The URL can be used to link to this page

Home My Public Portal About6016 PRIMROSE AVE_Electrical__ del WORKEtiS',COMPENS�ATION DECLARATION 76.4663 10/81 APPLICATION FOR ELECTRICAL PERMIT y, I,herdti�y affirm that"I have a certificate of consent to self CE-806G in'a c' or b certificate of°Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or certified copy thereof(Sec. 3800, Lab.C.) 4,' .Policy No. 550115 Company STATE FUM FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS X018 PR-�•� 1 &2-Famil S Ft. $ — $ LOCALITY rE-27PI�y ciw. ❑X Certified copy is filed with the county building inspec- Y� q. NEAREST tion department. Multi-family Sq. Ft. 2869 e � 10 42� Residential Swimming PoolCROSS ST. Date 4-23--86 -Applicant`�s S SP.TX*l42TC g s OWNER OR ' FIRM NAME ONEW DIEVJD)lNIMIT CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Outlets: Rec Light Sw._ ADDRESS COMPENSATION INSURANCE �• '. 1• tThis section need not be completed If the work Involved b First 20 he permit is for one hundred dollars($100)or less..) 1l Total No. Additional CITY HE Pyr 91731 Tel. No.575-0503 I certifythat in the performance of the work for which this PLAN CHECK P 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 Total No. Additional, CITY Tel. No. Date- Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If; after making this Certificate of APPLICANT JERRY`S >�r.>ir_1�TC,�C. 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 3876 D( G RD. with comply with. such provision..s.' or 'this permit shall be: • Top _ FAU W,H. _ deemed revoked. Hood _'Fan _Other_ CITY�T PARR Tel. Ivo.338-2558 LICENSED CONTRACTORS DECLARATION LICENSE.OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG..NUMBER 259475 ClassC 10 (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PR ED BY and Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances C 19 IL Size&Type HP; KW, KVA, or KVAR• �J [!j) O License Number 259475 Lic. Class C-10 Up to-1 Incl. FINAL t0 Over 1 to 10 Incl. DATE 99 Contractor ■TFmYI S h'i.F7C*W& 4-71-86 �� VALIDATION' ❑ - Over 10 to.50 Incl. FINAL tJ I am exempt under Sec. Over 50 to 100'Inc. BY IL B.&P.C. for this reason Over 100 .r — PA Date: Services,Swbd., MCC&Panelboards ► 0.-200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp, or-Over 600'V ;24538A SINGLE FAMILY Temp. Power Pole&Appurtenances # 0 0 0 0 0 2 HOME OWNER-BUILDER DECLARATION Sign with One.Branch Circuit1 1 Q 9 2 I hereby affirm that I am exempt from tile.Contractor's License Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and 0 0 1 1 Q 9 2 Professions Code.): ❑ 1, as owner of the property, will do the work and the Misc. Conduits&Conductors o k25-86 structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ 704.4, 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 0 50 PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the TOTAL FEE 110.92 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-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 4-23-86 Signature of Permittee Date -• •.',� WORKERS'•COMPENSATION DECLARATION 76AM3 10/81 APPLICATION FOR ELECTRICAL PERMIT Ihere�affirm,that"I have a certificate of consent to self CE-8066 insure,' ore certificate of Workers Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or'a certified copy thereof(Sec. 3800, Lab. C.) Policy No55O1 15 company �. FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO: FEE ADDRESS 6016 PRIMROSE A/B ® 1 &2-Family, S Ft. $ — $ LOCALITY Certified copy is filed with the county building inspec- y� q• 'NEAREST tion department. Multi-family Sq. Ft. 2869 — 4-23-86 r+ Residential Swimming Pools CROSS.ST. Date Applicant XqW— �A�_KRJC OWNER OR QllisL- JOEMEW FIRM NAME CERTIFICATE.OF EXEMPTION FROM WORKERS' ig MAIL Outlets: Rec Light Sw._ 27� R.YMINM AVE COMPENSATION INSURANCE ADDRESS 4� � � This section need not be completed If the work Involved b First 20 ( p Y Total No. CITY, Tel. No. 575-050375-0503 the permit is for one hundred dollars($100)or less.) Additional I certify that in the performance of the work for which this APNCCANT 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 _ Total.No. Additional' CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If; after making this Certificate of n� S EUCMC, DE. Exemption, you should become subject to the Workers' Range_ Heater_D.W. _ APPLICANT Compensation provisions of the Labor Code, you must forth- Oven —Dryer _W.M.— ADDRESS 3,0'76 D RD. with comply with such provisions or this permit shall be Top _ FAU —W.H. —. }�TdXATAT PARK deemed revoked. Hood CITY Tel. No:' _ Fan _Other_ LICENSED CONTRACTORS DECLARATION LICENSE OR — I.hereby affirm that i am licensed under provisions of Chapter 9 D.isp. — Room Air Cond. — REG.NUMBER 259475 Class• (commencing with Section 7000)of Division 3 of the Business DISTRICT•NO. PROCES D BY and Professions Code,and m. license is in full force and effect. Power Apparatus&Large Appliances �` f 3- y Size&Type HP, KW, KVA, or KVAR' lJ a t/ . Q License Number 259475 Lic. Class C-10 FINAL- Up to 1 Incl. Over 1 to 10 Incl. DATE . Contractor �sS T�'T.FY,9�2 Qe 4-23-86 VALI TION ❑ --, Over 10 to 50 Incl. FIN I am exempt under Sec. Over 50 To 100 Inc. BY f� B.&P:C. for this reason Over 100 #A Date: Services, SwbcI MCC A Ponelboards 0 -200 Amp. Under 600-V Signature 201 - 1000 Amp. Under 600 V 94 5 3.9 A Over 1000 Amp. or Over 600 V ❑ Exemption for Reg. Maint. Elect. # 0 0 0 0. 0.2 SINGLE FAMILY Temp. Power Pole&Appurtenances ( 0 1 1 Q 9 2 HOME OWNER-BUILDER.DECLARATION Sign with One Branch Circuit I hereby-affirm that I am,exempt from the Contractor's License o 0 1 1 Q 9 2= Law.for the following reason (Section redfor Business and Additional Sign Branch Circuits 5 Professions Code): 6 [I.2 5-8 6 F1I,.as owner of the property, will do the work and the Misc. Conduits&Conductors structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ Poo IlAlla_ 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 10. 0 Lender's Address I certify that I have read this application and state that the TOTAL FEE 110.92 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-mentioned property for inspection.purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 4-23-86 Signature of Permittee Date