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Home My Public Portal About9924-9926 WOODRUFF AVE_Electrical__ i, • WORKERS'COMPENSATION DECLARATION CE-8P6 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self �CE-8o6G ^ insure, or a certificate of Workers'Compensation Insurance, �I COUNTY OF LOS ANGELES + BUILDING AND SAFETY or a certified copy thereof(Sec. 3800, Lab. C.) 4 I Policy No. . Company It FOR APPLICANT TO FILL IN JOB' � � Certified co it-hereby furnished. EACH NO. FEE ADDRESS q PY Y I. New Residential Bldgs. &Pools LOCALITY ❑ 'Certified copy is filed with the county building inspec- ( 1 &2-Family, Sq. Ft. $ — $ - t.iPs1r .tion department. Multi-family-Sq. Ft. — :'NEAREST CROSS ST. II Residential Swimming'Pools OWNER OR i Dell, Date Applicant S FIRM NAME' r ilk Dell, r '.CERTIFICATE OF'EXEMPTION FROM WORKERS' ` MAIL ' COMPENSATION INSURANCE I Outlets: Rec Light Sw._ ADDRESS 2_&—7e—iit tie First 20 .(This section need not be completed if the'woiTotal No: k involved,by Additional CITY Lf� -Tel. the'permit'is,for'one hundred dollars($100)or less.) J I` 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 so.as to become subject to the Workers'Compensation Laws. I Lighting Fixtures First 20 ADDRESS Additional Total No. CITY Tel. No.'' Date- Applicant Fiked 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. C'oinpensation provisions of the Labor Code, you must forth= Oven _Dryer —W.M:— ADDRESS --1 '.with comply with such provisions or this :permit' shall be �' Top _:FAU —W.H. — WF deemed revoked. Hood Fan OtherCITY .� FI* t �� Tel. No 2,?Pp LICENSED CONTRACTORS _ _ _ .RACLORS DECLARATION 'LII.CENSE OR ' I hereby affirm that I am licensed under provisions of Chapter 9 i Disp. _ Room Air Cond. REG.NUMBER Class.. (commencing!with Section 7000)of Division 3 of the.Business I DISTRICT NO. PROCE ED BY and Professions Code;and•my license ii-in full force and effect. F Power Apparatus&Large Appliances IL Size&Type HP, KW,.KVA, or KVAR• O License Number Lic. Class FFINAL Up to 1. Incl. I69 'Over 1 to 1'0lncl. �-.�� VALIDATION ®' Contractor Date I Over 10'to,50 Incl. I am exempt under Sec. Over 50 to 100 Inc. L' B.&P.C.'for This reason Over 100 Date: r Services, Swbd., MCC&Panelboards " 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 �• 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 { 0'0 0 0 C Professions Code): Misc.%Conduits&Conductors 2 0 0'2 0,j C s Elas owner the property, will do the work and the I, Other(See Complete Fee Schedule)_ ' structure is not: t intended or offered for sale (Section ,. 0;0 0 2•V � 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY09-23- 8 .2 1 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' Lend'er'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 la s regulating Electrical wiring, and hereby.authorize,r pre tativos of this County to enter upon th v -m ti ed pertyfor inspection.purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE l $ignatuie of Permittee Date ) i WORKERS'COMPENSATION cafeDECLARATI(*corse , e CE..E :l0/B1 APPLICATI® FOR ELECTRICAL PERMIT I hereby affirm that 'I have a certificate of consent to self CE_-BO6G 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 q DRESS �s (� (�•�vr�/�V�/ Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ❑ g _ g LOCALITY G 7 Certified copy is-filed.with the county building inspec- 1 &2-Family, Sq. Ft. ' tion department. I' Multi-family Sq. Ff. NEAREST CROSS ST. Vd Residential Swimming Pools OWNER OR Date -Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL COMPENSATION INSURANCE i3Outlets: Rec Light. Sw._ ADDRESS, leted if the work involved b• First 20 his section need not he com (T P Y Total No. Additional CITY ��LrG Tel. Nap`�� the permit is for one hundred dollars( $100)or less.) PLAN CHECK 1'certify that in the performance of the work for which this j, 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 t� 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 WOOS GGC�/ /lIG 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' ,41 ��1 . with comply with such provisions or this permit shall be i. Top _FAU —W..H. — CITYL�U�7� Tel. IVo � " . deemed revoked. ' _ LICENSED CONTRACTORS DECLARATION !I Hood Fan _Other_ LICENSE OR L' /'�• 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 , 'power Apparatus&Large Appliances DISTRICT NO. PROCESSED BY and Professions Code,and my license is in full force and effect.. A. Size&Type HP, kW, KVA, or KVAR' 22O License Number Ltc. Class ; FINAL U Up to 1 Incl. II Over 1 to.10 Incl. DATE VALIDATION 99 Contractor ' DateOver 10 to 50 Incl. b aFINAL r I am exempt under Sec.' Over 50.to 100 Inc. BY LU B.&P.C. for this reason Over 1'00 Date: Services, Swbd.,MCC&Panelboards 0 -200 Amp. Under 600 V RP Signature 201 - 1000 Amp. Under 600.V Exemption for Reg. Maint. Elect. , Over 1000 Amp. or Over 600'y SINGLE FAMILY Temp. Power Pole&Appurtenances ` HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit - I hereby affirm that I am exempt from the9Contractor's License Additional Sign Branch Circuits Law for the.following.reason (Section 7031.5, Business and Professions Code): , 7333A.' ' I, as owner of the property, will do the work and the' &sc. Conduits&Conductors structure is not intended or offered for sale (Section Other(See Complete Fee Schedule) 0 0 o a o.2 7044, Business and ProfessionsCode'). Q o o F.9,9 8 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending,agency for I. a o o u 9.C,f' the performance of the work for which this.permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). 1 1,03-82 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, and hereby authorize represenfatives of this County to enter upon the above- ntion d ropertl, or,inspection purposes. 1` SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o. r Be Daie