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Home My Public Portal About9560 BROADWAY_Electrical__ 76A66']CE`6a6(6/76) APPLICATION FORELECTRICAL PERMIT _ COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN JOB New Residential Bldgs.&Pools EACH NOr FEE ADDRESS W /T I &2-Family,Sq. Ft. S .025 — 8 LOCALITY � �� Cp� Multi-family Sq. Ft. '02 CROSS ST. /p" �F AREST NE Residential Swimming Pool 25.00 OWNEROR \� FIRM NAME O_utleis: Rec�Light Sw._ MAIL 4' O first 20 .50 ADDRESS Total No. Additional .30CITY I.No. PLAN CHECK _ APPLICANT Lighting Fixtures First 20 .50 ADDRESS Total No. Additional '30 CITY Tel.No. Fixed Appliances Not Over 1 HP _ _ PERMIT e,, Heater_D.W. _ APPLICANT ZZ Dryer—W.M.— ADDRESS Top FAU _ W.H._ ,f CITY Hood–,LFon _Other_ LICENSE OR ' Disp.L Room Air Cond. 2050 REG.NUMBER Class. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA. Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO Size&Type HP, KW, KVA,or KVAR COMPLY-WITH ALL COUNTY ORDINANCES AND STATE LAWS } 2.50 REGULATING ELECTRICAL WIRING. 6 Up to I Incl. HEREBY CERTIFY-THAT I AM PROPERLY REGISTERED AND/OR C Over 1 fo 10 Incl. 5.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND 5TATE OF as Over 1Oro 50 Inc[, 12.50 1 1 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE O Over 50 to 100 Inc. 25.00 DESCRIBED RE510 Ni L P PERTY.' 0 Over 100 .40.00 SIGN PERMITEE .` SIGNATURE Services, - 1 DISTRICT NO, 5 D BY 0-200 Amp.Under 600 V 12.50 � � ^ d• ` � _ 201 1000 Amp. Under 600 V 25.00 Over 1000 Amp.or Over 600'V 50.00 ` Z Temp. Power Pole&Appurtenances 10.00 Sign with One Branch Circuit 10.00 ;94437A Additional Sign Branch Circuits 2'00 INSPECTION > #-0 0 0 0 o 'L INFORMATION u Misc.Conduits&Conductors 10.00 ON REVERSE z Other ISee Complete Fee Schedule)_ SIDE u 2 0 o 1 350 . Z a o'6 61 3505 6 05,18!-79 PERMIT FEE (Sub Tomll Z PLAN CHECKING FEE (One-Fourth Permit Feel O G PERMIT ISSUING FEE t $7.00 — o TOTAL FEE / tJ > r INSPECTION FINALED (� W date: 5"�'1 � il 8y � �s 76A6�3CE-806(6/78) APPLICATION FOR ELECTRICAL PERMIT - COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANTTO FILL IN JOB !�j' New Residential Bldgs.&Pools EACH NO. FEE• ADDRESS 1.J (� n�{'U (�+-3 1 &2 Family,Sq. Ft. $ .025 — $ LOCALITY t C� Multi-family Sq. Ft. 'NEARESST 25.00 t / L^ Residential Swimming Pools CROST. SOWNER OR r/ FIRM NAME Outlets:Rec_Light_Sw._ MAIL First 20 .50 - ADDRESS' Tocol No. Additional .30 CITY �LG 1::�_,/ Tel.No.4,k3:22jj aPLAN CHECK -APPLICANT tV' N.._, , Lighting Fixtures First 20 .50 ADDRESS'. Additional .30 Total No. CITY Tel,No. - Fixed Appliances Not Over 1 HP PERMIT - - APPLICANT Range—/ Heater_D.W. _ ADDRESS Oven I Dryer_ W,M._ Top —FAU _ W.H._ CITY _ Tel,No. Hood—Fan —Other— ICENSE OR Disp.—Room Air Cond. 2.50 - EG.NUMBER Class. IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA - PowerApparatus&Large Appliances TION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO Size&Type HP, KW,KVA,or KVAR COMPLY WITH ALL COUNTY ORDINANCES AND-STATE-LAWS 2.50 REGULATING ELECTRICAL WIRING. Up to 1 Incl. 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR C Over 1 to 10 Incl. 5'00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF m Over 10 to 50 Ind. 12.50 CALIFORNIA OR THAT I AM THE LEGAL OWNS OFTHEE Over 50 to 100 Inc. ' 0 25.00 DESCRIBED RE51 TI P PERTY, 0 Over 100 40.00 PERMITEE _ SIGNATURE Services DISTRICT NO.- - 0 200 Amp. Under 600 V 12.50 Q 201-1000 Amp. Under 600 V 25.00 J� Over I OOO Amp.or Over 600 V 50.00 Z 2 Temp. Power Pole&Appurtenances 10.00 i Sign with One Branch Circuit _ 10.00 Additional Sign Branch Circuits .2'00 INSPECTION Y2389.2A Misc.Conduits&Conductors 10.00 INFORMATION Other(See Complete Fee Schedule)'_ _ ON REVERSE u # 6 a 6 o o 2 SIDE. 2 - - 1200 6 a - - 12006 PERMIT FEE (SubTotal) 0419-79 PLAN CHECKING FEE (One-Fourth Permit Feel O F PERMIT ISSUING FEE $7.00 TOTAL FEE - . C > INSPECTION FINALED v W dare: q� �•� �� / By ' Crji WORKER'Shave COMPENSATION DECLARATION20-0019 663DPW9,69 APPLICATION FOR ELECTRICAL PERMIT 6-0A 1 hereby affirm that I have a certificate of consent to self insure, 7 or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec..3800 Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB _ ADDRESS ❑ "Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE LOCALITY ❑ Certified co is filed witli the count tbuildm 1&2-Family,Sq.Ft. $ — $ copy y ginspectiod" NEAREST / department. - Multi-family Sq.Ft, CROSS ST ASSESSOR. ✓i< _ Residential Swimming Pools Date Applicant MAP BOOK PAG PARCEL r: . CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER OR Outlets:Rest. Light Sw._ FIRM NAME rt COMPENSATION INSURANCE First 20 (This section need.not be completed if the work involved by the MAIL ADDRESS permit is for one hundred dollars($100)or leis.) Total No. Additional z A� certify that in the performance of the work for which this,permit CITY - Tel No is issued, I shall not employ any person in any manner so as to PLAIN CHECK become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT - Total No. Additional ADDRESS Dat — ' l App li k n hi g OR20A,120V BRANCH CIRCUITS NO CSCE TO AP .LIGAN.LIGAN T: If, of r makin his CerlIfic f CITY Tel.No. Exemption,you should became act to the orkera Comp tion 1 TO 10 INCLUSIVE EACH provisions of the Labor Code, you must forthwith comply with such '11 TO 40 INCLUSIVE EACH - PERMIT L{w4 u.c P rob'' rr. f .Lr+'lS provisions.or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH APPLICANT } LICENSED CONTRACTORS DECLARATION - - - ADDRESS I hereby affirm that i am licensed untler provisions of Chapter 9 150R 20A,208V TO 277V LIGHTING EACH /o Al -�x A4,ZJe 0� (commencing with Section 7000) oVDivision 3 of the Business and .. CITY. �sPM,o,e:> Tel.No. A U Professions Code, and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR /.v' Q ��/ [Y/� Power Apparatus&Large Appliances REG.NUMBER 4 ey Class.C License Number 4�" T i Lic.Class a—xy Size&Type HP,KW,KVA,or KVAR DISTRICT NO. p PROCESSED BY F- / 1 G� UP to 3 Incl. �r 0 a a G y Over 310 10 Incl. FINAL /// Contracto �P Date 9-�/.1�� DATE / U) ❑ - Over 10 to 50 Incl. /Q /C(� Z I am exempt under eC. Over 50 to 106 Incl. VALIDATION FINAL B.&P.C.for this reason Over 100 BY .Se ices,Swbd, CC8/Pa Ibo Date: �� f - 0-200 Amp. briarH'/I! - a.. Signature 201 -1000 Amp.Under 600V - - - - ❑ _. Over 1000 Amp.or Over 606 V Exemption for Reg.Maint.Elect. - ♦- ^ _ '^ ,�aa//��r SINGLE FAMILYAppurtenances - tla`LT t a •T TemSip.Power Pole&Brancr _cuit _ _ = T 07 C�.R HOME OWNER-BUILDER DECLARATION Sign with One h Cir J J JJ I hereby affirm that I am exempt from the Contractor's License Law i ITEMS . for the following reason (Section 7031.5, Business and Professions Additional Sign Branch.Circuits . _ -- S Code): I,as owner of the property, will do the work and the structure �� 'n, � �Misc.Conduits&Conductors TOTAL is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule)_ kt x ® (..HE4{ya �7•JJ and Professions Code). `1,� - CONSTRUCTION LENDING AGENCY - _ CHANGE •`O I hereby affirm that there is a construction lending agency for the f� [ n performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE... - .(Sub-Total) _ ?lx.,`: i1 ]�lY�l7 Civ. C.) _ - VWV VOV1 L PLAN CHECKING FEE ))^ r- c /,krirl�f� Lender's Name - _ 5455 1 AMIO'01 PERMIT ISSUING FEE f" •' - -" a<. 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 purpPlus. SEE REVERSE FOR EXPLANATORY LANGUAGE r X— T OF PLICAr ORAGEM t GATE WORKER'S COMPENSATION a certificate DECLARATION 76A669DPW 9/89 APPLICATION FOR ELECTRICAL PERMIT I I hereby affirm that 1 have a certificate at consent to self insure, 76A663 ( or a cedificate.of at Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab:C.) Policy No. Company FOR APPLICANT TO FILL IN - _ JOB ' SOD Y L ADDRESS Certified,copy is hereby furnished. New Residential Bldgs.8 Pools $EACH NO: $ FEE- LOCALITY Q ��. ❑ Certified copy is filed with the county building inspection - 1&2 Family,Sq.Ft. - department. , _ Multi-family Sq.Ft. — NEARE S Date ApplicantResidential Swimming Pools - - ASSESSOR + - / '". 'MAPBOOR PAGE PARCEL 'CERTIFICATE OF EXEMPTION FROM WORKERS' (�' - OWNER OR t - COMPENSATION INSURANCE Outlets:Pec. Light Sw._ FIRM NAME �jr First 20 //"0 _ _ a•' MAILL (This section need not be completed,if the work involved by.the Total No. P" Additional 'ADDRESS /f0 d permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this,permit - CITY 61=f f' el.No. r is issued, I shall not employ any person in any manner so as to /y� become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APP First Total No. Additional ��D� ADDRESS ' Date Applies t 16 OR 20A,120V BRANCH CIRCUITS / NOTICE TO APPLICANT: HV ter an ing'this Ce Ui to of f !P� CITY Tel No. Exemption, you should become subject 1 the Workers o ensation 1 TO 1 CLUSIVE.EACH r provisions of the Labor Code, you must forthwith comply with such `11 TO 40 INCLUSIVE EACH - 'APPERPLIMIT . CANT provisions or this permit shall be }evoked. 41 OR BRANCH CIRCUITS EACH LICENSED CONTRACTORS DECLARATION - - - - - ADDRESS } - I hereby affirm that IN am licensed under provisions of Chapter 9 180R 20A,208V T027LIGHTING EACH � if Al �/ q d (commencing with Section 7000) of-Division 3 of the Business and CITY yreceaCy Tel NCl'fd & p , 0 Processions Codd,and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR (• SS n Power Apparatus&Large Appliances _ REG.NUMBER Cless. License Number([—Lie.Class - �1V Size&Type HP.KW.KVA.or,KVAR. DISTRICT No. PRrJ�[�k,D BY Q 7 11 lClfl GJ Up to'3 Incl. Contractz"DGata �� y Z Over 3 to 10 Inc. FINAL DATE - ❑ - Over 10 to 50 Incl Z _ `� — I am exempt untler Sec. _Over 50 to 100 Incl. VALIDATION Over 100 - - FINAL B.&P.C.for this reason BY '��O�� Services,.Swbd.,MCC&Panefboaais - Date: �as _ Signat �� 201 --1000 Amp.Under 600 V - ❑ Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. _ SINGLE FAMILY Temp. Power Pole&Appurtenances _ HOME OWNER-BUILDER DECLARATION - 1 hereby affirm that I am exempt from.the Contractor's License Law Sign with One Branch Circuit _ for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits... Code): ❑ 1,as owner of the property,will do the work and the structure Miser Conduits&Conductors is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) 3 ' 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).- - - Civ. C.) - .. OLII?o'-f,[:x,11 PLAN CHECKING FEE f• SLh ?_. Lender's Name LQ� j gm' PERMIT ISSUING FEE _ _ _ _ _e�_ _ rVi Lender'a Address I certify that I have read this application avid 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 nrposes. SEE REVERSE FOR EXPLANATORY LANGUAGE IG "URE APPL N OR AQ N.F DAT ' WORKER'S hveacertificate COMPENSATION DECLARATION 76A663 DPW 9189 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate df consent t0 self insure, 76A663 or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.,3800 Lab. C.) P❑OI'ICy NO. Company FOR APPLICANT TO FILL IN AOB DDRESS Certified copy is hereby furnished. New Residential BIdgS.&Pools EACH NO. FEE .LOCALITY Y 9 P ❑ Certified copy is filed with ins count building inspection 1 &2-Family,Sq.Ft. $ — $ _ NEAREST department. Multifamily Sq.Ft. CROSS ST. R Date Applicant Residential Swimming Pools ASSESS.. MAP BOOK p E PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Red. Light_Sw. OiWN NAME r COMPENSATION INSURANCE. - AIL (This section need not be,completed if the work involved by the First / permit is for.one hundred dollars($700)or less.) Total No. Additional ADDRESS I certify that in the performance of the work for which this,permit is issued,'I Shall not employ any person'in any manner s0 as t0 It PLAN CHECK` become subject t0 the Workers' Compensation Laws: Lighting Fixtures First 20 - - APPLICANT /} r Total No. Additional ADDRESS Date Q —,z- ' y Applican '� Z; 15 OR 20A,120V BRANCH CIRCUITS NOTICE TO APPLICANT: H, er maki 'this"Certifi of CITY .Tel.No. Exemption,you should become ject to tN Workers' Comp tion 1 TO 10 INCLUSIVE EACH provisions Of the Labor Code, you must forthwith comply with such - 11 TO 40 INCLUSIVE EACH PERMIT provisions pr SPL IC„This permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH ANT >_LICENSED CONTRACTORS DECLARATION - •– .ADDRESS W - �' d 1 hereby affirm that I am licensed under provisions of Chapter 9 150.20A.208V TO 277V LIGHTING EACH 0. (commencing with Section 7000) Of Division 3 of the Business and CITY E,C ,Tel.No. .1 >G C..) Professions Code, and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR r I= / Power Apparatus&Large Appliances REG.NUMBER v 16 Class. P O License Number 6� i • LIC.Class �• G /a{� Size&Type p I A,Or KVAA DISTRICT NO. PROC BY 1!D A )tp///hoA ,f Aboo-g nJyLLI EL Contractor' ald &r ( o ..to �L Over 3 to 10 Incl. DATE. U) Over 10 t0 50 Incl. _�7 Z ❑ I am exempt under Sec. _ Over 5010 100 Incl. L 2� VALIDATION 'B.&P.C.for this reason - Over 100 FSINAL - Services,Swbd.,MCC&Panelboards - ate: - 0-200 Amp.Under 600 V S'gnal rem/�- �7�".a A . 201 .1000 Amp.Under 600 V ❑ Over 1000 Amp.or Over 600 V Exemption for Re .int.Elect. - - -- - - - SINGLE FAMILY Sign w.ith One Pole&Appurtene Branch Circuitnances _ _ Aty,�;T.a- HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law _ 34.33 for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits _ 307 Code): - 1 ITEMS ❑ I,as owner of the property,will do the work and the structure Misc:Conduits&Conductors TpTAL +-�T J is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule)_ - and Professions Code). – D CHECK 34.43 CONSTRUCTION LENDING AGENCY - .. .. CHANGE - .00 ]'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), - ... Co.C.) PLAN CHECKING FEE o000-06031 8/21/92 Lender's Name / 5143 1 AM 3:337 • - PERMIT-ISSUING FEE p_'ly- � - 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 P_Ljpposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATUR FAPPL R NT •