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Home My Public Portal About4819 WILLMONTE AVE_Electrical__ q. WdRK&S'COMPENSATION DECLARATION CE-8066 10/81 A PPLOCATI®N FOR ELECTRICAL PERMIT I lereby.affirm that I have a certificate of consent to self CE-806 `n-ilure, or a certificate of Workers'Compensation Insurance, ICOUNTY,OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof(Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN G'� Pol . Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS ❑ 1 &2-Family, S Ft. $ — $ LOCALITY Certified copy is filed with the county building inspec- Y. q• • tion epartment.r .I Multi-family Sq. Ft. — NEAREST CROSS ST. Date App /L licanResidential Swimming g Pools OWNER OR • .� i FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light�_Sw.� MAR COMPENSATION INSURANCE First 20 ADDRESS (This section need not be completed if the work Involved by Total No. Additional CITY Tel. No. 2 the permit is for one hundred dollars($100)or less.) that in the performance of the work for which this PLAN CHECK I certify P 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 TAdditional Total No. 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' Range_ Heater_D.W. — Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS •""��Cs. with comply with such provisions or this permit shall be Top — FAU —W.H. — CITY Tel. No. deemed revoked. Hood _-Fan _Other_ LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disg: Room Air Cond. REG.NUMBER Class. (commencing with Section 7000)of Division 3 of the Business DISTRICT NO. PROCESSE BY and Professions Code,and my license is in full force and effect. Power Apparatus 8 Large Appliances Size&Type HP, KW, KVA, or KVAR 5, V License Number Lic. Class FINA U Up to 1 Incl. LL Over 1 to 10 Incl. DATEk� / VALID ION 09 Contractor Date Over 10 to 50 Incl. U FINAL / ❑ I am exempt under-Sec. Over 50 to 100 Inc. BY / � • B.&P.C. for this reason Over 100 r�-'-"✓✓ y Services, Swbd., MCC&Panelboards Date: 0 -200 Amp. Under 600 V 2179. 1 A Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V # 0 0 0 0 0 'z Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole&Appurtenances ( 0 - 1 S O O HOME.OWNER-BUILDER DECLARATION Sign with One Branch Circuit o 0 -.1 5 0 0 5 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 0IL 0 3—85 Professions Code): I, as owner of the property, will do the work and the Misc..Conduits&Conductors structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ 7044, Business 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 PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE O t Lender's Address 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 ab o -m nfioed propert ins ct'on purposes. i SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 76-866 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-806G ` insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES ~� (� BUILDING AND SAFETY or a certified copy thereof(Sec. 3800, Lab. C. / JOB or Policy No. Company FOR APPLICANT TO FILL IN ADDRESS Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ❑ 1 8 2-Family, S Ft. $ — $ LOCALITY 4lxz— Certified copy is filed with the county building inspec- y' q' NEAREST tion department. Multi-family Sq. Ft. Residential Swimming Pools CROSS ST. Date Applicant OWNER OR �,Q • FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec LightSw. ' MAIL COMPENSATION INSURANCE First 20 7 ADDRESS r �- (This section need pot be completed if the work involved by -Amp-' /� CITY Tel. No the permit is for one hundred dollars($100)or less.) Total No. Additional -/"Y I certify that in the performance of the work for which this A PNCHECK HE K 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 0 D_o 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 Exemption., you should become subject to the Workers' Range— HeaterUZD.W. — APPLICANT 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_ CITY Tel. IVo. LICENSED CONTRACTORS DECLARATION v!? LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond.�_, REG. NUMBER Class. (commencing with Section 7000)of Division 3 of the Business DISTRICT NO. PROCE ED BY and Professions Code,and my license is in full force and effect. Power Apparatus 8 Large Appliances r Size 8 Type HP, KW, KVA, or KVAR- / O License Number Lic. Class FINAL V Up to 1 Incl. 09 Over 1 to 10 Incl. DATE �'� 4VALIDATION Contractor Date FINAL Over 10 to 50 Incl. ❑. 1 am exempt under Sec. Over 50 to 100 Inc. BY B.BP.C. for this reason Over 100 Services, Swbd., MCC 8 PonelboardsNab Date: 0 -200 Amp. Under 600 V Signature •201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole 8 Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 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 Professions Code): I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors structure is not intended.or offered for saie (Section Other(See Complete Fee Schedule)_ fr n o o o o G 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY i �' o - 27.70 1 hereby affirm that there is a construction lending agency for o o ?r ;� ^_ the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) o v� (Sec. 3097, Civ. C.). ( 0 L PLAN CHECKING FEE Lender's Name ry (� PERMIT ISSUING FEE b J Lender's Address. I certify that I have read this application and state that the TOTAL FEE 7 7e 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 of PermitTee Date WORKERS'COMPENSATION DECLARATION 76A663CE-806 10/81 APPUCATI®N FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-8066 insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES / BUILDING AND SAFETY or a certified copy thereof(Sec. 3800, Lab. C.) /(� Policy No. Company FOR APPLICANT TO FILL IN AOB DDRESS ! / '' Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ❑ Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ — $ LOCALITY C� tion department. Multi-family Sq. Ft. — REST j��/ dw Residential Swimming Pools ROSS ST. fd/6e+ P OWNER M Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec _ MAIL COMPENSATION INSURANCE Light Sw. ADDRESS .0/0 //? �ILL/�i�v/� This section need not be completed if the work involved b First 20 ( P Y ITY Tel. No. ��!! the permit is for one hundred dollars(;100)or less.) Total No. Additional I certify that in the performance of the work for which this PLAN CHECK ' permit is issued, I shall not employ any person in any manner APPLICANT VD as fo become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS �, 0 Total No. Additionalte pplican i /� l7 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. _ APPLICANT 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. CITY Tel. IVo. LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other— Disp. — Room Air Cond. LICENSE Class. I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER (commencing with Section 7000)of Division 3 of the Businesspower Apparatus 8 Large Appliances DISTRICT NO. PROZCEE7DBY�and Professions Code,and my license is in full force and effect. Size&Type HP, KW, KVA, or KVAR L5 . O License Number Lic. ClassUp to 1 Incl. FINAL C_ � Over 1 to 10 Incl. DATE :3r�J �� VALIDATION 0 ad Contractor Date❑ Over 10 to 50 Incl. FINAL I am exempt under Sec. Over 50 to 100 Inc. BY LM Over 100 IL B.&P.C. for this reason ?A Date: Services, Swbd., MCC&Panelboards L ` 1 0 -200 Amp. Under 600 V Signature 209 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V 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 Additional Sign Branch Circuits `'Q 1 7.6 P Law for the following reason (Section 7031.5, Business and Professions Code): f� 0 0 0.0 0 2 ❑ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)— [ 0 0 2 a 5 0 7044, Business and Professions Code). 0 0 0 29-50M CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for 0'3 0 3—8 3 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE /0 Mu 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 with all County ordinances and State laws regulating Electrical wiring, and hereby authorize represe.nfatives of this County to enter upon he above- enfioned property for inspe tion urposes. d' SEE REVERSE FOR EXPLANATORY LANGUAGESignature of Permittee Date WORKERS'COMPENSATION DECLAMATION 76A663 APPLICATION FOR ELECTRICAL SCTRIpP ` PER IT%Vcnsentto self CE-806G ' 1 hereby affirm that I have a certificate o insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof(See. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS Certified copy is hereby furnished. 1 New Residential Bldgs. & Pools EACH NO. FEE ❑ I 1 &2-Family, S Ft. $ _ $ LOCALITY , Certified copy is filed with the county building inspec- Y. q• tion department. Multi-family Sq. Ft. NEAREST It Residential Swimming Pools CROSS ST. Date Applicant OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' � � MAIL Outlets: Re Light Sw. COMPENSATION INSURANCE First 20107 ADDRESS (This section need not be completed If the work involved by Total No. Additional01 CITY Tel. No. the permit is for one hundred dollars($100)or less.) 11 I certify that in the performance of the work for which this A PPLALICANTK 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 Total No. Additional. Date Applicant CITY Tel. No. Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of 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.— ADDRESS with comply with such provisions or this permit shall be , _ Top _ FA W.H. — deemed revoked. . Hood Tel. No. LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other— OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. LICENSE REG. NUMBER Class. (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PROCE ED BY and Professions Code,and m license is in full force and effect. y Size&Type HP, KW, KVA, or KVAR' f 04-711 License Number L'ic. Class Up to 1 Incl. FINAL. ti f Over 1 to 10 Incl. DATE !9 VALIDATION O Contractor Date Over 10 to 50 Incl. FINA ❑ I am exempt under Sec. Over 50 to 100 Inc.. BY ,'! 916. BAP.C. for this reason Over 100 f �'� CL Services, Swbd., MCC&.Panelboards Date: ! 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 Sign with One Branch Circuit 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, Professions Code): % 1 P, Misc. Conduits&Conductors 54 I, as owner of the property, will do the work and the v a a - 2 structure is not intended or offered for safe (Section Other(See Complete Fee Schedule)_ 7044, Business and Professions Code). ® a r.' 1,'/ Q 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 PERMIT FEE (Sub-Total) i r (Sec. 3097, Civ. C.). 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 with all County ordinances and State laws regulating Electrical wiring, ands hereby authorize representatives of this County to enter upon the above-mentioned property for in pe ion purposes. Q SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date