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Home My Public Portal About9509 BROADWAY_Electrical__ 76Ar^a13-CE806 I0/72 APPLICATION- FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER gooRE66 '�, BUILDING.AND SAFETY'DIVISIONIR oiq-c> LOCALITY - FOR APPLICANT TO FILLIN NEAREST CROSS ST,. OUTLETS NO. EACH FEE OWNER OR FIRM NAME RECEPT._ S S AMAI L DDRESS FIRST 20 LIGHT__ TOTAL '25 i Z;"' o , . OVER 20 CITY •. / TEL. NO:�p 7e SWITCH_ .10 PLAN CHECK ' LIGHTING' ;TOTAL FIRST 20 25 APPLICANT FIXTURES OVER 20 .10 ADDRESS RESIDENTIAL APPLIANCES CITY TEL. NO. PERMIT RANGEDRYER_WTR. HTR._ APPLICANT' PV .Q P, LbG IIG I STA. COOK_OISP. F.A.U._ A00 KESS 1 1 'S#q nI SPACE HTR. AIR CONE) CIT• EL. ND. 9 Q 'CENSE OR CLOTHES WASH. OISM WASN._ REG. NUMBER CLASS. a FAN_OTHER I,00 LlJ I FEHEBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 0 AHD STATE iXAT THE ABOVE IS CORRECT RECT AND AGREE.TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL_COUNTYORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. NW. KVA. ELECTRICAL WIRING. SIZE & TYPE . OVER TO I - ' I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 - 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ' CALIFORNIA OR THAT I AM THE LEGAL OW R OF THE ABOVE 1 - 10 300 DESCRIBED flE6/ AL PROPERTY. T le' PERMITEE V 10 - 50 5.00 . SIGNATURE C O 50 - 100 1000 DISTRICT NO. koPROCEqSED BY w 100 - 500 15.00 A BE. Z SIGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE INSPECTO SSIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 100 TEMP. POWER POLE , SERVICENOTOVER 600 VOLTS OR 20OAMP 3.00 Q 17UNDERSLAB WORK SERVI CEOVER 600 VOLTS OR 200 AMP 10.00 ROUGHCONDUIT - TEMPSERVICE,POLE. &APPURTENANCES 5.00 WIRING 2 /-9vP '1� c�J ab�9J I TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED FINAL :?1.-75".Ih'91�.:n...•� PERMIT FEE 'SUB TOTAL) NOTES: T PLAN'CHECK FEE I PERMIT ISSUING FEE. - 3.00Q.0 TOTAL FEE - O PLAN CHECK VALIDATION CK. M.D. CASH PERMIT VALIDATION CK. M.O. CASH 1 3 8i`MAR 11 2 D 7•0 O Ai an - SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE �.RKERS'COMPENSATIONDECLARATION 76A663 t0/81 AppLICATION FOR ELECTRICAL PERMIT CE.606G .. .that I have a certificate of consent to self insure, ora certificate of Workers' Compensation Insurance, or a certified -COUNTY OF LOSANGELES -BUILDING AND SAFETY copy thereof(Sec.3800,Lab.C.) _ Policy No: - - --' Company - G ,' ,FOR APPLICANT TO FILL IN _ =JOB - r Certified cp is hereby•furnished EACH 'NO. .N .FEE-. ADDRESS n' PY. _ , New Residential Bldgs. &.Pools ,. Certified bo is tiled with the,county inspection •1 8•2-Family.Sq.Ft. - S — $ •LOCALITY ' _ ec PY Y 9 P ' • NEAREST Multi- mil .Fi.- � de rime Mu a — P I. Y Sq - _ .. CROSS 3T. M' f r I C . R i I Swlmmin Po es dente cls- - . 0 9 «\t /� 6 _ OWNER OR Date_ APPlicant � - 1 .� .... v- 6 '. CERTIFICATE•OF EXEMPTION FROM WORKERS LI 'r J rx`a ` 1 t, MAIL Outlets:Rec LID SrSw r • "COMPENSATION INSURANCE. ` r • - - (ADDRESS - (This�section need not be completed'itthe workdrwolved by the 'First 20,' - Total No. Adddional _ CITY Tel No. permit is for one hundred dollars($100) or less.) _ .I certif that in the.performance'of the work for which this permit - PLAN CHECK v': is issued, 4shall not employan - PPLICANT - y person in any manner.so as to 'become subject to the Workers'Compensation Laws. •)Lighting Fixtures . First 20 ADDRESS Q - • Total No. .Additional. •CITY - Tel.Na• ' Date -,Applicant - - - Fixed Appliances Not Over'1 HP PERM) NOTICE TO ,APPLICANT: If, -after,making this Certificate of Exemption,.you should,become subject;to,the Workers'Compensation muRange.,_@Heater_ D.W .f APPDCANT provisions.of the Labor Code,you st forthwith comply with such Oven ...�-Dryer W.M ADDRESS .provisions or this permit shallbe deemed revoked i- Top.._ FAU W.H. LICENSED CONTRACTORS DECLARATION, HlFan Other CITY', ' ' Tel No. I'hereby affirm that am licensed under'provisions of Chapter 9 .. Q 3 Q LICENSE OR y Disp. Room Air Cobb,' REG.NUMBER - - Class. (commencing with-Sechon 7000) of Division 3 of the Business and � - - ` Professions Code,and,my Iicense'is in full force and effect. .Y + DISTRICT NO.. - PRO E3 D BY Power Apparatus&.Large Appliances_ - - • ^x• Size:& Type HP, KW,KVA,or KVAR 0 U • License Number Lfc.Class Up to 1 Inc[. FINAL ContractorDate Over 1 b 10 Incl. DATE 6 23 .VALIDATION... H Over 10 to 50 Incl. FINA�L ' -a❑ '� I,am a ampt.under Sec_ Over 50 to 100 Inc. BY I f > B&PC. for this reason , Over 100 / W - _ "Services,'Swbd.,MCC& Panelboards / Z i Date:> - - !, , - � ,. ,-•.._4 . ,_ ,•. ,_ ..y. 0-.200 ArtIP.Under 600 V W.: m _ .. _ ..�.�.. Signature 20i=1000`Amp.7Under 600 V ❑ - - ,Over,1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect - SINGLE FAMILY .. Temp.Power Pole& Appurtenances _ _ _ - 'I 'HOMEOWNER-BUILDER DECLARATION., Sign with One Branch Circuit - - A�nT. - I hereby affirm that I am exempt Trom.tne Contractors License Law _ �.O $' 7 for the.following reason(Section 7031-.5, Business,and Professions Additional Sign Branch Circuits, - - _ � r� . pp en Code):' - +'.' WV/. ❑ Misc.Conduits &Conductors' 1,as ownerof the property,will do the work and the structure is not intended'or offered for sale (Section7044, Business Other(See Complete Fee Schedule) ' and Professions Code),. - TOTAL 98.50 CONSTRUCTION LENDING'AGENCV - - - - -- 1 DECK `•+ - 18.W I hereby affirm that there.is a construction Iending,agency for the. 'performance of the work for which this permit is issued(Sec-3097, pERMIT'FEE - '• (Sub``-Totaq '' '• -' yrlltf1t� --" ..Vu' ,Civ.C.). . - - • - PLAN CHECKING FEE - - - - 1 �/� `Lender's Name ' ^ O PERMR ISSUING FEE t _ � /[[ttTTii •..Lenders Address - '. - a T3J. •1' ."�y f' $;,` I certify that,) have.read this application and state that the above TOTAL FEE _ 70 _Sd information is correct. Iagree to comply with all'County'ordinances' ' and State laws regulating Electrical wiring, and,hereby authorize representatives of'this Co ty.to enter upon the above-mentioned - proper inspection' rpose SEE REVERSE FOR.EXPLANATORY LANGUAGE Sigifature of Permittee Dae, • • - _ , RKERS'COMPENSATTON'DECL:ARATION 16-663 10/01 ./�ppLICATION FOR ELECTRICAL PERMIT that have a certl(ICate^of cOIlSept't0'Self InBnre CE-806G r� or certificate of Workers' Compensahon Insurance, or a certified COUNTY OF LOS ANGELES •' BUILDING AND SAFETY copy thereof(Sec.3800,Lab.C.) _ . -_ �PPolicy No rry C.(/ ro~d Compa #"7",e FOR APPUCANT.TO FILL IN 't - JOB .• - A ^J r.1 Certified copy is hereby jurnished. New Residential Slogs.8 Pools . I EACH NO.. , , ADDRESS - FEE - Certified cd e y g 7 & 2-Famil .LOCALITY copy Is (ileB,with'the count building inspection Y,.Sq.FL $ — $ department. i . } Multi-family Sq Ft. - NEAREST• L #. Date •S. ��4. Residential SwimmingPools OWNER O �♦✓«� / - Applicant �« S'9re� D OWNER OR i . FIRM NAME Chi}/V�1L YC/--^I Vim✓I � ,�/� CERTIFICATE OF EXEMPTION FROM WORKERS', Light Sw - MAIL COMPENSATION INSURANCE. - Outlets Rec First 20• (This section isfnee hung ed completed t tl i6 the work involved by.the -. CITY ", Tet.Nole77Y permit Is for/one hundred dollars($100)�or less.) Total No.' Additional - r J,certify that the performance.ofWhe work for which this.permit - PLAN CHECK r ^ 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 NotOver 1 HP PERMIT. '- NOTICE TO APPLICANT If, ,after making this, Certificate of APPLICAM (/ P ' Exemption,you should become subject to the Compensation Range+ Heater_ D.W. . .. - . - ADDRESS - _ provisions or the Labor Code,you must forthwith comply with such Oven_ Dryer _ W.M.._ ( L��p * LICENSED�CONTRACTOR5DECLARAT Top FAU W H. _ __' _ - ,v provisions or,this; ermit shall be deemed revoked.'ION ,. rTood Fan _.Other_ CITY' r' Tet.N Y�-S' `7.' . I hereby affirm,that I am licensed.untler. 'RED.provisions of Chapter 9 Disp. RoomAir Cond. Class.LICENSE R i" (commencing with Section 7000)of Division 3 of the Business and —., . - NUMBER d Professions Code,and my license is in full force and effect. ' DISTRICT NO. PR ED BY • Power Apparatus& Large,Appliances _ •_ }" ' 7�7 Sin 8 Type HP,KW,KVA,or KVAR 0 License Number -71 /rl S Lic.Class " Up to T Incl. - r FINAL Over 1 to 10 Incl.' DATE /JJ VALIDATION , Contractor 5_ i d O[i Date '.�• -�7 - _ - V Over.10 to 50 InR FINAL i •OF- - ' I am ezempK under Sec. Over 50 to 100 Inc. By _ W B.&P.C.for this reason ,• � - Over 100 - - - �,� ' Date: i ,Services,-Swbd.,MCC& Panelboards - r - - - Z - , _-:• � 0-200 Amp.Under 600 V � '► - .. `Signature 201 - 1000Amp!Under•600>V Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect SINGLE FAMILY -- ' •Temp Power Pole 8 Appurtenances I L I HOME OWNER-BUILDER DECLARATION Sign with-One Branch Circuit f hereby affirmThat I am exempt from the Contractor's Licenae.LaW - •'y♦P r for the4ollowing,reason(Section 7031,5„Business-and Professions Additional Sign Branch Circuits : ❑ ;Miscr Conduits&,Conductors.- -- - - .. TC- I, not inter of the property,will do the work and the structure i r LV f7 • is not intended or offered for sale (Section 7044;Business- Other(See Complete Fee Schedule). - ;and Professions,Code). - / _ -r 7} G(_ 25._ 50, ., n nr> . . CONSTRUCTION LENDING AGENCY - . . ._ s�� 2rc s.c rl:I I hereby affirm that there is a construction lending agency for'the ` ,i 1 rr o- n 'performance of the work for which thls permit is issued(Sec.3097, _pERMIT,FEE - (Sub-Total) -'4j', - ft Civ.'C.) PLAN CHECKING.FEE - _ Lenders Name •. _ - ' •,. PERMIT ISSUING FEE Lenders'Address I certify that I have mad this application and state that the above TOTAL FEE Lti0 SO - informahon is correct. I agree to coimply with all County ordinances -and State laws-regulating Electrical wiring, at-W hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. 'I SEE,REVERSE,FOR EXPLANATORY LANGUAGE, _. .. .r ...- _. . S' ature f Permittee Date, _