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Home My Public Portal About9150 EMPEROR AVE_Electrical__ v COUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of Engineer DIVISION OF BUILDING & SAFETY WILLIAM J FOX. County Engineer FOR APPLICANT TO FILL IN DISTRICT Na. GROUP ZONE PERMIT NO. ELECTRICIAN Gp CC r RECE,I/V�(jFD^B'Y READY FOR DATE ISSUED ADDRESS p �� G FIRST INSPECTION CITY TEL NO COUNTY LICENSE NO LAIQ EXP RES BUILDING PERMIT FEES ADDRESS FEE NUMBER EACH LOCALITY LIGHT OUTLETS NEAREST RECEPTACLES CROSS ST WALL SWITCHES OWNER TOTAL OUTLETS 5c MAIL ELEC RANGES 85 ADDREBB ELEC HEATERS 25 CITY TEL. NO FIXTURES 5 QI /� �t I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS MIBC )) APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCE4 NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING MOTORS I CERTIFY THAT I POSSESS THE ABOVE VALID LOS NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER NEW I MVD HP OVER INC EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE 1/2 6 LESS $ 2$ /` SIGNATURE OF 2 50 PERMITTE • i- 2 5 1 DD INSPECTION RECORD 5 15 1 50 15 50 250 SO 200 Soo 200 500 1000 500 1OGO 15130 !✓FI Q 1H — -, %=d) lie F'7 OVER 1000 2000 tl rte- n 19 M G SET/FREQ CHANGER-HP WELDERS: AC-KVA h O GENERATORS - KW TRANSFORMERS - KVA TEMP MOTORS (75% OF ORIG) MOVED MOTORS (75% OF ORIG) MIBC SIGNS NO NO TRANS APPROVALS NO NO LAMPS FOR EACH PERMIT: DATE INSPECTOR'S NAME WIRING $1.00 CONDUIT FIXTURES $1.00 WIRING SUPPLEMENTARY 50 FIXTURES POWER TOTAL FEE g ' UTILITY CO.NOTIFIED �✓ /( i ii FINAL .6A663 DBS#5A 4-52 T OS SA 25M SETS 2-47 ITIPA DDEPARTMENT OF BUILDING Alice SAFETY APPLICATION FOR EIB CWM. J. FOXOUNTY OF LOS ANGELES "ELECTRIC CHIEF ENGINEER a NAME DISTRICT NO. GROUP I ZONE PERMIT NO. ADDRESS NU CITY ! -=TEL.NO. RECEIVED BY. READY FOR DATE ISSUED U COUNTY FIRST INSPECTION D CERT.NO. Q EXPIRES APPLICANT FILL IN HEAVIOLY OUTLINED PORTION ONLY DESCRIPTION OF WORK ADDRESS � d C/- NUMBER NUMBER OF OUTLETS ON CIRCUITS LOCALITY V LOCATION BY ROOMS NEAREST ��"� - LIGHT OUTLETS SW. PLUGS FI](T CROSS ST. v CIRCUIT A B C D E F G H a NAME z MAIL G Y ADDRESS O CITY TEL.NO. 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION., ELECTRICIAN. H ANI THE ILEGAL OWNER OF 7 PROPERTY DESCRIBED ABOVE �'p7��,gvr� OWNCR. COR.RE :TIONS L J z E3 a 0 [NO. L �® I�. A F OUTLETS APPI�®VA�.S F FIXTURES $ `r k� DATE INSPECTOR'S NAME NO. OF MOTORS H.P. $ CONDUIT i NO. OF SIGNS TRANS. $ WIRING NO. OF RANGES OR HEATERS $ FIXTURES MISCELLANEOUS $ POWER / PERMIT FEE $ UTILITY CO.NOTIFIED i n 1A n TOTAL FEE I L FINAL �' V i. '" WORKERS' COMPENSATION DECLARATION 10/81 APPLICATION FOR ELECTRICAL PERMIT hereby affirm that I have a certificate of cor'isent to self CE-806G i sure, or a certificate of Workers' Compensatio Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY r,a 7F�tifjed cc}gy,th of �. 3800 Lab. C.) P❑allcy No d`f' Compa FOR APPLICANT TO FILL IN JOB Q Certified co is hereby furnished. EACH NO. FEE ADDRESS G p Y New Residential Bldgs. & Pools ❑ $ = g LOCALITY 4 ti Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. fie) tion department. Multi-family Sq. Ft. NEARESCROSS ST. Residential Swimming Pools OWNER OR / Date Applicant C FIRM NAME r- 1-!c &e� CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec .Light Sw.6__ MAIL COMPENSATION INSURANCE First 20 / 5 ` Oct ADDRESS (This section need not be completed if the work involved by Total No. — Additional =� PJ'� CITY ,0M 1e I. No. 8d the permit is for one hundred dollars ($100)or less.) PLAN CHECK 1 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//r Additional Total No. CITY r a Tel. No. Date Applicant Fixed Appliances Not Over 1 HP ; NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT S 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 with comply with such provisions or this permit shall be Top _ FAU k CITY Tel. No. deemed revoked. 'L Other_ LICENSED CONTRACTORS DECLARATION Hood _ Fan �� O LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. REG. NUMBER Z / /�2 Class. (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCESS BY and Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances ` IL Size &Type HP, KW, KVA, or KVAR V License Numb s Lic. Class Up to 1 Incl. FINAL Fg Over 1 to 10 Incl. DATE VALIDATION O Contract Date { � ❑ Over 10 to 50 Incl. FINAL I am exempt under Sec. Over 50 to 100 Inc. BY Over 100 B.&P.C. for this reason Services, Swbd., MCC & Ponelboards Date: 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Moint. Elect. SINGLE FAMILY Temp. Power Pole & Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 5 4 1,0 A I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits ;t' 0 0 0;o 0 2 Law for the following reason (Section 7031.5, Business and Professions Code): 20 0 4200 ❑ 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)_ ► ° o o 1� 2.0 0 v 7044, Business and Professions Code). 09.20-83 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 PERMIT ISSUING FEE LQ Lender's'Address I certify that I have read this application and state that the TOTAL FEE Z. 00 above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize represent ti s of this County to enter upon the above-mentrrepertq for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Si at re of Permute Date WORKERS' COMPENSATION DECLARATION 76A663 10/81 APPLICATION FOR ELECTRICAL PERMIT 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 BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS G it Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE J ❑ 1 & 2-Famil S Ft. $ _ $ LOCALITY Certified copy is filed with the county building inspec- y q tion department. Multi-family Sq. Ft. CROSSS T. Residential Swimming Pools OWNER OR Date Applicant PP � FIRM NAME � f CERTIFICATE OF EXEMPTION FROM WORKERS' lets: Rec Light Sw.'� MAIL COMPENSATION INSURANCE OutADDRESS First 20 (Thi's section need not be completed if the work involved by Total No. Ox Additional CITY Tel. 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 - y so as to become subject to the Workers'Compe, ws Lighting Fixtures First 20 ADDRESS / �/ Total No Additional CITY Date A licanit� [/� f Cf?� aTel. No PP r u 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_ Heater 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 _ FAUeH. — deemed revoked. Hood Fan ther_ CITY Tel. No. LICENSED CONTRACTORS DECLARATION 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 BusinessDISTRICT NO. i PROCESSED BY and Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances Size &Type HP, KW, KVA, or KVAR' ��"® O License Numbeldf-7ZI 3 Lic. Class Up to 1 Incl. FINAL W DATE Over 1 to 10 Incl. t ��. �, r VALIDATION Contractor' 09 Date / Over 10 to 50 Incl. V ❑ FINAL I am exempt under Sec. Over 50 to 100 Inc. BY B.&P.C. for this reason Over 100 � Date: Services, Swbd., MCC & Panelboards B�q ► 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 v 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): Z0 b 9 3,4 A ❑ 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)_ , ` o o .0 0 o 2 7044, Business and Professions Code). 2 CONSTRUCTION LENDING AGENCY 0 o25-50 I hereby affirm that there is a construction lending agency for ° ° ° 25,.5 0 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) ' (Sec. 3097, civ. C.). 11, 1 8-83 PLAN CHECKING FEE Lender's Name 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 above-mentio.ned,property fo inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE l Signature of Permittee Date