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Home My Public Portal About8863 ELM AVE_Electrical__ 768663-CB806 ,0/72 .APPU A M BOO Q ktCUMC AL pERNU COUNTY OF LOS ANGELES DEPARTMENT-OF COUNTY ENGINEER"' JOB BUILDING AND SAFETY DIVISION ADDRESSc�aa . .. LOCALITY ✓�.-....._.--•.�.Lc._ .�-'[v(_..• NEAREST J'• r .�. ' FOR APPLICANT TO FILL IN CROSS,ST, N0. EACH FEJEOUTCETSOWNER OR /f $ ,$ :_ FIRM NAME ,Za•.. RECEPT, f•}jfLRST 20 .29ADDRESSLfGHTti.>.. TO.TAL ' 'CITYj7 TEL: NOp10 1`�lr�--(J�D SWITCH OVER 20 ,10 . PLAN, CHEC .FI RST 20 - LIGHTING 25 APPLICANT TOTAL - .- OVER 20 . _ ADDRESS, ' FIXTURES ` � 10 � �- , RESIDENT,IAL'APPLIANCES CITY ,TEL. NO: ral PERMIT RANGE b ;DRYER WTR. HTR. APPLICANT ' STA.'COOK •- DISP.. F:A.U. ADDRESS AV SPACE HTR:.. _ IR' COND. � CITY _ ! .TEL.,NO. -� CLOTHES WASH. , DI`S.H.WASH. LICENSE OR- AEG. NUMB CLASS.' .FAN OTHER 1.00HE.E.X ACKNOWLEDGE THAT I HAVE 'READ THIS APPLICATION (�sGd AND STATEITHAT 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. IND, TYPE OVER TO ' 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 1 AM THE .LEGAL OWNER _OF THE ABOVEj_ r bE;CRI:P,ED R ��W ESIDENTIAL PROPERTY. d 1 - 10 3.00 PERMITE G7 10.- 50 1' 5.00 SIGNATU p: .. - O 50 - 100 10.00 - DISTRICT NO.- PROCE SED BY V LLI 100 _ 500 1x.00, Z -SIGN; GASS1 GN AND ONE CIRCUIT 5:00. APB ROVALS DATE INSPE,. 'S SIGNATURE TUBE, OR _ MARQUEE •ADDITIONAL CI.RCU.ITS 1.00 - TEMP. POWER POLE SERVICE,NOTOVER'600VOLTSOR200AM'P 3.00 UNDERSLAB WORK SERVICE OVER 600'VOLTS.OR200AMP :10.00 ROUGH CONDUIT TEMP SER VICE, POLE,&APPURTENANCES 5.00 -• WIRING TEMP LIGHT�OR RECEPT. SYSTEM 3.00' FIXTURES " POWER AUTHORIZED UTILITY CO. NOTIFIED . FINAL / ...i( PERMIT FEE '(SUB TOTAL): - NOTES: PLAN CHECK FEE PERMIT ISSUING FEE - 3.00 TOTAL FEElei• PLAN CHECK'VALIDATION CK. M.D. CASH PERMIT VALIDATION, CK. M.O. CASH' SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE , 76A663-CE806 B-62 APPUCAIMN FOR ELEC UMCAd PERWr COUNTY OF LOS ANGELES -71 DEPARTMENT OF COUNTY ENGINEER BUILDING 3 BUILDING AND SAFETY DIVISION ADDRESS C� e JOHN A. LAMBIE. COUNTY ENGINEER 7:: AA WILLIAM A.JENSEN, SUPT OF BUILDING - �I LOCALITY / NEAREST ) FOR APPLICANT TO-FILL IN CROSS ST. fi RECEi – TOTAL NO. EACH FEE OUTL TS FIRST 20 $20 $ OWNER' * LIGHT" MAIL /� x. ADD'L 10 ADDRESS �(Y� -c,GK. a.. SWITCH. - OVER 20 - TOTAL CITY TEL. NO. T -- .3 ;, LIGHTING l� FIRST 20 .20 FIXTURES 1 ADD'L 1O ELECTRICIAN "y OV9R 20 �. RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS GARB.DISP. STA.COOK - CITY . TEL. NO.. DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.W.H.P.MAX.) .50 LICENSE NO. .i MOTORS: OVER NOT OVER H.P. DISTRIC NO. GR NE 0 1 1.00Nz— G' C 1 3 1.50 INSPECTION RECORD 3 B 2.00 d'_- —1 3 /, c ✓'� - ,. .nh�. 8 15 2.50 15 50 3.00 f 9L 50 100 5.00 0 SIGNS: NO.TRANS , NO.LAMPS ov O SERVICE D-60OV-NOT.OVER 200A 1.00 W ,S SERVICE 0.60OV-OVER 200 A. 2A0 H SERVICE OVER-600V 5.00 ? MISC. ' c PERMIT ISSUING FEE 2.00 - -,` SUPPLEMENTARY PERMIT ISSUING FEE' 1.00 , TOTAL FEE - APPROVALS DATE INSPECTOR'S SIGNATURE 1 HEREBY ACKNOWLEDGE THAT I. HAVE READ THIS APPLI ATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY r1 CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING +J, ELECTRICAL WIRING. ,� WIRING 1 HEREBY CERTIFY THAT I 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 RESIDE TIAL PROPERTY. .n POWER d ^ SIGNATURE r UTILITY CO.NOTIFIED A r/ +t. fif.A/1 1 OF PERMITTEE _ FINAL VAUDAT ARTHUR C. VEIT SUPERVISING ELECTRICAL ENGINEER CK MO CASH, - Lrti�o 07 4. 1'13 FEB 2 Fl 4, WORKER'S COMPENSATION DECLARATION 20-0019DPW.(12-91) i�f�fl� ��aa ��pp FOR Impp 22��aa ��++i�pp I�(�I��/� 76A663 - . 'APPU eA��®IIV' ICOR L�I�I�CTMI ALS I�LSIf�111 T �J 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.) FOR APPLICANT'TO FILL IN, JOB � -T. ��(+ lr Policy No Company s ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE �n_�., _-+_ - _� ` . -.$ $ LOCALITY Q J l Z ❑' Certified copy is filed with the county building inspection 1&2-Family,Sq.FL _ NEAREST department. Multi-family Sq.Ft. CROSS ST. ' DateApplicant. Residential Swimming Pools ASSESSOR _ MAP BOOK I PAGE PARCEL CERTIFICATE OF.EXEMPTION FROM,WORKERS' OWNER OR- L COMPENSATION INSURANCE Outlets:Rec. Light Sw. Qb FIRM NAME 17Y e�tucn 4r7 G� First 20 v v Al (This section need not be completed if the,work involved by the ��'� ADDRESS permit Is for 111 one hundred dollars($ 0)or'less.) Total.No. Additional I certify that in the performance of the work for which this permit CITY e` L:f TeL No. is issued, I shall not'ehiploy any person in any manner so as to (J CHECK Lighting Fixtures First 20- /Q o PLAN become subject to-the Workers'Compensation Laws.. 9 9 APPLICANT Total No. 4Additional ADDRESS Date yap rgApplicant RESIDENTIAL AP.PLIANCES:NCTOVE iP. NO ICE TO APPLICANT:,If„after making this Certificate of CITY Tel:No. ' Exemption,.youshould become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3-HP.- provisions of the Labor Code, you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked. Power Apparatus&.Large Appliances APPLICANT `'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 and CITY Tel.No. Professions Code,and my license is in full force and.effect. Over 10 to 50 Incl. LICENSE OR Class Over 50 to 100 Incl. REG.NUMBER . d License Number Lic.Class Over 100 DISTRICT NO. P OCESSED By 0. U Services;Swbd.,MCC&Panelboards ; '� G &u��L T_ Contractor Date 0-393 Amp. UnderFINAL600.V. DATE c, ❑ I am 400-1000 Amp.Under 600 V �� v ` / VALIDATION V exempt under Sec. Over 1000 Amp.or Over 600 VFINAL / LU B.&P.C.for this reason- BRANCH CIRCUIT FEES BY ` /, fV W. Date: 15A,or 20A, 120V,Lighting or Recept. . Z_ 1 To 10 Branch Circuits Signature 11 To 40 Branch CircuitstZ it ❑: 41 On More Branch Circuits Exemption for Reg.Maint. Elect, 15A,20A,208V To 277V Lighting Br.Circuits f T SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit is T for the following season (Section 7031:5, Business and Professions Additional Signi Branch Circuits Code t Z:I I,as owner of the property, will do'4he work and the structure Misc.Conduits&Conductors ..._-_ E-1 is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) D �• d and Professions Code). - s = , 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.) PLAN CHECKING FEE Lender's Name _ PERMIT ISSUING FEE ='=SE-�°I�I'_sa a ?' Lender's Address5M I certify that I have read this application and under penalty of purjury state TOTAL FEE ,3,=s]” s 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-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SI USI U-{3tE DATE - WORKER'S COMPENSATION DECLARATION 9 DPW(12-91) 76A663 IS AI�l��sAT�®11�1' FOR ELECT�O�/l�',L� PERMT RJ -• 76A66 �. L( �l hereby. ,,ffirm tgat I have a certificate of consent to self insure, or a certificate of,Worker's 6ompensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy-thereof(Sic.3800 Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB pQ/3 67, G M S j ADDRESS C"0'6 , E l Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY 1 &2-Family,Sq.Ft. — $ $ Certified copy is filed with the.county building inspection _ NEAREST Az / TSS department. Multi-family Sq.Ft. CROSS ST. A _em1 l�� Date' Applicant Residential Swimming Pools ASS gooK p MAPQ PAGE PARCEL CERTIFICATE OF.EXEMPTION FROM WORKERS'COMPENSATION INSURANCE OWNER OR L ! , Outlets:Rec.`�^Light Sw._� / �0 o 74 4k A)a / Of `♦a L{ (� FIRM NAME First 20 e) MAIL (This section need not be completed if the work involved by the Total No. Additional ADDRESS permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITYTqt �P G1f T.I.No.p/.0- / is issued, I 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 Total No. Additional ADDRESS �B ��J RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE.TO APPLICANT: If, afi�lna 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,.you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT 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 and CITY Tel.No. Professions Code, and my license is in full force and effect. Over 10 to 50 Incl. >_LICENSE Class. CL Over 50 t0 100 Incl. REG.NUMBER O Over 100 DISTRICT NO. - ESSED BY V License Number Lia Class Services,Swbd.,MCC&Panelboards �� 0-399 Amp.Under 600 V FINAL Contractor Date DATE / U El400-1000 Amp.Under 600 V �+w � ' VALIDATION I am exempt under Sec. Over 1000 Am or Over 600 V LU P• FINAL a- B.&P.C.for this reason BRANCH CIRCUIT FEES BY / co Date: 15A,or 20A,120V,Lighting or Recept. J� z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits 41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances ( ,� HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law g W, _ ,HI for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits - ITEMS Code): - s L I.r ElI,as owner of the property,will do the work and the structure Misc.Conduits&Conductors TOTAL 9 00 is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). (_V; _• �f_`•!! CONSTRUCTION LENDING AGENCY CWWI- it 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.) ) e-yi 3;4; PLAN CHECKING FEE �i Lender's Name i Bi' � PERMIT ISSUING FEE Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE q 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-mentioned property /ffoor inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ' V SIGNATURE OF PERMITTEE 1/ DATE WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) 76A663 �I APPLICATIOn„ FOR ELECTRICAL PERMIT ll ' I hereby affirm that-I have�a certifichbte of consent to self insure, ora 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. n Company FOR APPLICANT TO FILL IN JOB ADDRESS . Sem . Certified co is hereby furnished. NO. EACH FEE PY Y New Residential Bldgs.&Pools LOCALITY 1 $ $ g ' El f&2-Family,Sq.Ft. 67 �GC T Certified copy is filed with the county building inspection _ NEAREST department. Multi-family Sq.Ft. CROSS ST.V MAP Residential Swimming Pools ASSESSOR BOOK PAGE PARCEL Date Applicant ' CERTIFICATE OF EXEMPTION,FROM WORKERS' OWNER OR COMPENSATION INSURANCE Outlets:Rec:_Light Sw. FIRM NAME e, : . (This section need not be compl'etedFirst'if the work involved by the 20 MAIL ADDRESS permit.is for one hundred'dollam($100)or less:) Total No. Additional 1T " I certify'fhat in''the'performance of the work for which this permit CITY C+. Tel.No. e"issued, I shall not employ any person-in any manner so.as to PLAN CHECK _ become subject to the Workers' Compensation Laws Lighting Fixtures. FirsY20 APPLicANT = / Total No. Additional' ADORE Date J Applicant L✓ S D R ENTIAL APPLIANCES NOT OVER 3 HP. NOTICE,TO,APPLICANT:. If., after ing Is Certificate of CITYTeLNo. 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 suchPERMIT provisions or Uiis permit shall be deemed revoked. t Power Apparatus&.Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION qSize&Type HP,KW,KVA,or KVAR ADDRESS 1 hereby affirm that I 4m licensed under provisions o .f Chapter 9 Over 3 to 10 Incl (commencing with Section 7000) ofiDivision 3 of'therBusiness and CITY Tel.No. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl LICE SE OR Over 50 to 100 Incl. REGNNUMBER Class. J Over 100 DISTRICT NO`. PR BY o License Number Lic.Class U ' Services,Swbd.,MCC&Panelboard �• Q 0-399 Amp. Under 600 V FINAL Contractor Date - DATE / El -1000 Amp.Under 600 V (��gJ� VALIDATION I am exempt under Sec. ` W Over 1000 Amp.or Over 600 V FINAL 11 B.&P.C.for this reason BRANCH CIRCUIT FEES BY ., 'Y z Date: 15A,or 20A, 120V,Lighting or Recept. — 1 To 1.0 Branch Circuits Signature .11 To 40-Branch Circuits' 0" Exemption.for Reg.Maint.Elect41 Or More Branch Circuits. 15A,20A,208V To 277V Lighting Br.Circuits 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 Misc.Conduits&Conductors = 1 t k`• F 9 is not Intended or offered for sale (Section 7044, Business. Other(See,Complete Fee Schedule) 92 and Professions Code). t� CONSTRUCTION LENDING AGENCY I hereby affirm that,there is a construction lending agency for the •I isit3Eo ° performance of the work for which this permit is issued (Sec. 3097, -PERMIT FEE (Sub-Total) S Civ.C.) PLAN CHECKING FEE 01 i1-1 E+j3 Lender's Name PERMIT ISSUING FEE t z Sy�la { -V; _ Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE 2 5s that the above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring,and hereby authorize /orresentatIves of this County to enter upon the above-mentioned property inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SIG U,//�EE DATE ti