subject to the Workers Compensation Laws Lighting Fixtures First 20 ) Q ADDRESS Additional Dote Applicant Total No ---I— Additional No NOTICE TO APPLICANT If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT ' ExemptionRange Heater_D W — APPLICA you should become subject to the Workers 9 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 — deemed revoked CIN Tel IN / LICENSED CONTRACTORS DECLARATION Hood — Fan —Other— Disp — Room Air Cond — LICENSE OR Class I hereby affirm that I am licensed under provisions of Chapter 9 REG NUMBER (commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO P ED B Y and Professions Code nd y license is in full force and effect OL Size 8 Type HP, KW, KVA or KVAR ) Q Licenseroc Num Lis Class L� A�0 Up to I Incl FINAL n 6 Over 1 to 10 Intl DATE / VALIDATION Contract fa�� OF_ ❑ Over 10 to 50 Incl FINA am exempt under SecOver 50 to 100 Inc BY LU 8 8P C for this reason Over IOD d Date - Services Swbd MCC 8 PonelbcordZ s W 0 200 Amp Under 600 V 011111', — Signature 201 1000 Amp Under 600V ❑ Exemption for Reg Maint Elect OA at 1000 Amp or Over 600 V SINGLE FAMILY i Temp Power Pole 8 Appurtenances �- HOME OWNER-BUILDER DECLARATION ` I hereby affirm that I am exempt from the Contractor s License Sign with One Branch Circuit ni T T Law for the following reason (Section 7031 5 Business and Additional Sign Branch Circuits Professions Code) _?[I( -0. Ell, as owner of the property will do the work and the Misc Conduits 8 Conductors I ITEII structure is not intended or offered for sale`(Section 70" Other (See Complete Fee Schedule)_ , _ Business and Professions Code) TO AL 20 - 20 CONSTRUCTION LENDING AGENCY l j '.}A ;�Il„_I3 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) CWIGE .[ID (Sec 3097 Civ C Lender s Name l) ` L t / ,d-� hLPLAN CHECKING FEE PERMIT ISSUING FEE Lender s Address ;5rjy ], ryh 1Cl;e+ I certify that I have read this application and state that the TOTAL FEE -� ' above information is correct I agree to comply with all County ordino es and State laws regulating Electrical wiring and ' J her uthonze representatives of this County to enter upon ' e ve mention proper, r inspection p rposes SEE REVERSE FOR EXPLANATORY LANGUAGE ' Signature o rmittee DateIF ®' 1 WORKERS COMPENSATION DECLARATION h 63 ,DiBt APPLICATION FOR ELECTRICAL PERMIT I erkby aHir4r that I have a certificate of consent to set( CE CE 8O6G s y' •,insure— , o'cerhficote of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY Illlll or o cerhf+=d tojYy thereof (Sec 3800 Lob C ) Policy No Company FOR APPLICANT TO FILL IN JOB 0 Certified copy is hereby furnishedNew Residential Bldgs 8 Pools EACH NO FEE ADDRESS F1Certified copy is filed with the county building inspec 18 2-Family Sq Ft f — f LOCALITY hon department Multi family Sq Ft — NEAREST Residential Swimming Pools CROSS ST Date Applicant OWNER OR p 70 / FIRM NAME f/ L CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec�Li ht�sw A-. v` IL T COMPENSATION INSURANCE g t� ADDRESS First 20"1 `� `r J.- _ (This se<hon need not be completed if the work Involved by Total No Addihonol V f CITY Tel No the permit is for one hundred dollars ($100)or loss ) PIAN CHECK I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner APPLICAM so as to become subject to the Workers Compensation Laws Lighting Fixtures First 20 ADDRESS Dote Applicant Total No Additional CIN Tel No �O NOTICE TO APPLICANT If after making this Certificate Fixed Appliances Not Over 1 HP PERMIT e of f�/Y Exemption you should became subject to the Workers Range_ Heater_D W APPLICANT C� ) Compensation provisions of the labor Code you must forth Oven _ Dryer _ W M _ ADDRESS v 0 with comply with such provisions or this permit shall be Top_ _ FAU —W H deemed revoked Hood — Fan _ Other_ CIN No LICENSED CONTRACTORS DECLARATION I herebyaffirm that I am licensed under P Dnp _ Room Air Cond LICENSE R Class provisions of Chapter 9 REG NUMBER _ (commencing with'Section 7000) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO SED BY, d and Professions Code and my license is in full force and effect ,aT, QQQ ' �.z Size 8 Type HP KW KVA or KVAR V J a C/ 8 License Number Uc ClassUp to 1 Incl FINALof ate Over I to 10 Incl DATE �^ VALIDATION O Contractorr Over 10 to 50 Incl FIN rc+ 13 I am oxen pt under Sec Over 50 to 100 Inc B Q. B 8P C for this reason Over 100 Z Dote rL Services Swbd , MCC & Ponelboards 0 200 Amp Under 600 V Siann_tore 201 1000 Amp Under 600V ❑ Over 1000 Amp or Over 600 V , Exemption for I eg Maim Elect SINGLE FAMILY Temp Power Pole 8 Appurtenances 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 for the following reason (Section 7031 5 Business and Professions Code) ❑ I as owner of the property will do the work and the Mist: Conduits 8 Conductors structure is not intended or offered for sole.(Section Other (See Complete Fee Schedule)_ ' 7044 Business and Professions Code) 3 5 4 a 5 A CONSTRUCTION LENDING AGENCY # is e,e • is 2 1 hereby affirm that there is o construction lending agency for I e,,e 3 9. 0 0 the performance of the work for which this permit is issued PERMIT FEE (Sub Total) (Sec 3097 Gv C ) PLAN CHECKING FEE e e e 3 9' Lender s Name 0 9 2 3-8 6 PERMIT ISSUING FEE �D5-0 ' Lender s Address 1 certify that I have read this application and state that the TOTAL FEE it above information is correct I agree to comply with all County ordinances and State laws regulating Electrical wiring and 35 oa hereby authorize representatives of this County to enter upon the ob ve me ned property for inspection purposes el SEE REVERSE FOR EXPLANATORY LANGUAGE S.gn6fur of PermMee Date