The URL can be used to link to this page

Home My Public Portal About9842 WENDON ST_Electrical__ i, WORKERS'COMPENSATION DECLARATION i CE 8o8G tD/St APPUCATION FOR ELE8 RICAL PERMIT I herebK affirm that I have a.certificate of consent to self insure, or a certificate of Workers'Compensation insurance, or a certified copy thereof(Sec.3800,Lab.C.) COUNTY OF LOS ANGELES j BUILDING AND SAFETY Policy No. Company j FOR APPLICANT TO FILL IN JOB /^ 6 44>W �• ❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ADDRESS ❑ Certified copy is,filed with the county building inspection 1 &2-Family,Sq..Ft, I — $ LOCALITY department. i Multi-family Sq.Ft. — NEAREST T£ /91C, Residential Swimming Pools CROSS ST. Date Applicant OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM.WORKERS' Outlets:Re.,? Light—Sw.— MAIL S r1 COMPENSATION INSURANCE ADDRESS (This section need_ not be'completed if the work Involved by the. ; First 20 Total No. Additional CITY Tel.No.. � 'permit'is for one hundred dollars(.$100)or less.) � I certify that in the perfoPLAN CHECK rmance of the work for which this permit APPLICANT 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 j Additional 1 Total No. CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HP NOTICE •TO APPLICANT: If,, after making this Certificate of , PPP ICDANTig"r��'.� Exemption,you should become subject to the Workers'Compensation Range_ Heater_ DAr provisions of the Labor Code;you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS 7 312 provisions or this permit shall be deemed revoked. Top — FAU _ W.H. _ CITY C't Tel.No:Z��-' LICENSED CONTRACTORS DECLARATION Hood —' Fan _ Other_ I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR Class. (commencing with Section 7000)of Division 3 of the Business andAppliances REG.NUMBER Professions Code,and-my license is in full force- Power Apparatus&'Large and effect. I DISTRICT NO. V PROCE B Size&Type HP,:KW,KVA,or VAR o Y � 1 • I. K. � License Number Lic.Class I Up to 1 Incl. . FINAL 1 V Over 1 to 10 Incl. DATE X ' Contractor Date il- VALIDATION C Over 10 to 50 Incl. FINAL 8 ❑ I am exempt under Sec. Over 50 to 100 Inc. BY "i W B.&P.C:for this reason Over 100� �l �,�;• Services,Swbd.,MCC&Panelboards R Date: 0-200 Amp.Under 600.V Signature 201 - 1000 Amp.Under.600 V ❑ Elect.Exemption for Reg.Main1 Over 1000 Amp.or Over 600 V I t. SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 1 i I hereby affirm that I am exempt from the Contractor's License Law I. A for the following reason(.Section 7031.5,Business and Professions Additional Sign Branch Circuits I ACCT.F Code): ❑ I,as owner of the roe Misc.Conduits&Conductors ` 330( 15 o.7Ll property,rty,will do the work and the structure lets Fee Schedule)Complete _ ! ITEM is not intended or offered for sale (Section 7044, Business j• Other( p and Professions Code). 0 TOTAL 15 .70 CONSTRUCTION LENDING AGENCY I I CHECK 15070 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 o0[1 Civ.C.). PLAN CHECKING FEE Lender's Name I 110110-01101 3/19/90 'PERMIT ISSUING FEE Lender's Address 9575 1 AM 9:211 1 certify that I have read this application and state that the above TOTAL FEE i information is correct.I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize r representatives of this Coy fer upon the above-mentioned p r in actioM 7Ar SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date %ORKERS'COMPENSATION DECLARATION 1 20-0019 M-60DPW3/B7 ®®j��®�I®da® ®� �L�� j�� ®�A®f)r@� p 1 hereby affirm that I have a certificate of consent to self i ��D /�![� I� O insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES i DEPT. OF PUBLIC WORKS or a certiVed coy thereof(Sec. 3800, Lab. C.) i V .9 79502-0 FjP � oIicy o. ompany Fremont FOR APPLICANT TO FILL IN JOB ❑Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ; ADDRESS 9842 WendOn Ave. OF, copy is filed with the county building inspeLOCALITY c- � 1 &2-Family, Sq. Ft. $ -- $ Temnle City tion department. Multi-family Sq. Ft. NEAREST Date 4-16-91 1 Residential Swimming Pools CROSS ST Goldenwest Applicant AAA Air FIRM NAME Frei i-ag CERTIFICATE OF EXEMPTION FROM WORKERS' �, Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work involved by Total No. Additional al CIT it Tel. No-443-9411 the permit is for one hundred dollars(;100)or less.) PLAN CHE 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 so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS 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 AAA Conditioned Air Compensation provisions of the Labor Code, you must forth- ! Oven — Dryer —W.M.— ADDRESS 10160 Valley Blvd. with comply with such provisions or this permit shall be ` Top — FAU x--W.H. — deemed revoked. - Hood — Fan —Other— CITY El Monte Tel. No-579-1800 LICENSED CONTRACTORS DECLARATION Dis — Room Air Cond. — LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 P REG. NUMBER 293529 Class. C 2 0 (commencing with Section 7000)of Division•3 of the Business ' Power Apparatus&Large Appliances DISTRICT NO. PROCESSED BY >- and Professions Code,and my license is in full force and effect. y a— Size&Type HP, KW, KVA, or KVAR �49e U License Number 2 9 5 Lic. Class 2 n Up to 1 Incl. I FINAL Contractor AAA Cond° A' -�P• Over ] to 10 Incl. DATE.`',`1'/ VALIDATION 0 to 9-30=92 Over 10 to 50 Incl. !y 0 FINAL ❑ U I am ez1empt under Sec. Over 50 to 100 Inc. BY W ,B.&P.C. for this reason Over 100 a Date: Services, Swbd., MCC&Ponelboards Z Z 0-200 Amp. 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 I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits 7�,r Profess33�ions Code): 7 X-4° ❑ I, as owner of.the'property, will do the work and the Misc. Conduits&Conductors ' !T 11.: structure is not intended or offered for sale(Section 7044, i Other(See Complete Few Schedule)_ Tk 1 T L 22 m 00 Business and Professions Code). i i CONSTRUCTION LENDING AGENCY I �:1'�ECK I hereby affirm that there is a construction lending agency for I-- I:I the performance of the work for.which this permit is issued I PERMIT FEE RT,3t ° P p (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE z a Lender's Name ( 0113 113(31 6.1 U P"I PERMIT ISSUING FEE , Lender's Address 269 1 €til S'.52 1 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 i hereby thorize.representatives of this County to enter upon the ab ve}mention prty inspection purposes. , fy f SEE REVERSE FOR EXPLANATORY LANGUAGE D Vi d rocs 6-3-91 Signature of Permittee Date ®° 76ASOB DBS SA 8-45 ® APPLICATION'FOA PERMIT DEPARTMENT OF BUWING AND SAFETY COUNTY OF.LOS ANGELES ELECTRIC 1. WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GR/OUP ZONE PERMIT NO. ELECTRICIAN 6- f 4 ! RECEIVED BY READY FOR DATE ISSUED ADDRESS FI INSPEC ON CITY /fxgi►� TEL. NO.&Tlfl 11.2 O'"161 COUNTY LICENSE - ® EXPIRES BUILDING �� ►//�Q PERMIT FEES. ADDRESS ,f IYIV I 144 NUMBER OUTLETS EACH FEE LOCALITY ,lam \i2 LIGHTS Sc ffi NEAREST _ CROSS ST. ill,/JII RECEPTACLES 5 FIXTURES 5 OWNER�oll- �1 'WALL SWITCHES 5 MAIL �� W -ELEC. RANGES 25 ,ZSR ADDRESS`� rG ELEC. HEATERS 25 I C CITY s EL. NO. MISC. 1 HEREBY ACKNOWLED THAT I HAVE READ THIS NUMBER OF CIRCUITS INSTALLED: 1 LV LIGHTS AND STATE THAT THE ABOVE IS CORRECT LIGHTSI' RECEPTACLES AND AGREE TO COMPLY WITH ALL COUNTY 'ORDINANCES MOTORS "AND STATE LAWS REGULATING ELECTRICAL WIRING. NUMBER HORSEPOWERI CERTIFY THAT I POSSESS THE ABOVE VALID LOS' FEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER NEW MVD. HP OVER INC. EACH ryry OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE: ' a LESS $ .25 �fv V2 2 .50 SIGNATURE OF PERMITTEE 2 5 1.00 5 1s 1.50 INSPECTION RECORD is so 2.50 so 200 5.00 200 Boo 10.00 Soo 1000 15.00 "01 d. OVER 1000 20.00 Z M.G. SET FREQ. CHANGER-HP WELDERS• AC-KVA GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS 75% OF oRIG.) MOVED MOTORS (75% OF ORIG.) SIGNS TYPE: NO. TRANS. TYPE: NO. LAMPS APPROVALS FOR'EACH PERMIT: DATE INSPECTOR'S NAME WIRING $1.00 CONDUIT FIXTURES $1.00 Q® WIRING SUPPLEMENTARY .50 FIXTURES [ POWER TOTAL FEE $ T �i0 UTILITY CO. NOTIFIED FINAL