Loading...
HomeMy Public PortalAbout5001 ENCINITA AVE_Electrical__ i� 76A683-CES06-6-57 APPLICATION FOR ELECTRIC PERMITi COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING ' BUILDING AND SAFETY DIVISION ADDRESS D D 1 ! JOHN A LAMBIE.COUNTY ENGINEER rr ��- CASSATT D GRIFFIN,SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN cRoss sr N U C F- PERNIIT FEES OWNER LIGHTS RECEPTACLES SWITCHES NUMBER i I T E M I EACH FEE MAIL I 7 ADDRESS O C7 G. /N / TOTAL OUTLETS $ 10 � ELEC RANGES WATER HEATERS,_ CITY / TEL NO 191 .J CLOTHES DRYERS so ELECSPACE HEATERS STAT Y COOK ELECTRICIAN ING UNITS GARBAGE DISPOSERS, ADDRESS AUTO WASHERS DISHWASHER 25 �q CITY TEL NO LIGHTING FIXTURES 10 ..fi� STATE MOTORS LICENSE NO HORSEPOWER ISTRI CT NO GRO P ON H P OVER INC READY FOR INSPECTION IA&LES9 25 ` +iz — 2 50 INSPECTION RECORD 2 5 100 5 15 1 so IS — 50 250 50 200 500 MISC SIGNS I NO TRANS NO LAMPS SERVICE O-600V 1 00 SERVICE OVER 600V 500 ,t WIRING PERMIT 100 FIXTURE PERMIT 100 SUPPLEMENTARY PERMIT 50 APPROVALS TOTAL FEE f DATE INSPECTORS SIGNATURE I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING �..- ELECTRICAL WIRING WIRING I HEREBY CERTIFY THAT 1 PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY ANGELES COUNTY AND TATE OF CALIFORNIA OR THAT 1 A HE LEGAL OWNER F E ABOVE POWER DESCRIBED RESIDENTIAL P PERTY. SIGNATURE UTILITY CO NOTIFIED OF PERMITTE FINAL / JOHN A LAMBIE. V VALIDATION ARTHUFtC VEIT. COUNTY ENGINEER CK MO QAA!p SUPERVISING ELECTRICALGIN 3972 Nt�V 1 2 250 M 7GA6GS-CEBOS_,1-VAPPLICATION FOR ELECTRIC PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER ADDRESS I BUILDING AND SAFETY DIVISION C10%rrOFIDi Al LAMHIE. Couaty Eagmeer D. GBIFFIN'8»tot Sfaldi>xp LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST PERNIIT FEES ITEM NUMBER EACH FEE OWNER / L OUTLETS $ S MAIL _ LIGHTS RECEPT SW r 1O ,b ADDRESS �O ei�V! t LIGHTING FIXTURES 10 CITY TEL NO ELEC RANGES CLO DRYERS ELECTRICIAN WATER HEATERS 50 ADDRESS LEC SPACE HTRS DISHWASHERS GARBAGE DISPOSERS AUTO- CITY TEL NO - WASHERS STA COOKING UNITS 25 STATE LICENSE NO MOTORS OVER INC H P 0 V2 25 DIS RCT O GROUP ZONE READY FOR INSPECTION 1/z — 2 50 2 - 5 100 INSPECTION RECORD 5 — 15 ISO 15 — 50 250 50— 200 500 SIGNS NO TRANS NO LAMPS SERVICE 0-600V 100 SERVICE OVER 600V Boo MISC WIRING PERMIT too FIXTURE PERMIT 100 SUPPLEMENTARY PERMIT 50 TOTAL FEE CIS APPROVALS I HEREBY ACKNOWLEDGE THAT 1 HAVE' READt THIS APPLICATION DATE INSPECTORSSIGNATURE 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 1 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 ROPERTY /J SIGNATURE _ .I/ UTILITY CO NOTIFIED OF PERMITTE FINAL VALIDATI ARTHUR C.1/EIT, CK Mo H SUPERVISING ELECTRICAL ENGINEER L&34.1 -1v° JM 31 2A 2.85 O;pi � 1 DBS 15A BA 11.55 APPLICATION FOR ELECTRIC PERMIT DWISION OF BUILDING AND SAFETY Dep, ent Of County Engineer BUILDING County Of LOS Angeles ADDRESS JOHN A LAMB1E.COUNTY ENGINEER CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST PERMIT FEES C 2 sT NUMBERI OWNER LIGHT OUTLETS MAIL RECEPTACLES ADDRESS WALL SWITCHES FEE CITY TEL NO TOTAL OUTLETS @ 92 ELECTRI AN 1041 ELEC RANGES 28 ADDRESS ELEC HEATERS 28 CITY j TEL.NO. � V IC1A/EA STATE FIXTURES S LICENSE NO MOTORS DISTRICCI_NOOUP ZONE READY FOR INSPECTION NUMBER HORSEPOWER FEE -��I NEW MVD HP OVER INC EACH INSPECTION RECORD V2 s LESS $ 25 14 2 so 2 s too s is 1150 Is so 2 150 50 200 s 00 MISC NO SIGNS NO TRANS NO SIGNS NO LAMPS �v FOR EACH PERMIT WIRING $t 00 FIXTURES $100 SUPPLEMENTARY so APPROVALS TOTAL FEE S DATE INSPECTOR'S SIGNATURE 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI ATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE POWER p� DESCRIBED RESIDENTIAL PROPERTY SIGNATURE J\U UTILITY CO NOTIFIED / OF PERMITTEE FINAL JOHN A LAMBIE.COUNTY ENGINEER VALID ARTHUR CNEIT.CHIEF ELECT. INSPECTOR CK M CASH �_.CC,9 7 5 1 JA 2 2.0 0 In oe'DEPARTMENT OF BUILDING AND SAFEff APPLICATION FOR PERMIT DING COUNTY OF LOS ANGELES ELECTRIC WM 4, FOX, CHIEF ENGINEER i NAME DISTRICT NO. GROUP ZONE PERMIT NO. U ADDRESS � a I' RECEIVED'B READY FOR _DATE ISSUED U CITY TEL NO FIRST INSPECTIONCOUNTY W CERT NO EXPIRES APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB DESCRIPTION OF WORK ADDRESS NUMBER OF OUTLETS ON CIRCUITS LOCALITY LOCATION BY ROOMS NEAREST LIGHT OUTLETS Isw PLUGS FIXT CROSS ST CIRCUIT A B C D I E F G H W NAME Z MAIL 3 ADDRESS f� v O CITY.r6�/ AAM THE LEGAL POSSESSOR OF THE ABOVE LOS EI rn COUNTY CERTIFICATE OF QUALIFICATION. ELECTRICIAN. I AM THE LEGAL OWNE_,R..�OF THE PR�ERTY DESCRIBED ABE �OV OWNMI:'r 'A. CORRECTIONS � z a a TOTAL NO. OF OUTLETS $ APPROVALS 1 NO. OF FIXTURES S DATE INSPECTOR•S,NAME NO. OF MOTORS H P. CONDUIT NO OF SIGNS TRANS $ WIRING Qt NO OF RANGES OR HEATERS $ FIXTURES ` MISCELLANEOUS $ POWER s PERMIT FEE $ ® UTILITY CO NOTIFIED TOTAL FIE loo,6y FINAL DOS S-A 1.46 PLICATION FOR PERTIM 'DEPARTMENT OF BUII.DING AND SATErY ELECTRIC COUNTY OF LOS ANGELES WM J FOX CHIEF ENGINEER z NAME DISTRICT NO. GROUP I ZONE PERMIT NO. ADDRESS O 1 `�� A F f::vED B READY FOR ATE ISSUED CITY TEL FIRST INSPECTION R WCOUNTY CERT NO EXPIRES 5-j9 9-7 APPLICANT FILL IN HEA Y OUTLINED PORTION ONLY JOB DESCRIPTION OF WORK ADDRESS NUMBER OF OUTLETS ON CIRCUITS LOCALITY LOCATION BY ROOMS NEAREST LIGHT OUTLETS ISW PLUGS FIXT CROSS ST CIRCUIT A B C D I E F G H w NAME y Z MAIL L� 3 ADDRESS CITY TEL NO 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERT FIC TB 0 Q gALIFICATION. 4 IIL1cQe��p'_JI�IJ.►1A�Ot� —6L—ECTRICIAN. I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE OWNUA. CORRECTIONS IVa z n _ a TOTAL NO OF OUTLETS 13 $ APPROVALS NO. OF FIXTURES ® $ DATE INSPECTOR'S NAME NO OF MOTORS H P $ CONDUIT ?? NO OF SIGNS TRANS $ WIRING [NO OF RANGES OR HEATERS $ FIXTURES MISCELLANEOUS S POWER PERMIT FEE o�-� $ O`er UTILITYCO NOTIFIED TOTAL FEE FINAL I DOS-5A 11-55 APPLICATION FOR ELECTRIC PERMIT g Das.aw DIVISION OF BUILDING AND SAFETY Dep- ent of County Engineer 7BULDINGCounty of Los Angeles RESS ` JOHN A LA BIE, COUNTY ENGINEER CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST EAR s dV 0 GC c5' PERMIT FEES NUMBER OWNER LIGHT OUTLETS MAIL RECEPTACLES ADDRES U� t WALL SWITCHES FEE CITY ¢i ` EL NO � LF TOTAL OUTLETS ® s¢ $ I ELECTRICI N ELEC RANGES 25 2 ADDRESS ELEC HEATERS 25 KW EA CITY TEL NO. STATE FIXTURES 5 LICENSE NO MOTORS DISTRICT NO. GROUP ZONE READY FOR INSPECTION NUMBER HORSEPOWER FEE 11 1141 NEW MVD HP OVER INC EACH >h�LESS $ 2s INSPECTION RECORD Yz 2 so 2 5 100 kI 1J c- b,& S 18 ISO n 15 so 2 so I 1 .l �. ►�� t_C .�n�Le�. 50 200 S 00 MISC NO SIGNS NO TRANS NO SIGNS NO LAMPS FOR EACH PERMIT WIRING $100 JABOVE FIXTURES $100SUPPLEMENTARY 50 APPROVALSTOTAL FEE $ DATE INSPECTOR'S SIGNATURE IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLIAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CCONDUITWITH ALL COUNTY ORDINANCES AND STATE LAWS REGUWIRING OELECTRICAL WIRING1 HEREBY CERTIFY THAT I PROPERLY REGISTERED AFIXTURES LICENSED AS REQUIRED BY ANGELES COUNTY AND STCALIFORNIA OR THAT I THE LEGAL OWNE OF POWER DESCRIBED RESIDENTIA OPERTY. UTILITY CO NOTIFIED SIGNATURE oL OF PERMITTEE�j ilk FINAL r JOHN A LAMBIEVOUNTY ENGINEER VALIDATION ARTHUR C.VEIT.CHIEF ELECT. INSPECTOR CK MO CASH J_AC,0 4 1 1 7 ty, MAR 14 2 1 .25 In 76AE53-CEBO6 4-68 APPLICATION FOR ELECTRI AL PERMI ' COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING • BUILDING AND SAFETY DIVISION ADDRESS o .JOHN A LAMBIE. COUNTY ENGINEER COLEMAN W JENKINS, SUPERINTENDENT OF BUILDING LOCALITY IIIIIIII NEAREST 7�TOTAL ANT TO FILL IN CROSS ST NO ' AC FEE $ $ OWNER _ RECMAIL LIGHST 20 20 1j(J ADDRESS moa/ e SWITER 20 10 CITY TEL NO PLANCH CK LIGHST 20 20 APPLICANT FIXTURES OVER 20 10 ADDRESS RANGE_DRYER—WTR HTR CITY ,TEL NO STA COOKM1_DISP _F A U C0i,TRAC T-0R SPACE HTRAIR COND ADDRESS JD •�Z CLOTHES WASH _DISHWASH / CITY TEL NO FAN—OTHER 1 00 / Da LICENSE IJO Z2— HOZ CLASS MOTORS TRANSFORMERS RATING ' IND HEATERS ETC HP KW KVA IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY SIZE & TYPE OVER TO WITH ALL COUNTY ORDINANCES AND' STATE LAWS REGULATING ELECTR ICAL W IR ING 0, — 1 1 00 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 1 — 10 3 00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF 'AND INTEND TO 10 - 50 5 00 RESIDE IN THE ABOVE DESCRIPED RESIDENTIAL PROPERTY U SIGNATURE 50 – 100 10 00 pF PERMITTEE ' O 100 — 500 15 0o DISTRICT, R P E P E D B SIGN GAS SIGN AND ONE CIRCUIT 3 00 N TUBE, OR _ _ Z MARQUEE ADDITIONAL CIRCUITS ' 1 00 ` NOTES SERVICE NOT OVER 600 VOLTS OR 200 AMP 2 00 04) ' SERVICE OVER 600 VOLTS OR 200 AMP 5 00 TEMP SERVICE POLE &APPURTENANCES 3 00fR PROVALS DATE INSPECTOR'S SIGNATURE , OWER POLE LAB WORK G CONDUIT PERMIT FEE (SUB TOTAL) ES PLAN CHECK FEE (50% PERMIT FEE) UTHORIZED PERMIT ISSUING FEE 200 OL CO NOTIFIEDSUPPLEMENTARY PERMIT ISSUING FEE 1 '00 TOTAL FEE JOSEF&H C ROOHAN SUPERVISING ELECTRICA GI NEER PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION CKM o CASH C �'= s 7: � 23 2 Q 8.20' 'C4 SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE WORKERS COMPENSATION DECLARATION 810/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirta that I have a certificate c. consent-to self insure, CE CE a06osG or a'certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY 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- F-11 & 2-Family,Sq Ft $ _ $ LOCALITY �N� Certified copy is fled with the,county building inspection department Multi-family Sq Ft NEAREST CROSS ST jQ Ll,s Date Applicant Residential Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL COMPENSATION INSURANCE Outlets Rec Light Sw ADDRESS (This section need not be completed If the work Involved by the First 20 Total No AddttA6 ,,permit Is for one hundred dollars($100) or less) Additional CITY �� 11 �, Tel No �t�r�s�� 'certify that in the performance of the work for which this permit PLAN CHECK p P APPLICANT 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 yy���q1 Sew Additional Date - Applicant A'lrt� r)Z./7/c 140616! iL 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'Compensation Range_ Heater_ DW _ APPLICANT provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W M _ ADDRESS provisions or this permit shall be deemed revoked _ LICENSED CONTRACTORS DECLARATION Hood — Fan - Other_ LICECITY Tel No OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp — Room Air Cond REGNSE Nu BER Class (commencing with Section 7000) of Division 3 of the Business and Professions Code,and my license is in full force and effect Power Apparatus& Large Appliances DISTRICT NO PROCESSED BY Size& Type HP,KW,KVA,or KVAR O License Number Lic Class Up to 1 Incl FINAL1�h I N U Over 1 to 10 Incl DATE VALIDATION Contractor Date Over 10 to 50 Incl FINAL V ❑ I am exempt under Sec Over 50 to 100 Inc BY W B&PC for this reason Over 100 0- r N Services�s ® Z Date 0- 200 Amp Under 600 V 2- Signature Signature 201 - 1000 Amp nder 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 - ;CCTeAir I hereby affirm that I am exempt from the Contractors License Law for the following reason (Section 7031 5, Business and Professions Additional Sign Branch Circuits Code)Jk ` t Misc Conduits & Conductors 1 1TEM"S I,as owner of the property,will do the work and the structure l d h S Fee ee ceue) is not intended or offered for sale (Section 7044, Business Other(See Comp ® TOTAL 3 :1 . 01D and Professions Code) CHECK +j,uO CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the C.}'AK-E .00 performance of the work for which this permit is issued(Sec 3097, PERMIT FEE (Sub-Total) 0 Ci Civ C) PLAN CHECKING FEE f3IJf C_I 3 6/ "O1 i Lender's Name PERMIT ISSUING FEE r-13 11Q i - 1 AIS 7:41 Lender's Address I certify that I have read this application and state that the above TOTAL FEE information is correct I agree to comply with all County ordinances _ and State laws regulating Electrical wiring, and hereby authorize representatives of this Count to enter upon the above-mentioned property for inspection purp s �s) SEE REVERSE FOR EXPLANATORY LANGUAGE - S—C)o Signa ure of Permittee Date 1 WORKERS'COMPENSATION DECLARATION once 200013 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT �~ I -hereby 6ffirn'i that I have,a cern}ica,te ofconsent to self CE 806G COUNTY � , 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 /y r� w'/ ❑Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS X1 A//�A AVC, FCertified copy is filed with the county building inspec- 1 & 2-Family, Sq Ft $ — $ LOCALITY tion department Multi-family Sq Ft — NEAREST CROSS ST Residential Swimming Pools OWNER OR `'0��A/ /� Date Applicant J//�r FIRM NAME �/V�!� �/( CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets kecLight-LO—Sw 5 MAIL �d COMPENSATION INSURANCE A ADDRESS h CIVC/N! 4 V6 [� Frrst 20 (This section need not be completed if the work involved by cc the permit is for one hundred dollars ($100)or less ) Tptal No �L Additional CITY L���� fri� Tel No 5353 I certify that in the performance of the work for which this PLAN CHECK 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 /�i��_26) �} Total No Additional CITY Tel No Date Applicant_ /J Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT If, after making this Certificate of WaltAPPLICATION Exemption, you should become subject to the Workers' Range— Heater DW — 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 V_ deemed revoked Hood — Fan —Other_ Y� CITY Tel No LICENSED CONTRACTORS DECLARATION Disp _ Room Air Cond ✓'I)L) �© LICENSE OR Class I hereby affirm that I am licensed under provisions of Chapter 9 REG NUMBER (commencing with Section 7000)of Division 3 of the Business 1 Power Apparatus& Large Appliances DISTRICT NO PROCESSED Y >- and Professions Code,and my license is in full force and effect ��- ''-1/ O Size 8 Type HP, KW, KVA, or KVAR License Number Lic Class " Up to 1 Incl FINAL U Contractor Date Over 1 to 10 Incl DATE VALIDATION 0 ❑ Over 10 to 50 Incl FINAL ` I am exempt under Sec Over 50 to 100 Inc BY LU B &P C for this reason Over 100 a Services, Swbd , MCC& Panelboards U) Date 0-200 Am Under 600 ? Z Signature 201 - 1000 Amp Under 600 V aExemption for Reg Maint Elect Over 1000 Amp or Over 600 V NCCT.g SINGLE FAMILY 31:07 46.-,G HOME OWNER-BUILDER DECLARATION Temp Power Pole &Appurtenances I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit 1 ITEC Law for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits TOTAL 46 - 40 0Professions Code) "-,.HECK 43.,fi9 1, 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)_ CHANGE Business and Professions Code) CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for lblG=1—�IfIEl1 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) L � deft (Sec 3097, Civ C ) PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE /3 00 Lender's Address � \ I certify that I have read this application and state that the TOTAL FEE 416, 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 property for inspection purrppgoses SEE REVERSE FOR EXPLANATORY LANGUAGE �j Signature of Permittee Date ©s WORKERS'COMPENSATION DECLARATION 76-663 10i81 APPLICATION FOR ELECTRICAL PERMIT � s I hereby affirm that I have a certificate of consent to self insure, CE-806G or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY \copy thereof(Sec 3800 Lab C) y r r Policy No Company FOR APPLICANT TO FILL IN JOBADDRESS �f'i` r t .'� X" J r,' 1 I ��'f j4 V f' Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO, FEE g LOCALITY *€% �' 1�� >F ''1 T A 1 & 2-Family,Sq Ft ❑1 Certified copy Is fled with the county budding Inspection NEAREST t I department Multi-family Sq Ft CROSS ST Date Applicant Residential Swimming Pools OWNER OR /% FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets'Rec— Light Sw MAID r ,,fj COMPENSATION INSURANCE ADDRESS CITY (This section need not be completed if the work Involved by the First 20 - . permit Is for one hundred dollars($100)or less) Total No Additional p!vv til i• C+� f Tel No ' > PLAN CHECK . I certify that in the performance of the work for which this permit APPLICANT 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 '^ CITY�'.��% / rr'.:�J�N�i/3l= Total,No Additional CITY Tel No Date ' Applicant Fixed Appliances Not Over'1 HP PERMIT t NOTICE TO APPLICANT If, after making this Certificate of APPLICANT ) J"1 Exemption,you should become subject to the Workers'Compensation Range_'Heater_ DW ° 1 provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W M ADDRESS provisions or this permit shall be deemed revoked Top — FAU _ WH LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ CITY Tel No I hereby affirm that I am licensed under provisions of Chapter 9 Disp — Room Air Cond LICENSE B Class (commencing with Section 7000)of Division 3 of the Business and REG NUMBER Professions Code,and my Ilcerise is in full force and effect DISTRICT NO PROCESSED BY 0" Power Apparatus& Large Appliances �f � O Size&Type HP,KW,KVA,or KVAR U W License Number Lic Class Up to 1 Incl FINAL J ' Over 1 to 10 Incl DATE VALIDATION L... Contractor Date Over,10 to 50 Incl FINAL � I am exempt under Sec Over 50 to 100 Inc BY B&PC for this reason Over 100 O Services,Swbd7MCC& Panelboards < ® a Date -0"200'Amp Under-600.V! W y Signature 201 - 1000 Amp Under 600 V F— ❑ Over 1000 Amp or Over 600 V Exemption for Reg Maint Elect i SINGLE FAMILY Temp Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ' I hereby affirm that I am exempt from the Contractors License Law,' Additional Sign Branch Circuits for the following reason (Section 7031 5, Business and Professions T ,Cod i A 5�9� p-F Mlsc Conduits& Conductors w U I,as owner of the property,will do the work and the structure .n Other(See Complete Fee Schedule) is not intended or offered for sale (Section 7044, Business E �� Orr 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(Sec 3097, PERMIT FEE- (Sub-Total) Civ C) PLAN CHECKING FEEh! Lender's Name I I ; 1 ` ISM � �� II PERMIT ISSUING FEE ,_Lender's Address I certify that I have read'this application and state that the above TOTAL FEE information Is correct I agree to complN�with all County ordinances and Statd laws regulating Electrical wiring, and hereby authorize ' representatives of this County to enter upon the above-mentioned property for inspection purpos SEE REVERSE FOR EXPLANATORY LANGUAGE Y­.lrr7'f Signature of Permittee Date