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Home My Public Portal About6024 RENO AVE_Electrical__ +• WORKERS'COMPENSATION DECLARATION 7eA8e31 0 /8 1 I heaeby affirm that,I h certificate of consent to self insure, CE-806G APPLICATION FOR ELECTRICAL PERMIT i};±��or a eertifieate of Warked a;-Compbnsation Insurance, or a certified' COUNTY OF LOS ANGELES BUILDING'AND SAFETY cdr y thereof(Sec.3806,.Lab.C.) 19 U 'Policy.No;., Company , FOR APPLICANT TO FILL IN JOB artified copy is hereby furnished. New Residential Bldgs.&Pools! EACH NO. FEE ADDRESS ❑ Certified copy is filed with the county building inspection 1 1 &2-Family,Sq.Ft. $ _ $ LOCALITY 7-9 ' department. + Multi-family,Sq.Ft. 1 Noss ST Date Applicant Residential Swimming Pools b ' OWNER OR ` FIRM NAME O . CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec=Light Sw • IL COMPENSATION INSURANCE % ADDRESS (This section need not be completed if the Work involved by the First 20 F r Total No. Additional , j CITY Tel.No. permit is for one hundred dollars($100)or less.) PLAN CHECK 36 hriv I certify that in the performance of the work for which this permit APPLICANT is issued, I shall not employ any person in any manner so as to I become subject to he Workers' nsation Laws. i Lighting Fixtures First 20 t75 1 ADDRESS — Additional Total No. Additional � CITY I. Date Applicant f Fixed Appliances Not Over 1 HP PERMIT NOTICE -APPLICANT: after 'making this Certificate of ' Exemption,your should become subject o the Workers'Compensation' 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. _ CITY Tel.No. LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ I hereby affirm that I am licensed under provisions of Chapter'9UCENSE•ORClas (commencing with Section 7000)of Division 3 of the Business and Disp. Room Air Cond. " REG.NUMBERs Professions Code,and my.Iicense,is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO. PROCESSE Size&Type.HP,KW,KVA,or K•VAR �! �� O License Number Lim Class Up to 1 Incl. /' FINAL (� i Over•1 to 10 Incl. DATE �� •` Contractor Dates VA TION, Over 10 to 50 Incl. FINAL ❑ f am exempt under Sec. Over 50 to 1.00 Inc. By 2 8 9 2 2 A d Oyer 100 B.&P.C.for this reason 0 0 0 0 0 fn Services,Sykd:,MCC&Panelboards 0 0 0 = Z Date: 0-200 Amp.Under 600 V / , 0 0 0 $� v Signature 201 - 1000 Amp.Under 600 V '0207+88 ❑ Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. SINGLE.FAMILY Temp'.Power Pole&Appurtenances 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 for,the following reason(Section 7.031,5,Business and Professions. Code): . Misc.Conduits&Conductors I,as owner of the property,will do the work and the structureOther(See Complete Fee Schedule) is not intended or offered for sale (Section 7044, Business'' poll.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.3067,.; PERMIT•FEE (Sub TStal) Civ.C:): , i .r PLAN CHECKING FEE Lender's Name 011 PERMIT ISSUING FEE Lender's Address + I certiiythat I have read this application and'state that the above.' TOTAL FEE 3 information is correct.I agree to comply with all County ordinances and.State laws regulating Electrical wiring, and hereby authorize represeniatives of this County to enter upon the above-mentioned, .pe for in n rp ses: I SEE REVERSE FOR.EXPLANATORY LANGUAGE ' Si nature Of Pe I Erat, WORKERS'COMPENSATION DECLARATION 76-663 70/81 APPLICATION F R ELECTRICAL I hereby affirm that I have a certificate of consent to self CE-8EPERMIT o6G L5 ® ®•i insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES + BUILDIING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN .,JOB r ADDRESS ®�� '"• � Certified copy is hereby furnished. i New Residential Bldgs. &Pools EACH NO. FEE ❑ $ — $ LOCALITY �t�P L_Q G l Y Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. tion department. I Multi-family Sq. Ft. — NEAREST Residential Swimming Pools �NER OR Date Applicant I FIRM NAME ®�d– CERTIFICATE OF EXEMPTION FROM WORKERS' i Outlets: Rec Light Sw._ MAIL r COMPENSATION INSURANCE First.20 ADDRESS®Q7�g.1L• �� c C 6�O �.-.�r ,(This section need not be completed if the work involved by Total No. Additional ITY d� ►� (yG (� Tel. No. —��L the permit is for one hundred dollars($1100)or less.) PLA I certify that in the performance of the work'for which this ' A PLICANTK permit is issued, I shall not employ,any person in an manner so as to become subject to the W ers'Compen n La s. Lighting Fixtures First 20 ADDRESS Additional i . �� •� 1,51W otal No. CITY Tel. No. Date 7 Applicant A AFixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Cer ficate 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 with comply with such provisions or this permit shall be Top _ FAU —W.H. — deemed revoked. Hood _ Fan _Other— CITY Tei. No. LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. REG.NUMBER Class. (commencing with Section 7000)of Division 3 of the Business DISTRICT NO. PROCE BY and Professions Code,and my license is in full farce and effect. Power Apparatus&Ldrge.Appliances lop 96 Size&Type HP, KW, KVA, or KVAR' O License Number Lic. Class Up to 1 Incl. FINAL Over 1'to 10Incl. DATE •�.•��r VALIDATION Contractor Dale. Over 10 to 50 Incl. SINAL � ❑ I am exempt under Sec. Over 50 to 100 Inc. BY ��r ILU Over 100 BAP.C. for this reason Date: Services,Swbd., MCC&Panelboards 0 -200 Amp. Under 600 V Signatur 1 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit "3 I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits }� r, 0 0 0 0 Law for the following reason (Section 7031.5, Business and Professions Code): ❑ Misc. Conduits&Conductors o o I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)— c, c;o X 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 07,05-83 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) (Sec. 3097, 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 TOTAL FEE above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and her y authorizer resentatives of this County to enter upon the ove-mentio d pro erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Perm tee Date