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Home My Public Portal About6223 RENO AVE_Electrical__ WORKERS'COMPENSATION DECLARATION 7M ft3 DPW 31V APPLICATION/�,TION FOR ELECTRICAL PERMIT O I her by"affirm*that I have a i<ertificate of consent to self C�� A`� 6'0 !`� Sa/R Out 4or a certificate of Workers'Compensation Insurance, � COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified ercopy //th``ereof(Sec. 3800, Lob. C..)�/ �dsA`/g �y Policy No.,_[aG�&Company—=LZ!•C • °"`�'ia y FOR APPLICANT TO FILL IN JOB ❑Certified•copy is hereby furnished. New Residential Bldgs. &Pools EACH NO: FEE. ADDRESS �lr¢ • ❑Certified copy is filed with the county buildin�_71 ' 1'&2-Family, Sq. Ft. �� $ — $ LOCALITY r r tion department. Iti-family Sq. Ft. -- NEAREST CROSS ST.l �ps sidential Swimming Pools OWN �� moaDate _/ _0 Applicant eze FIRM NAME 4.49 CERTIFICATE OF EXEMPTION FRdM WORKERS' Outlets: Rec Light First 20 Sw._ MAIL �l COMPENSATION INSURANCE ADDRESS ® dfGr, ' (This section need not be completed if the work Involved by CITY Tel. No. the permit is for one hundred dollars($900)or less.) Total No. Additional 4�Jb 44cee� � PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ any person in any manner Lighting Fixtures First 20 ADDRESS so as to become subject to the Workers'Compensation Laws. Additional Date Applicant • Total No. CITY Tel. No. NOTICE TO 'APPU NT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range— Heater—D.W. APPLICATION Compensation provisions of the Labor Code, you must forth- Oven .� Dryer -tom W.M.— ADDRESS with comply with such provisions or this permit shall be Top — FAU --W.H. - ® deemed revoked. Hood -�- Fan —Other— // CITY �Cr! Tel. No. LICENSED CONTRACTORS DECLARATION Disp. lO, Q LICENSE OR /��+� ,A� I hereby affirm that I am licensed under provisions of Chapter 9 -� Room Air Cond. — F� 7 Class,a� REG. NUMBER (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PCESSED BY >_ and Professions Code,and my license is in full force and effect. i d Size&Type HP, KW, KVA, or KVAR �.DD O License Number c� Lir Class Up to_flncl. FINAL U Overs to 10 Incl. DATE VALIDATION � Contract - ate - O ❑ Over 1-0 to 50 Incl. FINAL U I am.exempt under Sec. Over 50 to.100 Inc. BY W B.&P.C. for this reason Over 100 a Services, Swbd.,MCC&Panelboards Z Date a Z 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 SINGLE FAMILY Temp. Power Pole&Appurtenances d. HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit rig. Law for the followingSection 7031.5, Business and Additional Sign Branch Circuits Professions Code): reason ( ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors ! i.;•EF'�' structure is not intended or offered for sale(Section 7044, Other(§ee Complete Fee Schedule)_ TOTAL ;. s.._.� 75.Business and Professions Code). 64 CONSTRUCTION LENDING AGENCY B �� ;-•ia=':r; �- �' i i•1 i hereby affirm that there is a construction lending agency for 'ul the performance of the work for which this permit'is issued PERMIT FEE (Sub-Total) ;;,?All (Sec. 3097, Civ. C.). PLAN CHECKING FEEyl _I,i_I-,i t- =,I .. f Lender's Name i' J. r ' i PERMIT ISSUING FEE � _ "1i''' t •. Lender's Address 4 x' 4: 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 hereby authorize represe atives of this County to enter upon i th above-mentioned pr erty inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE I' Sign ure of Permittef Date ®s , RS'COMPENSATION DECLARATION I 76A663 10/81 APPLICATIONFOR AECTRICAL PERMIT I hefeby affirm that'I have. a certificate of consent to sglf CE-806G i� insure, or a certificate of Workers'Compensation Insurancr, COUNTY ®F LOS ANGELESBUILDINGISN® SAFELY or a certified copy thereof (Sec. 3800, Lab. C.) I IuJ Policy.-No. Company: l FOR APPLICANT TO FILL IN JOB le, /�� Certified copy is hereby furnished. I EACH NO. FEE i ADDRESS �Z3 -� J L -;,L_ New Residential Bldgs. &Pools ❑ Certified copy is filed with the county building inspe -� 1 &2-Family, Sq. Ft.. $ — $ LOCALITY tion department. Multi-family Sq. Ft. — NEAREST CROSS ST. Residential Swimming Pools OWNER OR Date Applicant - I � FIRM �'Yl CERTIFICATE OF EXEMPTION'FROM WORKERS' Outlets: Rec - Light. � w.�SMAIL NAME COMPENSATION INSURANCE OADDRESS yL (This section need not be completed if the work involved by Ffrsf 20 the permit is for one hundred dollars($100)or less.) I Total No. Additional CITY C. Tel. N I certify that iPLAN CHECKn the performance of the work for which this � APPLICAN permit is issued, I shall not employ any person fn any marine so as to become subject to the Workers'Compensation Laws.. Lighting Fixtures First 20 � ADDRESS Additional CITY I` Total No.. Z Tel. No.. Date ppIicar - "( Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after icing thi Certificate of PERMIT 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 with. comply with such provisions or this permit shall be, Top _ FAU _W.H. — deemed revoked. ' Hood _ Fan _Other_ CITY Tel. No. LICENSED CONTRACTORS DECLARATIONLICENSE 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.I DISTRICT NO. OC SSED BY Power Apparatus&Large Appliances r O and Professions Code,and my license is in full force and effect. , , i 1 Size&Type HP, KW, KVA, or KVAR' S C4 V License Number Lic. Class Up to 1 Incl. FINAL Q Over 1 to 10 Incl. DATE _ VALIDATION O Contractor Date Over 10 to 50 Incl. FINAL i� ❑ LLI I am exempt under Sec. Over 50 to 100 Inc. BY p• B.&P.C. for this reason ,ver 1 �4 z Date: ) Services, Swbs ,vOOFPSrielboards �} 0 -'200 Amp. Under 600 V Signature I 201 - 1000 Amp. Under 600 V Exemption for Reg. Maint. Elect. Over 1000m.p. or Over 600 V SINGLE FAMILY �` Temp. Power Pole&RAppurtenandes 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 Law for the following reason (Section 7031.5, Business and Plipfess ions Code): I, 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)_ 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 2 5 5 2 1 A I hereby affirm that there is a construction lending agency for #•o,o,o o o 2 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 309.7, Civ. Ci). I o o 3 a 0 0 PLAN CHECKING FEE o 0 0.3 Q Q v Lender's Name Lender's Address PERMIT ISSUING FEE D V 9.2 9=8 6 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 (ar GD hereby authorize representatives of this County to enter upon th bove-mentioned roperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE A SlIdnature of Verrn7lttee Date ON I e that I have a''ceON,DOeLof on consent to self 76A663 10/81 CE-CE-806Gf" 6.P APICATION FOR ELECTRICAL PERMIT irpsOr ,fir r tificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY L or d certified copy thereof (Sec. 3800, Lob C.) Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS h Z � e ,Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE '- Cortifiod copy is filed with the county building inspec- y, q. LOCALITY 1 &2-Family, S Ft. $ — $ /d97 tion department. Multi-family Sq. Ft. — NEAREST Date Applicant Residential Swimming Pools CROSS ST. OWNER OR CERTIFICATE OF EXEMPTION FROM WORKERS' FIRM NAME Outlets: Rec�Light� Sw.� MAIL COMPENSATION INSURANCE First 20 �7� ADDRESS (This section need not be completed if the work involved by Total No. J'S CITY T.I. No. the permit is for one hundred dollars($168)or loss.) Additional (�M I certify that in the performance of the work for which this PLAN CHECK permit is issued, I shall not employ any person in any manner ., APPLICANT so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 y S ADDRESS 1 j Total No. Additional CITY A Tel. No. Date Applicant 't Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after aking s ertif1cate off 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 _ deemed revoked. Hod _ Fan _Ot heCITY Tel. 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 power Apparatus 8 Large Appliances DISTRICT NO. r- OC SED B)/ D. and Professions Code,and my license is in full force and effect. C Size&Type HP, KW, KVA, or KVAR u s r� lu License Number Lic. Class Up to 1 Incl. /•ua FINAL / V IM Over 1 to 10 Incl. .U J DATE //r N bALIDAT00N C Contractor Date i� Over 10 to 50 Incl. FINA / LtJ I am exempt under Sec. Over 50 to 100 Inc. BY /' B.&P.C. for this reason Over 100 / ca Services, Swbd., MCC&Ponelboards Date: 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 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 Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and g Professions Code): MiscConduits 8 Conductors 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)_ 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 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 I TOTAL FEE 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 �he above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 7/1r- * `, - Signatu a ermi a Date aWORKERS'COMPENSATION DECLARATION C-803 10/81 �pp1�0��1®� FOR ELECTRICAL PERMIT I hereby affirm i t I have a certificate of consent to self insure, E-eosG or a ber-1111cWt Af Workers' Compensation Insurance, or a certified .COUNTY OF LOS ANGELES BUILDING AND SAFETY copy therero?TSecc..3800 Lab.C.) �/ �/ —$ Policy No.t l V I Company �/'f� C FOR APPLICANT TO FILL IN JOB /mo/ ❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE 10MESS I Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. $ — $ LOCALITY department. / Multi-family Sq.Ft. NEAREST Date 43 Applicant, d� Residential Swimming Pools CROSS O �� OWNER OR � • FIRM NAME r— CERTIFICATE OF EXEMPTION FROM WORKERS' ri S � MAIL Outlets:Re Light_Sw. COMPENSATION INSURANCE v7-0 ADDRESS (This section need not be completed If the Work Involved by the �1�J First 20 Total No. L Additional i• D 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 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 ' For %✓ ADDRESS Total No.�n Additional CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of . PERMI7 Exemption,you should become subject to the Workers'Compensation Range— Heater— D.W. APPLICANT [ +C h • provisions of the Labor Code,you must forthwith comply with such Oven Dryer W.M.— ADDRESS 1 cir provisions or this permit shall be deemed revoked. Top FAU W.H. — ��•� i S 7C LICENSED CONTRACTORS DECLARATION Hood Fan Other— CITY Tel.No. 7�y / I hereby affirm that I am licensed under provisions of Chapter 9 A /p / LICENSE OR Disp. — Room Air Cond. REG.NUMBER �{p Class. (commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. DISTRICT NO. SSED BY Power Apparatus&Large Appliances j% / a Size&Type HP,KW,KVA,or KVARG'� License NumAber/ / Lic.Class Up to 1 Incl. / FINAL t/ ( [� Date q e s Over 1 to 10 Incl. DATE (/ 5' Q VALIDATION Contractor_r Le-5 R Over 10 to 50 Incl. 7' J —1/ UUU FINAL ❑ I am exempt under Sec. Over 50 to 100 Inc. BY a BAP.C.for this reason — 'Seva�`r?��'OvMer 100 p z elboa Date: h s a4kil Lfnlafl00 V rds Signature ; 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 I Sign with One Branch Circuit A CTe4 I hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits ., 24106 Code): ❑ ' I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors 1 ITEMS Fee Schedule)is not intended or offered for sale (Section 7044, Business Other(See Complete ) — ® TOTAL 24 6101 and Professions Code). Gf{E'CW 241.60 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the CHANGE .00 performance of the work for which this permit is issued(Sec.3087, PERMIT FEE (Sub Total) Civ.C.). PLAN CHECKING FEE GCOD-0001 it/ 9/95 Lender's Name PERMIT ISSUING FEE �� 3Q 3243 1 AH 9°36 Lender's Address / I certify that I have read this application and state that the above TOTAL FEE !A 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 ropertyfor in�p� ion purposes., �l � SEE REVERSE FOR EXPLANATORY LANGUAGE \` aurePmDate