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Home My Public Portal About6272 AVON AVE_Electrical__ WORKERS',COMPENSATIONDECLARATION 76A663 10/81 ' I hereby affirm that I have a certificate of consent to self.insure, CE-806G APPLICATION FOR ELECTRICAL PERMIT or a,certificaie of Workers' Compensation Insurance, or-a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab. C.) Pplicy No. 1 CompanyM IRMMSI FOR APPLICANT TO FILL IN JOB ❑ Certified copy is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE ADDRESS Z 2 ❑ 1 & 2-Family, Sq.Ft. $ _ $ LOCALITY Cw Certified copy is filed with the county building inspection department. Multi-family Sq.Ft. NEAREST ST: Date' – �P A licant Residential Swimming Pools CROSS OWNER OR //�q� PP FIRM NAMEL'j ,-Je /v CERTIFICATE OF EXEMPTION FROM ORKERS' Outlets:Rec Light _> Sw. MAIL COMPENSATION INSURANCE ff ADDRESS This section need not be completed if the work involved b the First 20 ( P y Total No Additional CITY Tel.No. � permit is for one hundred dollars($100)or less.) I certifythat in the performance of the work for which this permit PLAN CHECK P P APPLICANT is issued, I shall not employ any person in any manner so as to 7 become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ` ADDRESS Additional • Total No.� CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of PERMIT Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. APPLICANT G C. provisions of the Labor Code, you must forthwith comply with such Oven Dryer W.M._ ADDRESS O ' _ provisions or this permit shall be deemed revoked. Top FAU W.H. _ LICENSED CONTRACTORS DECLARATION Hood Fan Other_ CITY A Tel.No.30 Tri I hereby affirm that I am licensed under provisions of Chapter 9 / LICENS OR (commencing with Section 7000) of Division 3.of the Business and Disp: Room Air Cond. — REG.NUMBER 2�_ Class. G'-!49 Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PR E ED BY Size & Type HP,KW,KVA,or KVAR -5 , 0,F b License Number Lic.Class Up to 1 Incl FINAL /,/J�► ` & d 10 1 Over 1 to 10 1ncl.'1Q/L', DATE 5f/ VALIDATION O Contractors Date d� Over 10 to 50 Incl. FINAL V (~� ❑ I am exempt under Sec. Over 50 to 100 Inc. BY144 0 LL1 BAP.C.for this reason Over 100 N i Date: Services,Swbd.,MCC& Panelboards ® Z 00 Under 600 V Signature 201 - 1000 Amp.Under 600 V _.............__..............._..... Over 1000 Amp.or Over 600 V Eq/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 Law ACCT A' ... . for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): ' .._............._.._.......__..... 3L/7 7801+50 4p El 1, Conduits I,as owner of the property,will do the work and the structure & Conductors -• - -• I d is not intended or offered for sale (Section 7044, Business Other (See Complete Fee Schedule) TOM –� and Professions Code). , __.......+eO��Pt��. B" ,,m 50 CONSTRUCTION LENDING AGENCY CASA 78M 1 hereby affirm that there is a construction lending agency for the .. ... rUlf performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) CME Civ. C.). Lender's Name PLAN CHECKING FEE C=–=1 7/13/089 PERMIT ISSUING FEE 4463 3 q AM M4 Lender's Address y I certify that I have read this application and state that the above TOTAL FEE 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 l U proper for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Pep6riffe,6 Date c� a-� �-�o for : ••.: .:. .....�,.•�' ,, ._ -.,..; .. .. <:.:;.:..• .,.. .. MI DEPARTMENT OF.BUILDING _1ND $Ap�rTy "'APPLICATION FOR PERT COUYTY OF'LOS ANGELES : ELECTRIC I WM J FOX CHIEF ENGINEER NATURE OF INSTALLATION . O1GTRICT • . GRgWP zo B I P RMITQNo, WIRING FIXTURES ( SERVICE 1 + r RANGE HEATER RtCE1VlCG� READY FOR AT ISSUED POWER ( FIRST 1141310 10N SIGNS MISCELLANEOUS 1 V r APPLICANT FHL IN HEAVILY OUTLINED PORTION ONLY Ar .� NAM �. �f..r ion . . „` ADDRESS. V(_ ADD�RE99 L-CALf.rY JCITY Tt'L No. :�. NEAREST Y COUNTY CROSS sT CERT. NO. 7 J '� `✓ti I EXPIRE! u.'.^�` DESCRIPTION OF WORK Z MAIL, NUMBER OF OUTLLTS ON CiRCUITti 3 ADDR[:t3 LOCATION BY ROOMS O LLIGHT OUTLETS SW. PLUGS rIXT. C1� TEL No• CIRCUIT I AM THE L POssra R W T t ABOVE Lou I A B C D E F G :4— + ANGELES-CO p LIVING ROOM + `— ftl.[CTRICtAM DINING ROOM __ I 1 AM THE LEGAL OWNER OF THE PROPERTY DUCRIBCD ABOVQ. BRFST, RM, J _ JN LL 1 L HALL NO. _ •f.._.��^a.'.f'�::^---+r.':.�--:ice_ .w_._Y.:� �•�.r•%4�" �e�.�-, _ `� + 7 -- KITCHEN •I��fl SERV. .1 Bf1RM. No__ _ .,• Z ct.0sET t s t7 CLOS['T TOTAL I ( I I r NO. OF OUTLETt s APPROVALS NO. OF FIXTURES s •U . DATE INR/[CTOR-61 MAWR NO. OR MOT�-IRS . ..H. P. tom,.° :[ CONDUIT NO. OF SIGNS TRA1•►R,' ¢ „ WIRING -!NO.-OF RANGES OR•H[AT'`RS ' f ri ^ 1P " FIXTURES, MISCELLANEOUS � Y PERMIT FE[ , -� r vTtuTv ea NOTiFIEp 4� �y •.� [r ./ili:tt• Ji t+q ,.y ry..' x�,N g �r'. `.h �, t �.¢ F,�'�`� q b a w = UT o. . tot, - APPLICATION FOR' PERMIT:. DEPARTMENT OF..BUILDING AND SAFETY COUNTY OF LOS ANGELESC1l�ll, WM J. FOX CHIEF ENGIN[Ett NATURE OF INSTALLATION DISTPICZ O• - GR O P Z NE ERMIT No. WIRINGELMRA T'UREi fCRVIC!' ( � , gR � O_ Y LADY FOR D ' ISSUED RANG>iTlR I�aiWlR " pp FIRST INfP[CT70N QtON9 CELLANEOVf ` ? y /� .�......... Ll J APPLICANT FILL IN IIEAVII.Y OLTTLINED PORTION ONLY job_� ( NAl+itrSr'i.w •.� ^'rte r.:, ADDRtf! e v U _ j AOnrtERs ✓ LOCALITY N C►TY�• j— TEL NG. Zd I �^ NEAREST couNTY cHoss ST. CERT. NO. y EXPIRES NAM! w� DESCRIPTION Or WORK x !GAIL NUx=Vt or OUTLETS ON CIRCUM O ADDRGbd LOCATION BY ROOMS CITY TEL No. LIGHT OUTLETS SWI PLUGd n>R. I AM THE LEGAL POSSESSOR OF THA ABOVE LOS CIRCUIT ( A Ej C O E F I G H ANGELES COUNTY CERTIFIC E F LIVING ROOM l t CTRtCtAN. DINING ROOM ! ABOVE THE LEGAL OWNER OF THE PRO DgCRISED 8RF9T. RM. D "T #.,, , I CORRECTIONS FRONT PORCH I ! Z1,.iw.9c!t,�"i:i err?.:�: •': -. - ..-.i k..... .. �.,�. KITCHEN SERV. PCH. FORM. No. 1 , Jam_ / Z CLOSET :. CORM. No.3 Nig. or ouTLETf tc APPROVALS rir NO. OF FIXTURES f DATE S' NO. OF MOTORS CONDUIT77 .J NO. OF, SIGNS TRAM$. l{ WIRING,.. . ,.1 1_ •. Ll NOi OP.RANGES OR HEAT! S t } ►IXTSTR[S r 'Y PERMIT f[l e ' S TTY CO NOTIFII[p ;5• S `�. >:. --FTNAc r,<w.lv ar,.'i d:."f-�,Jti:t.:: .x;°:'?-n 5..�,•YR"F.MeRi. b".. "�r:� T si)A=t""1"p}Y, ��x: ' ,�cc. 7✓ ... -'S+� WORfCf-9 have a NSATION DECLARATION 76-806 10/81 APPLICATION FOR ELECTRICAL PERMIT CE-806G P hereby affirm tt�t I have a certificate of consent to self insure, or•a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY cppy•thereof(sec.3800,Lab.C.) Policy'NO. Company FOR APPLICANT TO FILL IN JOB - D LTJ'} New Residential Bldgs.& Pools Certified copy is hereby furnished. EACH NO. FEE ADDRESS Z G ❑ 1 & 2-Family,Sq.Ft. $ _ $ LOCALITY Certified copy is filed wit the .county building inspection epar nt. Multi-family Sq.Ft. NEAREST CROSS ST. Residential Swimming Pools L�/V7 Date Applicant OWNER OR ' FIRM NAME ERTIF T� F EXEMPTION FRO ORK S' Outlets:Rec Light Sw. — MAIL R 7 COMPENSATION INSURANCE ADDRESS Z Z U 1V (This section need not be completed if the work involved by the First 20 ` Total No. Additional CITY r Tel.No. y permit is for one hundred dollars($100) or less.) '0 I certify that in the performance of the work for which this permit' PLAN CHKAPPLICANT is issued, I shall not employ any person in any manner so as to become gyoushoulKbecome ' orkers'Compensation Laws. Lighting Fixtures First 20 ADDRESS 172 Additional Total No. CITY Tel.No. Date ApplicantFixed Appliances Not Over 1 HPNOTICET: If, afte mak' this Certificate PERMIT Exemptio , subject to t Workers'Compens Range_ Heater_ D.W. _ APPLICANTS provisions of the Labor Code, you must orthwith comply,wit ch Oven Dryer _ W.M._ ADDRESS provisions or this permit shall be deemed revoked. Top FAU _ W.H. LICENSED CONTRACTORS DECLARATION CITY Hood Fan. Other_ Tel.No. I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR (commencing with Section 7000) of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER Class. Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PROCESSEU BY Size & Type HP,KW,KVA,or KVAR U License Number Lic.Class Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE VALIDATION 0 Contractor Date Over 10 to 50 Incl. FINAL V ❑ I am exempt under Sec. Over 50 to 100 Inc. BY W Over 100 B.&P.C. for this reason N Services,Swbd.,MCC& Panelboards ; , Z Date: 0-200 Amp.Under 600 V Signature 201 - 1000 Amp. Under 600 V' F1 Exemption 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole& Appurtenances 2 HOME OWNER-BUILDER DECLARATION Sin with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits yy�!� -25M S Code): 1 b i�t OTA I,as owner of the property,will do the work and the structure Misc.Conduits& Conductors TOTAL V i Y'eL 25t050 is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , 25.50and Professions Code). 4P1�S� ,J�Vy CONSTRUCTION LENDING AGENCY4Y'AMI E 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) ^' � �� / ��pp Civ. C.). t Gtr 77 PLAN CHECKING FEE �� Lender's Name S 46 PERMIT ISSUING FEE Lender's Address r �/ I certify that I have read this application and state that the above TOTAL FEE JC 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 ;gn y for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGEA, • re fPemittee Dat WORKERS' COMPENSATION DECLARATION 20-0019 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT 76A663 hereby afrirm that I have a certificate of consent to self CE-806G insure, or a certificat; of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a c.rtified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB El Certified copy is hereby furnished. New Residential Bldgs. & Pool EACH NO. FEE ADDRESS ' ;2 Z L Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft.--n\ _ $ LOCALITY tion department. Multi-family Sq. Ft. NEAREST �j CROSS ST. Y Date A licant Residential Swimming Pools OWNER OR PP FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RecJ6kLightJ7_Sw./_0_ MAILVC I M COMPENSATION INSURANCE ADDRESS First 20 (This section need not be completed if the work involved by Total No. Additional CITY -�• Tel. No.2St _ 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 G permit is issued, I shall not employ any person in any mannerZ S so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 7 ADDRESS Additional Total No. CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION 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 414 ry with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. Hood — Fan —Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR Disp. — Room Air Cond. Class. I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER (commencing with Section 7000)of Division 3 of the Business Power Apparatus & Large Appliances DISTRICT NO. PRS D BY d and Professions Code,and my license is in full force and effect. Size 8 Type HP, KW, KVA, or KVAR r v O License Number Lic. Class Up to 1 Incl. FINAL C\ Over 1 to 10 Incl. DATE VALIDATION tr qN1 Contractor Date Over 10 to 50 Incl. FINAL O aI am exempt under Sec. Over 50 to 100 Inc. BY 3 j W B.&P.C. for this reason Over 100 d Services, Swbd., MCC& Ponelboards z Date: 0- 200 Amp. Under 600 V 11 Signature 201 - 1000 Amp. Under 600 V 1 El Exemption 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 Profgssions 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 7044, Other (See Complete Fee Schedule)_ 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 L 4a 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 t.Me above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sign ure of Permittee Date