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Home My Public Portal About9207 WEDGEWOOD ST_Electrical__ �i,,rd WORKERS'COMPENSATION DECLARATION .• 76A66310/81 APPLICATION FOO ELECTRICAL PERMIT +.I.�R'ereW affirm that I•have,a fertificate of consent to self CE-8066 insure, ona certificate of Workers'Compensation Insurance; COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certilled copy thereof(Sec. 3800, Lab. C.) f u Policy No. Company FOR APPLICANT TO FILL IN .JOB a•7 f�c� Certified copy is hereby furnished. EACH NO. FEE i ADDRESS �L New Residential Bldgs. 8 Pools ^ ❑ -Family, LOCALITY (� Certified copy is filed with the county building inspeci 1 &2 Sq Ft. $ — $ tion dep6rtment. I Multi-family Sq. Ft. T. Date I CROSS S %/L3G�%'� - Residential Swimming Pools OWNER T. / Applicant i FIRM NAME Cal iry CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec / Light Sw._ IL COMPENSATION INSURANCE ADDRESS 9 2--c,7Firdt W ! . c✓ (This section need not be completed if the work involved b�r Total No. Additional i CITY /� CTel. No. the permit Is for one hundred dollars($100)or less.) PLAN CHECK I certify that in the performance of the work for which this APPLICANT •5aM G permit 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 I ADDRESS Additional I Total No. i CITY Tel. No. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range_ Heater—D.W. _ APPLICANT Compensation provisions of the Labor Code, you must forth- Oven _Dryer _W.M.— i ADDRESS with comply with'such provisions or this permit shall be Top — FAU _W.H. — deemed revoked. I CITY Tel. No. LICENSED CONTRACTORS DECLARATION I Hood _ Fan _Other_ j Disp. _ Room Air Cond. � LICENSE OR Class. I hereby affirm that I am licensed under provisions of Chapter 9 REG.NUMBER (commencing with Section 7000)of Division A of the Busines DISTRICT NO. P O SED BY p Power Apparatus&Large Appliances and Professions Code,and my license is in full force and effect i p Size&Type HP, KW, KVA, or KVAR' i U License Number Lic. Class Up to 1 Incl. FINAL fL' Over 1 to 10 Incl. DATE 1 VALIDAT N Contractor Date I Over 10 to 50 Incl. FIN I am exempt under Sec. Over 50 to 100 Inc. BY O B.&P.C. for this reason Over 100 I Z Date: I Services, Swbd., MCC&Ponelboords i 0 -200 Amp. Under 600 V Signature I 201 - 1000 Amp. Under 600 V ;95322A Over 1000 Amp. or Over 600 V Exemption for Reg. Mainf. Elect. # 0 0 0.0 0 2 SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION I Sign with One Branch Circuit O a 2 8'''8 b I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Law for the following reason (Section 7031.5,,Business and g ;25322A Professions Code): Misc. Conduits&Conductors 0 0 0 0 0 X 0 I, as owner of the property, will do the work and IN structure is not intended or offered for sale (Sectio Other (See Complete Fee Schedule)_ 1 0 0 0 0 0 7044, Business o 0 0 0 and Professions Code). a O O CONSTRUCTION LENDING AGENCY I I hereby affirm that there is a construction lending agency fo ; 0 0 0 0 Q 0 0`� the performance of the work for which this permit is issue PERMIT FEE (Sub-Total) ` (Sec. 3097, Civ. C.). �9 0 0 0 0 PLAN CHECKING FEE ! Lender's Name 0 0 0 o Q 0 PERMIT ISSUING FEE ' Lender's Address 0 0 00 I certify that I have read this application and state that th TOTAL FEE above information is correct. I agree to comply with all Countv I o 0 0 0 (a Q C LL, ordinances and State laws regulating Electrical wiring, an hereby authorize representatives of this County to enter upo I ;2 0 0 00 the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE I. •,i SiSigna .re of Pallrhittee Date ; WORKERS'COMPENSATION DECLARATION 7& 63 10/87 APPLICATION FOR ELECTRICAL PERii�f1T I heresy affirm that I have a certificate of•consent'to self Ins re, ,CE!BoeG -or a certificate,of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY " d6 thereof(Sec.3800,Lab.C.) Policy Nc Company FOR APPLICANT TO FILL IN JOB •7 �� ADDRESS Certified copy is hereby furnished. New EACH NO. FEE Residential Bldgs.&Pools �... Certified copy is filed with the county building inspection I 1 &2-Family,Sq.Ft. $ _ $ LOCALITY NEAREST r" 1 department. Multi-family Sq.Ft. CROSS ST. `,•yCi N Date Applicant Residential Swimming Pools OWNER OR /�1 FIRM NAME L CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec—Light. Sw. MAIL D (,,^ �odn COMPENSATION INSURANCE I 141 ADDRESS, °I Z , •7 t/t This section need not be completed if the work Involved b the First 20 ( y CITY Tel.No. . permit is for one hundred dollars($100)or less.) Total No. Additional ' I certify that in the performance of the work for which this permit PLAN CHECK APPLICANT S is issued, I shall not employ any person in any manner so as.to Pi become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 92 ADDRESS + Total No. Additional CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. 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. _ CITY Tel.No. LICENSED-CONTRACTORS DECLARATION Hood — Fan Other_ I hereby affirm that I am licensed. under provisions of Chapter 9 ' I Disp. — Room AiCd —. LICENSE OR (commencing with Section 7000)'of!Division 3 of the'Business and. ! r on . REG.NUMBER Class: Professions Code,and my license is in full force and effect. power Apparatus&Large Appliances DISTRICT NO�J �/ PR.O ED BY _ Size&Type HP,KW,KVA,or KVAR License Number Lic.Class. Up to 1 Incl.' FINAL Over 1 to 10 Incl. DATEVALIDATION Q ' Contractor Date. Over 10 to 50 Incl. FINAL ❑ I am exempt under Sec. Over 50 to 100 Inc. BY 15 Over 100 B.&P.C.for this reason I Z ervices,Swbd.,MCC&Panelboards Date: 0-200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V ❑ i Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole&Appurtenances 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License:Law '1 A40ToQ.., for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits Code): 7 I,as owner of the property,will do the work and the structure 4isc.Conduits&Conductors 1 ITEMS is not Intended or offered for sale (Section 7044, Business- Other(See Complete Fee Schedule) and Professions Code). ® TOTAL 27 o 00 CONSTRUCTION LENDING AGENCY i �'ECK i?■E!i I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub Total) CHANGE Civ.C.). I PLAN CHECKING FEE Lender's Name I - ® 13000-13001 BY PERMIT ISSUING FEE Lender's Address 6022 1 ASI 8 4:.' I certify that ['have read this application and state that the above TOTAL FEE information is correct.I agree to comply with all County ordinances I 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 Permitte Date WORKER'S COMPENSATION DECLARATION 20.0019 DPW(12.91) APPLICATION p� , p T 76A663 APPLI.CAT'ION F®R ELECTRICAL PERMIT' L I hereby affirm that I have a certificate of consent to self 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 theFeof(Sec.3800 Lab.C.) Policy NO. Company FOR APPLICANT TO FILL IN JOB Poli ADDRESS yt,6 Certified copy is he furnished. NO. EACH FEE P New Residential Bldgs.&Pools _ $ $ LOCALITY ❑ Certified copy is filed with the county building inspection 1&2-Family,Sq.Ft. _ NEAREST1 department. Multi-family Sq.Ft. CROSS ST. JF °t: Date Applicant Residential Swimming Pools MAP BOK ASSESSOR -9�f PAGE o .CEL CERTIFICATE OF EXEMPTION FROM WORKERS' R � �0 OWNER OR O COMPENSATION INSURANCE utlets:Rec. Ligh First 20 MAIL Sw ,�O B� FIRM NAME' ec► /'C? (This section need not be completed the work Involved by the Total No. Additional ADDRESS C permit Is for one'hundred dollars($7000)or less.) 1 certify that in the performance of the work for which this permit CITY Tel.NO. is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No.. Additional t) 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. rovisioris of the Labor Code,you must forthwith comply with such PERMIT P P y Appliances APPLICANTe A tus&Lar aragpp provisions or this permit shall be deemed revoked. Power App - LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,.or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000)of Division 3 of the Business and CITY Tel.No. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR Over 50 to 100 Incl. REG.NUMBER Class. IZ Over 100 DISTRICT NO. PROCE ED BY O License Number Lic.Class f� V Services,Swbd.,MCC&Panelboards Q Contractor Date 0-399 Amp.Under 600 V DATE O ❑ I am exempt under Sec. 400-1000 Amp.Under 600 V — VALIDATION LUII Over 1000 Amp.or Over 600 V FINAL Q„ B.&P.C.for this reason BRANCH CIRCUIT FEES BY co Date:. 15A,or 20A,120V,Lighting or Recept. Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits 41 Or More Branch Circuits -� ❑ Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br,Circuits s •' 2 SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION ACCT.JT' h Circuit Bra3 Sigh with One Branch I hereby affirm that I am exempt from the Contractor's License Law v07 1Btilc e;J55 for a following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits C e): 1-ITEMS 1,as owner of the property,will do the work and the structure Misc.Conduits&Conductors TOTAL .m -a-E •-.. - � 5 is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). ® CHECK 185.55 CONSTRUCTION LENDING AGENCY CHANGE .00 I hereby affirm that there is a construction lending agency for the _ performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ.C.) 4000-010111 3/ 2/03 PLAN CHECKING FEE Lender's Name 8425 1 Editi:f 8:48 PERMIT ISSUING FEE Lender's Address TOTAL FEE �� I certify that I have read this application and under penalty of purjury state that the above 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 O PERMITTEE DATE Worm that I havNSATIONcate of 9DPW3/B7 APPLICATION KATION FOR (�L"ECTRICAL PERMIT' I hereby affirm that I have a certificate of consent to,self .764M3 /�i IL 1�6 t� , O insure, or a certificate of Workers'Compensation InsuPaAea; F ' COUNTY OF LOS ANGELES t DEPT. OF PUBLIC WORKS or a certified copy thereof(Sec. 3800, Lab. C.) Policy filo. r,? •Company FOR APPLICANT TO FILL IN JOB �&rtified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS -a Lt1b�6��»p–O Certified co is filed with the count building $ — $ LOCALITY copy ' y g inspec- 1 &2-Family, Sq. Ft. tion department. Multi-family Sq. Ft. -- NEAREST Residential.Swimming Pools CROSS ST. 1L1C' ;Date Applicant OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE I ADDRESS First 20 S ;(This section need not be completed if the work involved by Total No. Additional i CITY Tel. No. the permit is for one hundred dollars($100)or less.)' PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit is issued,I shall not employ any person in any manner Lighting Fixtures First 20 ADDRESS so as to become subject to the Workers'Compensation Laws. Additional Date Applicant Total No. CITY Tel. No. NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range— Heater—D.W. — APPLICATION Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. Hood — Fan —Other— CIN Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR Disp. — Room Air Cond. — REG.NUMBER Class. I hereby affirm that I am licensed under provisions of Chapter 9 , (commencing with Section 7000)of Division 3 of the BusinessPower Apparatus&Large Appliances DIST RI NO. PROt DB >_ and Professions Code,and m license is in full force and effect. tl y Size&Type HP, KW, KVA, or KVAR ' A O License Number Lic.Class i Up to 1 Incl. r FINAL C1 Contractor Date { Over 1 to 10 Incl. DATE VALIDATION 0 Over 10 to 50 Incl. • FINAL U I am exempt under Sec. Over 50 to 100 Inc. BY LU B.&P.C. for this reasonOver 100 i a Date: Services, Swbd.,Mdkielboards � � 0-200 Amp.`�ider — Signature 201 - 1000 Amp. Und r ❑ 00 V Exemption for Reg. Maint. Elect. Over 1000 Amp. or r 6 SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION �, 2 I hereby affirm that I am exempt from the Contractor's License iSign with'One Branch Circuit /r, Law for the following reason (Section 7031.5, Business and lAdditional Sign Branch Circuits rtCCTaV Professions Code): ' 3307 15,.9-.0 WA as owner of the property, will do the work and the IMisc. Conduits&Conductors 1 ITEMS structure is not intended or offered for sale(Section 7044, Other(See Complete Fee.Schedule)_ pol. Business and Professions Code). I T071 AL 25.50 CONSTRUCTION LENDING AGENCY 25.511I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) CHANGE .00 (Sec. 3097, Civ. C.). i PLAN CHECKING FEE Lender's Name '1 PERMIT ISSUING FEE ® 0000-DOCII 11/15/839 Lender's Address ! 6811 1 AM 8.15 I certify that I have read this application and state that the TOTAL FEE s above 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 �p.r Date ®' I WORKER'S COMPENSATION DECLARATION 9 DPW 9/89 APPLICATION iFOR,'"LECTRICAL PERMIT 76A66 I hereby d1fiP/n that I have a certificate of consent to self insure, 76A663 or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES FcPT. IQ[ PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB 'J ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools❑ $EACH NO. $ FEE LOCALITY Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. department. Multi-family Sq.Ft. NEARESTCROSS ST. (� C. G 4Yl Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. OWNER NAME COMPENSATION INSURANCE (This section need not be completed if the work involved by the First 20 MAILTotal No. Additional ADDRESS _ '7 permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITY — Tel. ,(� is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional // /� ADDRESS Date/n – �O �GZ Applicant C- t NOTICE TO APPLICANT: If, after making this C tificate of 15 OR 20A,120V BRANCH CIRCUITS CITY Tel.No. Exemption,you should become subject to the Workers'Compensation 1 TO 10 INCLUSIVE EACH provisions of the Labor Code, you must forthwith comply with such 11 TO 40 INCLUSIVE EACH PERMIT provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH APPLICANT LICENSED CONTRACTORS DECLARATION ADDRESSCL I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH O (commencing with Section 7000)of Division 3 of the Business and CITY Tel.No. U Professions Code, and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR [t Power Apparatus&Large Appliances REG.NUMBER Class. License Number Lic.Class Size&Type HP,KW,KVA,or KVAR DISTRICT NO. PROCESSED BY C~7 Up to 3 Incl. Q d Over 3 to 10 Incl. FINAL Cn Contractor Date Over 10 to 50 Incl. DATE (� Z ❑ I am exempt under Sec. Over 50 to 100 Incl. �~ 12 VALIDATION FINAL B.&P.C.for this reason Over 100 By Services,Swbd.,MCC&Panelboards Date: 0 200 mp.Under 600 V 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 Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , and Professions Code). 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. 3097, PERMIT FEE (Sub-Total) Civ.C.) PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE a Lender's Address I certify that I have read this application and state that the above TOTAL FEE 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 �fo�insppec�tiion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE q. SIGNATURE OF APPLICANT O AGENT DATE