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HomeMy Public PortalAbout6343 TRELAWNEY AVE_Electrical__ • WORKERS COMPENSATION cats of once T� ta,et APPLICATION FOR ELECTRICAL PERMIT I ereby affirm that I have a certificate of consent to self D:�' ins e,: oro certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY ora rI fmd copy thereof (Sec 3800 Lab C ) Policy N Company FOR A/PLIGM TO FLLl W lOB Certs copy is hereby furnished New Residential Bldgs 8 Pools EsCH NO FEE ADDRESS CertiCot iii p;.q of fied y is filed wdh the county budding mspe< 1 8 2 Family Sq Ft s — S LOCALITY hon deport nt Multi family Sq Ft — NEAREST CROSS ST Date beam Residential Swimmmg Pooh OWNER OR FIRM NAME CERTIFICATE OF E TION FROM WORKERS' MAIL Outlets Rec_light_Sw_ COMPENSATI INSURANCE ADDRESS (This section need not b•coin 1•f If the work Involved First 20 P �' Total No Additional CITU Tel No the permH h for ono hundred dolls 100)or Ins ) PLAN CHECK I certify that in the performance of the rk for which this APPLICANT permit is issued I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws Lighting Futures First 20 ADDRESS , iso Additional Total No CITU Tel No Dote pPlicom J Fixed Appliances Not Over 1 HP PERMIT - N01KE TqVAPPLiCANT If, after making this Certificate of Exemption you should become subject to the Workers Range— Heater_D W _ APPLICANT Compensation provisions of the Labor Cade you must forth- Oven _ Dryer —W M — ADDRESS with comply with such provisions or this permit shall be Top — FAU _WH _ CITY Tel No deemed revoked Hood _ Fan _Other_ LICENSED CONTRACTORS DECLARATION uCEN I hereby offem that I om licensed under provisions of Chapter 9 Dap _ Room An Cond REG NUMBER Clas N (commencing with Section 7000) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO D BY a and Professtons Code and my license is in full force and effect Size 8 Type HP KW KVA or KVAR 6 a S8 t- O• License Number Lic Class L 0 FINAL K �..++��/� Up to I Incl F � oCOve 1 to IO Incl DATE i2� G Gj ATION U Connecta Date r -/ Over 10 to 50 Incl ❑ " FINA i d I am exempt under Sec Over 50 to 100 Inc BY N B 8P C far this reason Over 100 Z Dote Services, Swbd MCC 8 Panelboords 0 -200 Amp Under 600 V Signature 201 - 1000 Amp Under 600 V ❑ Exemption for Reg MaiOver 1000 Amp or Over 600 V Maim Elect SINGLE FAMILY Temp Power Pole 8 Appurtenances 1115 1 2 3 A HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit 1 hereby affirm that I am exempt from the Contractor s License # • • • • is 2 Low for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits Professions Code) Mix Conduits 6 Conductors ) • • 3 2 5 0 El I as owner of the property will the work and the structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ pis - 32505 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY 0 7 2 4-8 6 1 hereby affirm that there is o construction lending agency for the performance of the work for which this permit is issued PERMIT Fff (Sub-Total) (Sec 3097 Cv C ) j PLAN CHECKING FEE Lender s Name PERMIT ISSUING FEE (/ Lender s Address I certify that I have read this application and state that the TOTAL FEE above information is correct I agree to comply wnh all County l ordinances and State laws regulating Electrical wiring and y authorize representatives of this County to enter upon thea ve mentioned pr arty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE ignoture of ermittee e WORKERS'COMPENSATIONDECLARATION 76A678A06CE 63 APPLICATION FOR ELECTRICAL PERMIT {� k (2 00) U Lhereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or _ baa cc's !fled copy thereof(Sec 3800,Lab C) Policy Novy ��JTompany!ee'e*ON/ -7r-"` ' FOR APPLICANT TO FILL IN 3pg n New Residential Bldgs &Pools EACH NO FEE ADDRESS Re�f1[vNe Certified copy is hereby furnished 1 &2 Family.Sq Ft $ — $ LOCALITY Te/)f le Pr f dCertified epartment Residential is flMulti-family Sq Ft ed with the county building ins action CRST OWNER OR Residential Swimming Pools Date 7_/r_3 bA hcent / FIRM NAME 2 F- �.j /(/e�SVN pp Outlets Rec LLight Sw MAIL / CERTIFICATE OF EXEMPTION FROM WORKERS' '3 first 20 ADDRESS fx 3� COMPENSATION INSURANCE Total No Additional CCTV sf (dr'� Tel No -yl } PLAN CHECK CJ is sectiUUU8 on need not be completed If the work involved 'APPLICANT (Th by the permit u for one hundred dollars ($100) or less) Lighting Fixtures First 20 ADDRESS Total No Additional O issued, I shall not employ any person ,n any manner PERMIT I certify that ,n the performance of the work far which this Fixed Appliances Not Over 1 HP CITY Tel No Cd G permit is w so as to become subject to the Workers Compensation Lawn Range_Heater_D W APPLICANT �dNNO2 A Oven _ Dryer_W M ADDRESS 9 i N NCi�N/�� 2 Date Applicant Top _ FAU _WH _ Hood _ Fen _Other_ CITY /Q n� Tel No (�f NOTICE TO APPLICANT If after making this Certificate of Disp _Room Air Cond— LICENSE �.� Exemption, you should become subject to the Workers' REG NUMBER 03 -SCleas Compensation provisions of the Labor Code, you must forth Power Apparatus& Large Appliances DISTRICT NO PROCES ED BY with comply with such provisions or this permit shall be deemed revoked Size&Type HP,KW, KVA,or KVA Up to 1 Incl FINAL Over 1 to 10 Incl DATE �J LICENSED CONTRACTORS DECLARATION Over 10 to 60 Incl hereby affirm that I am licensed under provisions of Chapter Over 60 to 100 Inc FINA (commencing with Section 7000)of Division 3 of the Bus, Over 100 BV and Professions Code, and my license is ,n full force and ect Services ansa Number 4149373SLin Class 0 200 Amp Under 600 V CJ tf 201 1000 Amp Under 600 V tractor 66NAf0 Z Data 7-��a Over 1000 Amp or Over 600 V HOME OWNER BUILDER DECLARATION Temp Power Pole& 8 5 0 5 6 A Appurtenances aby affirm that I am exempt from the Contractor's Sign with One Branch Circuit # a a 2 se Law for the followingreason Section 7031 5, Bus, Additional Sign Branch Circuits , nd Profnuons Code) ' ( I a a 1 3 5 0 Misc Conduits Conductors i a • • 1 3505 as owner of the property will do the work and the Other(See Complete Fee Schedule)— ructure ,s not intended or offered for sale (Section Q •] 1 6t-86 4, Business and Professions Code) CONSTRUCTION LENDING AGENCY affirm that there ,s a construction lending agency performance of the work for which this permit is PERMIT FEE (Sub-Total) ec 3097 Civ C) Name PLAN CHECKING FEE (One Fourth Permit Fee) ddress PERMIT ISSUING FEE t I have read this application and state that the TOTAL FEE ation is correct I agree to comply with all County 13 nd State laws regulating Electrical wiring, and rize representatives of this County to enter upon honed property for ins c ion purposes SEE REVERSE FOR EXPLANATORY LANGUAGE ; 7- s- of Permittee Date