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Home My Public Portal About5011 SERENO DR_Electrical__ ' J Wm that I COMPENSATION DECLARATION 78-003 10/61 APPLICATION FOR ELECTRICAL PERMIT {� I herGhy ahem that I have a certificate d coreent t0 sell assure GE-1108G �J or a certdcote d Workers Compensatm Insurance or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec 3800 Lab C) ` Policy No Company v FOR APPIJCANT TO FILL IN JOB ❑ Cerhfed copy is hereby furnished - Bygs a Pods EACH NO FEE ADORESs New Resdentil / ❑ Certified copy rs hied With the county budding Inspectwn 1 S 2-Family Sq Ft $ — $ LOCALITY department Mulb-family, Sq Fl — NEAREST CROSS ST Date Applicant Readenhel Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec� Light �. S. ` MNL COMPENSATION INSURANCE .� ; v 'T., ADDRESS (Th � e section need not it completed H mrdFlret 20N the Work Ived by the _ permit Fo for one hundred dollars($100)or lees ditaralCITY Tel No 1 Toted No Ad � I certify that in the performance of the work for Which this permit PLAID CHECK - is Issued I shall not employ arty person in any manner so es to APP.ICANi become subject to the Workers Compensation Laws Lighting Futures First 20 - ADDRESS Total No Additonei CITU Tel No Date �� Appi NOTICE TO APPLICANT If after, making ficate d Fixed Appliances Not Over 1 HP PERMIT Exemption you should become subject to the ens Cwpersabon Range_ Heater_ DW _ APPLlonrrT prevision of the Labor Code you must forthwith cornply With such Oven _ Dryer _ WM _ ADDRESS provisions or this permit shall be deemed revoked Top _ FAU _ WH _ , LICENSED CONTRACTORS DECLARATION CITY Tel No I hereby affirm that I am licensed under provisiorts of Chapter 9 Dsp _ Room Air Cond er— LICENSE OR Cra+a (commencing wash Section 7000)of Divsion 3 of the Business end PEG NUMBER Professions Code and my license a in full force and efedDISTRICT NO PROCE _ Power Apparatus d Lange Applsncea Size a Type HP KW KVA or KVAR ALU License Number Lc Class Lip to 1 Ind FINAL Over 1 to 10 Ind DATE Conhactor Date Over 10 to 50 Incl FINA ❑ I em exempt under Sec Over 50 to 100 Inc BY BAPC for this reason Over 100 IL Services Swbd MCC 8 Panelhoerds ;19 0 0 8 A N Z Date 0-200 Amp Under 600 V # • • • • • 2 Signature 201 - 1000 Amp Under 600 V ' ❑ Over 1 ogo Amp or Over 600 V ,I • *.14.25 Exempton,for Reg Ment Elect SINGLE FAMILY Temp Plower Pde 8 Appurtenaroes •,• • 1 &255 FIOME OWNER-BUILDER DECLARATION Sign with One Branch Cir n I hereby affirm that I em exempt from the Camractora Lcense Lax 0 (100t-88 for the following reason(Section 7031 5,Business and Protestors Additional Sign Baruch Circuits %w Conduits 8 Condixdors I as owner the property will do wank and ess structureOther(See Complete Fee Schedule) Is not fess de dor offered for -ale (Section (Section 7044 Busin ► and Professions Code) , CONSTRUCTION LENDING AGENCY ' I hereby affirm that there is a cwstructan lending agency dor the , performance of the work for which the permit a issued(Sec 3097 PERMIT FEE (Sub-Total) Civ C) PLAN CHECKING FEE Lenders Nano _ PERMIT ISSUING FEE - Lenders Address I certify that I have read the application and state that the above TOTAL FEE information is correct I agree to comply with all County ordinsroes and State Laws regulahng Electrical wiring and hereby authorize representatives of this County to enter upon the above-menbored property for inspection urpos J SEE REVERSE FOR EXPLANATORY LANGUAGE C �r� n • 'Mile WORKERS'COMPENSATIONDECLARATION -88086G (Z SOI CE- APPLICATION FOR ELECTRICAL PERMIT CE I hereby affirm thatI have a cent to of consent to self COUNTY OF LOS ANGELES 7 , C BUILDING AND SAFETY insure, or a certificate of Worken' nsatton Insurance,or a certified copy thereof(Sec 3800, Policy No VZICOmpanyQ=d FOR APPLICANT TO FILL rEACHN NOFEE ADDRESS O New Residential Bldgs &PoolsCertified copy u hereby furnished 1 &2 FamilySq Ft — S LOCALITY Multi-family Scl Ft CROSSS7Certified copy is filed with the county building inspection Residential Swimming Poolsmnt F OWNEROR FIRM NAMEDetAPPh ` Outlets Rec _Light_Sw , MAILADDD First 20 ERTIFICATE OF EXEMPTION FROM WORKERS' Total No Additional CITY al IN } COMPENSATION INSURANCE D. PLA CHIf EC vO APPLICANT (Tills section need not be completed If the( Work involved by the petmtt Is for one hundred dollars (SI00) or lies) LTotal No ighting Fixtures Fust ADDRESS S Additioonal 0 I certify that in the performance of the work for which this Fixed Appliance¢Not Over 1 HP CITY Tel No U permit is Issued, 1 shall not employ any person in any manner PERMITW so as to become subject to the Workers' Compensation Lam Range_ Heater_D W _ APPLICANT//`i N Oven _ Dryer_W M _ ADDRESS Pet; AbeZ Date Applicant Top _ FAU —W H Hood _ Fan —Other_ CITY eq Tal No NOTICE TO APPLICANT If, after making this Certificate of Dnp _ Room Air Cond_ LICENSE R Exemption, you should become subject to the Workers' REG NUMBER CI. C— U Compensation provisions of the Labor Code you must forth Power Apparatus& Large Appliances - DISTRICT NO PROC SED BY with comply with such provisions or this permit shall be deemed revoked Size& Type HP KW,KVA,or KVA f O X i Up to 1 Incl f/ v FINAL Over 1 to 10 Ind LICENSED CONTRACTORS DECLARATION Over 10 to 50 Ind DATE �`� –�� VALIDATION I hereby affirm that 1 am licensed under provisions of Chapter Over 50 to 100 Inc FBY INAL . 9 (commencing with Section 7000) of Division 3 of the Bust Over 100 nae and Professions Code, and my license Is in full force and effect 0-200 p Under 600 V License Numb Lic Class'— , 201-1 00 AmP Under 600 V Contrac Data��1-- Over 1000 Amp or Over 600 V ' HOME OWNER BUILDER DECLARATION Temp Power Pole& Appurtenances - I hereby affirm that I am exempt from the Contractor's Sign with One Branch Cirait License Law for the following reason,(Section 7031 S, Bust Additional Sign Branch Circuits ness and Professions Code) 2 3 t 3 8 A ' Mix Conduits&ConduMors 1, as owner of the property, will do the work and the Other(See Complete Fee Schedule)— structure is not intended or offered for sale (Section # •is • • 2 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY 2 a - 2950 1 hereby affirm that there u a construction lending agency •ia'a 2 9 5 0 c�5 for the performance of the work for which this permit is issued(S3097,Civ C) PERMIT FEE (Sub-Total) Oo Lender's NemePLAN CHECKING FEE (One-Fourth Permit Fee) 0 303-82 Lender's Address _ PERMIT ISSUING FEE 8 f I certify that 1 have read this application and state that the TOTAL FEE above information n correct 1 agree to comply with all County ordinances and State laws regulating Electric wrong and her au a representabv f this Count to enter upon I above n it o inspection rpo SEE REVERSE FOR EXPLANATORY LANGUAGE \40(gruiture of Permi e t ,