HomeMy Public PortalAbout6003 RENO AVE_Electrical__ .,—WORKERS'COMPENSATION DECLARATION - 10/81
CE-806G APPLICATION FOR ELECTRICAL PERMIT
Ihereby affirm that I have a certificat8 of conspht to self insure,
CE-806G
or's certificaff of Workers' Compensation Insurance,or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
coN thereof(Sec.3800,Lab.C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB � .
EACH NO. FEE ADDRESS
Certified copy is hereby furnished. New Residential Bldgs.&Pools $ _ $ LOCALITY
❑ Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft.
department. Multi-family Sq.Ft. NEAREST
CROSS ST.
Date Applicant Residential Swimming Pools OWNER OR f�
FIRM NAME �1
CERTIFICATE OF EXEMPTION FROM WORKERS' 2, Z ]�' MAIL /jam o
COMPENSATION INSURANCE Outlets:Rec Light_Sw. gJ ADDR.ES3 (,/i/
This section need not be completed if the work involved b the y� First 20
( p y Total No. 3 l Additional CITY Tel.No.
permit Is for one hundred dollars($100)or less.) ; PLAN CHECK
I certify that in the performance of the work for which this permit ' APPLICANT 5&LAA
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 PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT
Exemption,you should become subject to the Workers'Compensation Range_ Heater ,D.W.
provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer W.M.L ADDRESS
provisions or this permit shall.be deemed revoked. Top _ FAU W.H. _
LICENSED CONTRACTORS DECLARATION Hood Fan Other_ CITY Tel.No.
.� n ,
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. T: Room Air Cond. of LICENSE OR Class
(commencing with Section 7000)of Division 3 of the Business and REG.NUMBER
Professions Code,and my license is in full force and effect. power Apparatus&Large Appliances DISTRICT NO �,/
PROCnSBY Y
Size&Type HP,KW,KVA,or KVAR hh o(/ 0
License Number Lic.Class Up to 1 Incl. 191RJ FINAL elf
U
Over 1 to 10 Inc]. DATE _7/ ,/J,j VALIDATION ix
Contractor Date Over 10 to 50 Incl. U
❑ FINAL
1 am exempt Under Sec. Over 50 to 100 Inc. gY 1.1
B.&P.C.for this reason Over 100 U)
Date:
Services,Swbd.,MCC&Panelboards ® Z
0-200 Amp.Under 600 V 7—
Signature
Signature 201 - 1.000 Amp.Under 600 V
❑ Over 1000 Amp.or Over 600 V
Exemption for Reg.Maint.Elect.
SINGLE FAMILY Temp.Power Pole&Appurtenances ACCT A
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits 33]7 84°50
for the following reason(Section 7031.5,Business and Professions
Code): 1 ITEMS
Misc.Conduits&Conductors TOTAL 84 c 5O
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) I
and Professions Code). ® CCK U4"5
CONSTRUCTION LENDING AGENCY C .QO
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.). OOOO—Qm1 10/15/89
PLAN CHECKING FEE
Lender's Name 6273 1 lM 80-36
PERMIT ISSUING FEE AA Lender's Address
1 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
and State laws regulating Electrical wiring, and hereby authorize
representati f:-tl�i to enter upon the above-mentioned
pR!-:?u
ction purposes. ^C� A� SEE REVERSE FOR EXPLANATORY LANGUAGE
S natu oPermittee CrJ1 Date/S/+S
BA663ce.e061e"el APPLICATION FOR ELECT CAL PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN JOB
New Residential Bldgs.&Pools
EACH NO. FEE ADDRESS D
1 &2-Family,Sq.Ft. $ .025 — $ LOCALIT
Multi-family Sq.Ft. .02 — NEAREST
Residential Swimming Pools 25.00 CROSS S .
OWNER O
FIRM NAME ' to
Outlets:Rec Light—Sw. 50 ADDRESS
First 20 it to
Totol.No. Additional .30 CITY j*No.
PLAN CHECK
APPLICANT
Lighting Fixtures First 20 .50 ADDRESS
Additional .30
Total No. CITY Tel.No.
Fixed Appliances Not Over 1 HP PERMIT
APPLICANT
Range_Heater_D.W.
Oven_Dryer_W.M:— ADDRESS
Top _FAU —W.H._ CITY Tel.No.
Hood_Fan —Other LICENSE OR
Disp:—Room Air Cond. 2.50 REG.NUMBER Class.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA.
Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO
Size&Type HP,KW,.KVA,or KVAR COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS Up to 1 Incl. 2.50 REGULATING ELECTRICAL WIRING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR O
Over 1 to 10-Incl. .5.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE'00
Over 10 to 50 Incl. 12.50 CALIFORNIA OR THAT I AM THE LEGA WNER OF THE ABOVE Q
25.00 DESCRIBED RESIDE TIAL PROPERTY. \ `
Over 50 to 100 Inc.
Over 100 40.00 PERMITEE
SIGNATURE
Services DISTRICT NOS., =PD BY
0-200 Amp.Under 600 VT
201.-1000 Amp.Under 600 V 25.00
Over 1000 Amp.or Over 600 V 50.00 Z
O
Temp.Power Pole&Appurtenances 10.00
Sign with One Branch Circuit 10.00 0
Additional Sign Branch Circuits 2"00 INSPECTION > X 3 7 3.7 A
Mise.Conduits&Conductors 10:00 INFORMATION u su
ON REVERSE Zi o 0 0 0 o 2
Other(See Complete Fee Schedule, SIDE u
Z 2001950
d _
O O O 1',:0 F
PERMIT FEE (Sub-Total, ()(� .2—7 9PLAN CHECKING FEE (One-Fourth Permit Feel O
PERMIT ISSUING FEE $7.00 0
TOTAL FEE >
INS ECTIO FINALED W
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By 4PIZId-cZe�"
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