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Home My Public Portal About8712 WENDON ST_Electrical__ WORKERS'COMPENSATIONDECLARATION ' `76A60 APPLICATION FOR ELECTRICAL PERMIT CE-806G (2.80) I hereby 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 a certifiedc py thereof(Sec.3800,Lab.C.) ///��_ / Policy No6.?"Company� a �'` 1-2 FOR APPLICANT TO FILL IN JOB New Residential Bldgs.&Pools EACH NO. FEE ADDRESS Certified copy is hereby furnished. 1 &+2-Family,Sq. Ft. $ —" $ LOCALITY ❑TTT Mulli-family Sq. Ft. NEAREST Certified copy is filed with the county building inspection CROSS ST t department. /��''' Residential Swimming Pools OWNER OR —Dat Applicant FIRM NAME Outlets: Rec.-ZLight�Sw.� (� MAIL .. First 20 dO ADDRESS %Iqvx -e— CERTIFICATE OF EXEMPTION FROM WORKERS' TotlP No.J 4— AdditionalCITY Tel No. COMPENSATION INSURANCE PLAN CHECK C- PPLICANT O (This section need not be completed if the work involved Lighting Fixtures First 20 V by the permit is for one hundred dollars ($100) or less.) ADDRESS Total No. Additional I certify that in the performance of the work for which this CITY Tel No. I.. permit is issued, I shall not employ any person in any manner Fixed Appliances Not Over 1 HP V PERMIT1 tl� W so as to become subject to the Workers' Compensation Laws. Range_HeaterD.W. APPLICANTS d� p. . l�• �- Oven _Dryer_W.M._ ADDRESS '96 ` - Z Date Applicant Top' _ FAU _W.H-.. Hood Fan _Other— CITY Tel No. Z� NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond._ LICENSE OR Exemption, you should become subject to the Workers' REG.NUMBER lass' Compensation provisions of,the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BYv with comply with such provisions or this permit shall be Size&Type HP,KW,KVA,or KVAR �� ' deemed revoked. r Up to 1 Incl. FINAL LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATE /_e � VALIDATION Over 10 to 50 Incl.. I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL BY 9 (commencing with Section 7000)of Division 3 of the Busi- Over 100 ness and Professions.Code, and my license is in full force and effect. Services l.C� 0-200 Amp.Under 600 V ' License Number Lic.Class "/ 201-1000 Amp.Under 600.V Contractors Date;� ��I Ov0 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances I hereby affirm that I am eitempt from the Contractor's Sign with One Branch Circuit License Law for the following reason (Section 7031.5,, Busi- Additional Sign Branch Circuits { Hess and Professions Code): , Misc.Conduits&Conductors 0 I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)— = 1 9 0, 1 A structure is not intended or offered for sale-(Section ! 7044,Business and Professions,Code). .o 0 0 0 0 2 CONSTRUCTION LENDING AGENCY ` I hereby-affirm that there is a construction lending agency o o a for the performance of the work for which this permit is PERMIT FEE (Sub-Total) 8 issued(Sec.3097,Civ.C•), I o 0 0 22 0 0 Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) 60 Lender's Address PERMIT ISSUING FEE 1 1.09=81 I I certify that I have read this application and state that the TOTAL FEE. 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 abov -mentioned property for inspection purposes. + SEE'REVERSE FOR EXPLANATORY LANGUAGE ignature of Permittee Vate WORKER S'COMPENSATION DECLARATION CEIt -866G (2-80) APPLICATION FOR ELECTRICAL PERMIT I hereby 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 r �certified'cApy thereofm(Sec.3800,Lab.C.) v , ►J,((`(l�U� – FOR APPLICANT TO FILL IN JOB P opany ADDRESS ( Z N New Residential Bldgs.&Pools EACH NO. FEE ❑ Certified copy is hereby furnished. '� 1 &2-Family,Sq.Ft. $ — $ LOCALI Y �C (✓ Certified copy is filed wMulti-family Sq. Ft. NEAREST (. ith the punt building inspection CROSS ST �epart a Residential Swimming Pools q OWNER ORts FIRM NAME (•(7J� Date Applicant S Outlets: Rec.—' ' w. MAIL First 20 ADDRES CERTIFICATE OF EXEMPTION FROM WOR RS' Total No. Additional CIT Tel No. } COMPENSATION INSURANCE PLAN CHECK a APPLICANT (This section need not be completed if the work involved Lighting Fixtures First 20 U n by the permit is for one hundred dollars ($100) or less.) g ADDRESS Additional Total No. p I certify that in the performance of.the vyork for which this Fixed Appliances Not Over 1 HP CITY Tel No. permit is issued, I shall not employ any person in any manner PERMIT lU=U so as to become subject to the Workers' Compensation Laws. Range_Heater D.W. _ APPLICAN a Oven _ Dryer_W.M._ ADDRE' .L �i 'Z0 S-At. c Date Applicant Top _ FAU _W.H.._ o Hood _ Fan _Other CITY 1J Tel N Q NOTICE TO APPLICANT: If, after making this Certificate of Disp. _Room Air Cond._ LICE OR'�S� Exemption, .you should become subject to the Workers' REG.NUMBE lass Compensation provisions of the Labor Code, you must forth- Power Apparatus&Large Appliances DISTR'I'CT O. P CE D BY with comply with such provisions or this permit shall be Size&Type HP,KW,KVA,or KVAR deemed revoked. Up to'1 Incl. VVV Over 1 to 10 Incl. FINAL LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. DATE VALIDATION I hereby affirm that Iain licensed under provisions of Chapter Over 50 to 100 Inc. FINAL 9 (commencing with Section ,7000)of Division 3 of the Busi- Over 100 BY ness•and Professions.Code, and my license is in full force and effect. Services • 0-200 Amp.Under 600 V License Nu — L c.Class ff 201-1000 Amp.Under 600 V Contracto Date- ` 1 Over 1000 Amp.`or Over 600'V HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit License Law for the following reason (Section 7031..5, Busi= Additional Sign Branch Circuits ) 8 6.0. ness and Professions Code): 41 0 0 0 0 o 2 Misc.Conduits&Conductors ❑ I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)— •0 „ J G structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY 0 0 0 S�.�� C. I hereby affirm that thbre is a constructiod lending agency for the perfor ance of the work for which this permit is PERMIT FEE (Sub-Total) issued(Sec.309 Civ: .). Lender's Namb PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE I certify that I have read this application and state that the TOTAL FEE above information is correct.I agree to comply with all County,. ordinances and S e la egulating Electrical wiring, and hereby authoriz rep enta ves of this County to enter upon the above-men ' ned o er y for inspection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE Signature,of Permittee Date WORKERS'COMPENSATIONDECLARATION CE-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT ' I hereby affirm7that I have a certificate of consent to self COUNTY OF LOS ANGELES I BUILDING AND SAFETY insure,or a certificate of Workers'Compensation Insurance,or j a certified copy thereof(Sec.3800,Lab.C. � /� `�.� New Residential Bldgs.&Pools FOR APPLICANT TO FILL IN JOB' / Policy Nony EACH NO. FEE ADDRESS (,2 s ®/ • ❑ Certified copy is hereby furnished. 1 &2-Family,Sq.Ft. $ $ I LOCALITY Multi-family Sq, Ft., — NEAREST Certified copy is filed with the county building inspection CROSS ST department. Residential Swimming Pools OWNER OR L 56 S /_ / FIRM NAME Date 'O 2JZplicant GIS Outlets: Rec.—Light Sw. MAIL �L L First 20 ADDRESS �� f CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY Tel No. fff COMPENSATION INSURANCE � PLAN CHECK APPILICANT (This section need not be completed if the work involved U by the permit is for one hundred dollars Fixtures First 20 ADDRESS s ($100) or less.) Additional I O Total No. CITY Tel No. I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP permit is issued. I shall not employ any person in any manner I PERMITW so as to become subject to the Workers'Compensation Laws. Range_HeaterD.W._ APPLICA f d Oven Dryer_W.M._ ADDRESS r U Date Applicant Top _.FAU W.H,,_ Hood _.Fan _Other_ CITY Tel No. NOTICE TO APPLICANT: If, after making this Certificate of' Disp. _Room Air Condom LICENSEOR /�� Exemption, you should become subject to tile Workers' REG.NUMBER 6D Class Compensation provisions of the Labor Code, you must forth- Power Apparatus&Large Appliances DISTRICT NO. PROCESSED BY with comply with such provisions or this permit shall be deemed revoked. Size&Type HP,KW,KVA,or KVAR a Up to 1.Incl. FINAL C9�� LICENSED CONTRACTORS DECLARATION — Over 1 to 1.0 Incl. ' DATE � ��- Over 10 to 50 Incl. VALI DATION I I hereby affirm that I am licensed under provisions of ChapterOver 50 to 100 Inc. FINAL f 9 (commencing with Section 7000)of Division 3 10 the Busi- Over 100 BY, ness and Professions.Code, and my license is in full force and effect. Services License Number' Lic.Class 0-200 Amp.Under 600 V, 201-1000 Amp.Under 600 V Contractor Date Over 1000 Amp.or Over 600 V ` HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances it hereby affirm that. I am exempt from the Contractor's Sign with One Branch Circuit ,License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits. m 2$ Q a mess and Professions Code): ❑ p p Misc.Conduits&Conductors l #t 0 0 0 0 0 2 I, as owner of the ro erty, will do the work and the Other(See Complete Fee Schedule)— + structure is not intended or offered for sale (Section 7044,Business and Professions Code). ) o o1 [) rj CONSTRUCTION LENDING AGENCY •I hereby affirm that there. is a construction lending agency o'o o 1 (I,5 0 for the performance of the work for which this permit is G� issued(Sec.3097,Civ.C.). PERMIT FEE (Sub-Total) Q �,2.9.^8 2 Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) �— Lender's Address. PERMIT ISSUING FEE certify that I have read.this application and state that the TOTAL FEE ,4 Ya Pbove information is correct.I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representatives f this County to enter upon the above ntioned property f pection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE G . -,z - z Sig tore of Permittee Date