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Home My Public Portal About9665 BROADWAY_Electrical__ APPLICATION W 98A663-CE80810 81 APPLICATI®N F®R ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING / BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER WILLIAM A. JENSEN, SUPT OF BUILDING ' LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS sr. I T E M NO. EACH FEE I+ OUTLETS: (FIRST 20) $ $ 20 LIGHTS RECEPT. SW. MAIL OUTLETS: (ADo�L UNITS) 10 ADDRESS LIGHTS RECEPT. SW. LIGHTING FIXTURES: (FIRST 20) 20 CITY TEL. No. i LIGHTING FIXTURES: (ADDITIONAL) .10 ELECTRICIAN,{ O c 4 ^X4r— /C RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS GARD.DISP. STA.COOK CITY i /7/L EL. NO {o b 7Z . DISH WASH. AUTO.-WASH. STATE ` SPACE HTRS. STA.APP.I'/.H.P.MAX.) .50 LICENSE NO. JLL Zf moioRs: OVER NOT x. DISTRICT e . GRO(U�p ONE P E SE'D BY O .11 P. 1.00 J i .}-- c./ _ 1 3 1.501 INSPECTION RECORD } 3 S 2.00 71% 41 Z-- 0 S is 2.501 �I 1s So 3.001 so 100 5.00 _ SIGNS: NO.TRANS. 1 7�7 z NO.LAMPS SERVICE 0.60OV-NOT OVER200A 1.00 SERVICE 0-60OV-OVER 200 A. 2.00 1)I' )•f-�1! �f�� y/y�r` SERVICE OVER 600V 15.00 ^ / , �• MISC. /0 PERMIT ISSUING FEE 2.00 QQ SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT A WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING qn ••�� _ ELECTRICAL WIRING. C WIRING 1 HEREBY CERTIFY THAT 1 AM PEL GISTERED ANDIOR LICENSED AS REQUIRED BY LOS TY ANO STATE OF FIXTURES CALIFORNIA OR THAT 1 AM T E R OF THE ABOVE DESCRIBED RESIDENTIAL PROP Y. POWER SIGNATURE UTILITY CO.NOTIFIED OF PERMITTEE �p1 FINAL A L2 f VALIDATION A YHUR`C. VETT y CK MO CASH SUPERVISING ELECTRICAL ENGINEER LAGo1 6 0 3% J116 2 D 3.00- TEMPLES CITY Y 76A563-CES0610.61 APPLICATION FOR ELECTRICAL. PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER 6u U_DING BUILDING AND SAFETY DIVISION' ADDRESS / JOHN A. LAMSIE, COUNTY ENGINEER -!� WILLIAM A.JENSEN, SUPT OF BUILDING ° LOCALITY C.= (r / d NEAREST FOR APPLICANT TO FILL IN CROSS SL ,/LE 6 A'✓D- BAI-bolw-A A I T E M NO. EACH FEE / OUTLETS: (FIRST 20) $ S OWNER �{ d wcL c �� LIGHTS RECEPT. SW. ,20 / MAIL OUTLETS: (ADD�L UNITS) - ADDRESS !9'e, G r ,dXo&D LIGHTS RECEPT. SW. .10 ' LIGHTING FIXTURES: (FIRST 20) 20 CITY #PIE CJ2�TEL. NO. D LIGHTING FIXTURES: (ADDITIONAL) ,10 ELECTRICIAN RANGES CLO.DRYERS WTR,HTRS, 1.00 ADDRESS GARB.DISP. STA.COOK CITY TEL. NO, DISHWASH. AUTO.-WASH. STATE - SPACE HTRS. STA.APP.('/,H.P.MAX.) ,50 LICENSE NO. MOTORS: OVER NOT OVER H.P. -DISTRICT NO. GRO P ZONE I PROCfESSED B 0 1 1.00 ( t, 1 3 1.50 INSPECTION RECORD } 3 S 2.00 1 O V 8 15 2:50 15 50 3.00 O 50 100 5.00 w a SIGNS: NO.TRANS. h NO.LAMPS Z SERVICE O.60OV-NOT OVER 200A 1.00 SERVICE 0-6OOV-OV ER 200 A. 1 12.00 SERVICE OVER 600V 5.00 MISC. PERMIT ISSUING FEE 2,00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE 5 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE I INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT / WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING / ELECTRICAL WIRING. WIRING G� 1 HEREBY CERT FY THAT 1 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 RESIDENTIAL PROP Y. POWER' SIGNATURE UTILITYCO.NOTIFIED �q % OF PERMITTEE •y FINAL VALIDATIASH� ARTHUR'C. VEIT CK MO SUPERVISING ELECTRICAL ENGINEER LAG0,1 7 5 9% JM 17 2 D 220- 4 /Lt WORKERS' COMPENSATION DECLARATION '200019 ovw alar APPLICATION FOR ELECTRICAL �� 0 = I hsoac ereby affirm that I have a certificate of consent to self ce- insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES - DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB r Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO, FEE ADDRESS _ 4W'i Certified copy is filed with the county building inspec- 18 2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. — NEAREST Residential Swimming Pools CROSS ST. Date Applicant - ORM NAME (' ST -I yl Q WNER OR CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Re<�Light�5w. MAIL �'' COMPENSATION INSURANCE First 20 DDRESS �d Or WH (This section need not be completed if the work involved by Total No. Additional CITY_no4z L Tel.'No.2 5-63-q the permit is for one hundred dollars ($100)or less.) PLAN CHECK I certify that in the performance of the work for which this ' permit is issued,'I shall not employ any person in any manner APPLICANT so as to become subject to the Workers'Compensation Laws, Lighting Fixtures First 20 DRESS Additional CITY Total No. I Date Appli<a 'Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION j 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 _ deemed revoked. - Hood — Fan —Other— CITY Tel, No. LICENSED CONTRACTORS DECLARATION Disp. _ Room Air Card, — LICENSE OR ' I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER Class. (commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. PROCESSED BY > and Professions Code,and my license is in full force and effect. O Size 8 Type HP, KW, KVA, or KVAR License Number Lic. Class _ Up to 1 Incl, FINAL / �j U Over 1 to 10 Incl. DATE / / T Q Contractor Date 1_ VAII ATI N Q ❑ Over 10 to 50 Incl. FINAL - F- I am exempt under Sec. Over 50 to 100 Inc. By V( UU B.BP.C. for this reason Over 100 Date, Services, Swbd., MCC& Ponelboards ;20 7 G,C4 A W 0-200 Amp. Under 600 V D # e 4 e e e 2 . Signature Ml,- 1000 Amp. Under 600 V _ ( e'e j1 (J,^Gj ❑ - Over 1000 Amp. or Over 600 V Exemption for Reg. Mainl. Elect. e • i,� [!,`� Cj v SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp. Power Pole 8 Appurtenances I hereby affirm that I am exempt from the Contractor's License Sign-with One Branch Circuit 0 9.2 2c�8 8 Law for the'following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code):' as owner of the property, will do the work and the Misc. Conduits 8 Conductors structure is not intended ar offered for sale(Section 7044, Other (See Complete Fee Schedule)_ D 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-Total) (Sec. 3097, Civ. C.). ' PLAN CHECKING FEE ' I Lender's Name ' PERMIT ISSUING FEE D Lender's Address _ q` I certify that I have read this opplicotion and state that the TOTAL FEE rev 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 toenter upon the obov entioned.property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date �s u WORKER'S COMPENSATION DECLARATION 20.0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT LI 6A663 I hereby affirm-that I have a certificate of consent to self insure, 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 JOBYA ADDRESS l+' Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE ❑ _ $ $ LOCALITY .. departm copy is filed with the county building inspection 1 &i--Family,Sq.Ft. department. Multi-family Sq.Ft. — NEAREST ROSS ST. Date Applicant Residential Swimming Pools ASSESSOR Q fJ 1_ Q MAP BOOK �e�,J(i.',[,,t7�,yy PAGE /Q PARCEL •CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:RBC.A Light Sw.SL > RP.M NAME Me r'1�.7, 7,A•r12 COMPENSATION INSURANCE First 20 (This+section need not be completed If the work Involved by the MAIL permit is for one hundred dollars($100)or less.) Total No. Additional /' ADDRESS �(Yri certify that in the performance of the work for which this permit CIN C T.I.No. i5 Issued, 1 Shall not employ any person In any manner so as to PLAN CHECK become subject,to the Workers'Compensation Laws. •- Lighting Fixtures First 20 APPLICANT Told l No. Additional q ADDRESS Date•T 2$/ Applicant '^" hi �W .RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE�TO ItlPPLICANT: If, after making this Certl ' to of CITUTeL No. Exemption,you should become subject to the Workers' Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you'must forthwith Comply with such PERMIT /� j,''.� 5) � provisions or this permit shall be deemed revoked. - 7�� Power Apparatus&Large Appliances APPLICANT4 0-1(6 & I LICENSED CONTRACTORS DECLARATION "' Size&Type HP,KW,KVA,or KVAR ADDRESS A'60 Thereby affirm'that I am licensed under provisions of Chapter 9 Over 3 to 10 Ind.(commencing with Section 7000) of Division'3 of the Business and CITY ToL No.5C8�� Professions Code, and my license is in full force and effect. Over 10 to 50 Ind. } '1^ Over 50 to 100 Ind. LICENSE B �y ,� G[ Class.p / . �W I VI REG.NUMBER 7 .AJ a License Number Lie.Class Over 100 DISTRICT NO. PROCESSED BY O p II1Services,SWbd.,'MCC&Panelboards •�� Ir U ContractorNni*l r 6'1yv-;. Date. - IVT q v 0-399 Amp. Under 600 V FINAL O ❑ 400-1000 Amp. Under 600 V DAT am exempt under Sea "'r7i y'`Z j' VALIDATION Over 1000 Amp,or Over 600 V FINAL LLI B.&P.C:far this reasonBy d BRANCH CIRCUIT FEES to Date: 15A,or 20A, 120V,Lighting or Recept. . Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits - 0 4 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits y SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION rwith One Branch Circuit Sign I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits _ Code): - + 17"Ir d &C it d Conus Conductors - I, as owner of the property,will do the work and the structure Misc. " ^� 'w--:t, _ is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) t '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) bow Civ. C:) PLAN CHECKING FEE t- l?Ill,i 7{trr yJ,J', Lender's Name ..tY(( - -- "' PERMIT ISSUING FEE pr� Lender's Address I certify that I have read this application and under.penalty of purjury state TOTAL FEE / that the 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-mentionetl property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF PERMITTEE