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HomeMy Public PortalAbout8943-8951 EMPEROR AVE_Electrical__ 76A663-CE606 10,74 , APPLICATION FORF ELECTRICAL PERMITI COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER JOB (jC /. BUILDING'AND SAFETY DIVISION ADDRESS X C a 1 LOCALITY C NEAREST FOR APPLICANT TO FILL IN CROSS ST. OUTLETS N0. EACH FEE OWNER OR $ $ FIRM NAME RECEPT._ MAIL LIGHT TOTAL FIRST 20 .25 ADDRESS CITY TEL. NO. SWITCH OVER 20 ,10 PLAN CHECK LIGHTING TOTAL FIRST 20 25 APPLICANT FIXTURES 10- OVER 20 ADDRESS RESIDENTIAL APPLIANCES CITY TEL, NO. PERMIT RANGE DRYER_WTR. HTR. APPLICANT STA. COOK DISP. F.A.U. ADDRESS SPACE HTR, AIR COND. CITY TEL. CLOTHES WASH. DISHWASH. REG NUMBER , 2, CLASS.(,,,`/ FAN OTHER 1.00 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 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 & 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 THAII AM THE LEGAL 9WNER OF THE, ABOVE d 1 - 10 3.00 DESCRIPEU D RESI TI PROPE p PERMITEE 10 - 50 5.00 SIGNATURE CD I-- 50 - 100 10.00c DISTRICT NO. ROCE SED BY Li1 a 100 - 500 15.00 e� / Z SIGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS V DATE INSPECTOR SIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP, POWER POLE SERVI CENOT OVER 600 VOLTS OR 200 AMP / 3.00 UNDERSLAB WORK SERVI CE OVER 600 VOLTS OR 200 AMP 10.00 ROUGH CONDUIT TEMPSERVICE,POLE, &APPURTENANCES 5.00 WIRING TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES Af--7 U FINAL PERMIT FEE (SUB TOTAL) NOTES: PLAN CHECK FEE PERMIT ISSUING FEE ` 3.00 TOTAL FEE C7 evo Aff PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION /CCN• M.0. CASM �i bb 1 4 SER 2 D 1 8.0 0 o SEE BACK OF APPLICATION FA COMPLETE SCHED LE 76A663.c zee06e 12775 APPLICATION FOR ELECTRICAL PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN JOB F2Fmaily ntial Bldgs. &Pools EACH NO. FEE ADDRESS' 1-19 aily Sq. Ft. $ — $ LOCALITY 01ily Sq. Ft. — NEAREST CROSS ST.al Swimming Pools FIRM NAMEht, Switch & Receptacle MAIL $2,, ADDRESSal CITY Tel/�tO,r 7f -09 PLAN CHECK Lighting Fixtures APPLICANT First 20 ADDRESS Additional CITY Tel. No. .� Fixed Appliances Not Over 1 HP PERMITISJ (``J Range Heater_ D.W. ADDRESS Oven Dryer W.M. Top — FAU VV.H. CITY % Tel. l'61,Vy ©9 >- Hood Fan LICENSE OR Disp. A.C. L " O REG. NUMBER Class. — C_')� I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION Q AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY U Power Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING LV Size&Type HP, KW, KVA,or KVAR ELECTRICAL WIRING. Cn Up to 1 Incl. z I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR Over 1 to 10 Incl. LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER F THE ABOVE Over 10 to 50 Incl. DESCRIBED RESIDE NTI PROPERTY. Over 50 to 100 Incl. PERMITEE Over 100 SIGNATURE DISTRICT NCY. R CED BY Services _ 0-200 Amp. Under 600 V 201 - 1000 Amp. Under 600 V APPROVALS A E 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 i / v POWER AUTHORIZED , FPERMIT (Sub-Total) UTILITY CO.NOTIFIEDING FEE (One-Fourth Permit Feel FINAL PERMIT ISSUING FEE NOTES TOTAL FEE d PLAN CHECK VALIDATION CK. M.0. CASH PERMIT VALIDATION M.0. CASH t 9 9 2'r-AIN 14 14 p- _. _. 6.9 t WORKERS'COMPENSATION DECLARATION DPW 3/87 76A663 APPLICATION FOR ELECTRICAL PERMIT O I r�,.reb�:r&firm that ( have a certificate of consent to self CE 806G insure, r.)r a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lab. C.) r Polir<y No. Company FOR APPLICANT TO FILL IN JOB ❑,Certified copy is hereby furnished. New Residential Bldgs. & PoolsEACH NO. FEE ADDRESS ❑Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY'1 L tion department. Multi-family Sq. Ft. — NEAREST 4 `� Residential Swimming Pools CROSS ST. lei➢ Date Applicant OWNER OR FIRM NAME �J . CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL (� 3K _ COMPENSATION INSURANCE First 20 ADDRESS L" C� (This section need not be completed if the work involved by Total No. Additional CITY J el. No. the permit is for one hundred dollars ($100)or less.) PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit 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 D Total No. CITY Tel. No. Date�' Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after aking his Certificate of APPLICATION Exemption, you should become 'e 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 Top — FAU —W.H. — deemed revoked. Hood — Fan —Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATION Dis — Room Air Cond. LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 p REG. NUMBER Class. (commencing with Section 7000)of Division 3 of the Business Power Apparatus & Large Appliances DISTRICT NO. PROCE ED BY >_ and Professions Code,and my license is in full force and effect. U t1 Size &Type HP, KW, KVA, or KVAR C, V Q License Number f Lic. Class Up to 1 Incl. FINAL U 1� l7 Over 1 to 10 Incl. DATE —� V ATION 0 cr Contractor - Date �' Over 10 to 50 Incl. FIN6k Flam exempt under Sec. Over 50 to 100 Inc. g U B.&P.C. for this reason Over 100 G a Z Services, Swbd., MCC& Panelboards Z Date: 0-200 Amp. Under 600 V — Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V f z 0.1 b3 A SINGLE FAMILY Temp. Power Pole &Appurtenances 161) HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit #."e a a':*;e 2 Law for the following reason (Section 7031.5, Business and AdditionalBranch Circuits Professi Code): ie— ,( 0 0 30.50 I as owner of the property, will do the work and the Misc. Conduits&Conductors o e e 3:0 5 czi structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ Business and Professions Code). o 71 3;-8 8 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 Lender's Name [P�ERMIT ISSUING FEE V Lender's Address I certify that I have read this application nd state that the AL 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 ab 5;;�� nspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �—I —m Signat of Per ittee Date ©s WORKERS' COMPENSATION DECLARATION DPW 3/87 76A663 APPLICATION FOR ELECTRICAL PERMIT I hgreby affirm that I have a certificate of consent to self CE 806G O ' 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 7 ❑Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS ❑Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. NEAREST Residential Swimming Pools - CROSS ST. Se=lr4C Date Applicant WNER OR FFIIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL 7�Z /�� Outlets: Rec Light Sw._ J COMPENSATION INSURANCE First 20 ADDRESS (This section need not be completed if the work involved by Total No. Additional CITY a �a l� Tel. No. 1190 _W1( the permit is For one hundred dollars ($100)or less.) I certify that in .he performance of the work for which this PLAN CHECKAPPLICANT permit 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 t9--;-1— 6 --1 - � r ��� Total No. Additional CITY Tel. No. Date Applicant l%e f K NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range— Heater—D.W. — APPLICATION Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS 3C y,;I- � �� with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. Hood — Fan —Other_ CITY I�i� ( �� Tel. . y No ?'QK-06y LICENSED CONTRACTORS DECLARATION LICENSE OR } ! I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. — REG. NUMBER �j� fJ Class. Certo (commencing with Section 7000)of Division 3 of the Business Power Apparatus & Large Appliances DISTRICT NO. PROCESSED BY >_ and Professions Code,and my license is in full force and effect. ( LSize &Type HP, KW, KVA, or KVAR O _4 License Number-_393- 56 Lic. Class ��� Up to 1 Incl. FINAL U Contractor � �/Ii.� Dated Over 1 to 10 Incl. t DATE VALIDATION 0 ❑ Over 10 to 50 Incl. FINAL I am exempt under Sec. Over 50 to 100 Inc. BY C) l B.&P.C. for this reason Bf� 4"'9G,� Over 100 WLL _ Z Date: Q $� Services, Swbd., MCC& Panelboards Z 0- 200 Amp. Under 600 V — Signature 201 - 1000 Amp. Under 600 V 22 0 5 4,4 A ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V # 0 0r-* 0 2 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp. Power Pole &Appurtenances - 'o 6 7 6 2 I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit 0 = Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits 0 '0 b��],b 2 6 Professions Code): &2 9!—8 8 ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ 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) l (Sec. 3097, Civ. C.). 67-7 �'T y,A.h PLAN CHECKING FEE Lender's Name (j ` !�'LC/"I�CQ�7 I✓ � , ` PERMIT ISSUING FEE Lender's Address 07 TOTAL FEE I certify that I have read this application a�tate that the i 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 propinspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE &,,Z:Signature at of Permittee Date ©s WORKERS'COMPENSATION DECLARATION DPW 3/87 76A663 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that.I have a certificate of consent to self CE 806G O 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 ❑Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS 1441 e Ar 4 C , ❑Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. 1112-9 $ — $ CALITY tion department. Multi-family Sq. Ft. — NEAREST t^ Residential Swimming Pools CROSS 5T. s,—t¢ j61 JJ Date Applicant OWNER OR FIRM NAMEJ�.s4 S&r CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE ADDRESS I/ First 20 (This section need not be completed if the work involved by Total No. CITY Tel. No. the permit is for one hundred dollars ($100)or less.) Additional l,av(G ��" PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit 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 Date ten. z5. ylyie/ Total No. CITY Tel. No. r _ Applicant Gr NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' a Range— Heater—D.W. _ APPLICATION klG tyle Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. CITY /T ",r �Gyj_ Tel. No; of I LICENSED CONTRACTORS DECLARATION Hood — Fan —Other Disp. •— Room Air Cond. — LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER 3T3.)-66 Class. /Q (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY >_ and Professions Code,and my license is in full force and effect. a- Size &Type HP, KW, KVA, or KVAR Q License Number_313?-�l Lic. Class �� U C j' Up to 1 Incl. FINAL 9-s /:.�CC�Y� t2 �r g� Over 1 to 10 Incl. DATE VALIDATION CC Contractor Date Over 10 to 50 Incl. ❑ 1 am exempt under Sec. Over 50 to 100 Inc. g N 0 B.&P.C. for this reason $C�f` �'�� Over 100 / �. -��/ � �q^ Services, Swbd., MCC& Panelboards Z Date: 0- 200 Amp. Under 600 V — Signature ' 201 - 1000 Amp. Under 600 V z O 5 4,3 A ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. # o 0 0 ® 0 2 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp. Power Pole &Appurtenances o - 67,6.2 Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Sigb 7,6 2= Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits o,o•o c) Professions Code): Misc. Conduits& Conductors 0 2 9-8 8 Ell, as owner of the property, will do the work and the 8 structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ Business and Professions Code). CONSTRUCTION LENDING AGENCY b 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) A / (Sec. 3097, Civ. C.). /ST PLAN CHECKING FEE Lender's Name ( ����"C�d? �rl� PERMIT ISSUING FEE Lender's Address 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 the a ov/��-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ,U-men, Signature of Permittee Date ©s WORKERS' COMPENSATION DECLARATION 20-0019 DPW 3/87 t O hereby affirm that I have a certificate of consent to self CE806G APPLICATION FOR ELECTRICAL PERMIT 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 �` � ❑Certified copy is hereby furnished. New Residential Bidgs. & Pools EACH NO. FEE ADDRESS / 7 e'er C P CLC ,.q,. ❑Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. /Ll.2'g $ _Is OCALITY s,_I tion department. Multi-family Sq. Ft. ` � CROSS NEAREST ST. Residential Swimming Pools. �1 Date Applicant o �` ` OWNER OR C FIRM NAME __r ? LX.r �U CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec light Sw._ +. \` MAIL �, / COMPENSATION INSURANCE First 20 q ADDRESS 3l �` lC 1f/d. (This section need not be completed if the work involved by Total No. Additional CITY ��� � Tel. No. - /� the permit is for one hundred dollars ($100)or less.) PLAN CHECK I certify that in he performance of the work for which this APPLICANT permit 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 Date Date �q �WApplicant_ �i:+ 4-v14-1C, Total No. CITY Tel. No. NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range— Heater—D.W. APPLICATION lxd Vy Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESSGN rvP p� with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. Hood — Fan —Other_ CITY , � ' Tel. No. 71y RicIS LICENSED CONTRACTORS DECLARATION LICENREG. NUMBSE OR ER I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. CJClass. C-O (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY �- and Professions Code,and my license is in full force and effect, a Size & Type HP, KW, KVA, or KVAR (� 0 License Number ?r32-5� Lic. Class C-/U Up to 1 Incl. FINAL U Rl` S� �l�To✓C S a� - Over 1 to 10 Incl. DATE _ �� — ALIDATION Cc Contractor Date Over 10 to 50 In . F F] FINA 0 I am exempt under Sec. / Over 50 to 100 Inc. g / B.&P.C. for this reason S� , �Plat�t� Over 100 / w a gZ g Services, Swbd., MCC& Ponelboards Z Date: 0-200 Amp..Under 600 V — Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole&Appurtenances o HOME OWNER-BUILDER DECLARATION z 0 54.2 A I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits # e o a.e o2 Professions Code): ❑ Misc. Conduits& Conductors a 6 7,6 2 1, as owner of the property, will do the work and the ® structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)— , 0 0 0 6 7. 6 2 Business and Professions Code). CONSTRUCTION LENDING AGENCY p g 2 9"8 8 1 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.). S r PLAN CHECKING FEE Lender's Name / /' �erAL4,jn 6o-"A1- Lender's Address y/ - 1/'•z�fey PERMIT ISSUING FEE / I certify that I have read this application an state that the TOTAL FEE 6 above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize represent tives of this County to enter upon the ov -mentioned pro�rty for inspection purposes. xJ/ SEE REVERSE FOR EXPLANATORY LANGUAGE 9 — 9 S $ Signature of Permittee Date ©s 1 - 'WORKERS' COMPENSATION DECLARATION 2o-ootaDPW 3iez APPLICATION ELECTRICAL PERMIT I hgreby affirm that I have a certificate of consent to self Ce 806E 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 ❑Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS eM Jr ,O TT ❑Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. t•H $ _ $ LOCALITY tion department. Multi-family Sq. Ft. NEAREST Id CROSS ST. /hLI ^ICoUl Residential Swimming Pools,, , Date Applicant „ OWNER OR v FIRM NAMEi[_ L�r°�ds Lir CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL COMPENSATION INSURANCE Outlets: Rec Light Sw._ ,Y) t ADDRESS Uo-. i First 20 (This section need not be completed if the work involved by Total No. Additional CITY �v sek"C[k-G Tel. No.� /y the permit is forone hundred dollars ($100)or less.) PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Com ensation Laws. Lighting Fixtures First 20 ADDRESS Additional Total No. CITY Tel. No. Date �• Applicant Fixed Appliances Not Over I HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION liJa"oC 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 �� �CvtTud"G with comply with such provisions or this permit shall be Top — FAU —W.H. — n deemed revoked. CITY ffv�T, fr��J� Tel. Not. VS�c�e Hood Fan —Other— LICENSED CONTRACTORS DECLARATIONLICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REG. NUMBER Class. (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PROCESSED B d and Professions Code, and my license is in full force and effect. �^-,( )n Size &Type HP, KW, KVA, or KVAR � O License Number 3932-:7 " Lic. Class' / Up to 1 Incl. FINAL U E M Over 1 to 10 Incl. DAT ,� D — V ATION O Contractor K rC/4 Date Over 10 to 50 Incl. FIN U ❑ I am exempt under Sec. Over 50 to 100 Inc. gV W B.&P.C. for this reason Over 100 e t1 f2,g'P$$ Services, Swbd., MCC & Ponelboords 0 5 4,5 A Z ���rDat 0- 200 Amp. Under 600 V Signature ++� 201 - 1000 Amp. Under 600 V #,o.6;o;o 0.2 ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V {° 6 7.6 2 SINGLE FAMILY Temp. Power Pole &Appurtenances - -.o67,625 HOME OWNER-BUILDER DECLARATION . I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits 0 2 9�m, 8 8 Professions Code): ❑ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for /Z the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). _ f/ ,P y 1< PLAN CHECKING FEE Lender's Name A�tC��GtI� F'x++� PERMIT ISSUING FEE Lender's Address g/�y W F 1�eLff°'c. .0i'). I certify that I have read this application and state that the TOTAL FEE 14 L 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 .ythe, pro erty for inspection purposes. �s SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date es WORKERS'COMPENSATION DECLARATION DPW 3/87 76A663 APPLICATION FOR ELECTRICAL PERMIT O ' I hereby affirm that I have a certificate of consent to self CE 806G 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 ❑Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS L Com' •e [2. El —Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. / �'�i� $ $ [ CALITY 7GitiJP�h ��^ tion department. Multi-family Sq. Ft. NEAREST v� CROSS ST. Residential Swimming Pools ! OWNER OR �^ri Date Applicant FIRM NAME ✓ Del/ CERTIFICATE OF EXEMPTION FROM WORKERS' igSw._ t E "MAIL Outlets: Rec Lht e I COMPENSATION INSURANCE ADDRESS I3/.� ��� lr,�• (This section need not be completed if the work involved by First 20 Total No. Additional CITY �o wc, Tel. No. A!?o the permit is for one hundred dollars ($100)or less.) PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ any person in any manner Lighting Fixtures First 20 ADDRESS so as to become subject to the Workers'Compensation Laws. p y Total No. Additional CITY Tel. No. Date �L/ Applicant Ice, Fixed Appliances Not Over 1 HP PERMIT ���� NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION ,e1 J64,,1n'tt°� 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 3 1(q1 I-ew Fa rr. lor-r with comply with such provisions or this permit shall be Top — FAU —W.H. — / deemed revoked. Hood — Fan —Other— CITY r Tel. No. 71q CP'0--,063 LICENSED CONTRACTORS DECLARATION LICENSE OR Disp. Room Air Cond. REG. NUMBER Class. C'--i® I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business Power Apparatus & Large Appliances DISTRICT NO. 1, PROCES D BY d and Professions Code,and my license is in full force and effect. ` Size&Type HP, KW, KVA, or KVAR (�� 0 License Number �g JZ �U Lic. Class C-+ 40 Up to 1 Incl. FINAL U �S ���`����' Over 1 to 10 Incl. DATE if i-� JDATION 0 Contractor Date— Over 10 to 50 Incl. FINAL U ~ ❑ I am exempt under Sec. �+ `` j Over 50 to 100 Inc. BY U B.&P.C. for this reason �/-r Alef ` Over 100 _ w Services, Swbd., MCC& Panelboards Z te. 0-200 Amp. Under 600 V — Amp.201 - 1000 AmUnder 600 V Signature � - ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION 2 0 5 G.,1 A I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits # o o;o,e o 2 Professions Code): ❑ 1, as owner of the property, will do the work and the Misc. Conduits&Conductors .1. 67.62 structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ , o e o (D 7.6 2= Business and Professions Code). CONSTRUCTION LENDING AGENCY 0 a 2-9:-8 8 1 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.). Alt `� „/� / PLAN CHECKING FEE Lender's Name i� !-� /� C y PERMIT ISSUING FEE Lender's Address I certify that I have re r is app ica< t end t t t 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 obo�e-'�mentioned pro erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date ©s