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Home My Public Portal About6158 AVON AVE_Electrical__ WORKERS COMPENSATION DECLARATION CE&)8066(' 10/e1 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE 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 JOB ADDRESS / t 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 tion clepart ent Multi family Sq Ft — NEAREST Residential Swimming Pools CROSS ST Date l Y Applica CERTI(IC �FROM /. OWNER OR1✓ FIRM NAME ATE OF EXEMPTIORKERS Outlets Rec Light Sw_ SIL COMPENSATION INSURANCE First 20 ADDRESS (This section need not be completed if the work involved by 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 Workers Compensation Laws Lighting Fixtures First 20 ADDRESS Total No Additional CITY Tel No Date Applicant 4 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 ADDRE S Q , with comply with such provisions or this permit shall be Top _ FAU —W Hn _ _ deemed revoked Hood _ Fan _Other_ CIT Lv/Z Tel IN �J LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp _ Room Air Cond REG NUMBER6�tt5Fy_ 76 Class 3 ij� (commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO PROCES ED BY and Professions Code and my license is in full force and effect d �� G e;LO a ` Size & Type HP KW KVA or KVAR 0 License Numbe Lic Class (o Up to 1 Incl FINAL Q V f Over 1 to 1t0 Incl DATE ��i7i U VALIDATION OC Contractor ate Over 10 to 50 Incl V ❑ FINAL I am exempt under Sec Over 50 to 100 Inc BY �—��.` d B &P C for this reason Over 100 Date Services Swbd MCC& Panelboards S 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 —9 8 0 49 A Professions Code) ❑ I as owner of the property will do the work and the Misc Conduits & Conductors #'0 0 0 o o 2 structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ 2 - 2350 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY - 235030: 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) 203-82 (Sec 3097 Civ C ) PLAN CHECKING FEE Lenders Name PERMIT ISSUING FEE L4ha Ive read this application and state that the TOTAL FEE an is correct I agree to comply with all County otate jaws regulating Electrical wiring andhrepresentatives of this County to enter upon tconed ro rt for inspection p rposes 1 I SEE REVERSE FOR EXPLANATORY LANGUAGE y S1 gna tureNQY Permittee Efate A—. f.G.'t('l��Ms n .� v-1Y' .,� 'S '+�rY( �..- K � ♦ li1c�. �'--...�a�'�--'�--rt.+�.�r`�rr4 T'T!+F��n` +Y'�!'R""f—^.►i^i""'I"l'„"..p�-.R � ��f`�iC�++^^. s�....�e•�l•S�?p.M1��-...- a y,.. _ a — yw. K•- � taw; .-....+�__..yy�+++44 'Y ] ""t .y+, • �*Q DEPARTMENT OF BUILDING APPLICATION FOR PERMIT COI —T�' OF LOS ANGELES ELECTRIC i NATURE1 5 No I PYPE l NO -7— ^^ I «w Rtx3 I_I f. r _-- �'t I I ILk -� f` READY FOR RECEIVED BY I DATE 19SUED HEATER POWER FIRST RANGE INSPECTIt ION _ SIGNS Mt4CELLANEOUS `.f, jt h� ! -2 !7 - �_ APPLICANT FILL IN IIEA�ILY OUTLINED PORTION ONLY Z A.a. c2tre-4. NAM[ ADDR E[l JJs"w ! )2.,4 2-7- U e ADDRESS LOCALITY Y~ �4 NEAREST CI fY TEL NO Z.Z(V CROSS RT y STATECOUNTY a 4-44 J ( LICENSE NO 0-33 REG NO /�t��,/✓1 ` NAME MAIL DESCRIPTION OF WORK ( Z I ADDRESS NUMBER OF OUTLETS ON CIRCUITS O I I CITY TEL NO, LOCATION BY ROOMS i LIGHT OUT-LETS 6w,—PLUGS lFiXT� CORRECTIONS � I I I { , CIRCUIT I Al B C I D I EI I F G H I _ � ,.ry c RSO?.. 1 1 1 1 1I I _1 CMI-411,10 ROOM I I I I 1 1 1 1 L BRKFST RM BATM I I I I I I I Imo. I TNT HALL I I I I I I I t i ! ! _1 FRONT PORCH i 1 I I I fir^ ( I _ _ Rawl j �R�� .,.'rt.,' .. ��Hy�t%..l"��t ' Y1.,.,L t .�< ,S.wa„K� f... w�+.i»�e'P+nc�R.....-r•r--.-.. «._� _ _ .. � �. y+- r.-. 1y n�i ^�..) KITCHEN J t� SERV PCH �� " I Z<, w r Domm P40 CLOSET 4 d s i� BORM CLOS" nom—T—��! —I—T—T—C--f—T 1 l / _wJL !TOTAL NO OF OUTLETS i APPROVALS ►►►111 �'' O, T'..'-- -„ . �9 DATIF tft*"C'tOR) wA.,a NO OF MOTORS 0 CONDUIT NO OF BIGNS'" TRANS S M WIRING 4'^` NO OF RANGES OR H£! RS FIXTURES MISCELLANEOUS S t` POWER PERMIT FEE s r7jCO NOTIFIEQ TOTAL FE[ FINAL r 4 ^ ... -gum � Y �+...+-►n.- ...t .+ �.irn�.sir...�...,..a-+.-r..�.-ti..a�.+caaa�Y.iA..ii^ ti+..+r .++..+..r�-uGr!<;if�:My-•r�` ..�1..tr �,p,t A. a '1 � c ,,,(1 DEpAVEZ �iiEivT OF BUILDING APPLICATION FOR PERMIT dorT CTD J COUTY OF LOS r.r,sELES - LLU A.%.IC NATURE No— I NOmom IMOM TMISCLILLAII-C-2 READY FOR RECEIVED BY DAT[ ISSUED RANGt HATER POWER F RST INSPECTION �HE •IONS I_ f O APPLICANT FILL I*: EEAvII Y OTT", .':EO i'0:'I:O;: O.":L. Joe NAME ►�ir� / Au'FC'ao U v t[ ADDRESS / LOCALITY NEAREST W CITYlzza.I�TEL NO CRCS9 ST Y J I STATE COUNTY 1 W LICENSE No REO No S NAME DESCRIPTION OF WORK 2 HAIL ADDRE68 nUnl--t OF OUTLETS ON CIRCUITS I rrTY TEL NO - LOCATION eV ROOMS LIGHT OUTLETS low� PLUOa FI:T CORRECTIONS ' CIRCUITA I B I C I D E F G ( H I LlYIYG ROOt4 DINING ROOM I / RRKFST RM I I BATH I I,aZI I I FRONT►ORCN .- - - .n ��''+f l��^ ..k Fr a ww w r� fi♦' •.,'�T+� \ r � 1, � �R KITCHEN I I I I I /i I` I t i SERV PCH son" No CLOSET I ( I Q �r aunnt Ho 1 / 1 1 1 t I At CLOSET .+.ars rsr r? _y rs►t I TOTA L VZ I/6/1 ' I/M I '/1 I J� I Y I I • I r NO OF OUTLrn s T APPROVALS -- 7 DA's Ii.iFLCT011 i /.A i1 NO OF MOTORS H P S J CONDUIT NO OF BIONS TRANS / WIRING a NO OF RANGES OR II it3 I FIXTVA[i I i MISCELLANEOUS • 4" Pow CR c t PERMIT FEE / - ~ UTILn C0.NOTIFIED TOTAL FL[ FINAL� '�' �7 I WORKERS COMPENSATION of crosent to CE 806 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have q certificate of consent to self Insure CE Bose dF or a cert+hcate of Workers Compensation Insurance'or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY wpZ thereof(S c 00 Lab C) r POI y No� �+Company ``'I, "-` FOR APPLICANT TO FILL IN 1 JOB 21 (v 1711 Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS It ` ' ` Ir y $ — $ LOCALITY a ❑ Certified copy is ifiled with the county building inspection 1 & 2 Family Sq Ft a� NEAREST n department � � Multi family Sq Fi CROSS ST x Residential Swimming Pools ' ' OWNER OR Date �'— Applicant_ 3 � FIRM NAME � CERTIFICATE O EXEMPTION FROM WORKERS / Outlets Rec Light Sw N MAIL '2— �J COMPENSATION INSURANCE r ADDRESS I 2— _ jG x (This section need not be completed if the work involved by the Total No First 20 CITY l Tel No f permit is for one hundred dollars ($100)or less) Additional I certify that fin the performance of the work for which this permit t PLAN CHECK ` n n� islissued I shall not employ any person in any manner so as to .� APPLICANT c become_ subject to the Workers Compensation Laws Lighting Fixtures First 20 ADDRESS Iia Total No Additional Date } Applicant + CITY Tel No B Fixed Appliances Not Over 1 HP NOTICE TO{APPLICANT If after making this Certificate of pP PERMIT , Exemption you should become subject to they Workers Compensation u, Range_ Heater DW _ ° APPLICANT � i provisions of the Labor Code you must forthwith comply with such Oven _ 'Dryer _ W M _ ti j ADDRESS W �� provisions or this permit shall be deemed revoked Top _ FAU WH _ < f CITY Q Tel No r90 t,% LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ lyhereby affirm that I am licensed under provisions;f Chapter 9 Disp — Room Air Cond LICENSE OR Class ` (commencing with Section 7000) of Division 3 of the Business and REG NUMBER 1 Professions Code and my license is In full force'and effectr DISTRICT NO PRO SED B t ' Power Apparatus& Large Appliances � � �/ e Size& Type HP KW KVA or KVAR (JX License Num S b ► 3 Lic Class - U Up to 1 Incl FINAL t Over 1 to 10 Incl DATE VALIDATION Q Contractor ate y ❑ Over 10 to 50 Incl FINAL V I am ex pt under S c Over 50 to 100 Inc BY W r t ^ a t " B&P C for this reaso ` Over 100 N Services Swbd MCC & Panelboards v , - F Z Z 0 200 Amp Under 600 V Signature ' 201 1000 Amp Under 600 V r s t Over 1000 Amp or Over 600 V u ❑ Exemption for Reg Maint - r SINGLE FAMILY Temp Power Pole& Appurtenances _ 2 HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractors License Law ACCUL for the following reason(Section 7031 5 Business and Professions Additional Sign Branch Circuits r, •tr. Code) ' - ❑ ¢ I as owner of the property will do the work and the,structure Misc Conduits & Conductors 1 ITEM is not intended or offered for sale (Section 7044 Business Other (See Complete Fee Schedule) , and Professions Code) ler " TOTAL 32�?5 CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the , pu�f performance of the work for which this permit is issued(Sec 3097 PERMIT FEE (Sub Total)' rtJAN 1 ' _ E •0 0 Civ C) c PLAN CHECKING FEE , t Lenders Name , tA '' PERMIT ISSUING FEE a �„Mi 10 0/24/8e Lenders Address M1 1 ""'11:14 1 certify that I have read this application and state that the above TOTAL FEE information is c rrect I agree to comply+with all County ordinances and State laws regulat lectrical wiring and hereby authorize representatives f this oun to enter upon the above mentioned propert or insWPros s i JA SEE REVERSE FOR EXPLANATORY LANGUAGE f + Sign re rmi ee Date „ t , µ