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Home My Public Portal About5048 SERENO DR_Electrical__ c 1 WORKERS COMPENSATION DECLARATION 63 10iE1 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate 8ate of consent to self � 06G , insure or a certificate of Workers Compensation Insurance - COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec 3800 Lob C ) I - I a d !' Policy No Company FW APPLICANT TO FILL IN JOB ADDRESS ,0 y0 G /1( 0 Certified copy is hereby furnished New Rmtdh enal Bldgs 8 Pools EACH NO FEE ❑ 1 8 2-Family Ft $ — i LOCALITY ,on department copy a filed with the county building mspec- Y SQ ,on department Multi family$q FI r`iO NEAREST CROSS ST [ Dote Applicant Residential Swimming Pools OWNER OR FIRM NAME S S CERTIFICATE OF EXEMPTION FROM WORKERSMAR - COMPENSATION INSURANCE Outlets RecLight_Sw_ ADDRESS 3S f /N $ his section need not be completed If the work Involved b First 20 (T P Y the permit is for one hundred dellen (1100)or less ) Total No Additional CIN A1411:4V4 Tel No CHECK I certify that in the performance of the work for which this PLANAN permit is issued I shall not employ any person in any manner , so os to become subject to the Workers Compensation Laws_ Lighting F,.tures First 20 ADDRESS Additional Data Y � ppliconte G 195er�T/1Ll Total No CITY Tel No NOTIC O APPLICANT If after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Gr fs C 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 •O aoj( with comply with such provisions or this permit shall be T _ FAU _WH _ deemed WH — deemed revoked Hood _ Fan _Other_ CIN A,?,C a0q Tel No 6 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&Large Appliances DISTRICT NO PR7D BY and Professions Code and my license a in full force and effect 1 11011116-1111 Aft� Size 8 Type HP, KW KVA or KVAR O License Number 10 /G IAW Lic Class end Up to 1 Incl- FINAL V /�j/ /v� O Over 1 to 10 Incl DAA ✓ r`� VALIDATION tr Conactor CJ �Ul7lDr�te /Q t Over 10 to 50 Incl FIN ❑ I am exempt under Sec Over 50 to 100 Inc BY y 111. B 8P C for this reason Over 100 A N Dole Services Swbd MCC&Ponelboards ; Z 0 -200 Amp Under 600 V Signature 201 - 1000 Amp Under 600 V Over 1000 Amp or Over 600 V ❑ Exemption for Reg Maint Elect i 1f iQ 1f SINGLE FAMILY Tem Power Pole 8 11 - 17675 ' 7675 HOME OWNER-BUILDER DECLARATION p Appurtenances Sign with One Branch Circuit e # 176758 hereby affirm that j g r exempt from the 31 5 Business License Law for the following reason (Section 7031 5 Business and Additional Sign Branch Circuits — ) Q 1 5—8 4 Professions Code) ' ❑ 1 as owner of the property will do the work and the Mix Conduits 8 Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ ► 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY I hereby off irm 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 Lenders Name PERMIT ISSUING FEE Lenders 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 jaws regulating Electrical wiring, and - hereby authorize representatives of this County to enter upon the abo�ed propert fomnspechon purposes s� /—✓t � SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Perminee, Q to •�� COUNTY OF LOS ANGELES APPLICATION FOR PERM ' DIPARTDUIT OF COUNTY ELGDOM ELECTRIC 1 DIVISION OF BUILDING 6 SAFETY WUJJAM COUNTY EQG MER FOR APPLICANT TO FILL IN DISTRICT NO GROUP ZONE `PERMIT NO ELECTRICIAN � A- / 7% ADDRESS RRC 8IVED BY READY FOR DATA ISSUED FIRST INSPECTION CITY TEL' NO Y3� I 7 CW LI EN ID(P RIB BUILDING PEBI�T Fm ADOREae D y _ PER NUMBER EACH LOCALITY �{ TV LIES OUTLETS NEAREST �M ,RECEPTACLES CROSS ST WALL SWITCHES OWNER TOTAL OUTLETS sc MAIL D ELEC RANGES IIS ADDRUS,, RIRC HEATERS IIS —� FIXTURES S CITY TEL NO 7yY0 M SG I HRRE84 ACKNOW 6 THAT 1 HAVE READ THIS NUMBER OF LIGHT CIRCUITS APPLICATION AND STATE THAT THE ABOVE 18 CORRECT AND AGRES TO COMPLY WITH ALL COUNTY ORDINANCES NUMINR OF RECEPTACLE ClRCUnV AND STATE LAWS REGULATING ELECTRICAL WIRING MOTORS I CERTIFY THAT I POSSESS THE ABOVE VALID LOB ' Hu HORem gn R FEE ANGELES COUNTY LICENSE OR I AM THE LEGAL OWN NEw Mvo HP oYEE INc Got OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE V1000 YS SIGNATURE OP SO PERMY 1 DO INSPECTION BECORD E 1 So IS IIBOEo B00 r. % 200 l0 00SOO IS 00 Z OVER 1000 IIO 00 !Cf Y l 0 1 M O awr/FREQ CHANGER-HP !O 4 WELDERS. AC-KVA O GENERATORS KW TRANGPQRMERS-KVA TEMP MOTORS 7 or o1HO NOV" MOTOR/ 75OV omo I MISC SIGNS NO NO TRANS AMOVALS No. NO LAMPIR FOR IT DATE INSPECTOR'S NAME WIRING BI 00 0 0 CONDUIT FIXTURES $1 00 WIRING SUPPLEMENTARY SO FIXTURES POWER TOTAL FEE S w UTILITY CO NOTIFIED y� FINAL 7"4" DW4 M t92 I 15At9r"t05 10'74 APPLICATION FOR ELECTRI@AL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER aQioBRESS I N G . !v BUILDING AND SAFETY DIVISION J LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST OUTLETS NO EACH FEE OWNER OR FIRM NAME RECEPT_ S S MAIL LIGHT_ TOTAL FIRST 20 25 ADDRESS J OVER 20 CITU EL NO - 7 SWITCH_ 10 PLAN CHECK LIGHTING FIRST 20 25 APPLICANT N T TOTAL FIXTURES OVER 20 10 ADDRESS 15t�, A.b /L, RESIDENTIAL APPLIANCES CITY EL NO RANGE-DRYERPERMIT WTR HTR_ APPLICANT T STA COOK_DISP _F A U _ ADDRES QIZ CA*J /L SPACE HTR �..A.I�R COMO CLIryEHg a TEL ND -S CLOTHES WASH S�_,uISHWASH FEG NUMBER CLASS FAIFZOTXER 100HEREBY ACKNOWLEDGE THAT 1 HAVE GRAD THIS APPLICATION AMD STAT! THAT THE ABOVE It CORRECT AND AGR[[ TO COMPLY MOTO RSA TRAN5/ORMER5 RATING WITH ALL COUNTY ORDINANCES AND STAT[ LAW/ REGULATING IND HEATER! [TC HP KW KVA ELECTRICAL WIRING ■II[ 5 TYPE OVER TO XSR0SY CERTIFY THAT I AM PROPERLY 91015 TER ED ANO/OR 0 — I 100 LICE NS EO At RlOUIR[0 5Y LOS ANE[L!5 COUNTY AND STATE 0/ CALIFORNIA OR THAI I •M TME LEO AL OWNER OF THE ABOVE I — 10 500 OEDCRISED RE/IDE MTIAL OPERTY U 10 - 50 500 PERMITEE SIGNATUR eeO 50 - 100 1000 pISTRILT N/p,�. ROC SED BY d 100 - 500 1500 J , 0 g N SIGN GAS SIGN AND ONE CIRCUIT SOO APPROVALS DAT[ litmFESPIlPsSwNo Tuft TUBE OR MARQUEE ADOITIONAL CIRCUITS 100 TEMP POWER POLE SKRVI CENOT OVER 600 VOLTS OR 200 AMP 300 (I UNDERSLAB WORK SERVI CEOVER 600 VOLTS OR 200 AMP 1000 ROUGH CONDUIT TEMPSERVICE POLE, &APPURTENANCES 500 WIRING TEMP LIGHT OR RECEPT SYSTEM 300 FIXTURES POWER AUTHORIZED UTILITY CO NOTIFIED FINAL D /- PERMIT FEE (SUB TOTAL) NOTES PLAN CHECK FEE PERMIT ISSUING FEE 300 U Q 1 TOTAL FEE PLAN CHECK VALIDATION CK M 0 Ae PERMIT VALIDATION cx M 0 CASH 116 JUL 24 2 1 6.0 0- - 819 SE! SAM OF APPLICATION FOR COMPLETE SCHEDULE c WORKERS COMPENSATION DECLARATION Ig/B, APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-006GCEADOG insure or a certificate of Workers'Compensation Insurance COUNTY OF LOS ANGELES `� BUILDING AND SAFETY or a c�QtItrfrod copy thereof��(Sec 3800, ) - Policy'Na a33 Compan FOR APPDCANT TO PILL IN I 108 ❑ Certified copy is hereby furnished r I New Residential Bldgs 8 Pools EACH NO FEE ADORE55 Cer_r-�� t — y LOCALITY �B tpon department copy is filed with the county 6wWmB mspec- 1 8 ti-famJy $q t I'� hon department MultrvfamJy Sq Ft — CREST CROSS ST Residential Swimming Pools OWNER OR Datezr_ Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERSMAIL COMPENSATION INSURANCE, Outlets Rec_Light_$w_ ADDRE (This stolen need not be completed if the work involved by - First 20 CITY the permit is for one hundred dollars ($100)or less ) Total No Additional comfy that in PLAN CHECK the performance of the work for which this APPLICANT permit is issued, I shall not employ any person in any manner - so as to become subject to the Workeri Compensation Laws Lighting Futures First 20 ADDRESS Total No Additional CITY Tel No Date Applicant Fixed Appliances Not Over I HP PERMIT NOTICE TO APPLICANT If after making this Certificate 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 t i with comply with such provisions or this permit shall be Top _ FAU —W H — CITY Tel No r deemed revoked Hood _ Fan _Other_ LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Dnp _ Room Au Cond REG NUMBER Class (commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances _ DISTRICT NO PROCESSED BY > and Profemiore Code and my lice se is in full force and effect v O Size 8 Type HP, KW KVA or KVAR License Number. Lic Class Up to 1 Incl 4FINAL V Over 1 to 10 Ind ATE VALIDATION O 119 Contracto Over 10 to 50 Ind L. ❑ NAL V I am exempt under Sec Over 50 to 100 Inc Y W d B 8P C for this reason _ Over 100 Z Date r Services Swbd MCC d Panelboards ► 0 -200 Amp Under 600 V Signature 201 - 1000 Amp Under 600 V ❑ Exemption for Reg MoOver 1000 Amp a Over 600 V Moms Elect SINGLE FAMILY Temp Power Pole 8 Appurtenances 2 7 & 2 A 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 #�i' ' ' • 2 Law for the following reason (Section 7031 5, Business and Professions Code) _ 2 .,.'2 ra`r5 D ❑ I as owner of the property will do the work and the Misc Conduits 8 Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)— loop. •'•'• 2 .SL 5 0 E 7044 Business and Professions Code) • ti 071 '7-84 CONSTRUCTION LENDING AGENCY - I hereby affirm that there is a construction lending agency for the Performance of the work for which this permit a issued PERMIT FEE (Sub-Total) - -- (Sec 3097 Civ C ) N Q PLAN CHECKING FEE Lender's Name /j PERMIT ISSUING FEE Lender s Address I certify that I have read this application and state that the TOTAL FEE �Q above information is correct I agree to comply with all County ordinances and State lows regulating Electrical wiring, and Itb rib. -muthorae repr } natives of this County to a ter u on -� entioned party for inspection put ses SEE REVERSE FOR EXPLANATORY LANGUAGE 6 Sig otu a of Permittee to