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HomeMy Public PortalAbout9081 EMPEROR AVE_Electrical__ t 'WORKERS' I have a cerci DECLARATION CE-806 tD�81 APPLICATION FOR ELECTRICAL PERMIT erE�y affirm' that I have a certificate of consent to self CE-806G insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) / /�r�/� Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS ( /"/—L+i✓�f� Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE Y Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY 1�4,A/ A tion department. Multi-family Sq, Ft. NEAREST CROSS ST. Residential Swimming Pools OWNER OR 7 Date Applicant CERTIFICATE OF EXEMPTION FROM WORKERS' rr'� MAIL IL NAME COMPENSATION INSURANCE Outlets: Rec�]_Light Sw. ADDRESS f First 20 (This section need not be completed if the work involved by Total No._/0 Additional CITY ( Tela No, the permit is for one hundred dollars ($100)or less.) - I certifythat in the performance of the work for which this PLAN CHECK P APPLICANT permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compens ion L ws. Lighting Fixtures First 20 ADDRESS n i Total No. Additional CITY Tel. No. Date Applicant ' ed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certific e o APPLICANT Z eO;AJ J• ��C�7C I 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_371 4�/VAA/,Q with comply with such provisions or this permit shall be Top _ FAU —W.H. — / deemed revoked. Hood _ Fan _ Other_ CITY'� ��A� y Tel. N $ _ �4• LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. =E 6s�n CIass. Q (commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliancesp DISTRICT NO. PROCESS BY y and Professions Code,and m license is in full force and effect. r Size & Type HP, KW, KVA, or KVAR' J License Number Lic. Class Up to 1 Incl. FINAL �/� lip Over 1 to 10 Incl. DATE �� �G/ `,Y VALIDATION Contractor Date Over 10 to 50 Incl �✓ �/ FINA I am exempt under Sec. Over 50 to 100 Inc. FI B.&P.C. for this reason Over 100 111dt4f Services, Swbd., MCC & Panelboards Date: 0 - 200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V 1 5 S 4 A ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V # o a o a o 2 SINGLE FAMILY Temp. Power Pole &Appurtenances 0 - 1 9.50 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Additional Sign-Branch Circuits o 0 0 1 9.5 0 v Law for the following reason (Section 7031.5, Business and Professions Code): Misc. Conduits &Conductors 0 2 2 0-8 5 I, as owner of the property,will do the work and the structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)— ► 7044, 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 Lender's Name /J PERMIT ISSUING FEE 1✓ 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 bove-mentione property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permits Date WORKER S'COMPENSATIONDECLARATION CE866G (2-80) APPLICATION FOR LECTRICAL PERMIT 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 co y there,,,PPPf(Sec. 3800,Lab ]� � � � / FOR APPLICANT TO FILL IN ,JOB y _ ,l o cy o. Co ny / EACH NO. FEE ADDRESS O h �_ (//i / New Residential Bldgs.&Pools - Cert' ied copy is hereby furnished. /o��T� 1 & 2-Family,Sq. Ft. $ _ $ LOCALIT Multi-family Sq. Ft. NEAREST Certified copy is filed with the count building inspection CROSS ST Residential Swimming Pools department. OWNER OR /`' �J FIRM NAM Date— Applicant Outlets: Rec��LightS�Sw. 0 �.� © irst 20 ADDRESS F CERTIFICATE OF EXEMPTION FROM WORKERS' Total No Additional r ,{��, �,/ COMPENSATION INSURANCE C CITY �� /' 6 el No.` 4' �-+� PLAN CHECK IL APPLICANT O (This section need not be. completed if the work involved Lighting Fixtures First 20 U by'the permit is for one hundred dollars ($100) or less.) ADDRESS Additional � Total No. O I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. I­_permit is issued, I shall not employ any person in any manner PERMIT ��•y /J W so as to become subject to the Workers' Compensation Caws. Range_ Heater_D.W. APPLICANT! —r/�'// 4 Oven _ Dryer_W.M. ADDRESS��, �� , �!/�r G_ Date Applicant Top . _ FAU _W.H.._ CIT��jj � i � 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 t 166-- Class 844 Compensation provisions•of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO'. FVALA SED BY with comply with such provisions or this permit shall be Size&Type HP, KW, KVA,or KVAIR (� deemed revoked. Up FINAL to 1 Incl. 2S _ Over 1 to 10 Incl. DATE / y LICENSED CONTRACTORS DECLARATION IIDAT NN 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 lfll/ ness and Professions.Code, and my license is in full force and ��/ effect. Services 3 0-200 Am Under 600 V License Number Lic.Class ) 201-1000 Amp, Under 600 V Contractor1&6�a/q !CrJ/Y trate Over 1000 Amp.or Over 600 V 0 $9,2 A HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances # 0 0 0 0-0 2 I hereby 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 2 °;° 3 U,5 0 ness and Professions Code): 40.01- 7J 5 0 Misc.Conduits&Conductors 60 E1, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— structure is not intended or offered for sale (Section 0 8 25-8 1 7044, 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 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 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 thea ove-mentioned property for inspection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE Signature of Permitt Dat 7B DBS-5A 9.55 APPLICATION FOR ELECTRIC PERMIT i •5A DIVISION OF BUILDING AND SAFETY Department of County Engineer BUILDING County of Los Angeles ADDRESS WM.J. FOX, COUNTY ENGINEER CASSATT D. GRIFFIN. SUPT OF BUILDING =00�191NZhl!M2LIOCALITY FOR APPLICANT TO FILL IN NEAREST PERMIT FEES CROSS ST. ®/w • NUM-BER EACH FEE OWNER LIGHT OUTLETS MAIL RECEPTACLES ADDRESS I � WALL SW ITCHES TOTAL OUTLETS 5¢ S -c CITY TEL. NO. ELEC. RANGES 25 AN& ELECTRICIANr- , ,-17—eet4 tw �&,aMAN _ELEC. HEATERS 25 ADDRESS �� -/''{IIS*[6�• , KW d EA I I CITY r�/L.1 r3'T-1.0.41�" TEL. NO.16p FIXTURES 5 ® LICENSE NO. r NUMBER OF LIGHT CIRCUITS DISTRICT NO. GPQLJP ZONE I READY FOR INSPECTION NUMBER OF J— OOOJJJpRECEPTACLE CIRCUITS I I .11w i MOTORS NUMBER HORSEPOWERFEE INSPECTION RECORD NEW MVD. HP OVER INC. EACH 1/2&LESS S .25 rr�_ i/2 2 .50 2 5 1.00 5 15 1.501 650 / I��,n A 15 50 2.50 1— (f�6 /�'1„ 7)�cf.l�'C�1'll• 1 — 50 200. 5.00 q r 62A1,14 41Y 7 MISC. L NO.SIGNS NO.TRANS. NO.SIGNS NO. LAMPS FOR EACH PERMIT: WIRING 51.00 FIXTURES S 1.00 /�. SUPPLEMENTARY .50 APPROVALS TOTAL FEE. SI ® DATE INSPECTOR'S SIGNATURE 1 T D HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT ANSTATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY I ' WITH ALL COUNTY ORDINANCES /AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING. 1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES - ����� ,i✓ '.� LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AMT LEGAL Q.IVNER OF THE ABOVE POWER i DESCRIBED RESIDENTIAL PRD RT ._ , UTILITY CO. NOTIFIED SIGNATURE -' ��G� LGA•- � OF PERMITTE -� �< j''�Y`�"fl �' /��! FINAL �' I II r'�•:^14LI l WILLIAM J. FOX. C NTY E ,INEER VALIDATION A. C.VEIT.CHIEF ELECT. INSPECTOR .�C09 1 5 3« OCT 1.4 2 5.4 0 '�