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HomeMy Public PortalAbout9002 PENTLAND ST_Electrical__ WORKERS COMPENSATION DECLARATION 76A663 ID,BI APPLICATION FOR ELECTRICAL PERMIT I laffirm`that I have a certificate 80613ate of consent to self CE insure or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec 3800 Lab C ) I - Pot No Company FOR APPLICANT TO FILL'IN JOB ADDRESS Z Certified copy is hereby furnished New Residential Bldgs 8 Pools EACH NO FEE LOCALITY IDCertifiedcopy is filed with the county building nspec 18 2 Family Sol Ft $ = S hon department - Multi family Sp Ft NEAREST • - CROSS ST wn Residential Swimming Pools OWNER O Date Applicant FIRM NAME _ I CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec 3 Light,�Sw IL COMPENSATION INSURANCE ' - ADDRESS is section d on neenot be completed of the work involved b First 20 (thR T the permit a for ono hundred dollen ($I00) or InTotal No c ) Additional CITY Tel No I'cernfy that in the performance of the work for which this } PLANCHECK permit is issued I shall not employ any person in on manner so as to become sublecl to ANT the W er Co pen t n Laws Lighting Fixtures First 20 x ADDRESS - Total No Adcht anal �. ' � � CITY - Tel Na Dote ppb nn Fixed Appliances Not Over 1 HP PERMIT NOTIC TO PPLICANT If after ma ng this Cert,ficote of APPLICANT Exemption you should become subject to the Workers Range_ Heater_D W Compensation provisions of the Labor Code you must forth- Oven _ Dryer — W M _ ADDRESS DO ^tom f with comply with such 'prov,smns or this permit shall be Top _ FAU —W H — � �S deemed revoked Hood _ Fan _Other— - CITY ar Tel No LICENSED CONTRACTORS DECLARATION ' LICENSE OR I hereby affirm that I am licensed under provrsons of Chapter 9+ D,sp _ Room Air Cond 'REG NUMBER Class (commenting with Sectiond y tic of Division nfu 3 of the Business DISTRICT N PROC�S$ED BY s 6 and Professions Cada and m license is in full force and affect Power Apparatus 8 Large Appliances G'(////// Size 8 Type HP KW KVA or KVAR O License Number Lic Class Up to 1 Incl FINAL %; Over 1 to 10 Ind DATE /O 77 VALIDATION 0 Contractor Date Over 10 to 50 Incl FIN u " ❑ I oat exempt under Sec Over 50 to 100 Inc BY r IYw B 8P C for this reason Over tib N Services Swbd , MCC 8 Ponelboards _ Date - 0 - 200 Amp Under 600 V Signature 201 1000 Amp Under 600V f-7 9 a 3 A ❑ Over 1000 Amp or Over 600 V Exemption for Reg Maint Elect # is • • • • Q SINGLE FAMILY Temp Power Pole 8 Appurtenancesk ' HOME OWNER-BUILDER DECLARATION t - 1 9. 5 0 Sign with One Branch Circuit ) hereby affem that I exempt from the Contractors license Additional Sign Branch Circuits Law for the followingg r reason (Secnonf 7031 5 Business and �g • • • 1 9 505 Pro essions Coda) as owner of the property will do the work and the hM,sc Conduits 8 Complete Condchedule). 9'Il 6 �8 7 structure is not atOter (See tended or offered for sale (Section Fee Suctors- 7044 Business and Professions Code) t 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 y ' Lender s Name Q PERMIT ISSUING FEE Lenders Address ^.I I certify that I have read this application and state that the TOTAL FEE J U above information is correct I agree to comply with all County ` ordinances and State laws regulating Electrical wiring and _ hereby oath r¢e rep'es entan ves of Ih's County to enter upon t bov tit ned pro ,for inspection purp es _ SEE REVERSE FOR EXPLANATORY LANGUAGE - 9 / 8 lqn ure P rm,tt Dafe , 1 / a 1 WORKERS'COMPENSATIONDECLARATION 76A663`, APPLICATION FOR ELECTRICAL PERMIT •-e iCEE06G S0) Ihereby affirm that I hale a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY ,. bar a certificate of Workers Compensation Insurance or / a certdted copy thereof(Sec 3800, Lab C) ` FOR APPLICANT TO FILL IN JOB Policy No Company EACH NO FEE ADDRESS New Residential Bldgs &Pools Certified copy is hereby furnished , 1 &2 Famdy,Sq-Ft $ — $ LOCALITY i Certified copy is filed with the county budding inspection , Multi family Sq Ft CROSS ST �Q• department Residential Swimming Pools OWNER OR /O i©S RM NAME Date Applicant _ `Outlets Rec:21 Li9ht�_Sw 9 O ` q DO RESS 9002 . ��T,�,,� ,g e 20 CERTIFICATE OF EXEMPTION•FROM WORKERS Fust „• COMPENSATION INSURANCE Total No iAdditnonal e CLAN C ECK ITY Tel No APPLICANT 0 (This section need not be completed if the work involved Lighting Fixtur s Fust 20 / J ADDRESS U ` by the permit is for one hundred dollars ($100) or less) Addrtwnalcc Total No I certify that in the performance of the work for which this i F xed Appliances'Not Over 1 HP CITY Tel No permrl,is ensued I shall not employ any person in any manner PERMIT LU so as-to become subjecbt0 the Wor s pensation Laws ,Range_ Heater_DW APPLICANT d i \ Oven _ Dryer W M ' N ADDRESS Z Date\ Applicant Top _ FAU _W H Hood _ Fen _Other— CITY rel No NOTICE TO APPLICANT If after making this Certificate of Dlsp _ Room Air Cond_ LICENSE OR Exemption you should become subject to the Workers' REG NUMBER Class Compensation provisions of the Labor Code you must forth Power Apparatus& Large Appliances DISTRICT NO PROCESSED BY with comply with such provisions or this permit shall be deemed revoked Size&Type HP KW KVA,or KVA Up to 1 Incl Over 1 to 101net FINAL LICENSED CONTRACTORS DECLARATION - DATE / G // VALIDATION Over 10 to 50 Incl I / �f• I hereby affirm that I am licensed under provisions of Chapter Over 50 tg100 Inc FINAL 9 (commencing with Section 7000) of Division 3 of the Bust - Over 100 BY ness and Professions Code and my'hcense is to full force and effect Services - ` License Number Lic Class 0 200 Amp Under 600 V i 201 1 DDO Amp Under 600 V ti Contractor Date Over 1000 Amp or„Over 600 V a HOME OWNER BUILDER DECLARATION Temp Power Pole&Appurtenances Sign with One Branch Circuit I hereby that lam exempt from the Contractors Additional Sign Branch Circuits ' aLmense Lewwfor for the following reason (Section 7031 5 Buv I nese and Professions Code) - :96752A Mix Conduits& Conductors a L as owner of the property will do the work and the Other (SeexComplete Fee Scheduler # e •le • • Z structure is not intended or offered for sale (Section _ _ 1 •7044 Business and Professions Code) . v 2 o ie 1 950 CONSTRUCTION LENDING AGENCY t I hereby affltm that there is a construction lending agency i o e a 1 9.5 0` for the performance of the work for which this permit is PERMIT FEE a (Sub Total) i issued (Sec 3097 Civ C) 1 I 1 1-Ox 8 3 Lender's Name PLAN CHECKING FEE (One Fourth Permit Feel a Lender's Address PERMIT ISSUING FEE `) I certify that I have read this application and state that the TOTAL FEE above information is correct 1 agree to comply with all County i - erdmances'and State laws regulating Electrical wiring and a hereby authorize representatives of this County to enter upon \ ab a menannoned pro rty for inspection purposes `\ Q SEE REVERSE FOR EXPLANATORY LANGUAGE i r Signature o ermittee , Date • ` WORKERS COMPENSATION DECLARATION E6, I0/81 APPLICATION FOR ELECTRICAL PERMIT -1 I hereby affirm that I have a certificate C ate of consent to self CE 806G insure or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY or o certified copy thereof (Sec 3800 Lob C ) Policy No Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished New Residential Bldgs 8 Pools p EACH NO 7FEE ADDRESS Certified copy is filed with the county building inspec I &2 Family, Sq Ft f — $ LOCALITY bon department 4 Muln-fomily Sol Ft — NEAREST , CROSS ST \ Date ApplicantResidential Swimming Pools OWNER OR L� ( !, FIRM NAME \� ' CERTIFICATE OF EXEMPTION FROM WORKERS Outlets RecLight_Sw= 'MAIL li COMPENSATION INSURANCE ADDRESS 7 (Thu section need not be completed if the work involved by First 20 P -Qthe permit is for one hundred dollars ($100)or lass ) Total No Additional CITY Tel No certify that in the performance of the work for which this - APPLI CHK permit is issued I shall not employ any person in any manner so asto become subject to the oil r Com ens bon laws Lighting Fixtures First 20 - ADDRESS \ ��i� \ Total No Additional , Datepyyp LL Applicant ` CITY Tel No I X NOTICE TO APPLICANT If after making his Certificate of Fixed Appliances Not Over I HP PERMIT Exemption you should becosubject to the Workers Range_ Heater_D W _ APPLICANT me 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 ° `Hood Fan _ Other_ CITY Tel No LICENSED CONTRACTORS DECLARATION — Room Air Cond LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp REG NUMBER Class (commencing with Section 7000) of Division 3 of the Business DISTRICT NO, PROCE D BY and Professions Code and my hcense is in full force and effect Power Apparatus 8 Large Appliances _ d t Size 8 Type HP, KW KVA, or KVAR S 021 •O t License Number Lic ClassFINAL - V Up ro 1,Ind Over 1 to 10 Incl DATE ��/V� VALIDATION cc nc❑ Contractor Date Over 10 to 50 Il OO L 0 FINAL I am exempt under Sec Over 50 to 100 Inc BY B 8P C for this reason Over 100 N Date Services, Swbd , MCC 8 Ponelboards , Z' 0 -200 Amp Under 600 V ' Signature _ 1201 - IODD Amp Under 600 V ❑ Exemption for Rag MoO'ver 1000 Amp or Over 600 V -Mount Elect SINGLE FAMILY Temp Power Pole 8 Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Grcwt , I hereby affirm that I am exempt from the Contractor s License r _ Law for the following reason (Section 7031 5 Business and Additional Sign Branch Circuits 3 1 7 A Professions Code) ) # • • • • • 2 Misc Condwis 8 Conductors ` as owner of the property will do the workrand the ) • 2.5 5 0 structure is not intended or offered for sale Section Other (See Complete Fee Schedule)— , _ _ . f 7044 Business and Professions Code) ( , �•:• • 2 5 0 CONSTRUCTION LENDING AGENCY _ 0'6'2 7 8-3- I I hereby affirm that there is a construction lending agency for the performance oi work for which this permit is issued' PERMIT'FEE (Sub Total) (Sec 3097 `Civ C ) PLAN CHECKING FEE Lender s Name r-F - PERMIT ISSUING FEE lot ( ' , Lender s Address I certify that I have read this application and state that the TOTAL FEE r 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 �ea menti property for inspe io p as c SEE REVERSE FOR EXPLANATORY LANGUAGE 2� Signature o ermittee Date 1 n r o fTirm that r.I have ATIONDECLARATION CE 863 tD,Bt APPLICATION FOR ELECTRICAL PERMIT a I h6ryby af�nm that I have a certificate of consent to self �806G insure or a certificate of Workers Compensation Insurance - COUNTY OF LOS ANGELES BUILDING AND SAFETY or o certified copy thereof (Sec 3800 Lab C ) Pal icy No Company FOR APPLICANT TO FILL IN TOB 7 ,.L-� 0 Certified copy is hereby furnished New Residential Bldgs 8 Pools EACH NO FEE ADDRESS �(� fG/"FIV $ — Certified copy is filed with the county building inspec 1 8 2 Family 9 Ft T f LOCALITY tion department Muiti-fResidential Jy wi Ft NEARECROSSST5�+✓'s Y r Residential Swimming Pools OWNER OR w` Date Appbwnf W FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS 3 ,3 IL �r COMPENSATION INSURANCE Outlets Ret Llght_Sw ADDRESS IQw� This stolon need not be completed d the work Involved b First 20 ( p Y S�d� the permit Is for one hundred dollars ($100)or loss ) Total No Additional CITY Tel NoSIS I certify that in the performance of the work for which this PLANCHEAWANK permit is issued I shall not employ a p on n any nner so as to be me ublect to the W m nsah na03 Lighting Fixtures�j First 20 ADDRESS Total No yL Additional Date Applicant CITY Tel No NOTI T APPLICANT If, aft-r mak g this Cerli6cote of Fixed Appliances Not Over I HP PERMIT Exe prion you should became subject to the Workers _ Range_ Heater_D W — APPLICANT Compensation provisions of the Labor Code you must forth Oven _ Dryer _ W M — ADDRESS90v2, >PLIT4-AtO with comply with such provisions or this permit shall be Top — FAU —W H — deemed revoked CITitzTel No ��d LICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other_ Dup — Room Art Cand LICENSE M C� Class I hereby affem 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 PROCESSED > and Professions Code and my license is in full force and effect .�` d Size 8 Type HP KW KVA or KVAR a O License Number Lc ClassUp to 1 Incl FINAL V Over I to 10 Ind DATE -� VALID ION 09 Contractor Date Over 10 to 50 Incl V ❑ FINAL I am exempt under Sac Over 50 to 100 Inc BY _ W B 8P C for this reason Over 100 y Services Swbd , MCC 8 Ponelboards ? Dote 0 -200 Amp Under 600 V Signature 201 - 1000 Amp Under 600 V Over 1000 Amp or Over 600 V 3 7 4 E 2 A Exemption for Reg Mount Elect ( , SINGLE FAMILY Temp Power Pole 8 Appurtenances # 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ,( s'* 21.00 1 hereby affirm that I am exempt from the Contractor s License Additional Sign Branch Circuits Low for the following reason (Section 7031 5 Business and Prof ssions Code) s s 21 O O kj I as owner of the property will do the work and the Misc Conduits 8 Conductors structure is not intended ar offered for sale (Section Other (See Complete Fee_Schedule)_ ► 07. 16-87 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) i r(Sec 3097 Civ C ) _ PLAN CHECKING FEE Lender s Name "Z PERMIT ISSUING FEE Lender sAddress I certify that I have read this application and state that the TOTAL FEE r06 above information is correct I agree to comply with all County ordinances and Stale laws regulating Electrical wiring and hereby authorize representatives of this County to enter upon theo en onedperty for inspection ipases SEE REVERSE FOR EXPLANATORY LANGUAGE _ gnor P r ee !VIA ate _