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Home My Public Portal About9306 BROADWAY_Electrical__ ,aAaan-QEeaea.aa APPLICA'T'ION FOR ELECTRIC PERMIT COUNTY OF LOS ANGELES . DEPARTMENT OF COUNTY ENGINEER- BUILDING C1 R 2 BUILDING AND SAFETY DIVISION ADDRESS / .3�-� -J rcIc d JOHN A. LAMBIE, COUNTY ENGINEER �f CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY Q 7 l= FOR APPLICANT TO FILL` IN NEAREST t PERMIT FEES CROSS ST. ITEM NUMBER I EACH FEE OWNER qred OUTLET : $ $ MAIL ADDRESS C. - LIGHTS RECEl. 9W. / .IO - LIGHTING FIXTURES 10 CITY �:�= TEL..NO. ELEC.RANGES CLO.DRYERS ELECTRICIAN C v eC WATER HEATERS .50 ADDRESS �" ez, S 'Q ELEC. PACE HTRS. DISHWASHERS _ CITY 1!�I B_ TEL. NO. 4.t4 3Z GARBAGE DISPOSERS AUTO.. STATE WASHERS STA.COOKING UNITS .25 LICENSE NO. 4 J J MOTORS: OVER INC. H.P. _ 'DISTRI tli G OUP PROCESSED BY a— 2 50 INSPECTION RECORD 2— 5 1.00 5— 15 1.50 IS— 50 2.50 f}� 50-200 5.00 / /of✓I //Jv/� cr' [f?Vn— OSIGNS: NO.TRANS. NO.LAMPS SERVICE O-SOON 1.00 _ 1,'&1','f 7- �G7-0,n SERVICE OVER 600V 5.00 tlf ®T fT Jn�_ n rnt�.f MISG. WIRINGPERMIT — 1.00 0Q ^^_/'o I- -1n' /t7�s FIXTURE PERMIT 1.00 0 Q SUPPLEMENTARY PERMIT -.50 !� 11#7a9 Cff 971'X-(50 '-O TOTAL FEE Is ',Z 7_ it ,/ lhRL6 )t7z - ^ ,� I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS ' DATE INSPECTOR'9S(GNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY T WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT /_//11 /�♦.A�� ¢ �` ELECTRICAL WIRING. WIRING 1 HEREBY CERTIFY THAT [,AM PROPERLY REGISTERED,AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT 1 AM THE LEGAL-OWNER OF THE ABOVE DESCRIBED'RE5IDENTIAL PROPERTY. �!! POWER SIGNATURE TTE / _ UTILITY CO.NOTIFIED O .n ®F KAIdDATION ARTHUR C.VETT, CK Mo CASH SUPERVISING ELECTRICAL ENGINEER Ufo94960 APR 1y 2 A 2 .75 r WORKERS'COMPENSATIONDECLARATION76A6' 812-801 63 CE 6G APPLICATION -FOR ELECTRICAL. PERMIT ' 1 hereby affirm. that I have a certificate. of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or - a certified copy thereof(Sec. 3800, Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB EACH NO. FEE ADDRESS .J (1 O(V_ New Residential Bldgs.& Pools Certified copy is hereby furnished. 1 & 2-Famlly.Sq. Ft. $ — $ LO CNEAREST ALITV Multi-family Sq. Ft. ❑ — Certified copy is filed with the county building inspection CROSS ST department. ` Residential Swimming POOI, OWNER OR FIRM NAME tiCYV Date Applicant - Outlets: Rea_Light Sw._ - MAIL First 20 ADDRESS 93(DG f rocit J CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional elv ,'� Tel No COMPENSATION INSURANCE CITY �`-' ' .cS'J5 O LAN CHECK d (This section need not be completed if the work involved APPLICANT p by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures, First 20 ADDRESS U Total No. Additional I certify that in the performance of the work for'which this Fixed Appliances Not Over 1 HP CITY Tel No. 0 permit is issued, I shall not employ any person in any manner PERMIT U so as to become subject to the Workers` Compensation Laws. Range— Heater D.W. _ APPLICANT 1 vv%,V� c.,i- �e-x-71 < W ven '_//,� W Dryer_ :M._ ADDRESS i J'CZ1t'J 6 �'`( y S Tk I_�C Date� 13�Applicant ` Top FAU _W.H. _ Hood _ Fan _Other_ CITU jr-Fr. l/-I Tel No.�bs I)t'?35`( 3Q NOTICE TO APPLICANT: If, after making this Certificate ofDisp. _ Room Air Cond. LICENSEG.NUMBE OR _ 3 Exemption, you should become subject to the Workers' � ' RE' 5_ Class O- Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCES ED BY with comply with such provisions or-this permit shall be deemed revoked. Size&Type HP,KW, KVA,or KVAR n Up to ),Incl. FINAL S_Over 1 to 10 Incl. DATE S �_Ae_ VALIDATION LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. 1 hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL 9 (commencing with Section 7000) of Division'3 of the Busi- Over 100 BY ness and Professions Code, and my license is in full force and effect. Services - License Num er� f s 3 S 3 Lia Cl..—C U 0-200 Amp.-Under 600 V ,1 201-1000 Amp.Under 600 V Contracto 151�J'�s--- e_ � Z3 Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp. Power Pole& Appurtenances _ I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit License Law for the following reason (Section 7031.5,.Busi-. Additional Sign,Branch Circuits ness and Professions Code): - Misc.Conduits& Conductors 5(7 7.9 A 1, as owner of the property, will do the work and the Other ISee Complete Fee Schedule)— structure is not intended or offered for sale (Section _ s 7044. Business and Professions Code). � e --0 e 2 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency 2,s - 27.00 for the performance of the work for which this permit is PERMIT FEE (Sub-Total) issued (Sec. 3097,Civ.C.). - o e o 2,7.0 0 r=-r Lender's Name PLAN CHECKING FEE (One-Fourth Permit/FeO Lender's Address PERMIT ISSUING FEE e.&,2 3`-8'2 t I certify that 1 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 bovc-mentioned pr perry for insp on purposes. r SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date ��• - WORKERS'COA1PENSATION DECLARATION '76A663 76A6 (2801 63 CE 6G APPLICATION FOR ELECTRICAL PERMIT 1 hereby affirm that I have a certificate of consent to self - COUNTY OF LOS ANGELES T �J BUILDING AND SAFETY .insure, or a certificate of Workers'Compensation Insurance,or / a Sgryfjed opy thereof(Sec. 3800 Lab. C.) - f`�JfO��//1 r7! FOR APPLICANT TO FILL IN JOB olicy No. Company 'e'� 3 C 0 New Residential Bldgs. &Pools EACH NO. FEE ADDRESS 9 J Certified copy is hereby furnished. 1 &2-Family Sq. Ft. $ — $ LOCALITY /,7W/4L Certified copy is filed with the count building Multi-family Sq. Ft. NEAREST f- i y g inspection Residential Swimming Pools CROSS ST / LGT- - department. . � OWNER OR L FIRM NAME T. G�iJf c(,/ Ua[e LApplican - _Outlets: Rec._�t_Sw._ p ,Ar `,/' CERTf FICATE OF EXEMPTION FROM WORKERS' First 20 ADDRESS / 3d 61 G - �l I��N CV1-/r COMPENSATION INSURANCE Total No. Additional CITY�?.��E G'i� Tel No. SgV } PLAN CHECK 6. (This section need not be completed if the work involved APPLICANT U by the permit is for one hundred dollars.(5100) or less.) Lighting Fixtures First 20 ADDRESS Total No. Additional O I certify that in the performance of the work for which this CITY Tel Fixed Appliances Not Over 1 HP No. F permit is issued, I shall not employ any person in any manner PERMIT W so as to become subject to the'Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT 1 c�/ N Oven _ Dryer ADDRESS_W.M. Z Uate Applicant Top- _ FAU _W.H. — 3 575 ��01 Hood — Fan —Other_ CITY Tel No. i NOTICE TO APPLICANT: If, after making this Certificate of Dina. _ Room Air Cond._ LICENSE ORi/7d7,j0 Exemption, you should become subject-to the Workers' REG. NUMBER Y 7 Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances �. DISTRICT NO. PROC D BY with comply with such provisions or this permit shall be - deemed revoked. Size&Type HP,KW, KVA,or KVAR / S� _ Up to 1 Incl. ✓ Over 1 to 10 Incl. FINAL �IACENSED CONTRACTORS DECLARATION DATE 9� F VALIDATION Over 10 to 50 Intl. I h eby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL BY 91 mencing with Section 7000) of Division 3 of the Busi- Over 100 �� z nes, oilProfessions.Code; and my license is in full force and ' e ffec,. Services - /Of 7 p 0-200 Amp. Under 600 V License Number LiaClass U 201-1000 Amp. Under 600 V Contractor Date - 3d Over 1000 Amp.or Over,600 V HOME OWNER-BUILDER DECLARATION Temp. Power Pole& Appurtenances I hereby affirm that I, Sign with One Branch Circuit exempt from the Contractor's Additional Sign Branch Circuits License Law for the following ng reason (Section 7031.5, Busi- ' ness and Professions Code): 253:51 A Misc.Conduits&Conductors ' 1, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— structure is not intended or offered for sale (Section ' 7044, Business and Professions Code). 2 e ro 1 1.5b CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agencys for the performance of-the work for which this permit is - i '1 1.5 M issued'(Sec. 3097,Civ.C.). PERMIT FEE (Sub-Total) Lender's Name - 080 2:-8 2 PLAN CHECKING FEE (One-Fourth Permit Feel Lender's Address PERMIT ISSUING FEE - I certify that 1 have read this application and state that the TOTAL FEE - above information is correct. 1 agree to comply with all County ordinances 'and State laws regulating Electrical wiring, and ' hereby authorize reppresentattves oft ounty to enter upon 7 thethe 6bve n �d prop t fori pec 'on purpos s. - At SEE'REVERSE FOR EXPLANATORY LANGUAGE L ,Signature of Permittee Date