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Home My Public Portal About9162 BROADWAY_Electrical__ FA663-'CE8o6 6,63 APPLICATION FOR E&TRICAL PMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS ,t% JOHN A. LAMBIE, COUNTY ENGINEER WILLIAM A. JENSEN. SUPT OF BUILDING LOCALITY i . .I--1,1 r: — -- .-„-.<. .: NEAREST FOR NEAREST I FOR APPLICANT TO FILL IN CROSS HT. RECEPT TOTAL NO. EACH FEE OUTLETS IFIRST 20 Z.O $.20 9 y dtl OWNER LIGNT / MAIL A00'L 'y � ADDRESS SWITC X.� OVER 20 � .10 TOTAL 5"U CITY f "/Jy _A -TEL. NO. LIGHTING FIRST 20 .20 FIXTURES ADO'L ip ELECTRICIAN R N✓ c..A OVER 20 ./T 'j /6 RANGES CLO.DRYERS WTR.NTRS. 1.00 ADDRESS / J /y .O19P. STA.COOK / V CITY iy F Ll TEL.NO. u / T J DISHWASH. CT O.�WABH� oo STATE SPACE NTRS. STA_.APP.(:/H.P.MAX.) -ql\ .50 ' LICENSE NO. MOTORS: OVER NOT OVER H.P. DISTRICT NO. GROUP O E P OLSSED O 1 1.00 1 s 1.50 INSPECTION RECORD 3 8 2.00 a — 15 2.50 �_.. '7Gt.ti/ OV LTd U 15 80 3.00 , w 10 O SO 100 5.00 SIGNS: MO.TRANS- �j �• I ,�.... ,�T'�—�J)'� C NO.LAMPS Si AA .I r µ.ClX .� Z_ SERVICE 0-600V-NOT OVER 200A 1.00 10 SERVICE O.600V.OvER 200 A. 2100 I c �j, � SERVICE OVER HOOV 5.00 r'' +r'^ /"Y MISC. PERMIT ISSUING FEE 2.00 OZ SUPPLEMENTA13Y PERMIT ISSUING FEE 1.00 TOTAL FEE a I1I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS VDAMINSPEROWS SIGNATURE AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLYOONDUIT WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATINGELECTRICAL WIRING. WIRING 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED L08 ANGELEe COUNTY ANO STATE OF FIXTURESCALIFORNIA OR TXAT A THELEGA O ER OF TXE ABOVEDESCRIBED REBIDENTI PO Y. POWERSIGNATURE / UTILITY CO.NOTIFIEDS OF PERMITTEE vFINAL 0OATION CAS ARTHUR C. VEIT 4 N SUPERVISING ELECTRICAL ENGINEER CK CABR 71 a0 3 3 7 7. SEP 1 2 D 12.3 0 .WORKERS' That'] have dceiCOMPENSATION DECLARATIONcorse "C7 o DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT rl herebyaffirmthat'I have d'certificate of consent b self '�� P91r Insure, or o cerlificale 6f Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS dr a certified copy thereof (Sec. 3800, Lab. C.) eolicy Na. Company FOR APPLICANT TO FILL IN JOB FZ Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS rz. 71 Certified copy is filed with the county building inspec- I & 2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. — NEAREST Dote Residential Swimming Pools CROSS ST. Applicant OWNER OR ,. ��jj }� x •to FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec�LLi htJ Z Sw.�L' 'WAIL COMPENSATION INSURANCE ADDRESS 0, - 1 (This section need not be completed if the work involved by First 0Total No. Addi2onal J CITY - �� '+' Tel. No. O �y the permit is for one hundred dollars ($100)or less.) I certify that in the performance of the work for wPLAN CHECK which this PLANAPPLICANT 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 Additional Total No, I L CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of gpPUCATION Exemplion, you should become subject to the Workers' Range— Heater—D.W. Compensation provisions of the Labor Lode, you must forth- .Oven _J_ Dryer LW.M.— ADDRESS• .�- with comply with such provisions or this permit shall be Top FAU -L W.H. — deemed revoked. - ( .y CITY. Tel. No. P Hood Fan Other— - • s .- LICENSED CONTRACTORS DECLARATION � Dis 3 LICENSE OR - I hereby affirm that I am licensed under provisions of Chapter 9 .�— Room Air Cord.._ REG. NUMBER'•, Class. (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRI T NO. PR6TD BY - Y and Professions Code,and my license.is in full force and effect. r O O. Size 8 Type HP, KW, KVA', or KVAR 0 License Number Lic. Class Up to 1 Incl. FIN - L)Contractor Date Over I to 10 Ind. DAT I VALIDATION ❑ Over 10 to 50 Incl. F0 ' FINAL am exempt under Sec. Over 50 to 100 Inc. BY LU B.&P.C. for this reason Over 100 A (L D Services, Swbd., MCC& Ponelboords U)Date: '�/0- 200 Amp. Under 600 V Z Signature 201 - 1000 Amp, Under-600 V ❑ Over 1000 Amp. or Over 600 V Exemption or Reg. Mainz. Elect. SINGLE FAMILY Temp. Power Pole &Appurtenances - HOME OWNER-BUILDER DECLARATION q17 Sign with One Branch Circuit n + I hereby affirm that I am exempt from the Contractors License g - AC:�-T, Low for the following reason (Section 7031.5, Business and - Additional Sign Branch Circuits �. Professions Code): .. 3,137 110.5 Misc. Conduits& Conductors 1 ITEMS' f Other ❑ I, as owner of the property, will o the work and the (See Complete Fee Schedule)_ D structure isnot intended or offered for sale(Section 7044, TI.ITQL . 110 -50 Business and Professions Code). CONSTRUCTION LENDING AGENCY CHECK 110.50 1 hereby affirm that there is a construction lending agency for CHANGE .1313 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-WW1 12/21/ 5' PERMIT ISSUING FEE IO 7��. 1 f�Mit3�`=� Lender's Address - I certify that 1 have read this application and state Ina' 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 above-mentioned property for inspection purposes. .SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Perbw toDate WORKERS' COMPENSATION DECLARATION - 76A663 10/8I I hereby Affirm that I have a certificate of consent to self CE- 06G APPLICATION mSLICATION FOR ELECTRICAL rEl IT insure, or a certificate of.Workers' Compensation Insurance, COUNTY OF LOS ANGELESC. BUILDING AND SAFETY or a certified copy thereof (Sed 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN ' JOB ❑ (�, / Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS q V'/p 77 ) ' ) :q ❑ Certified copy is filed with the county building inspec- 18 2-Family, Sq. FL $ — $ LOCALITY i v 0 s 1 4- NEAREST (I ll lion department Multi-family Sq. Ft. — Y Q. �( /:(:/ Residential SwimmingPools CROSS ST, b �f .n'�t Date u 2-V Applicant � �M1E ,�...,it OWNER OR r / FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec rrr Light 3- G MP'IL COMPENSATION INSURANCEr ADDRESS (' 1 This section need not be completed i(the work involved b ' 3 First 20 ( P Y Total No. Additional CITY �-,m / Tel. No.411g_1 the permit is for one hundred dollars ($100) or less:) 1 certify that in the performance of the work for which this LAN CHECK / permit is issued, I shall not employ any person in any manner - APPLICANT so as to become subject to the Workers'Compensatia Lawsk ighting Fixlures First 20 x ADDRESS Total No. Additional DoteApplicant .c zGR CITY Tel. No. Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making t is CertificateExemption, you should become subject to the WorkersRange_ Heater_D.W. — 'APPLICANT tt 12QN�is'�f Z Compensation provisions of the Labor Code, you must forth- Oven — Dryer — W.M._ ADDRESS 6 �( f 7 fl p 1 with comply with such provisions or this permit shall be _ Top FAU —W.H. — deemed revoked. Hood Fan Other— CITY SO. L AAONTF �Tel. No. 1 2- 03 LICENSED CONTRACTORS DECLARATION _ _ ' Disp. Room Air Cond. LICENSE M 2 G -0 / Class.C-�Q I hereby affirm that I am licensed under provisions of Chapter 9' - - REG. NUMBER 74 / b (commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO �/ PROCE and Professions Code, and my license is in full force and effect. 'OD BY } V O Size 8 Type HP, KW, KVA, or KVAR' iL License Number ic. Class �� Up to I Incl. FINAL W Y�Z . D �' Over I to 10 lnct. DATE /� VALIDATION Contractor we Y A ti _.1Z Over 10 to 50 Incl. ❑ 1- FINAL am exempt under Sec. Over 50 to 100 Inc. BY W B.BP.C. for this reason Over 100 y Q - '1 _te. Services, Swbd, MCC 8 Panelboards D ��f 7.2 ,� ? ��=i'---1 0 -200 Amp. Under 600 V Signature Q �' 201 - 1000 Amp. Under 600 V QOver 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. / z 3 1 3 N SINGLE FAMILY Temp. Power Pole 8 Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit #'0'° ° e,°.2 1 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 .2 •y 2350 Professions Code): ° ° I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors ° 2 3.5 0 t structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ D 0 8 0 2.—8 4 7044, 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-Tool), (Sec N Civ. ; PLAN CHECKING FEE Lender'sis Name PERMIT ISSUING FEE O 7 Lender's Address ' I certify that I have read this application and state that the TOTAL FEE above information is correct. I agrge to comply with all County ordinances and State laws reg sting Electrical wiring, and ; hereby authorize representativ of this County to enter upon the above-mentionol propertyor inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE . 2 - e / Signature of Permittee Dote WORKERS' COMPENSATION DECLARATION CE-806 IOiel APPLICATION Im ISA ICA TION FOR ELECTRICAL rt,i"TRIC p 0 ImER IT I hereby affirm that I have a certificate of consent to self CE-0066 i`Y Ir Ir IL 'L/"i II II�1 If" II'l IG IL IG'b 0 Y'( 'irP91L If"IG O'(!VE 0 L nsure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES T. ��^ BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) 1 Policy No. 1G 16 Company .O^t91 SID I - I U. FOR APPLICANT TO FILL IN JOB / Certified co is hereby furnished. EACH NO. FEE ADDRESS C7L.� CGVif PY Y New Residential Bldgs. 8 Pools ❑ Certified copy is filed with the county building inspec- 18 2-Family, Sq. Ft. $ _ $ LOCALITY tion de artment. Multi-family Sq. NEAREST CROSS ST. Residential Swimmm ing Pools OWNER OR Date Applicant .FIRM NAME CERTIFICATE OF EXEMPTION FROM WO KERS' � ! i IL COMPENSATION INSURANCE Outlets: Rec�Light Sw. / )ADDRESS _ ' � ) First 20 � 225 (This section need not be completed if the work involved by Total No..�L_ Additional CITY "T' •.� Tel. No 3 the permit is for one hundred dollars ($100)or less.) - performance of the work for which this PIAN I certifyCHECK that in the P APPLICANT permit is issued, I shall not employ any person in any manner r so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 l � 3 ADDRESS Additional ' Total No. CITY Tel, No. Date Applicant Fixed Appliances Not Over 1 HP PERMITt /� NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT 54- C Exemplion, you should become subject to the Workers' Range— Heater—D.W. A_ Compensation provisions of the Labor Code, you must forth- Oven _ Dryer _LW.M. ADDRESS /Z•j 4 S .LL7/' E'C with comply with such provisions or this permit shall be Top _ FAU —W.H. deemed revoked. Hood — Fan _Other_ CITY ATel. No.. ZB LICENSED CONTRACTORS DECLARATION Disp. Room Air Cond. SQ REG. NUMBER ,�1) -6 Class. d I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCE ED BY and Professions Code,and my license is in full force and effect. Power Apparatus 8 Large Appliances �j G ^^�� /(� Size 8 Type HP, KW, KVA, or KVAR' S- �0 O License Number (�`t' g / Lic. Class R Up to 1 Incl. FINAL V Over 1 to IO Incl. DATE ✓� �� VALIDATION 0O Contractor Date Over 10 to 50 Incl. FINAL N ❑ I am exempt under Sec. Over 50 to 100 Inc. BY W B.BP.C. for this reason Over 100 v _Z Services, Swbd., MCC 8 Ponelboards D T v Date: 0 -200 Amp. Under 600 V //3 Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. 9 3 1 57A SINGLE FAMILY Temp. Power Pole 8 Appurtenances #r e e o 0 0 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that i am exempt from the Contractor's License Additional Sign Circuits gs's 2 2,d 7 5 Law for the following reason (Section 7031.5, Business and oA o a H m Professions Code): ❑ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors ' structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)— D 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is o construction lending agency for the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) t2 - . (Sec. 3097, Civ. C.). PLAN CHECKING FEE _ Lender's Name _ PERMIT ISSUING FEE 0 - 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 above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature ofPermittee Date -