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Home My Public Portal About5947 AGNES AVE_Electrical__ e 76A663 CE 80616/781 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY 33 FOR APPLICANT TO FILL IN JOB New Residential Bldgs &Pools EACH NO FEE ADDRESS 1 &2 Family Sq Ft $ 025 — $ LOCALITY Multi family Sq Ft 02 — NEAREST / " Residential Swimming Pools 25 00 CROSS ST d ` OWNER OR FIRM NAME Outlets Rec Light Sw ADDRESS First 20 50 Total No Additional 30 CITY Tel Not i PLAN CHECK APPLICANT Lighting Fixtures First 20 50 ADDRESS Additional 30 Total No CITY el No � Fixed Appliances Not Over 1 HP PERMIT Range_Heater_D W APPLICANT v Oven_Dryer_W M_ ADDRESS 0'" Top _FAU _ W H CITYTel No Z Hood_Fan _Other_ LICENS OR Disp —Room Air Cond 2 50 REG NUMBER Class O IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO Size&Type HP KW KVA or KVAR COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS 250 REGULATING ELECTRICAL WIRING Up to 1 Incl I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR Over 1 to 10 Incl 5 00 LICENSED AS REQUIRED BY LOS ANGELES TY AND STATE OF Over 10 to 50 Incl 12 50 CALIFORNIA OR THAT I HE LEG OW OF THE ABOVE VV 25 00 DESCRIBED RESIDENTI R ERTY ` Over 50 to 100 Inc ' S�Ejj Over 100 40 00 PERMITEE SIGNATURE _ Services 1 2 50 /Z DISTRICT NO �� \PRO SSED B 0 200 Amp Under 600 V mac, Q Q 761000 Amp Under 600 V 25 00 �J o Over 1000 Amp or Over 600 V 5000 Z ' O Temp Power Pole&Appurtenances 1000 Q Sign with One Branch Circuit 10 00 G Additional Sign Branch Circuits 2 00 INSPECTION > 10 0o INFORMATION Misc Conduits&Conductors ON REVERSE _ 4 4 9 3 A Other(See Complete Fee Schedule) SIDE u Z # Q o o o o 2 d 2oo1950 PERMIT FEE (Sub Total) - Z 0 19500 PLAN CHECKING FEE (One Fourth Permit Feel O PERMIT ISSUING FEE $7 00 0 5,22 79 J TOTAL FEEj� > It— INSPECTION INSPECTION FINALED o�c W date5:�� J_010 '�`�e3_ �s I�WOWKERS COMPENSATION DECLARATION 76A663 10/81 APPLICATION FOR ELECTRICAL PERMIT jfeby affirm that I have a certificate of consent to self CE 8066 ' insp#e or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY oFa certified copy thereof (Sec 3800 Lob C ) Policy No Company FOR APPLICANT TO FILL IN JOB //--� Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS G-;S-4-7 At✓��S ❑ S —Certified cpy is filed with the county building inspec 1 & 2 Family q Ft $ $ LOCALITY tion department Multi family Sq Ft NEAREST Date Applicant Residential Swimming Pools CROSS ST FIRM NAME + OWNER M G CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec 1 6-Light Z Sw 5 MAIL COMPENSATION INSURANCE ADDRESS ( completed if the work involved b This section need not be com First 20 2B5 5(67 Y Total No Additional 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 so as'to become subject to the rkers Comp n ation Laws Lighting Fixtures First 20 ADDRESS 24'443FApplicant No -5 Additional Date Applicant CITY AA I No NOTICE TO APPLICANT If a r along this Cert ate of Fixed Appliances Not Over 1 HP PERMIT Exemption you should bec 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 No � Hood _ Fan _ Other LICENSED CONTRACTORS DECLARATION 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 Power Apparatus& Large Appliances DISTRICT NO PRO S D BY >- and Professions Code and my license is in full force and effect } d Size &Type HP KW KVA or KVAR O License Number Lic Class Up to 1 Incl FINAL U IM Over 1 to 10 Incl DATE /- VALI ON O Contractor Date Over 10 to 50 Incl Fj / U U ❑ I am exempt under Sec Over 50 to 100 Inc B / LY B &P C for this reason Over 100 / W Services Swbd MCC& Panelboards 1 - Z Date 0 200 Amp Under 600 V 1 Signature 201 1000 Amp Under 600V ❑ Over 1000 Amp or Over 600 V Exemption for Reg Maint Eject SINGLE FAMILY Temp PoweriPole &Appurtenances .22072 -+ 1 HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit # O O O O-O I hereby affirm that I am exempt from the Contractor s License Law for the following reason (Section 7031 5 Business and Additional Sign Branch Circuits 0 4 7 2 5, V 7structures ions Code) o 0 o 4 7 2 5 5 as owner of the property will do the work and the MISC Conduits& Conductors inot intended or offered for sale (Section Other (See Complete Fee Schedule)— 0 4,20 7044 Business and Professions Code) 1 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 ) f 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 representatives of this County to enter upon the ve mentioned pippErty for ins i ection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE SigMture of Permittee Date J WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) I hereby affirm that I have a certificate of consent to self insure, 76A663 APPLICATION FOR ELECTRICAL PERMIT or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec. 3800 Lab. C.) /,y,/�o / Policy NO. Company V/ FOR APPLICANT TO FILL IN JOB ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE + — e Certified copy is filed with the county building inspection 1&2-Family,Sq.Ft. $ $ LOCALITY CC" department. NEARESTMulti-famil Sq Ft. CROSS ST. Z Applicant Residential Swimming Pools Date ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROMO KERS' OWNER OR ` Outlets:Rec. Light / Sw. rO FIRM NAME �``•'� #T COMPENSATION INSURAN First 20 4 ;Le �j G (This section need not be completed if the work involved by the Total No. Additional ADDRESS S—[ ( 7 f permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITY C Q �.� 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 ADDRESS Date Applicant RE !EAnPIA:N�COTVER APVER 3 HP.NOTICE TO APPLICANT: 1f, after making this.Certificate of /v O CITY Tel.No. Exemption, you should become subject to the Workers' Compensation 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS U 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 CITYArduA*YTel.No. �/ Q Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. Over 50 to 100 Incl. LICENSE OR Class. P—2� REG.NUMBER License Number Lic.Class Over 100 DISTRICT NO. PROCESSED BY 0 U G� Services,Swbd.,MCC&Panelboards Q ContractorDate I / 0-399 Amp.Under 600 V FINAL O DATE I� 400-1000 Amp.Under 600 V ❑ I am exempt u r Sec. �— -2--1,7 VALIDATION V Over 1000 Amp.or Over 600 V FINAL LU B.&P.C.for this reason BRANCH CIRCUIT FEES BY Date: 15A,or 20A, 120V,Lighting or Recept. Z 1 To 10 Branch Circuits Signature '11 To 40 Branch Circuits El41 Or More Branch Circuits _ Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY -- S HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances Sign with One Branch Circuit s i I hereby affirm that I am exempt from the Contractor's License Law ,�1-1�. vcn t}� for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits 7 Code): 1 r iTE! .O ❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors TC IAL 65 - 10 5- ® 10 is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) Jl. and Professions Code). CHECK 65.1110 fJ S. � 5 n i f i CONSTRUCTION LENDING AGENCY CHANGE .00 f 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 f•,!0I_I`{—ILI0 C! 5�t/24/9 Lender's Name J 7894 1 tiM10'�4 PERMIT ISSUING FEE �,-'S I Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE J / 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 i ection p 7rpes. SEE REVERSE FOR EXPLANATORY LANGUAGE ��- aL-673673 SIGNATURE OFP ITTEE DATE