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Home My Public Portal About9008 - 9010 BROADWAY_Electrical__ RKE WOthat I haveCOMPENSATION DECLARATION 200019 DPW(12-91) ,-APPLICATION .FOR ELECTRICAL PERMIT )BA663 I hereby affirm that I have a certificate of consent to sell insure, � � or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. cop reof(Sec..3800 Lab C. (,� .WhoN0.Z. Company Lkl I p FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished '� ADDRESS — New Residential Bltlgs.&Pools NO. EACH FEE $ $ LOCALITY ❑ Certified copy is filed with t+cnty builtling ins action 1 8i--Family, .Sq. Ft Ft.de rtm n1. Mut-fam S Ft. NEARESTY g� OROSSSTDate 1�Z Applic Residential Swimming Pools - ASSESSOR MAP BOOK PAGE PAP EL CERTIFICATE OF EMOM WO E Outlets:Pec._Light Sw. OWNER OR _COMPEN TIANCE FIRM NAME `/CL•[/! !, First 20 n (This f need not be co e d the work Involved by the MAIL permlt IsIs for one hundred dollars($1000)or less.) Total No. Additional A . I certify that in the performance of the work for which this permit q7,43 S 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 AP NCH CK Total No. Additional ADDRESS NDate OT NOTICE TO APPLICANT: If, after making this Certificate of RESIDENTIAL APPLIANCES NOT OVER 3 HP. 'CITY " ' - ` ' -- Tel.N. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code. you mus(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 ADDRES/S� d5 G �/'�6(�ro I hereby affirm that I too licensed under provisions of Chapter 9 O R E /l��l)` r! �1 .' Over.3.to 10 Incl. (commencing with Section Tense is Division 3 Of the Business and _ - I. Professions Cade,and my license is in full force and effect. Over 10 to SO Ind. } LICENSE OR c3 7- Class.& fl A�� `� 9 Over 5010 100 Incl. REG.NUMBER L/ License Number��LIC.Class Over 100 DISTRICT NO. PROCESSED BY Services,Swbd.,MCC&Panelboards Contractor ' Date`7-'-T�-'` 0-399 Amp.Under 600 V DIATE F- F-1am exempt under Sec. 400-1000 Amp. Under 600 V -�'� VALIDATION W Over 1000 Amp.Or Over 600 V FINAL B.BP.C.for this reason CL BRANCH CIRCUIT FEES eY �� U) Date: 15A,or 20A,120V,Lighting or Recept. Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits 7 SINGLE FAMILY Temp.Power Pole&Appurtenances - ACCT.: HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 3 I hereby affirm that I.am exempt from the Contractor's License Law Y1 for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits e 1. ITEMS 62.10 Code): ❑ 1,as owner of the property,will do the work and the structure Misc.Conduits 8 Conductors TOTAL ICA is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). D CHECK 62.10 CONSTRUCTION LENDING AGENCY CHANGE .00 I hereby affirm that there is a construction lending agency for the �� per of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) (f Civ.C.) 0000-0001 3/ 7/96 PLAN CHECKING FEE .9185 1 FPi12:19 Lender's Name PERMIT ISSUING FEE Q Lender's Address I certify that I have read This application and under penalty of purjury state , TOTAL FEE (p that the above information is correct. I agree to comply with all County ordinances and State law regulating Electrical wiring,and hereby authorize representatives of this o my to wtthmentioned- property property for insp ction purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 3 7 1(GNAT RE OF PERMITTEE, D E ' WQRKERSiLbMPENSRTIONOECLARATION -583 10,81 CE-806G APPLICATION .FOR ELECTRICAL PERMIT " I herehy-affirm that I haves certificate of consent,to seY insure, CE or a certifroate.of Workers Compensation Insurance, or a certified COUNTY OF LOS ANGELES - BUIL ND SAFe� . ' :'copy thereof(Sec.3800,Lab.'G) I ` -Policy NOI f i ii Company 6 Vp � ^iI FOR APPLICANT TO FILL IN -- JOBADDRESS Certified copy is hereby furnishetl. � 'EACH' NO. FEE New Resitlential Bldgs.8'PoolsCertified.copy is filed'with the county building inspection 1 & 2-Family,Sq.Ft. S — $ LOCALIT �/r departure t. - Multi-family Sq.Ft. I NEAREST �a/�/ •A!� CROSS ST./.I:J F Residential Swimming PoolsApplicant r OWNER OR FIRM NAME ' ERTI�EXEMPTION FROM WORKERS' . Outlets:Red— Light Sw.— MAIL -COMPENSATION INSURANCE. - - - ADDRESS .,1 (This section need not be completed if the work,involved'by the .First 20 ! permit.is for,one hundred dollars($100)or less.) ;y Total No. Additional CITY r/( Tel.Na. I certify that in the performance of the work for which this permit PLAN-CHECK:, APPLICANT is issued, I shall not employ.any person in,any manner so as to' - become subject to the'Workers'Compensation Laws, Lighting Fixtures Fust 20 'ADDRESS if/ ' - - . ' Additional Total No. _ CITY r Tel No3 ..Date __ _ Applicant ate`of-.- Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to thO APPLICANT: If, e Workers'Compensation Range_ Heiiter_ D.W. `APPLICANT- provisions of the Labor Code, you must°ifortbwith comply-with such. Oven *Oryern_.W.M._ _ _ ADDRESS - - - Provisions or this permit shall be deemed revoked. •` I Top FAU W.H. - - ---- -- - ' LICENSED CONTRACTORS DECLARATION CITY -• - Tel.No. Hood Fan Other_ hereby affirm_that L=am.licensed.under provisions„of`Chapter 9 i - LICENSE OR _ f. - _ _ <- = DisP, Room Air COM.. .y -REG..NUMBER Class. (commenting with Section 7000) of Division 3 of the Business antl .- -' - - -- _ ' Professions'Code.and my license is in full force antl effect. - DISTRICT NO. P SED BY_ - Power Apparatus& Large Appliances .r— tea/ Size& Type HP,KW,KVA,or KVAR O License Numberl-lV�� Date � f7Lia Clasls G •5 S Up to 7 Incl.' - FINAL - U d� -� I I - Over 1 to 10Incl. DATE - 4i Kt! - - < VALIDATION �. . ❑ � Over�10 to 501nc1. ' � FINAL F ' I am exempt under Sea - Over 50 to 100 Inc. - BY B.&P.C.for this reason Over 100. W d Services,Swbd.,MCC&-Panelboards D - N - Date: _ _ 0- 200 Amp.'Under 600 V - - Signstuire - ` 201 - 1000 Amp.-Under 600 V 0VV ElOver 1000 Amp.or Over 600 v 1 2 95 A Exemption for Reg.Maint.Elect.' r SINGLE FAMILY-- Temp.Power Pole& Appurtenances a e'e e e 'Z -HOME OWNER-BUILDER.DECLARATION '” - + - - I:hereby affirm that I am exempt from the Contractors License Law Sign with One Branch Circuit 'I e o 2 5.5 for the following reason(Section 7031.5, Business and Professions- Additional Sign Branch,Circuits - t Code): ' e'e o255�c�i ❑ I,as owner of the ro y,will tlo, Misc,Cor its•&•:Conductors p pert 'the`work and the structure 12.O 81_8 8 is not intended or offered,for sale (Section 7044, Business Other(See Complete Fee Schedule) ' 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(Sec.3097,-. .PERMIT FEE .. -(Sub-Total) Q Civ:C.). - PLAN.CHECKING�FEE. Lender's Name ' PERMIT ISSUING FEE L 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 or inspection perp I - SEE REVERSE.FOR EXPLANATORY LANGUAGE .Signature of mittee - - ,.-Dat= WORKERS'Cghaft SATIONcate of corse 20.0014DPW A,97 APPLICATION FOR ELECTRICAL PERMIT O hereby affirm that I haver certificate of consent Ia self CEABO�tG - insure, or ed copy ot y the of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEP P ORKS or G certified copy thereof (Sec. 3800, Lob. C/) .7c Policy Nc ompany dw� FOR APPLICANT TO FILL IN JOB ❑Certified copy is hereby furnished. New Residential Bldgs. &,Pools EACH NO. FEE ADORESX Certified copy is filed with the county building inspec- 1N8 2-Family, Sq. Ft._ t $ _ $,. LOCALITY= _ _ t tion d partment. r Multi-family Sq'Ft. NEAREST CROSS ST. _ U !�• �y�.O� Residential Swimming Pools OWNER Off Date �3 / Applicant _ FIRM NAME - G CERTIFICATE OF EXEMPTION,FROM WORKERS' Outlets: RecLighl_Sw.— MAIL - COMPENSATION INSURANCE a ADDRESS (This section need not be completed if the work Involved by First 20 CITY _ el. No. the permit is for one hundred dollars ($100)or less.) Total No. Additional certify that in the performance of the work for which this PLAN CHECKAPPLICANT permit is issued, I shall not employ any person in any manner Lighting Fixtures First 20 ADDRESS so as to become subject to the Workers'Compensation Laws. Additional Total No.� CITY Tel. No. Date Applicant Fixed Appliances Not Over I HP PERMIT -' NOTICE TO APPLICANTµlf, -after making-th ii 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 with comply with such provisions or this permit shall be Top —.FAU. —W.H. — _ - -deemed revoked. Hood — Fan —Other_ CITYTel. LICENSED CONTRACTORS DECLARATION ., LICENSE OR Disp.- — Room Air Cond 7� 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 8 Large Appliances DISTRICT NO. PRTDAa and Professions Code, and my license is in full force and effect. j.7 /� Size 8 Type HP, KW, KVA, or KVAR 0 License Number // : Lic Class 4a�� - Up to I Incl.' '- FINAL V �,//,y// p/ Over 1 to 10 Incl. DATE VALIDATION Q ContractodLJ yfj4'r�� Dote/'yL�+`-/--�--�'- .❑ Over 10 to 50 Ind. FINAL _ f- am exempt under Sec. Over 50 to 100 Inc. BY LU _ B.BP.C. for this reason Over 100 / d Services, Swbd., MCC 8 Ponelboards 2 D / Z Date: 0- 200 Amp. Under 600 V An Signature 201- 1000 Amp. Under 600 V - j• ❑ Exemption for Reg. Maiat. Elect. Over 1000 Amp. or Over 600 V .SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp. Power Pole 8 Appurtenances I hereby affirm that I r exempt from the Contractor's License Sign with One Branch Circuit Al Law for the followingg reason (Section 7031.5, Business and Additional Sign Branch Circuits _ - Professions Code): � `}`x07 92.I30 ❑ 1, as owner of the property, will do the work and the Misc. Conduits 8 Conductors 1 ITEMS structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ D TOTAL 92 - 00 Business and Professions Code). I_ CONSTRUCTION LENDING AGENCY _ CHECK 92?.01, I hereby affirm that there is a construction lending agency for CHANGE - - .00 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 0000-0001 11/ 9/89 Lender's AddrePERMIT ISSUING FEE 6687 1_ AM 10:44 ss / O ' 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 th ave-mentioned property for inspection purpose/s. w SEE REVERSE FOR EXPLANATORY LANGUAGE o. Signature of Permittee Date - - _J WORKERS';CyMPENSAR{ON DECLARATION -663 IDs, CE-806G APPLICATION FOR ELECTRICAL PERMIT I hej 12I affirm that I have a certificate of consent to self-,insure, CE orrtificale of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING A D AFETY copy Cher .:.3800.Lab.C} rl ®cy NO 3Company ��•LV FOR APPLICANT TO FILL IN JOB 1�2a'J/,_, Certified copy is hereb rmshed. EACH NO. FEE ADDRES New Resitlential Bldgs.& Pools -Certified copy is filed with th aunty building inspection 1 & 2-Family,Sq.FL S — $ LOCALITY �� apartment. \� Multi-family Sq.Ft. NEAREST — /Q�y(o>11J GP/l'�� Residential Swimming Pools CROSS ST. Date Applicant OWNER T. FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS"'-,,, Outlets:Fee Light Sw.— p COMPENSATION INSURANCE TS DRESS (This section need not be completed if the work involved by the First 20 permit IE for one hundred dollars($100)or less.) Total No. Additional CITY'' I.No. I certify 'hat in the performance of the work for which this permit PLAN CMECK is issued I shall not employ any person in any manner so as to APPLICANT become subject to the Workers'Compen tion Laws. Lighting Fixtures First 20 ADDRESS r• ^Zl Total No..4// Additional CITY Tel.No. Date plican 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_ H6ater_ D.W. _ APPLICANT 1 provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M._ ADDRESS s 5 — provisions or this permit shall be deemed revoked. Top _ I _ W.H. LICENSED CONTRACTORS DECLARATIONCITY 1 Tel.No ZJY7 Hood Fan Other_ 1 1 hereby affirm that I am licensed under-provisions of Chapter 9 Oise. _ Room Air Cond. UCE SE OR Class �. I (commencing with Section 7000)of Division 3 of theBusinessand REG.NUMBER Professions Code,and my license is in full force and effect. DISTRICT NO. PROCEED BY�('x SSr� Power Apparatus 8 Large Appliances \�\ \VA) J�/ I, Size& Type HP,KW,KVA, or KVAR ij V 0 License Numbe wV /t: Lie.Class_f—(� 7 FINAL V Up to 1 Incl. QnY` 6;- ��X Over 1 to 10 Incl. DATE UX /Vf J VALIDATION Contractor o/t+� Date O ❑ ) Over 10 to 50 Incl. .Q U FINAL BY �G W I am exempt under Sec. Over 50 to 100 Inc. ��JJIVVV B&P.C.for this reason Over 100 4. N Services,Swbd.,MCC& PanelboardsONO. Z Date: 0 - 200 Amp.Under 600 V ... Signature 201 - 1000 Amp.Under 600 V Or3 ❑ Exemption for Reg. Maint.Elect Over 1000 Amp.or Over 600 V d, SINGLE FAMILY Temp.Power Pole& Appurtenances r ( 2 HOME OWNER-BUILDER DECLARATION One Branch Circuit with _ •a I hereby affirm that 1 am exempt from the Contractor's License Law Sign n with Sign Branch Circuits 1f for the following reason(Section 703 1.5, Business and Professions _ Code): =773.75 I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors 1 *t1M is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) yi�[J h7 s� and Professions Cade). , R� '..• CONSTRUCTION LENDING AGENCY INA 73.75 5 I hereby affirm that there is a construction lending agency for the •M performance of the work for which this permit is issued(Sec.3097, Civ. O). PERMIT FEE (Sub-Total) W T� err L ' /i PLAN CHECKING FEE { _ 1 L V/MM Lender's Name (�/t/ LiI v' PERMIT ISSUING FEE b t,M '^ Lender's Address + 4 1 A"lY=55 I certify that I have read this application and state that the above TOTAL FEE 7J information is correct. I agree to comply with'all County ordinances - and S e laws regulating Electrical wiring, and hereby authorize to, tatives of this County to enter upon the above-mentioned P, r for inspection'CI I SEE REVERSE FOR EXPLANATORY LANGUAGE . iiorgriature of He polse Date