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Home My Public Portal About9902 BROADWAY_Electrical__ WORI:ERS'COMPENSATION DECLARATION 63 CE 806G (2-80) APPLICATION FOR ELECTRICAL PERMIT {I CE806G J I 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.) FOR APPLICANT TO FILL IN JOB. zr Policy No. New Residential Bldgs. &Pools Company EACH NO. FEE ADDRESS /c ez/�Z) Al/ -� Certified copy is hereby furnished. 1 &2-Family,5q. Ft. $ — Is LOCALITY l Multi-family Sq. Ft. CROSS 5NEARESTT 4(J Certified copy is filed with the county building inspection department. Residential Swimming Pools OWNER OR FIRM NAME Rj}N/' SA 41 FEiiee Date Applicant Outlets: Re Lighj/ Sw.� /� MAIL ESS fytlt First 20 ADDR2 /3/? /'-D CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY rF/)(P G/S C//"y Tel No.2 G- 5z3/0 COMPENSATION INSURANCE } PLAN CHECK 0— (This section need not be completed if the work involved /� U by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures, First io ADDRESS - cc Total No.i Additional 0 I certify that in the performance of the work for which this CITY Tel No. I_ permit is issued. I shall not em lov an person in an manner Fixed Appliances Not Over 7 HE CJ P P Y P Y PERMIT W so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT d Oven _ Dryer_W.M. ADDRESS y Z_ Date Applicant Top _ FAU _W.H,._ CITYC4 4.52 Hood _ Fan —Other— NOTICE TO APPLICANT: If, after making this Certificate of Disp. Room Air Cond_ LICENSE OR Exemption, you should become subject to the Workers' REG. NUMBER Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROQLSSF,6 BY with comply with such provisions or this permit shall be Size&Type HE,KW, KVA,or KVAR I A� deemed revoked. C/ Up to 1 Incl. ' FINAL Over 1 to 10 Incl. DATE LICENSED CONTRACTORS DECLARATION VALIDATION Over 10 to 50 Incl. I 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. r Services License Number Lie.Class 0-200 Amp. Under 600 V 201-1000 Amp. Under 600 V Contractor Date Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances I hereby affirm that 1 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 t 18 Z2 A Ell, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— # o e o e o 'Z `structure is not intended or offered for sale (Section ' 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 2 ° ° 1 0 5 0 I hereby affirm that there is a.construction lending agency for the performance of the work for which this permit is PERMIT FEE (Sub-Total) ° ° ° 1-Q 5 0 d issued (Sec. 3097,Civ. C.). Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) 11,06-81 Lender's Address PERMIT ISSUING FEE 7 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 _ ia bove-mentioned propeerrty for inspection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE gnature of Permittee �� Date 76AG63-CEBOS-6_57 APPLICATION FOR ELECTRIC PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS (/ 2 JOHN A.LAMBIE,COUNTY ENGINEER v` CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. PERMIT FEES OWNER LIGHTS RECEPTACLES SWITCHES NUMBER I T E M EACH FEE MAIL Jf $ $ ADDRESS TS10 LEC. RANGE WATER HEATERS, CITY TE9FOR CL ERS .50 O ELEC. SPACE HEATERS, STAT'Y. COON ELECT CIAN ING UNITE. GARBAGE DISPOSERS, ADDRESS AUTO WASHERS, DISHWASHER .25 LIGHTING FIXTURES .10 CITY STATE MOTORS LICENSE NO. HORSEPOWER ()I,STRICT NO. GROI.IP ZONREADY H.P: OVER INC. yi 8 LE55 .25 / vR - 2 .50 INSPECTION RECORD z 5 1.00 5 15 1.50 15 — 50 2.50 50 200 5.00 MISC. SIGNS NO.TRANS NO.LAMPS SERVICE O-600V / 1.00 SERVICE OVER 600V 5.00 WIRING PERMIT 1.00 FIXTURE PERMIT 1.00 _ SUPPLEMENTARY PERMIT .50 APPROVALS TOTALFEE $ I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICA ION DATE INSP//ECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT /D'ry%�j�4hzhlJ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING V11/1FR'4 ELECTRICAL WIRING. WIRING SFr I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE POWER DESCRIBED RESIDENTI PERTY. SIGNATUREUTILITYCO.NOTIFIED q Pr /!�AA�d1 /i/•'/// OF PERMITTE _ FINAL '✓ !� —U( o U- JOHN A.LAMBIE. F., VALIDAPQN- j ARTHUR C.VETT, COUNTY ENGINEER ON mCABH SUPERVISING ELECTRICAL ENGINEER �2938m APR15 2 A 2,70