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HomeMy Public PortalAbout5211 SERENO DR_Electrical__ yLORKERS CDMPBNSATION DECLARATION 76AM DPW(12 91) APPLICATION FOR ELECTRICAL PERMIT IJ I herebyalffirm thpt 1 have a Certificate of consent to self insure 71iA0B3 f or a certdlcete of Worker s Compbnaebon Insurance or a climbed COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV e0py thereof,(Sec 38,000 Lab C�I .yf,, �, •o �/(' Policy NO IZMIZLS TnCOinpany I��r-+�� 1 FOR APPLICANT TO FILL IN AJOB DDRESS �fQl+f J { Certified copy M hereby furnished New Residential Bldgs &Poole NO EACH FEE LOCALITY Family $ Sq Ft — S Garbled artm cop/is bled with the county building Inspection &2 NEMEST depertmeM o., �/ I/ Mutti femtly Sq Ft CROSS yT ' Dela /!Z9// S Applicant 71L����(SCd+�eo�N Residential Swimming Pools ASSESSOR MAP BOCK PAPE PARCEL I CERTIFICATE OF EXEMPTION FROM WORKERS , Outlets Rec -0— Q �_ Z' OWNER OR COMPENSATION INSURANCE Light Sw _ FlPM NAME irL r SC h First 20 MNL perm t Is fon need not be comrs($1 0 the work Involved by the Taal No 11L Additional ACORESs )O�( ' permit le for one hundred dollars(5700)or baa) I certify that in the performance of the work for which this permit CITY ILet I" e2c To 490mwra Is Issued I shall not employ tiny person In any manner So as to PLAN CHECK become Subject t0 the Workers Compensation Laws Lighting Fixtures First 20 AppLICANT Total No ----7�— Additional ' ADDRESS Date Applicant ..RESIDENTIAL APPLIANCES NOT OVER 3 HP NOTICE,TO APPLICANT If after making this Certificate of CITY Tel No Exemption you should become subject to the Workers Compensation OTHER APPLIANCES NOT OVER 3 HP PERMIT ) provisions or the perms Code you must forthwith comply with such Power Apparatus&Large Appliances PUOANT - / i provisions or this permit shell be deemed revoked � 9 � LICENSED CONTRACTORS DECLARATION Sus&Type HP KW KVA or KVAR ADDRESS 1 hereby affirm that I am licensed under provisions of Chapter 9 (44 Over 3 to 101nc1 ^ � (commencing with Section 7000)of Division 3 of the Business and CITY VJfLfS TSI y z� Professions Cade and my license is in full force and effect Over 10 to 50 Incl Over 50 to 100 Incl LICENSE OR Lys } �. REO NUMBER d License Number -T77J0 Lic Close /}/A-/fir 1DO DISTRICT NO ED BY O CC& CcawtiL7�L� Date Services Sw 399Tmp U arr�V O DA"Are •D(� U0 cc Contractor _ D 400 1000 Amp Under 1100 V '� ~ ❑ I ares exempt under Sec VALIDATION V Over 1000 Amp or Over 800 V FlNAL W a. B&P C for this reason - - BY BRANCH 206A1CIRCUIT FEES Date 15A w ZOA 120V Lighting w Recept Z Signature �� 1 To 10 Branch Circuits v 11 To 40 Branch Circuits ❑ Exemption/Or Reg Memt Elect - 15A 20A 208V To 27iV U Or More Branch ib rig Brr C=AS GOrrcu 'ZSINGLE . HOME OWNER BUILDERILY DECLARATION Temp Power Pole&Appurtenances ACCT.: I hereby affirm that I am exempt from the Contractors License Lew Sign with One Branch Circuit for the following reason (Section 7031 B Business and Professions Additional Sign Branch Circuits 3347 33.35 Cede) / 1 ITERS ClMISC COICUJb&Conductors I as Owner of the property will do the work and the structure / is not intended or offered for sale (Section 7044 Business 011ier(See Complete Fes Schedule)_ � TOTAL SJ:3 .35 and Professions Code) _ - CEACK 33.35 CONSTRUCTION LENDING AGENCY _ CHANE 00 I hereby affirm that there is a construction lendmg agency for the _ performance of the work for which this permit is issued (Sec 3097 PERMIT FEE (Sub Total) Cir C), � - PLAN CHECKING FEE M--OW 1 1/29/93 Lenders Name ' PERMIT ISSUING FEE a<! 7° 1 AM 114 Lenders Address ' I certify that I he"read this application and under penally of purjury state TOTAL FEE . that the above information is coned I agree to comply with all County ordinances and State laws regulating Electrical wiring and hereby authonze repreaentetivee of his County to enter upon the above-mentioned property -for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE WNANRE OF PERMITTEE DATE WORKCOMPENSATION DECLARATION 20-0019 DPW„2 811 APPLICATION FOR ELECTRICAL PERMIT I hereby eUIrlTr toott I havehave a certificate of consent to Bell Insure w or a,certificete of Worker s Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof(Sec 3800 Lab�C) Policy NO Company F011 APPLIGM TO FlLL W AJOBDORE39 /1 ❑ 'Canified copy ie hereby turn et etl i Nee ReeidentW Bldgs 6 Poole NO EACH FEE LOCALITY O' ❑' ICmtilied copy is filed with the county,buidmg mapectron 1 1 d 2 Firmly,SR Fl — $ f NEAv department i Multi family SO Ft CRO SST CR099 ST Date Appliwlt Readential Swimming Poole x ` t i __ ASSESSOR &` /),�./) -me BOOK .../ � PILE D7 PNCEL'"; " CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec ~ OWNER OR COMPENSATION INSURANCE I Lighi 201 _ 1` NUA(& C>y�/ _-r First / D ✓b RPM NAME (This section need not be completed If the work Involved by the Total No AddiUonel •�-� BO AGGRESS .iCQE/Iviult- �� 9— (This is for one hundred dollars($100)or Ina) I certify''that in the performance of the work for which tyle permit CITY j �l�' Tr No 17 Is issued I shell not employ any person in any manner so as to y PUN CHECK become Subject to the Workers Compensation Laws Lighbng Futures First 20 APPLIpyIT TOW No Additional •' ADDRESS 19me Dale- Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HIP ell Lc NOTICE TO APPLICANT It after making this Certificate of CITY Tel No Exemption you should become subject to the Workers Compensation OTHER APPLIANCES NOT OVER 3 HP provisions of the Labor Code you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked IPower Apparatus a Large Appliances APPLICANT' ' I " LICENSED CONTRACTORS DECLARATK)N� Sae a Type HP KW KVA oc KVAR ADDRESS I hereby affirm that I am licensed under provisions o1 Chapter B Over 3 to 10 Ind(commencing with Section 7000)of Division 3 of the Business and CITY Td No Profeeaions Code and my license is in full force and effect Over 10 to 50 Incl LICENSE IB Clued Over 5010 100 1=1 REO NUMBER Over 100 DISTRICT NO BY O Licari Number Lic Gass f U Services Swbd /M][cca a 0 38>IAm�Un MTE /� - ° Contacto Dale _ WTE _ 400 1000 Amp Under 800 V ~ ❑ I am exempt under Sec LI Over 1000 Amp or Over 600 V VALIDATION W B aP C for this reason BRANCH CIRCUIT FEES Y� IL Date 15A or 20A 120V Lighting or Recept Z Signature 1 To 10 Branch Grcuits I1 To 40 Branch Castilla - - ❑ Exemption for Reg Mamt Elect41 154 20A 209V To 27Na More ranch Ciirc its SINGLE FAMILY Temp Power Pole a Appurtenances HOME OWNER BUILDER DECLARATION _ I hereby affirm that I am exempt from the Contractor a License Lew Sign with One Branch CIMUd - 123 cl} for the following reason (Section 7031 5 Business and Professions Adtliluxwl Sign Branch Grcuire - 1 ._ Cod I ITEMS © 1 es owner of the property will do the work and the structure Mix Conduits a Conductora TOTAL 183 w 61D Is not intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule) CHECK 133.6Dantl Professions Code CONSTRUCTION LENDING AGENCY _ •.HANGE .IJO 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3087 PERMIT FEE .(Sub-Total) Civ C) PLAN CHECKING FEE 0000-0001 3/25/SA Larder a Name _ PERMIT ISSUING FEE Lender r;Address ' I certify,that I have read this applicalron and under penalty of puryury stele TOTAL FEE that the above inhxmat*n is correct I agree to comply w11h all County ordinances and Stale Lewis regulating Electrical wrong ardherebyauthomae v V /-epresentetwee of tha County in enter upon the above-mentioned property for nupeclion purposes SEE REVERSE FOR EXPLANATORY LANGUAGE �PlalOF EPI E ✓ ^ ' affirm that I have/ certificate DECLARATION 200019 DRY(12 e„ APPLICATION FOR ELECTRICAL PERMIT yllJll 7Mae3 I hereby a111rm (het I have a cerlillcete Ot consent to sell Insure ,yr a certificate of Worker a Compensation Insurance or a camped COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof(Sec 13800 Lab C) j,1 1 Policy No -Company FOR APPLICANT TO FILL IN a0a a//I ApORESS Certified copy U r hereby fumlahed New Reeldentul Bldgs 8 Paola NO EACH FEE LOCALITY lified Ce copy,Is filed with the county building Inspection 1 d 2 Family Sq Ft — t = 10, department , Mulb femly Sq Ft NEAREST Data` I ' - Applicant Residential Swlmmmg Pools ASSESSOR YAP BOOT( 0 P PNICELL.�� ,CERTIFICATE OF EXEMPTION FROM WORKERS Oiitlelb Rec Light Z Sw Z er Y W14E COMPENSATION INSURANCE —First a Q (This section need not be completed If the work Involved by the � MA1i_ permit Is for one hundred dollars(0100)or lees) Total No /.7 Additional I certify that In the perlormance of the work for which this permit CITY TM Is Issued 1 shall not employ any person In any manner so as to PLAN CHECK become subject to the Workers Compensation Laws Lighting Fixtures ZFirst 20 APPLICANT ,iI Total No Additional ADDRESS Date Applicant r NOTICE,TO APPLICANT If alter making this Certificate of RESIDENTIAL APPLIANCES NOT OVER 3 HP CITY Tel No Exemption you should become subject to the Workers Compensation OTHER APPLIANCES NOT OVER 3 HP provisions of the Labor Code you mustiforthwith comply with such PEmaT provisions or this permit shall be deemed revoked Power Apparatus a Large Appliances APPLICANT L ' • LICENSED CONTRACTORS DECLARATION Size a Type HP KW KVA or KVAR ADDRESS I hereby affirm that I am licensed under'provislons of Chapter 9 Over 3 to t0lncl (commencing with Section 7000)of Division 3 of the Business and CIT' Tel No Professions Code and my license Is In full force and effect Over 10 to 50 Inc] LICENSE 0R Over 50 to 100 Ind REO NU®ER CLee d License Number Lic Class Over 100 DISTRICT NO LL Ary D BY U O Somm Swbd MCC 8 Panelboerds �..J/OV Contractor Date 0 399 Amp Under S00 V DATERNAL !� 0 ❑ I enI exempt under Sec 400 1000 Amp Under 800 V L 2 VALIDATION W Over 1000 Amp or Over 800 V B BP C for this reasonGT.4 - BRANCH CIRCUIT FEES BYE L y Dale ISA or 20A 120V Lighting or Recepl 3307 52.65 Z 1 To 10 Branch Circuits ITEMS Signature 11 To 40 Branch Circuits 1 ❑ p Reg Memt-EIW "r 15A 20A 208V To znv Li Or Mae Branch b TOTAL 52-65 Exam tion/or tiLIc��1/ SINGLE FAMILY Temp Power Pole 8 Appune iancea CITCWt 52.65 HOME OWNER BUILDER DECLARATION - I hereby affirm MSign with One&aitch CucuCircuital I am exempt from the Contractors License Law t.T11flTVG .00 for the following reason(Section 7031 5 Business and Professions Additional Sign Branch Circuits Code) ITOO�I 1 as owner of the property will do the work and the structure MConduits a Conductors _ OUy�-�rO1 3/16/93 Is not intended or offered for sale(Section 7044 Business Other(Sea Complete Fee Schedule,,— and chedule)antl Professions Code) - 3681 1 AM 9:41 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 3087 PERMIT FEE (Sub Total Civ C) PLAN CHECKING FEE Lender a Name PERMIT ISSUING FEE Lende�s Address ry etTOTAL FEE I cervi he"that I haread this application and under partially of pu Was �. that the above information is correct I agree to crampy with all County oMi repr ces end State laws regulating Electrical wring ahereby authorize a ativee of this County to ter upon the above mentioned property for In a ion p fwaes SEE REVERSE FOR EXPLANATORY LANGUAGE aN1luN PPERI