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Home My Public Portal About6272 SULTANA AVE_Electrical__ WpRKERS`COMPENSATION DECLARATION CEE--8060 10/81 ' APPUCATION FOR ELECTRICAL PERMIT I hereby affiFM that I have a certificate of consent to self Insure, oris cArtificate o.PWorkers' Compensation'Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY ' copy thereof(Sec,800,Lab.C.) f Policy No.. ompanyl2� lam-1- FOR APPLICANT TO FILL IN SOBv ADDRESS � �/ ... L Certified copy is hereby furnished. New.Residential Bldgs.&Pools EACH NO. FEE T&2-Family,Sq.Ft. $ — $ LOCALITY L a�. Certified copy is filed with the county building inspection — NEAREST department. Multi-family Sq.Ft: Date Applicant � n � �5� Residential Swimming Pools CROSS ST. f+ OWNER OR FIRM NAME �,� G CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL COMPENSATION INSURANCE Outlets:Rec LightArest w., i ADDRESS �� S (This section need not be com feted,if the work involved b the 20 ilz V0 P Y CITY Tel.No. permit Is for one hundred dollars($700)or less.) Total No. . . Additional l� I certify•that'in the performance of the work for which this permit IF q pV CHECK is issued, 1 shall not'employ any person in.any manner-so-as to Lighting Fixtures First 20 o ADDRESS become subject to the Workers'Compensation Laws. 9 • Total No. Additional CITY Tel.No.,, Date Applicant Fixed Appliances No}Over 1'HP NOTICE TO APPLICANT: If, after .making. this Certificate of PERMIT C Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. ._ APPLICANT Cn>ccf5 'lr. l provisions of the Labor Code,you must forthwith comply,with,such Oven _ 'Dryer_ W.M._ ADDRESS �b �a S; provisions or this permit shall be deemed revoked. Top _ FAU W.H. LICENSED CONTRACTORS DECLARATION Hood — Fan /- Other_ CITY r- Tel.No. I hereby affirm that I am Licensed under provisions of Chapter 9 LICENSE B Disp. — Room Air Cond. REG.NUMBER' Ctass. (commencing with Section 7000)of Division 3 of the Business and • Professions Code,and my license lain full force and effect. Power Apparatus&Large Appliances DISTRICT NO. PRO ESSED BY i Size&Type HP,KW,KVA,or KVAR l� 'Q— License Number! Lic. lass ., Up to 1. Incl. FINAL V. DATE z— 7( r I Over 1 to 10 Incl. )_ / � _ ) VALIDATION Contractor --� Over 10 to.50 Incl. FINAL ❑ I ani exempt under Sec: Over 50 to 100 Inc. BY �- B.&P.C.for this reason Over 100 Services,Swbd.,.MCC&Panelboards ® Z. Date.: 0-.200 Amp.Under 600 V Signature 201 -1000 Amp.Under 600 V Over 1.000 Amp.or Over 600 V ❑' Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.-Power Pole&Appurteriances• r HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit AL I hereby,affirm that I ani exempt from the Contractor's License Law tionagri•Branch Circuits for the following reason.(Section 7031.5,Business and Professions Iy4) v Additional Si Code)- �+�-^r ❑ Misc.Conduits.&Conductors `e33 r _ I,as owner of the property,.will do the work and the structure is not intended or offered for sale.(Section 7,044, Business Other(See Complete Fee Schedule) _ pop. ' #�+: and Professions Code). i rt f! i. 52 m 50 CONSTRUCTION LENDING AGENCY �^ �. —•- I hereby affirm that there Is a construction lending agency for the :.•7'ICCK- Ziz.--dj performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) r" N ' CHAINGE Civ.C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE (J Y 0001,-1,1,111 9113141:1 Lender's Address ]`'ij1 r I certify that I helve read this application and state that the above 'TOTAL FEE p�� L '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 property for inspection purposes. , SEE REVERSE FOR EXPLANATORY LANGUAGE t Signature of Permittee Date woRKERS'COMPENSATION DECLARATION 76-603 10/81 �R�L��TI®� ®R ELECTRICAL PERMIT I`hereby affirm+lhat I have a certificate of consent to self. insure, CE-806G or a certificate of Workers'.Compensation Insurance, or'a certified ' COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab.,C.) Polipy No. ompany a � -r-F a� FOR APPLICANT TO FILL IN JOB t,� I ADDRESS: V ..Cern led copy is_hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE E] _ •Certified copy is'filed: with the county building inspection 1 &2;Family,Sq:Ft..• $ $ LOCALITY C department: a Multi-family Sq.Ft. NEAREST CROSS Date Applicant—'a; m Residential Swimming Pools OWNER OR v FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL ; Outlets:Roo Light—Sw.— COMPENSATION INSURANCE D ADDRESS v. S , .(This section need not be completed If the work involved by the First 20 . permit is for one hundred dollars($100)or less.) Total No. Additional• CITY Tel.No.. I'certify that in the performance of the work for PLAN CHECK- 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 ADDRESS• Additional • Total No. CITY Tel.No. Date Applicant Fixed Appliances Not Over•1 HP NOTICE TO APPLICANT: 4f, after making this Certificate. of PERMIT < Range— Heater D.W. APPLICA r Exemption,.you should become subject.to the Workers'Compensation ' 9 ,provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS. — provisions or this permit shall be deemed revoked. Top _ FAU _ W.H. _ �e o. LICENSED CONTRACTORS DECLARATION CITY Tel.N Hood — Fan _ Other_ IDisp.hereb affirm that I am licensed under provisions of Chapter 9 Room Air Gond: , LICENSE OR Clasa — . .. (commencing with Section 7000)of Division 3 of the Business and REG.NUMBER , Professions_ Code,and my license is'in full force and effect. .DISTRICT NOPRC SED BY Power Apparatus&Large Appliances j/ Size&Type HP,KW,KVA,or KVAR lie If' Q� License Number Lic.Class _ ' Up to 1 Incl. FINAL' • V r Over 1 to 10 Incl. DATE y -3 W" I VALIDATION Contractor le Over 10 to 50 Incl: t L L 0 ' ❑ I am exempt rider Sec._ ._ Over 50 toFINAL Over Inc.. BY LtJ BAP.C.'for this reason - Over 100 ' Date: Services,Swbd.,MCC bpi%' �. O 0-200 Amp..0 e. (f V��T�P Signature . 201 - 1000 Amp.Under 600 V Over 1000 Amp.or Over 600'V ❑ Exemption for Reg.Maint.Elect, - SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER=BUILDER DECLARATION _�.•s ri s Sign with One Branch Circuit I hereby affirm that I am exempt from.the Contractor's License Law Additional Sign Branch Circuits �� for the following reason(Section 7031.5,Business and Professions Z-7; Code): Code): I T7;7'- Misc.Conduits&.Conductors ..-IT-, -, ❑ I,as owner of the property,will do the work and the structure •r a: -7 •;-,-- is not intended;or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) — :'I_t I�_ it and Professions.Code). , 4• -•`; 711 .;'_ CONSTRUCTION LENDING AGENCY !`f;�i�. d• :i_ I hereby affirm that there is a construction lending agency,for the r''"'1't" a.- performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub Total) Civ.C.). . _ PLAN CHECKING FEE' i�3�'t1': I if.IYI 1 i 1 4 1 Lender's Name ♦k 3.4-1 } PERMIT ISSUING FEE all 0365 1 t?i� 3 a•ti' Lender's AddresspL • 1 ' • 'I certify that I have read this application and state that the above' TOTAL FEE O J 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 ' property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee �� Date