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Home My Public Portal About5233 SERENO DR_Electrical__ WORKER SCOMPENSATION DECUBATION r263 DPW„2e„ APPLICATION FOR ELECTRICAL PERMIT 11 I hereby affirm Ihel 1 have a certificate of consent to Bell insure 78ABBA663 or a certificate of Worker a Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof(Sec 3800 Lab C) Pal"No Comparry 1 FON APPLICANT To FILL IN - - JOB { 'Cenihed is hereby furnished ' ' NO EACH FEE AOORE53 ,SPY Y , New Residential Bldgs A Facts r - ❑' TCerbhed 162 Family SO Ft — $ $ LOCALITY copy is filed with the county building inspection c department mufti family Sq Ft qT Date I Ani lictnt Residential Swummmg Pools ASSESSOR _ MAP BOOK PAGE PNICEL ,CERTIFICATE OF EXEMPTION FROM WORKERS, Outlets Rec _Light_Sw NIRO R ,,11 /r P, l COMPENSATION INSURANCE .ME U M1/ (This section need not be completed If the work Involved by the �t Fiat ZO �, ADDRESS , permit Is for one hundred dollars($100)or leu) Total No Aifdamnal s - I certify that in the performance of the work for which this permit 1.. ` fJITY ' TO No is issued I shell not employ any person in any manner so as to Mm Fixtures First 20 PIAN CHECa ' become aubfed to Me Workers Compensation Laws Lighting APPLICANT - Total No Additional ADDRESS NOCO _ .cl{ Applicant �1� ��- TICE 70 APPLICANT If alter making this Certificate of RESIDENTIAL APPLIANCES NOT OVER 3HP CITY is No - - Exemption you should become subject to the WorkersCompensation OTHER APPLIANCES NOT OVER 3 HP provisions of the Labor Code you must forthwith comply with SuchP MN provisions or this permit shall be deemed revoked Power Apparatus A Large Appliances LICANT (� ' � ~r LICENSED CONTRACTORS DECLARATION Size 6 Type HP KW KVA or KVAR ADDRESS 6 1kLG A(Z 1 hereby affirm that I am licensed under provisions of Chapter B Over 3 to 101nd p � (commencing with Section 7000) of Division 3 of the Business and CITY U /`- Ta No Professions Code and my license is in lull force and effect Over 10 to 50 Incl Over 50 to 1D Incl _CENSE ORO O -7 Ci � I } REO NUMBER ` d / C- D Over 1DO DISTACT NO p SSE_BY O License Number 0 O Luc Clan � - - _ u�0 U A _ Services 0399 Amp Under 800 V s FINAL Damec[or�i'� PpA, J Date � 9S DATE 400 1000 Amp Under 500 V 2�a ❑ I em exempt under Sec VALIDATION V Over 1000 Amp or Over 800 V Fl Wy W B APC for this reason BRANCH CIRCUIT FEES BYCn - Date ISA or 20A 120V Lighting or Recept - Z 1 To 10 Branch Cumulus Signature - 11 To 40 Branch Cumuus 41 Or More Branch Circuits 7 ❑ Exemption for RegMaumElect ISA20A208VToZM Lighting BrCxcuas tCCT.I _ FAMILYSINGLE HOME OWNER BUILDERDECLARATION Temp Power Pob 6 Appurtersrucee - ` 3 1218.85 I hereby affirm that I am exempt from the Contractor a License Law Sign with Ona Branch Circuit c for the following reason (Section 7031 5 Business and Professions Adchtbnal Sign Branch Circuits T7�O11T�AL� ITEI'I..k F _ � Code) - [} 5 ❑ I Be owner of the property will do the work and the structure Mac Conduits 8 Conducloe _ T 63.05 ie not untended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule) and Professions Code) 1 0000-0001 6/ 2/95 CONSTRUCTION LENDING AGENCY _ 0699 1 AM 8:39 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sac 3087, PERMIT FEE (Sub Total) 9-0 Civ C) _ PLAN CHECKING FEE Landera Name PERMIT ISSUING FEE (pr Lends a Address - I certify that I have read this application and under penally of purlury state TOTAL FEE that the above information is correct I agree to comply with all County - ordinarlcesandStatelewsregulatingElectricalwiring end hereby authorize , representatives of this County to enter upon the above-mentioned property - far "robon pu SEE REVERSE FOR EXPLANATORY LANGUAGE 6-� �waTusE aOFrewaTiEE DAM ER S WORKtIhave COMPENSATION DECLARATION 20401DDPW(1281) APPLICATION FOR ELECTRICAL PERMIT 0.001 I hereby affirm,that I have a certificate of consent to sell insure ' or a certificate-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 I Company FOR APPLICANT TO FILL IN - rOSEl _ ADDRESS [�C- GenuflectCopy Is hereby lumielled ' New Residential 8 Pools al BI NO EACH FEE LOCALfTY ❑ Certified copy in filed with the county budding inspection 1 8 2 Family Sq FI /_�3/ — 3 Areg q department Multi family Sq FtCROSSSSS7 " Date ' r Applicant " Residential Swimming Pods - ASSESSOR PAPCEL�� y _ BOOK �i719 / - PAGE "I"/CERTIFICATE OF E%EMPTION FROM WORKERS Outlets Rec —Light_Sw OWNER OR L , COMPENSATION INSURANCEFIRM%NME /V (ThisFirst 20 MAIL fi J c) l pem iiefon need not d completed 0 the work Involve0rby the Total No Additional ADDRESS l pemnll Ie for one hundred dollars(3100)or lees) r I certify that in the performance of the work for which this permit CITY� l M,W�q 1' _ Tel No is issued I shell not employ any person Irl any manner so as to PLAN CHECK become subject to the Workers Compensation Laws Lighting Fixtures Fust 20 APPLICANT ' Total No Addltwnal ADDRESS Data Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP NOTICE TO APPLICANT 11 after making this Certificate of CRY - Tel NO Exemption you should become subject to the Workers Compensation OTHER APPLIANCES NOT OVER 3 HP y , provisions of the Labor Code you must forthwith comply with such PERMIT �ON provullons or this permit shall be deemed revoked Power Apparetun 8 Large Appliances APPLICANT I UCENSED CONTRACTORS DECLARATION Sue 8 Type HP KW KVA or KVAR ADDRESS Q - �� JAkA I hereby affirm that I am licensed under provisions of Chapter 8 Over 3 to 10 Ind l ` 1 /--� n (commencing with Section 7000) of Division 3 of the Business and CITU E) Jb L_. 7 Tel No �7�f Professions Code and my license is in full force and effect Over 10 to 50 Ind � 1 } Over 50 to 100 Incl REGE NE OR Cursui 102 11-1 C-10 Over 100 'STRICT NO $$ED BY License Number Lic Class Q �� Services Swbd MCC a Panelboards Contractor_ IiV1Y.v1 /w`-�1 Date 0 389 Amp Under 000 V FINAL F- ❑ - ' 400 1000 Amp Under 800 V A V I am exempt under Sec Over 1000 Amp or Over 000 V FINAL _� • VALIDATKIN LU B 8P C for this reason BY d BRANCH CIRCUIT FEES Dale ISA or 20A 120V Lighting or Recept Z ' Signature 1 To 10 Branch Circuits 11 70 40 Brooch Grcurts - ❑ _ Circlet Exemption for Rep SING 41 Or More Branch Elect 164,20A 206V To 27N LightingBr SINGLE FAMILY Temp Povver Poled Appurtenances •RCT�a ` t HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit J.]�. 173. 0 I hereby lllhrm that I on exempt from the Contractors License Law 33 for me following reason (Section 7031 5 Business and Professions Additional Sign Branch Circuits Code) ❑ I as owner of the property mil do the work end the structure Mex Conduits E Conductors Is not Intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule) 1 ITEMS Professions Code) —CONSTRUCTION LENDING AGENCY TOTAL 1-'3 I hereby'aflirm that there is a construction lending agency for the i � CHECK Civ Cance of the work for which this permit is issued (Sec 3097 PERMIT FEE (Sub Total) / CHANGE Lender s Name PLAN CHECKING FEE PERMIT ISSUING FEE Lenders Address - I cenity that I have read this application and under penalty of purjury state TOTAL FEE that the above information is correct I agree to comply with all County - - ordmancea and Stele lam regulating Electrical mining and hereby authorize �3.2 L representatives of this County to enter upon the above mentioned property -for m ion purposA SEE REVERSE FOR EXPLANATORY LANGUAGE A.NxwRE OF PEPIAn DAM