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HomeMy Public PortalAbout9117 EMPEROR AVE_Electrical__ 76A663C- CE8086 12,75 -APPLIC ON FOR ELECTRICAL PERMIT 13UILDIN AND SAFETY DIVISION FOR APPLICANT TO FILL IN /y� EACH NO. FEE ADDRESS IJ 1��i/LLJ1�. FResidentialtial Btdgs. & Pools JI ly Sq. Ft. $ — $ LOCALITYjy Sq. Ft. — NEAREST En CIh i ngCROSSST. II6�JSwimming Pools OWNERORFIRM NAME - , L ^nt, Swi1Ch &Receptacle M4DDRESS C OZc,. r S �j Additibnal CITYS� �'1,> l " Tel. No. 013'3 PLAN CHECK Lighting Fixtures APPLICANT First 20 ADDRESS Additional CITY Tel. No. PERMIT Fixed Appliances Not Over 1 HP APPLICANTC R '� Range Heater— D.W. i r� ADDRESS �b�'2.t7 Q�nD A0Z Oven Dryer W.M. TEM?FAU W.H. CITY IEM?(G Tel. No. 2. Hood Fan LICENSE OR Disp. A.C. o QL REG. NUMBER t Class. U I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT TME ABOVE IS CORRECT AND AGREE TO COMPLY O Power Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING H Size&Type HP, KW, KVA,or KVAR ELECTRICAL WIRING. V w Y1 0_ Up to 1 Incl. 1 HEREBY CERTIF A 1 AM PROPERLY IREGIS R D AND/OR Cn Over 1 to 10 Incl. LICENSED AS REO R BY OS ANGEL UNTY AND STATE OF CALIFORNIA OR A AM THE EG O ER F T E ABOVE Over 10 to 50 Incl. DESCRIBED RESI EN I L PR PERT Over 50 to 100 Incl. PERMITEE Over 100 SIGNATURE DISTRICT NO. OCES ED BY Services i� U C 0-200 Amp. Under 600 V 201 - 1000 Amp. Under 600 V APPROVALS DATE INAT DR'S Over 1000 Amp.or Over 600 V SI ATURE TEMP. POWER POLE Temp. Power Pole&Appurtenances UNDERSLAB WORK Sign with One Branch Circuit ROUGH CONDUIT Additional Sign Branch Circuits (Other) WIRING y �a FIXTURES POWER AUTHORIZED q-R Zf- +L PERMIT FEE (Sub-Total) UTILITY CO.NOTIFIED PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL PERMIT ISSUING FEE NOTES TOTAL FEE Co o o o Na PLAN CHECK VALIDATION CK. M.O. CASH PERMIT V-ALIIDATdONo aCK. M.O. CASH �J U1 (_4 GJ o I C) CD o STI 66666 -O U O N D-- 1\ cH WORKERS' COMPENSATION DECLARATION zo-ooi9DPW 3ie7 APPLICATION FOR ELECTRICAL PERMIT 0 I hereby affirm that I have a certificate of consent to self ' o6G CE8 4;1 ihsur,% or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lab. C.) A Policy No. Company FOR APPLICANT TO FILL IN JOB T Certified copy is hereby furnished. New Residential Bldgs. L1& Pools EACH NO. FEE ADDRESS y i= 277 Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. jow $ _ $ LOCALITY tion department. Multi-family Sq. Ft. NEAREST T. Residential Swimming Pools CROSS O Date Applicant OWNER M o CERTIFICATE OF EXEMPTION FROM WORKERS' FIRM NAME � "— Outlets: RecALight�Sw.-* 1 klO ADDRESS MAIL .4VA'—_ COMPENSATION INSURANCE First 20 �d (This section need not be completed if the work involved by Total No.� Additional CITY � �kl T.I. No. 7y 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 ADDRESSL Additional Total No. CITY Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION Exemption, you should become subject to the Workers' Range— Heater Z D.W. vim' Q o Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M._ ADDRES with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. Hood — Fan f�_2 Other— v 00 CITY _ 3g LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. — REG. NUMBER S (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PROC SED BY d and Professions Code,and my license is in full force and effect. Size &',Type HP, KW, KVA, or KVAR LL �� Q License Number Lic. Class � Up to 1 Incl. 0 'T 00 FINAL U Contractor Date Over 1 to 101ncl. DATE�— % i, VALIDATION Over 10 to 50 Incl. FINAL O ElI am exempt under Sec. Over 50 to 100 Inc. By .- U LU B.BP.C. for this reason Over 100 ( °a 4 Services, Swbd., MCC 8 Panelboards Date: Z0-200 Amp. Under 600 V , i "j F11_ —' Signature 201 - 1000 Amp. Under 600 V Over 1000 Amp. or Over 600 Vt�IL _ 3' Exemption for Reg. Maint. Elect. SINGLE FAMILY HU ""L HOME OWNER-BUILDER DECLARATION Temp. Power Pole &Appurtenances f"HU ;� I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit ;.•Hfi4`-�--E Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): 1z nil _ (� Misc. Conduits &Conductors l� I, 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)_ 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 /6 PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the I 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 above-mentioned prof I or inspection/purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE -1 1/1 VfJ i nature of Per a at ©s