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HomeMy Public PortalAbout5470 ENCINITA AVE_Electrical__ WORKERS"COMPENSATION DECLARATION 76A66eDow3,a7 APPLICATION FOR ELECTRICAL PERMIT I hereby aff rm that P have a certificate of consent to self 806E insure, or,,a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS o$,�i,certified copy theAof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB (^' 1 ❑Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS ^� 7`� C G\n\ LOCALITY ❑Certified copy is filed with the county-building inspec- 1 & 2-Family, Sq. Ft. $ $ (' tion department. Multi-family Sq. Ft. NEAREST Residential Swimming Pools CROSS ST, Date OWNER OR Applicant i FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec' � Light 1 Sw.2 MAIL COMPENSATION INSURANCE _ First 20 Q ADDRESS Sy Q "tit C_ l h �a \ (This section need not be.completed if the work involved by Total NoAdditional CITY ,A \� C' Tel. No. . the permit is for one hundred dollars($100)or less.) tv 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 a y manner so as to become subject to the Workers' ompens tion Laws. Lighting fixtures First 20 ADDRESS Additional (- Total No. CITY Tel. No. Date J "'1 D // _Applicant___� NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range_ Heater_D.W. APPLICATIONRC_ 4C�l�as 1�(f�d 1 Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS i�a31 C Q with comply with such provisions or this permit shall be Top — FAU —W.H. — ,) deemed revoked. CITYel. No. LICENSED CONTRACTORS DECLARATION Hood — Fan —Other [e' / 3 Disp.. — Room Air Cond. LICENSE 4700% Class. C I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. , P ED BY1 >_and Professions Code,and my license is in full force and effect. Q 0- Size &Type HP, KW, KVA, or KVAR Q License Number 'Z/�U�� Lic. ClassUp to 1 Incl. FINAL V Contractor',--` OWir-f Date 2-p��p B' � Over 1 to 10 Incl. DATE �� VALlDA]!jjjjj:!5 0 ❑ Over 10 to 50 Incl. FINAL I am exempt,under Sec. Over 50 to 100 Inc. BY W Over 100 d B.&P.C. for this reason Ove � Services, Swbd., MCC& Ponelboards 1 , Z Date: 0- 200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V X. ❑ Over 1000 Amp. or Over 600 V __: Exemption for Reg. Maint. Elect. _ SINGLE FAMILY 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 a 1 i:?s' Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits - t Professions Code): :E 11 61 °' z.=�� ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors : CK It,i°"'-1 structure is not intended or offered for sale(Section 7044, Other (See romplete Fee Sc ule)_ , t: 1P-1N EE Q UQ Business and Professions-Code). ��� u+ CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for 0'101 L I—00 0 j 1% the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) 43 t.-,; � �,�_ (Sec. 3097, Civ. C.). t r =• 1 [-111 _� :�[ 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 St to laws regulating Electrical wiring, and hereby authorize presentatives of this County to enter upon the aboYe- ent' ed property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ©s Signature of Permittee Date WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, 76A663 or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec. 3900 Lab. C.) �\ Polis No. Company - �/ FOR APPLICANT TO FILL IN JOB o 9�1 Jr/n/ ❑ Y P Y � �— ADDRESS � Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE $ $ LOCALITY �a Certified copy is filed with the county building' 1 &2-Family,Sq.Ft. _ NEAREST depa tment. Multi-family Sq.Ft. CROSS sT. 6C Date A licant Residential Swimming Pools ASSESSOR r MAP BOOK PAGE PARCEL PP WNER OR CERTI CATE OF EXEMPTION FROM WORKERS'/ Outlets:Rec. Light�Sw.� h / po ` FFIIRM NAME COMPENSATION INSURANCE v J / First 20 MAIL (This section need not be completed if the work involved by the Total No. Additional ADDRESS permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITY Tel.No. tOae is issued, I shall not employ any person in any manner so as to PLAN CHE K become subject to the Workers' Compensation Laws. Lighting FixtureFirst 20 APPLICANT Total No. Additional p� ADDRESS J l Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certificate of CIT , 4__ Tel.No. �� Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT p Y P Y Power Apparatus&Large Appliances APPLICANT provisions or this permit shall be deemed revoked. LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000) of Division 3 of the Business and CITY �� Tel.No. 7 d(- Professions Code, and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR ') a Over 50 t0 100 Incl. REG.NUMBER �v Class. // P 7 d Lic.Class Over 100 DISTRICT NO. ESSED BY O License Number ` h Services,Swbd.,MCC&Panelboards v� O FINAL Contractor Date 9 0•399 Amp.Under 600 V DATE V ❑ 400-1000 Amp.Under 600 V I am exempt under Sec. VALIDATION UJ Over 1000 Amp.or Over 600 V FINAL i d B.&P.C.for this reason BRANCH CIRCUIT FEES BY Z Date: 15A,or 20A, 120V,Lighting or Recept. 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits r_141 Or More Branch Circuits Exemption for Reg. Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits 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 Law for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): ❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors _ -t is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) 1 t_t i€ai �= x_03 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 FEE s(`s_SCI 1 -�I,!3#f 1 _/20.`-i?4 Lender's Name / C- PERMIT ISSUING FEE �(�/ JX I i AM1'_)_V-# Lender's Ad ress 1 certify that I have read this application and under penalty of purjury state TOTAL FEE that the ab ve information is correct. I agree to comply with all County or nd State laws regulating Electrical wiring,and hereby authorize represent fives of this County to en upon the above-mentioned property for i spe tion purpos SEE REVERSE FOR EXPLANATORY LANGUAGE I � � ATURE OF PERMITTEE ATE 76A663 CE-806(6/78) APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES BUILDING AICD SAFETY FOR APPLICANT TO FILL IN JOB A� r A New Residential Bldgs.&Pools EACH NO. FEE ADDRESSJ� {i / _ .,d 1 &2-Family,Sq. Ft. r.5 — $ LOCALITYMulti-family Sq. Ft. — NEAREST Residential Swimmin Pools CROSS ST.g OWNEROR 3FIRM NAME Outlets:Rec�Light�Sw. MAIL �/ First 20 / J ADDRESS Total No. ZZ Additional 30 CITY Tel. No. PLAN CHECK APPLICANT Lighting Fixtures First 20 .50 .� ADDRESS Additional .30 Total No.� CITY Tel. No. Fixed Appliances Not Over 1 HP PERMIT APPLICANT a A!S Range_Heater_D,W. — Oven—Dryer_W.M,–./— ADDRESS yd> L j V�� Top _FAU — W.H._ CITY Tel. No. d,®' Hood_Fan —Other LICENSE OR Disp.—Room Air Cond. 2'50 ` S REG.NUMBER IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA- Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO Size&T COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS Type HP, KW, KVA,or KVAR REGULATING ELECTRICAL WIRING. Up to 1 Incl. 2.50 I HER CERTIFY THAT I AM PROPERLY REGISTERED AND/OR Over 1 to 10 Incl. 5.00 LICENSED-AS REQUIRED BY LOS A ELES COUNTY AND STATE OF Over 10 to 50 Incl. 12.50 CALIFORNIA OR THAT I AM TH GAL OWNER OF THE ABOVE Over 50 to 100 Inc. 25.00 DESCRIBED RESIDE TIAL PROP Over 100 40.00 PERMITEE SIGNATURE Services DISTRICT NO. PR SED Y 0-200 Amp. Under 600 V 12.50 201-1000 Amp. Under 600 V 25.00 0 . 3 Over 1000 Amp.or Over 600 V 50.00 Z 10.00 �l "Y� Temp. Power Pole&Appurtenances Sign with One Branch Circuit 10.00 7 a 2 J Additional Sign Branch Circuits 2'00 INSPECTION > INFORMATION M Misc.Conduits&Conductors 10.00 ON REVERSE z Other(See Complete Fee Schedule) SIDE u -j3 44 4 A Z g o o a o o 2 20 - 1650 PERMIT FEE (Sub-Total) PLAN CHECKING FEE (One-Fourth Permit Feel Z o 0 0 16Jr v PERMIT ISSUING FEE $7.00 ' 2 9 7 9 J TOTAL FEE 4 > r INSPECTION FINALED o�c W date: �7 �? By ©5. 76AG63-CEBOG 10-59 APPLICATION FOR ELECTRIC PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEERJ72DRESS G . BUILDING AND SAFETY DIVISIONJOHN A. LAMBIE. COUNTY ENGINEER �+,1� �-5yyWILLIAM A.JENSEN.SUPT OF BUILDINGY Jj E D i) F k e FOR APPLICANT TO FILL IN NEARCROSS ST. 8 EST PERMIT FEES g R , dam-Q� ITEM NUMBER EACH FEE OWNE MAIL OUTLETS: $ $ ADDRESS ai �a C '� LIGHTS RECEPT. SW. .10 1 og LIGH7JNG FIXTURES 10 CITY I .NO. ELEC.RANGES CLO.DRYERS ELECTRICIAN WATER HEATERS .50 / ADDRESS ELEC.SPACE HTRS. DISHWASHERS CITY TEL. NO. GARBAGE DISPOSERS AUTO.- STATE WASHERS STA.COOKING UNITS .25 LICENSE NO. MOTORS: OVER INC. H.P. DISTRICT NO. IGROUP Z_ON(E P CESSED Y O— 1/2 .25 1/2— 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 SERVICE 0-600V 1.00 SERVICE OVER 600V 5.00 MISC. WIRING PERMIT 1.00 FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT .50 TOTAL FEE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT ELECTRICAL WIRING. WIRING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIREDBY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED ERTY. C D POWER E A PROP SIGNATURUTILITY CO.NOTIFIED i p. n.s OFPERMITTE FINAL OF "LVAT.TnATj0NE ARTHUR C.VETT, CK MO CwsH// SUPERVISING ELECTRICAL ENGINEER } 0 8 7 Qy�?d 2 D 2.5 0 zz t3