The URL can be used to link to this page

Home My Public Portal About9307 DAINES DR_Electrical__ 76A663-CE806 10/74 APPUCAMN PO o C LECU ICAL PERM � , COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER JOB �' r BUILDING AND SAFETY DIVISION ADDRESS Eq 1 LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. OUTLETS No. EACH FEE FIRM NAME / sSJ u� �.e1.lf RECEPT.y MAIL FIRST 20 5 $ U ADDRESS `rulgj'V'T,S LIGHT-- TOTAL CITY ✓h � -/ �—j � yT E L. NO_'), SWITCH_ OVER 20 - .10 D �_APLAN C PPLICANTK ��U / 0 ��/�b� LIGHTING FIRST 20 TOTAL l' OVER 20 ADDRESS FIXTURES S .10 RESIDENTIALj��(y'p�PLIANCES CITY TEL. NO. PERMIT RANGE DRYER // WTR. HTR. APPLICANT /AJ STA. COOK DISP. F.A.U. ADDRESS J t3 7 SPACE HTR. AIR COND. CITY � fjq !.� C%7—V TEL. NO.OR CLOTHES WASH. DISHWASH. LICENSE REG. NUMBER rJ CLASS. $f FAN OTHER .1.00 /_' / 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION (% V AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. SIZE N TYPE OVER TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 — 1 1.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ?. CALIFORNIA OR THAI I AM THE LEGAL &'IHE ABOVE C-' ED RESIDE T R . c:)1 — 10 3.00 DESCAIPL POPERT V PERMITEE CD 10 - 50. 5.00 SIGNATURELLJ -� U 50 - 100 10.00 M_ DISTRICT N0. P ED BY 100 — 500 15.00 S 4 SIGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE INSPECTOR'S SIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE SERVICENOTOVER 60OVOLTSOR200AMP 3.00 UNDERSLAB WORK SERVI CE OVER 600 VOLTS OR 200 AMP 10.00 ROUGH CONDUIT _ TEMP SERVICE,POLE, &APPURTENANCES 5.00 WIRING ,o zf-75' TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES POWER AUTHORIZED , UTILITY CO. NOTIFIED J FINAL PERMIT FEE (SUB TOTAL) NOTES.- PLAN OTES:PLAN CHECK FEE ' PERMIT ISSUING FEE 3.00 TOTAL FEE PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK. M.O. CASH 42 _�O T 29 2 2 5.8 0 m�b SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE _ '♦J� / 76A663{E806 12/75 APP UCAUM FOR REC UMC AL pEG°31MV U - tis COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER EADDRESS23$f�2;? Q BUILDING AND SAFETY DIVISION FOR APP 1 ANT OF IN LIT New Residential Bldgs& Pools EACH NO. FEE EST 1 & 2-Family, Sq. Ft. $ .025 — $ ST. f OWNER OR Multi-family Sq. Ft. .02 — FIRM NAM /dJ/ Residential Swimming Pools 20.00 MAIL ADDRES Outlets: Light, Switch & Receptacle CIT < Tel.No First 20 .50 PLAN CHECK Additional .30 APPLICANT ADDRESS Lighting Fixtures Q First 20 .50 8a CITY Tel.No. Additional .30 PERMIT APPLICANT Fixed Appliances Not,Over 1 HP ADDRES Range_Heate�.W._ CITY_ t 4 Tel. Oven=Dryer—T W.M. r LICENSE OR _ Top F A U __VW.H. l .SD REG.NUMB Class.�—� Hood_ Fan __ 2.00 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. Disp._A.C. ___ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. Power Apparatus&Large Appliances Size & Type HP, KW, KVA, or KVAR I H BY CERTIFY TH I AM G PROPERLY REGISTERED AND/OR 0— YP LI SED AS REQUIRED a LOS ANGELES COUNTY AND STATE OF Up t0 1 Incl. 2.00 :DESCRMED LIFORNIA OR THAI I-A THE LEGAL OWNER OF THE ABOVE 0. ;W Over 1 to 10 Incl. 5.00 RESIDENTIAL ROP Y. Over 10 to 50 Incl. 10.00 ERMITEE IGNA Over 50 to 100 Incl. 20.00 � Vf Over,100 30.00 DISTRICT NO. OCE SED BY Services d 020 Amp. Under 600 V 12.50 _ IN ECTOR'S Oe APPROVALS DATE SIGNATURE rA 201.1000 Amp. Under 600 V 25.00 Z Over 1000 Amp. or Over 600 V 50.00 TEMP.POWER POLE UNDERSLAB WORK Temp. Power Pole&,Appurtenances 10.00 Sign with One Branch Circuit 10.00 ROUGH CONDUIT Additional Sign Branch Circuits 2.00 WIRING (Other) FIXTURES - POWER AUTHORIZED UTILITY CO.NOTIFIED( y� FINAL PERMIT FEE (Sub-Total) NOTES ' PLAN CHECKING FEE (One-Fourth Permit Fee) i PERMIT ISSUING FEE $6.00 4 S� i TOTAL FEE �U PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION K. Mo: CASH V , 66 rSEP 2 493 SEE BACK'OF APPLICATION FOR COMPLETE SCHEDULE OUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of County Engineer DIVISION OF BUILDING & SAFETY ELECTRIC I WILLIAM J. FOX, County Engineer FOR APPLICANT TO FILL IN ' !A' 1 117 DISTRICT NO. GROUP ZONE PERMIT NO. ELECTRICIAN �j '-'-- RECEIVED BY READY FOR DATE ISSUED ADDRESS J'\w A.0'" FIRST INSPECTION �y CITYTEL.Y NO, COUNTY LICA E NO. EXPIRES BUILDING,93 C-. Q� ��6 PERMIT FEES' A RES. _UU --------- --! .NUMBER EACH FEE TaMp e, -cl-ry -- TTT I LIGHT OUTLETS NEAREI$ 0LTO y7�� CR.OBS$T. Ib U RECEPTACLES WALL SWITCHES OWNER ®�bT 5. D(iF-F TOTAL OUTLETS 5c $ I N MAIL 2tr�glJ] ® /l,(,,t� ip�,��A� 1� ADDRESS U a_a-AWYt��- tl ELEC. RANGES 25 2�,,J�fes.�p� ELEC. HEATERS 25 CITY (R04C-HP-PXD TEL. NO.FQ FIXTURES 5 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. MOTORS I CERTIFY THAT I POSSESS THE ABOVE VALID LOS NUMBER HORSEPOWERFEe ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER NEW MVD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. LESS $ .25 SI®NATURE OF _ I/2 2 .SO PERMITTEE_RAA4 4 _ ---- - ---- -.. --- __ 2 s 1.00 INSPECTION RECORD 5 15 1.50 15 50 _ 2.50 -- 50 200 5.D❑ �' 200 Soo_ 10.00 G C.2 Q SOO 1000 15.00 OVER 1000 20.00 - pJ M.G. HET/FREQ. CHANGER-HP Q' -- --- O WELDERS: AC-KVA GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (7S% OF ORIG.) MOVED MO'�IT��OII11RS fi(75% OF DRIG.) MISC. ael.Y/lea 1 SIG 13 NO. NO.TRANS. APPROVALS NO. NO. LAMPS - -- - DATE INSPECTOR'S NAME FOR EACH PERMIT: - WIRING $1.00 / J)7y CONDUIT FIXTURES $1,00 WIRING - SUPPLEMENTARY .50 FIXTURES Z POWER , TOTAL FEE 41 / UTILITY Co.NOTIFIED FINAL .1z--- 76AGG3 DBS#5A 4-52 COUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of County Engineer DIVISION OF BUILDING & SAFETY `� WILLIAM J. FOX, County Engineer DISTRICT NO. GROUP ZONE PERMIT NO. FOR APPLICANT TO FILL IN Is- ..-► 14— / 6 h _ELECTRICIA_N B mow' i r v ./ RECEIVED BY READY FOR DATE ISSUED ADDRESS B 7- Jr— G"'�- '0^- � FIRST INSPECTION CITY /9Y TEL. NO -L COUNTY LICENSE. NO. EXPIRES-'-1-G BUILDING PERMIT FEES ADDRESS NUMBER EACH I FEE LOCALITY ��'l�L� _LIGHT OUTLETS NEAREST +r' �,/ RECEPTACLES T CROSS ST. ! s �"� WALL SWITCHES OWNER 10o,5 F_z T TOTAL OUTLETS s0 $ .2-G7 MAIL d ELEC. RANGES 25 ADDRESS ELEC. HEATERS 25 CITY /C OS c-0-leA'6> TEL. NO.A-r-f"Z.j 3y FIXTURES 5 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS Z AND AGREE TO COMPLY WITH. ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS 5 AND STATE LAWS REGULATING ELECTRICAL WIRING. MOTORS 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER NEW MVD. HP OVER lHC. EACH ' + OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. fl './2 & LESS $ .25 SIGNATURE OF. 2 50 �t Q" PERMITTEE'' r 2 s 1.00 f s 1s i.so . '- `INSPECTION RECORD _ is so 2:50 J—y��`� `� / / XTL/I� S Iva�� 7' _ so 200 5.00 200 SOD 10.00__ J 500 1000 _1 5.DO a _Z "OVER 1000 20.00 [' M.G. SET/FREQ. CHANGER-HP R WELDERS: AC-KVA y O _GENERATORS - KW TRANSFORMERS - KVA _ TEMP. MOTORS (75% OF CRIB.) - MOVED MOTORS (75% OF ORIG.) _ MISC. SIGNS NO. NO.TRANS APPROVALS NO. NO. LAMPS DATE INSPECTOR'S NAME FOR EACH PERMIT: WIRING $1.00 CONDUIT q+ / FIXTURES $1.00 / �'v' WIRIN ��' //. (/ ` 93UPPLEMENTARY ,50 FIXTURES Z _ POWER TOTAL FEE $ UTILITY CO.NOTIFIED >�✓ r i FINAL ��' 76A663 DBS#5A 4-52 '76A�66?C' 8068 1275 &PPU� UM FOR ELEC�U OCG L MINE INE BUILDING AND SAFETY DIVISION, FOR APPLICANT TO FILL'IN JOB - New Residential Bldgs..&Pools EACH NO. FEE ADDRESS ' 9307R a.' Pr'z a 1 &2 Finaily Sq. Ft. $ — $ 1 LOCALITY City,_ Multi-family Sq. Ft. NEAREST y _Y-''" 9 `'a' CROSS ST. IN•I tnr Residential Swimming Pools OWNER OR FIRM NAME TJ( -T r3 'ni Outlets; Light, Switch& Receptacle MAI L First 20 3- L, ADDRESS. 9307 E. Daines Dr Additibnal - CITY a Tr Tel. No. 28 64a AN CHECK PL APPLICANT PJV, Lighting Fixtures First 20 - 3-90 ADDRESS. 9307 E. DainesNDr Additional CITYTeMple Citv Tel. No.2R5 4AF PERMIT'" Fixed Appliances Not Over 1 HP APPLICANT M J, PeCIriniv /J/0(f/ Range Heater D.W. ADDRESS ,;2 'T-' Oven Dryer W.M. f TOP FAU W.H., CITY A Pei. No,. _n- �0 Hood Fan LICENSE OR Disp. A.C. K .REG'. NUMBER � � -�� Class. �J v 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY O Power Apparatus&Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING V Size%Type HP, KWELECTRICAL WIRING., KVA,or KVAR J a Up to 1 Incl• ` �, ] HEREBY CERTIFY THAT,[ AM PROPERLY REGISTERED AND/OR Over 1 to 10 Incl. LICENSED AS REOU ED BY'LOS ANGELES COUNTY AND STATE OF CALIFORNIA ORT I T LEGAL OWNER OF THE ABOVE Over 10 to 50 Incl. DESCRIBED RES ID 11 P O Y. Over 50 to 100 Incl. PERMITEE Over 100 SIGNATUR DISTRICT NO. PRO ESSED BY Services �! 0'-'200 Amp. Under 600 V 201, 1000 Amp. Under 600 V APPROVALS DATE INSPECTOR'S Over 1000 Amp.or Over 600 V SIGNATURE TEMP. POWER POLE Temp. Power Pole&Appurtenances UNDERSLAB WORK Sign with One Branch Circuit Additional Sign.Branch Circuits ROUGH CONDUIT (Other) WIRING,. FIXTURES POWER AUTHORIZED PERMIT FEE (Sub-Total) L UTILITY CO.NOTIFIED ry PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL � �,�/,� " PERMIT ISSUING FEE NOTES TOTAL FEE PLAN CHECK VALIDATION CK. M.O. CASH P MIT VALIDATION. Ck. M.O. CASH TEMPLE RTY 76A663-CE80610-61 APPUC AMON FOR ELECT[ ALS PERN'T �. COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS CJ JOHN A. LAMBIE, COUNTY ENGINEER ! �+ WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITY h/ ( - NEAREST ,�.^. FOR APPLICANT TO FILL IN CROSS ST. p I T E M NO. EACH FEE j OUTLETS• FIRST 20) $20 $ OWNER / '. LIGHTS RECEPT. SW. MAIL +^ r. OUTLETS: (ADD'L UNITS) 70 ADDRESS 1:. LIGHTS RECEPT. SW. - LIGHTING FIXTURES: (-FIRST 20) 20 CITY �1A TEL. NO. ,. LIGHTING FIXTURES: (ADDITIONAL) ,10 ELECTRICIAN /'/t.O/0fi G�LIC - ' RANGES CLO.DRYERS WTR.HTRS. -4f 1.00 ADDRESS7-5-5, W`I►� ZCR Al,, GARB.DISP. STA.COOK CITY"AlTEL, NO. DISHWASH. r AUTO.-WASH. STATE SPACE HTRS. STA.APP.(+/z H.P.MAX.) .50 LICENSE NO. MOTORS: OVER, NOT OVER H.P. DISTRICT NO. GROUPN,E P C ED BY O 7 1.00 �j v -� / v� �' t 3 1.50 INSPECTION RECORD 3 3 2.00 CL O B 7 5 2.50 V 15 50 3.00 V 50 100 5.00 UJ SIGNS: NO.TRANS. Z NO. LAMPS D SERVICE 0.60OV-NOT OVER 200A 1.00 - r SERVICE 0-600V-OVER 200 A. 2.00 SERVICE OVER 600V - 5.00. MISC. r PERMIT ISSUING FEE r , SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE $ Q IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATI N APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ` CONDUIT n WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR - LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF �' FIXTURES CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIA ROPE Y. POWER SIGNATURE ` UTILITY CO.NOTIFIED ;: r OF PERMITTEE y� FINAL VALIDATION ARTHUR C. VEIT SUPERVISING ELECTRICAL ENGINEER CK MO CASH F6 U° 9 3 1 7 2 D 2 0,9 A w`k DBS-SA I1•55 'DIVISION OF BUILDING AND SAFETY Department Of County Engineer BUILDING .-. �).. County Of LOS Angeles ADDRESS (_/" JOHN A. GRIFFIN,COUNTY ENGINEER D.GRIF CA88ATT D. FIN, SUPT OF BUILDING LOCALITY �y FOR APPLICANT TO FILL IN NEAREST l/� lizic^G PERMIT ]FEES cRoss sr. tel/—ice_ NUMBER OWNER LIGHT OUTLETS MAIL a RECEPTACLES ADDRESS WALL SWITCHES FEE CITY TEL.NO. TOTAL OUTLETS @ 5¢ $ d ELECTRICIAN ELEC. RANGES p� 25 a �^ o EtEe-HS4kT-sRS yv 25 2S ADDRESS ✓ z CITY TEL.NO.A 2363tA, E KW EA STATE ?Cl � �Q ' FIXTURES S ,R,O LICENSE NO. / / _ MOTORS DISTRICT NO. GROUP ZONE READY FORINSPECTION NUMBER HORSEPOWER FEE 7 ,4. NEW MVD. HP OVER INC. EACH - -- - INSPECT%ON RECORD 3�2 e LESS $ .2s lf2 2 .50 2 - 5, 1.00 5, 15 1.50 IS 50 2.50 50 200 5.00 MISC. y r' NO.SIGNS NO.TRANS. NO.SIGNS NO. LAMPS FOR EACH PERMIT: WIRING $1.00 Od x FIXTURES $1.00 SUPPLEMENTARY .50 APPROVALS TOTAL FEE $ a { DATE INSPECTOR'S SIGNATURE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY I. CONDUIT e WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING. 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE POWER 3 DESCRIBED RES]DENTIA PR fPERTY. UTILITY CO.NOTIFIED SIGNATURE OF PERMITTEE FINAL s:r,z. mom,. JOHN A.LAMBIE.COUNTYENGINEER� . ALjM ARTHUR C.VEIT.CHIEF ELECT. INSPECTOR CK MO CASH L'GO . 0 9° PR 2 3 2 3.6 0 7 A663 DBS-5A 11.55 AP UCATMN FOR ELECTI11 C PERMT T DIVISION OF BUILDING ARID SAFETY �, :- -,: Department Of County Engineer BUILDING ec97 a a. Ccuntq Of LOS Angeles ' ADDRESS JOHN A.LAMBIE,COUNTY ENGINEER �"'' CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY::::r c�"�"� x.007 - 14..f=. .,, ,,.•. .ami. z FOR APPLICANT TO FILL IN NEAREST � I PERMIT FEES CROSS ST. NUMBER OWNER LIGHT OUTLETS MAIL RECEPTACLES ADDRESS ( WALL SWITCHES FEE CITY TEL.NO. TOTAL OUTLETS @ 5¢ $ ELECTRICIANS it,,�« G-" . sx� e- ELEC. RANGES 25 ADDRESS C!!!LV/ ELEC. HEATERS 25 KIM EA CITY Wi J2rt. e.9,A^ w- TEL.NO. STATE �+ FIXTURES 5 LICENSENO. MOTORS DISTRICT NO. OU a .w PE READY FOR INSPECTION NUMBER HORSEPOWER FEE I NEW MVD. HP OVER INC. EACH I/2&LESS $ .25 INSPECTION RECORD 1/2 2 .50 11 2 5 1.00 5 IS 1.50 15 50 2.50 50 200 5.00 R' G MISC. e r d r O.SIGNS NO.TRANS. 4 NO.SIGNS NO. LAMPS FOR EACH PERMIT: V WIRING $1.00 FIXTURES $1.00 SUPPLEMENTARY .50 APPROVALS TOTAL FEE $ DATE INSPECTOR'S SIGNATURE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION . AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING �b S� ELECTRICAL WIRING. I HEREBY CERTIFY THAT I AM PROPERLY R GISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY L,OS ANGELES AND STATE OF ' CALIFORNIA OR THAT I A HE LEG OW 'R OF THE ABOVE POWER DESCRIBED RESIDENTIAL PR SIGNATURE UTILITY CO.NOTIFIED OF PERMITTEE / ` FINAL JOHN A.LAMBIE, COUNTY ENGINEER DATION ARTHUR C.VEIT.CHIEF ELECT. INSPECTOR CK MO CASH WORKERS'COMPENSATION DECLARATION 76-663 10/81 /r�rl�fP �/PaAMON FOR E ECTMICA PIGRue711� II I hereby affirm that I have a certificate of consent to self insure, CE-806G Ci11rI� LL �1.o III L� I(� I� or a certificate o` Workers' Compensation Insurarice, or''e6ertified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec. 3800,Lab. C.) Policy No. Company FOR•APPLICANT'TO FILL IN JOB - �r�/�� (�' i • � ❑ Certified copy is herebyfurnished: EACH NO.. FEE ADDRESS New Residential Bldgs. &Pools LOCALITY _ F-1 - ' l Certified copy is filed with the. cou ty building. inspection 1 & 2-Family,Sq. Ft. $ $ � department. Multi-family Sq.Ft. NEAREST CROSS ST. {4,, „`t( � Residential Swimming Pools OWNER OR f un Date Applican FIRM NAMEL��`''`1 - CERTIFICATE OF EXEMPTION FROM WORKERS' � MAIL Outlets:Rec Light — Sw. . COMPENSATION INSURANCE If 6 ADDRESS This section need not be com leted if the work involved b the First 20 ( p Y permit is for one hundred dollars($100)or less.) Total No. CITY j � Tel.No. Additional - V PLAN CHECK - I certify that in the performance of the work for which this permit- 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.—I CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, „after making, this Certificate of (� APPLICANT Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. provisions of the Labor'Code, you must forthwith comply with such Oven — Dryer _ W.M. ADDRESS `IA provisions or this permit shall be deemed revoked. Top _ FAU W:H. CITY . rte Tel.No, LICENSED CONTRACTORS DECLARATION Hood — Fan Other_' I hereby affirm that I am licensed under provisions, of Chapter 9LREG.NUMBER ICENSE OR Disp. Room Air Cond.. Class. (commencing with Section 7000) of Division 3 of the Business and ' p Professions Code,and my license is in full,force and effect. Power Apparatus& Large Appliances DISTRICT_/}-0. PRO SED BY JV Size& Type HP,KW,KVA,or KVAR, >;�// � 0 License Number Lic.Class ' Up to 1 Incl:- FINAL U �J Over 1 to 10 Incl DATE VALIDATION 0 Over o Incl.Contractor' Date (4- O 10 t 50 Il. ❑ FINAL U I am exempt under Sec. .Over 50 to 100 Inc. BY W BAP.C.for this reason Over 100 N .. Services,Swbd:;MCC,& Panelboards ' Z Date: 0- 200 Amp.Under 600 V 600 V Over 1000 Am Signature. 201 - 1000 Amp.Under El .. P. or Ov er 600 V I ' Exemption for Reg.Maint.Elect SINGLE FAMILY Temp.Power Pole'& Appurtenances 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit. I hereby affirm that I am exempt from the Contractor's License LawACCT.` for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits. Code): > 3 - 44.20 ❑ I,as owner of the property,will do the work,and the structure Misc:Conduits & Conductors 1 ITEMS EMS is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) - - and Professions Code). D -J {TAL 44 . 20 CONSTRUCTION LENDING AGENCYi:�{ f}a}.2d 1 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) CHANGE ■�!� Civ.C.). PLAN CHECKING FEE Lender's Name ( f l^- ;,i 6/12/9I I PERMIT ISSUING FEE Lender's Address 12.219 1 AM 7.15 1 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 Zfo , s ction purpo es. SEE.REVERSE FOR EXPLANATORY LANGUAGE Signature K Kermittee Date , /ORKE,F'S COMPENSATION DECLARATION 20-0019 DPW(12-91)76A663 . APP UCAMN FOR ELECT ICA PERNT I hereby PZffirrn-that I have a certificate of consent to self insure, " or a certificate of Worker's Compensation Insurance,,or a cer d COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof„(Sec.3800 ab. C.)_ Policy No. Company FOR APPLICANT TO FILL IN 101, ADDRESS < - ❑ 'Certified copy-is hereby furnishe -New Residential Bldgs.&'Pools NO. EACH FEE LOCALITY ,Certified copy is filed the.co t building inspection 1 &2-Family,Sq.Ft. $ $ F pY Y 9 P NEAREST 1 department. Multi-family Sq.Ft. CROSS ST. 1 ��: Applicant Residential Swimming Pools - ASSESSOR p p Date APP MAP BOOK p d - • 3O - -' - - `PAGE PARCEL CERTIFICATE OF.EXEMPTION,FROM WORKERS' Outlets:Rec. Li ht Sw. OWNER OR '4 g / FIRM NAME COMPENSATION'INSURANCE Tfiis section need not,be com leted if the work involved I the +/^ First 20 MAIL ( p Y Total No: ”' Additional ADDRESS permit is for one hundred dollars($100)or'less.) QfQ I certify that in the'performance'6f the work for'which this permit CITY CJ(v Tel.No is issued, I shall not employ any person in any manner so as t0 -PLAN CHECK becomeisubject-to the Workers'Compensation Laws. Lighting Fixtures_ First,20 E APPLICANT. Total I\ Additional ADDRESS Date "• Applicant, RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO,,API?LICANT;.If; after making this Certificate of CITY Tel.No. Exemption,you should become subject-to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of'the Labor Code, ou must forthwith comply with such PERMIT Y p Y Power Apparatus&Large Appliances APPLICANT dA provisions or this permit shalCbe deemed revoked.:' f LICENSED CONTRACTORS DECLARATION '` Size'&Type HP,KW,KVA,or'KVAR ADDRESS . . I'hereby`affirm that I am licensed under provisions of Chapter 9 Over.3 to 10 Incl. (commencing with Section 7000) of-•Division 3 of the Business andCITY el.No. ,3'a� Professions Code, and my license is.in full force and effect. Over 10 to 50 Incl. >_ LICENSE OR Class. Over 50to100 Incl. REG,NUMBER 3 - O �/2 A IL Over 100 DISTRICT N0. P C SED BY 0 License Number J Lia Class Services,Swbd.,MCC&Panelboards Qd Contractor Date 0-399 Amp, Under 600 V DATe O ❑ 400-1000'Amp.Under 600 V V I am exempt under Sec. 000 Amp.or Over 600 V VALIDATION LV _Over 1 . FINAL B.&P.C.for this reasonBY BRANCH CIRCUIT FEES Date: 15A,or 20A,120V,Lighting or.Recept. Z 1 To 10 Branch Circuits Signature'_ _ 11 To 40 Branch Circuits 41 Or More Branch Circuits x ❑. Exemption for Reg. Maint.E16CE. 15A,20A,208V To 277V Lighting Br.Circuits ( `••i ::_-. SINGLE FAMILYTemp:Power Pole&Appurtenances _ri i`• ,3 HOME OWNER-BUILDER DECLARATION "Sign with One Branch Circuit 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 AI Code): ❑ I, as owner of.the property, will do the work and the structure Misc.Conduits&Con ductors i•• t is not intended or offered for sale(Section 7044, Business° Other(See Complete Fee Schedule) _ and Professions Code). �a CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the / ,srs^a .;.::t: r y y;r.:L;;:�:, performance of the work for which this permit is issued(Sec. 3097, PERMIT FEE (Sub-Total) b _.::mak-_3 M€:.rLa; ,,�7 ;�t• Civ. C.) r}( _¢_"~i PLAN CHECKING FEE Lender's Name ' PERMIT ISSUING FEE Lender's Address �7 I certify that 1 have read this application and under penalty of purjury state TOTAL FEE fT. that the above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring,and hereby authorize repre tatives of this Co my to e r upon the above-mentioned property form ectio' r SEE REVERSE FOR.EXPLANATORY LANGUAGE v SIGNATURE OF PERMITTEE -DATE - , WORKERS'COMPENSATION DECLARA-TLON 76 80CT; (2-8,'0):y AIP UCQTUO�1 FOR l LEC p 11'SUC AL PERMT t I•hereby affirm that"I have .a certificate of consenttoself COUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate o1 Workers'Compensation Insurance,or (� a certified copy thereof(Sec. 3800;Lab.C.) FOR APPLICANT TO FILL IN JOB r/7 Policy No. Company EACH NO. FEE ADDRESS;;/ New Residential Bldgs.&Pools Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY c Multi-family Sq: Ft. — NEAREST 0 Certified copy is filed with the county building inspection department, GROSS ST Residential Swim.rriing'Pools OWNER OR r - . IRM NAME Date Applicant Outlets:.Rec.�Light Sw: AIL ` k First 20 ADDRESS CERTIFICATE OF EXEMPTION.FROM WORKERS' Total No. 1 -Additional CITY Tel No. COMPENSATION INSURANCE } PLAN CHE tl (This section need not be completed if the work'involved r^s� APPLICAN 0 Lighting Fixtures First 20 6 �_ `�' -ADDRESS U by the, permit is for one hundred dollars ($100) or less.) Additional Ir Total No. �! O I certify that in.the performance'of the work for which this Fixed'Appliances Not Over 1 HP 'CITY Tel No. U permit is issued, I shall not employ any person in any manner PERMIT so as'to become subject to the Workers' Compensation Law . Range_ HeateD.W. APPLICANT �� 0- r Oven'_ Dryer_'W.M. ' ADDRESS 1r /� to Top FAU W.H. v �'7 Z_ . Date. Applicant _ YZgl" f Tel No. Hood — Fan _Other NOTICE TO APPLICANT: If,,after making this Certificate-of Disp. _ Room Air Cond.. (CENSE OR pl /� Exemption, you should' become subject to the Workers' REG.NUMBER DClass C� Compensation provisions.of the Labor Code, you must forth- Power Apparatus& Large Appliances. DISTRICT NO. PRCjGf.SSFe0 BY with complywith such provisions on this permit shall be Size.&Type HP,KW, KVA,or KVAR �` deemed revoked. Up to 1 Incl. • - '. FINAL Over 1 to 10 Incl. DATEa . LICENSED CONTRACTORS DECLARATION Over 10 to 50'1ncl, (, 6 VALIDATION, 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. Services License Number / Lic.•C!ass -/� " ',6-200 Amp. Under 600 V' �. 201-1000 Amp.Under 600 V i O(L'`];8 q, Contractorate ROver 1000 Amp.,or Over 600 V :#,0,0-.01'0,02 ' HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appur,tenances Sign with One Branch Circuit2.0'O 1 S O O I hereby affirm that ,I am exempt from the Contractor's Additional Sign Branch Circuits - License Law for the'following reason (Section 7031.5, Busi- 'O ° ° 1 -SO O, j ness•and Professions Code): ` Misc.Conduits& Conductors a will do the work and 'the 7,2 -8.1 I, as owner of the property, Other (See Complete Fee Schedule)— structure is .not intended or offered for sale (Section 7044, Business and'Professions.Cbde). CONSTRUCTION.LENDING AGENCY 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) issued (Sec. 3097,Civ.'C.). Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE I certify that I-have read this application-and slate 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 the ove- en t' ned prope for inspection purposes. z Q SEE;REVERSE FOR EXPLANATORY LANGUAGE Signature.of Permittee Date f WORKERS'COMPENSATION DECLARATION CE 806G (2-80) /r P UCAM Il l FOR ELLSCTMIC/r-i1LS P LSIISMII' I hereby affirm that:I.have a certificate of consent to self COUNTY OF LOS ANGELESBUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or T/ a certified copy thereof(Sec. 3800,Lab.C.) FOR APPLICANT TO FILL IN JOB t? Policy No. Company EACH NO. FEE ' ADDRESS q;7D P7 New Residential Bldgs.&Pools Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY — NEAREST Certified copy is filed with the county building inspection CROSS ST Eldepartment. Sq. Ft. department. Residential Swimming Pools OWNER OR C ��q �q_ AlIRM NAME (cant c�L l� ight.L Z' Sw.l 2a' K� MAIL. Date Applicant Outlets: Re First 20 , ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CIT Ye To. t COMPENSATION INSURANCE d PLAN CHECK O APPLICANT U (This section need not be completed if-the work involved .�L RE SS by.the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADD " Total No. Additional O' I certify that in the performance of the work for which thisCITY Tel No. Fixed Appliances Not Over 1 HP U permit is-,issued, I shall not employ any erson in Iany manner PERMIT W so as to become subject to the Wor ers Co pe ation Laws. Range_Heater_D.W. APPLICANT tZ Oven Dryer,_W.M. ADDRESS lA Top _ FAU _W.H.. z Date&t2: 3�Applicant. CITY Tel No.lf/' —7 Hood — Fan —Other NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond� 3 9th LICEN OR Exemption, you should become subject to the Workers' REG. NUMBE Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCESJED BY with comply with such provisions or this permit shall be Size&Type HP,KW, KVA,or KVAR ~ deemed revoked. Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. VALIDATION I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. BY AL 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 d' ness and Professions.Code, and my license is i,n full force and �pp effect. Services License Number, Lic.Class `0 V -200 Amp. Under 600' �.0 2011-1000 Amp. Under 600 V ' Contractor AsT,P� FZPy Date's CJ Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances Ihereby 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): Jr 5:7.'4 A `Mise.Conduits&Conductors F] I, as owner of the.property, will do the work and the Other (See Complete Fee Schedule)— # o 0 o o o2 structure is not intended or offered for sale (Section 7044, Business and Professions Code )• 2,o'0 5 0 110 CONSTRUCTION LENDING AGENCY 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) / o o�0 5 Q t�+,�'� issued (Sec. 3097,Civ.C.). Lender's Name PLAN CHECKING FEE (One-Fourth Permit Feel O�'—8 2 Lender's Address PERMIT ISSUING FEE 0 I certify that I have read this application.and.state thatthe TOTAL FEE above information-is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representativesf this County to enter upon the above- en ' ned pIrpe y f Anspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatu of Per ittee Date