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HomeMy Public PortalAbout5122 BARELA AVE_Electrical__ 76A663 CE-806R 9/76 APPLICATION FOR LECTRICAL PERMIT ' COUNTY OF LOS ANGELES f -DEPARTMENT OF COUNTY ENGINEER JOB ADDRESS 57/ 4>i^y 1 (I BUILDING AND SAFETY DIVISION FOR APPLICANTTO FILL IN - LOCALITY New Residential Bldgs.&Pools EACH NO: FEE CROSS ST. 1 &2-Family,Sq.Ft. $ .025 — $ OR Multi-family Sq. Ft. "02 — OWNERFIRMNAME Residential Swimming Pools 20.00' MAIL ADDRESS <3 Outlets:Rec LightZ.Sw. ?=I CITY Tel.No.o&'--'7 First 20 PLAN CHECK / Total No.— Additional 30 APPLICANT L41 *. 'Aso ADDRESS Lighting Fixtures First 20 0(f PV CITY Tel. No. � Additional .30 PERMIT Total No.'— APPLICANT Fixed Appliances Not Over 1 HP ADDRESS Range -Heater—D.W.— CITY Tel. No. Oven—Dryer—W.M. LICENSE OR i Top —FAU —W.H.— REG.NUMBER �/ Class. Hood_Fan _Other— I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Disp. — Room Air Cond. 2.00 THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY OWIN- ANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. Power Apparatus&Large Appliances Size&Type HP,KW,KVA,Or KVAR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS 2,00 REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM Up t0 1 Ind. 2.00 LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. Over 1 to 101nc1. 10.00 PERMITTEE 1 �� Over 10 to 50 Incl. 20.00 \ SIGNATURE V Q Over 50 to 100 Inc. 30.00 Over 100 DISTRICT NOVN ^ CESS D BY Q d Services 16J "� 6 -0-200 Amp.Under 600 V . .12.50 INS CTOR'S us 201-1000 Amp.Under 600 V 25.00 APPROVALS DATE SIGNATURE Z Over 1 b00 Amp.or Over 600 V. 50.00 TEMP. POWER POLE _ 10.00 UN"DERSLAB WORK f0-�>ZZ Temp. Power Pole&Appurtenances Sign with One Branch Circuit 10:00 ROUGH CONDUIT Additional Sign Branch Circuits 2.00 WIRING I Misc.Conduits&Conductors 15.00 FIXTURES Other(See Complete Fee Schedule) POWER AUTHORIZED UTILITY CO.NOTIFIED FINAL !!� d"�� .�/✓ PERMIT FEE (Sub-Total) NOTES PLAN CHECKING FEE (One-Fourth Permit Feel PERMIT ISSUING FEE ZZ TOTAL FEE PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 64 " -SEP 7 .2 ® 1 5.90a SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE .� r ©s �-; I )WORKERS'COMPENSATION DECLARATION CE-8066 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a,certificate of consent to self insure, or a•cer"tificate of'Workers' Compensation lnsur,�nce, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab.C.) Policy No. ` Company FOR APPLICANT TO FILL IN JOB e \ • r,� _r,���, ADDRESS ❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools t�rr EACH NO. FEE ❑ Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft.• 1 n '^' $ — $. �� LOCALITY TCJ'k r2 l e. Uhl department. Multi-family Sq.Ft. NEAREST Residential Swimming Pools CROSS ST. i Date Applicant FFIIRM NAIER ME CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL �7 COMPENSATION INSURANCE Outlets:Rec- Light - Sw. ADDRESS / AJ ( completed if the work involved b This section need not be com the First 20 3 y CITY I Tel.No. g 7o :� permit is for one hundred dollars ($100)or less.) Total No. Additional PLAN CHECK " I certify that in the performance of the work for which this permit APPLICANT 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 Additional Total No. CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HIP PERMIT !� NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT v le)Y1 Q f Exemption,you should become subject to the Workers'Compensation Range Heater] D.W. provisions of the Labor Code, you must forthwith comply with such Oven Dryer W.M._ ADDRESS provisions or this permit shall be deemed revoked. Top FAU W.H. _ CITY Tel.No. LICENSED CONTRACTORS DECLARATION Hood Fan Other_ m I hereby affirm that I am licensed under provisions of Chapter 9 �.� p G� LICENSE OR Dis (commencing with Section 7000) of Division 3 of the Business and p• Room Air Cond. REG.NUMBER Class. Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY Size&Type HP,KW,KVA,or KVAR o 0 License Number Lic.Class Up to 1 Incl. FINAL P U Over 1 to 10 Incl. DATE 3 —/S Contractor Date FINAL VALIDATION 1O Over 10 to 50 ElIncl. I am exempt under Sec. Over 50 to 100 Inc. BY d LLl i B.&P.C.for this reason Over 100 CL IL Services,Swbd.,MCC& Panelboards , 2 z Date: 02 0 mp.Under 600 V _ Signature 201 - 1000 Amp.Under 600 V ACCT. It ❑ Exemption for Reg.Maint.Elect. Over 1000 Amp.or Over 600 V 3307 211-55- SINGLE FAMILY mp.Power & Appurtenances zjQ �� � HOME OWNED-BUILDER DECLARATION Sin with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law g TOTAL 2 1:1-5 for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): L CHECK ?11■yG '`t "' '"' El 1,as owner of the property,will do the work and the structure Misc.Conduits&Conductors CHANE is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , and Professions Code). / CONSTRUCTION LENDING AGENCY 0000-000 1 5/24/911 I hereby affirm that there is a construction lending agency for the P� At�i ■ r performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) 07 AN :52 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 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 property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE a na ur f Permittee Date I . 76ABG3C_ CE9U6I3,f2/75 APPLICATION FOR ELECTRICAL PERMIT {� tz, r r� _ 9UILDING AND SAFETY DIVISIO I FOR APPLICANT TO FILL IN JOB V New Residential Bldgs.&Pools EACH NO. FEE ADDRESS r ® 1 &2 Finaily Sq. Ft. $ _ $ LOCALITY [ (!? I" � Multi-family Sq. Ft. NEAREST Residential Swimming Pools CROSS ST. �}�I� �'�L% OR FIRM NAME Outlets: Light,Switch &Receptacle MAI L C First 20 ADDRESS �^jr7/✓�E '9'G0'/,c r� Additibnal CITY Tel. No. PLAN CHECK Lighting Fixtures APPLICANT First 20 ADDRESS Additional CITY Tel. No. IT Fixed Appliances Not Over 1 HP APPLICANT -7- Range— 7- Range_ Heater_ D.W. ADDRESS 5_14a Al. Oven Dryer W.M. .�^ Top FAU W.H. CITY/e/'-/,0 ,, 61, 1� Tel. No. 2 Hood Fan LICENSE OR O REG. NUMBER j,0JVClass. a' Disp. A.C. 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY O Power Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES ANO STATE LAWS REGULATING (— Size&Type HP, KW, KVA,or KVAR ELECTRICAL WIRING. W Up to 1 Incl. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR Over 1 to 10 Incl. LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF —� CALIFORNIA OR THAT i AM.. THE Ly GAL OWNER OF THE ABOVE Over 10 to 50 Incl. DESCRIBED RESIDE J'IAL PROPERTY Over 50 to 100 Incl. PERMITEE Over 100 SIGNATURE Services DISTRICT NO. PROCESSED BY �i 0-200 Amp. Under 600 V BD 201 -1000 Amp. Under 600 V APPROVALS DATE INSPECTOR'S SIGNATURE Over 1000 Amp.or Over 600 V T E CONDUIT MP. POWER POLE Temp. Power Pole&Appurtenances DERSLAB WORK Sign with One Branch Circuit Additional Sign Branch Circuits (Other) WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (Sub-Total) UTILITY CO.NOTIFIED PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL �U -�L-� `7 r PERMIT ISSUING FEE NOTES TOTAL FEE ;(jo PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 0 6 6 5ti 2b 2- n 9.0 0 -- WORKERS'COMPENSATION DECLAPATION 76-663 10/81 CE-906G APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have-4 certificate of consent to self insure, or a;certificate of 40 rkErs' ComW.nsation Insurance, or a sertified " T COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab.C.) a fl Policy No. " Company FOR APPLICANT TO FILL IN JOB ❑ Ju Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ADDRESS ❑ 1 & 2-Family,Sq.Ft. $ — $ LOCALITY' C Certified copy is filed with the county building inspection — NEAREST r- department. � Multi-family Sq.Ft. CROSS ST. 1 � L L r�/\ Date Applicant Residential Swimming Pools OWNER l9 ` yN FIRM NAMOER T LI L -L yt� G u L'��� CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec—Light— Sw.— MAIL t COMPENSATION INSURANCE ADDRESS First 20 (This section need not be completed if the work involved by the Total No. Additional CITY' 1e. '� 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 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 PERMIT NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APPLICANT provisions of the Labor Cade,you must forthwith comply with such Oven _ Dryer _ W.M._ ADDRESS provisions or this permit shall be deemed revoked. Top — FAU _ W.H. CITY Tel.No. LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ I hereby affirm that I am licensed under provisions of Chapter 9LICENSE OR Class. (commencing with Section 7000) of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER lk Professions Code,and'my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT IyO.i ^� PROC SED BY Size &Type HP,KW,KVA,or KVAR V //) � !")yv Q License Number Lic.Class Up to 1 Incl. FINAL V Over 1 to 10 Incl. DATE „.j 9/ VALIDATION Contractor Date Over 10 to 50 Incl. FINAL E] I am exempt under Sec. Over 50 to 100 Inc. BY li/t G B.&P.C.for this reason Over 100 fn Date: Services,Swbd.,MCC& Panelboards 0 010. Z 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&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ° I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits. - 3 for the following reason(Section 7031.5,Business and Professions E � •s o 3 Code): _ 3117 31.NEI ❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors X is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , T"E'"NC i �.I ,I•_ and Professions Code). l TjITA 1 00 CONSTRUCTION LENDING AGENCY i�7 t r I hereby affirm that there is a construction lending agency for the CHE:•iti performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) J• ,. Civ.C.). CHANGE ,Psis 1 PLAN CHECKING FEE Lender's Name 0000-1,JI�011 8/10/9-0 PERMIT ISSUING FEE C Lender's Address c _,_r I certify that I have read this application and state that the above TOTAL FEE 34 t information is correct.I agree to comply with all County ordinances I 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 Signa e f Permittee Date