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Home My Public Portal About9138 EMPEROR AVE_Electrical__ ' �-WOR�RS'COMPENSATION DECLARATION 76A663 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent'to self CE-8066 insure, or a certificate of Workers' Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY 'uI or a certified copy thereof (Sec 3800, Lab C ) Policy No Company FOR APPLICANT TO FILL IN JOB J– Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS (� 1 & 2-Family, S Ft $ = E LOCALITY Certified copy is filed with the county building inspec- Y- q tion department Multi-family Sq Ft NEAREST CROSS ST Date Applicant Residential Swimming Pools -Y; OWNER OR r PP FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Re.4—. Light Sw_ IL COMPENSATION INSURANCE -'ADDRESS First rj 8111 1� (This section need not be completed if the work involved by Total No Additional CITY Tel No �C. 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 Total No Additional 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' Range_ Webler_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 I Hood Fan _Other_ CITY Tel No LICENSED CONTRACTORS DECLARATION 'y LICENSE 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 OC SED BY, (L and Professions Code,and my license is in full force and effect D Q U Size &Type H W, KVA, or KVAR t (� License Number Lic Class Up to 1 InclFINAL _ Contractor Date Over 1 to 10 Incl DATE ` � VALIDATION aOver 10 to 50 Incl I am exempt under Sec Over 50 to 100 Inc FBI N B &P C for this reason Over 100 z Date Services, Swbd , MCC& Panelboards 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 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 Law for the following reason (Section 7031 5, Business and Professions Code) I, as owner of the property, will do the work and the Misc Conduits &Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ , ;2 5 4 72 A 7044, Business and Professions Code) # 0 0 0 0 0 2 CONSTRUCTION LENDING AGENCY ) 0 o 3 6 7 5 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) 10 0036750 (Sec 3097, Civ C ) PLAN CHECKING FEE 0 9, 1 9-86 Lender's Nome , PERMIT ISSUING FEE 1 der s Address srtrfy that I have read this application and state that the TOTAL FEE e information is correct I agree to comply with all County nnzces and State laws regulating Electrical wiring, and 4 eby authorize representatives of this County to enter upon a ove-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE �,.,ePermittee Date DBS 5A 2SM BETS 2-47 ` P IC 6 TION FOR P8?gDT�lg'7T DEPARTMENT OF R[JII.DING AND SA '� ELECTRICCOUNTY OF LOS ANGELES WM J FOX CHIEF ENGINEER Q NAME wn. DISTRICT NO. GROUE' ZONE PERMIT NO. U ADDRESS '�90,,g4- �� v E - CITY i TEL NO RECEIVED BY READY FOR DATE ISSUED J COUNTY FIRST INSPECTION III CERT NO EXPIRES � APPLICANT' FILL IN HEAVILY OU'T'LINED POR'T'ION ONLY 13 (DESCRIPTION OF WORK A DRESS c�(� f_ NUMBER OF OUTLETS ON CIRCUITS LOCALITY LOCATION BY ROOMS NEAREST LIGHT OUTLETS SW PLUGS FIXT CROSS ST CIRCUIT A S C D E F G H It NAME Z MAIL ADDRESS O CITY TEL NO AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFIC4TEQOF QUALIFICATION. ELECTAIC1AN. I AM THE&EGAL.OWWER OF THE PROPERTY DESCRIBED ABOVE FtA- OWNER 1� CORRECTIONS L J a z 0 TOTAL . 71 NO OF OUTLETS ' $ 0 APPROVALS NO OF FIXTURES $ I DATE INSPECTOR'S NAME NO OF MOTORS H P $ CONDUIT NO OF SIGNS TRANS $ WIRING NO OF RANGES OR HEATERS $ FIXTURES MISCELLANE I $ POWER PERMIT FEE $ Ji UTILITYCO NOTIFIED TOTAL FEE � `� L.Il� FINAL v 76AG63-CES06-11-57 APPLICATION FOR ELECTRIC PERMIT 4 COUNTY OF LOS ANGELES 'DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE, County Engineer CASSATT D. GRIFFIN. Sup't of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. PERMIT FEES ITEM NUMBER EACH FEE OWNER (j�•x! i OUTLETS: $ $ MAIL LIGHTS RECEPT. SW. .10 ADDRESS LIGHTING FIXTURES .10 CITY TEL. NO. ELEC.RANGES CLO.DRYERS ELECTRICIAN WATER HEATERS .50 ADDRESS ELEC.SPACE HTRS.I DISHWASHERS CITY TEL.NO. GARBAGE DISPOSERS AUTO.- WASHERS STA.COOKING UNITS .25 STATE LICENSE NO. MOTORS: OVER INC. H.P. �+ DISTRICT NO. ZONE READY FOR INSPECTION O — I/2 .25 I/2 — 2 .50 INSPECTION RECORD 2 — 5 1.00 5 — 15 1.50 15 — 50 2.50 50— 200 5.00 SIGNS: NO.TRANS. NO.LAMPS SERVICED-600V 1.00 L, SERVICE OVER 600V 5.00 - MISC. WIRING PERMIT 1.00 FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT .50 TOTAL FEE �-+ <" - APPROVALS 1 HEREBY ACKNOWLEDGE THAT 1 HAVff'REAb THIS APPLICATION DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 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 1 AM THE LEGAL OWNER OF THE ABOVE POWER DESCRIBED RESIDENTIAL PROPERTY. SIGNATURE UTILITY CO. NOTIFIED OF PERMITTEE FINAL VALIDATION ARTHUR C.VEIT. SUPERVISING ELECTRICAL ENGINEER CK MO CASH . 5 5