Loading...
HomeMy Public PortalAbout9830 FLAHERTY ST_Electrical__ WORKERS'COMPENSATION DECLARATION :76A66vDPW 3ia7 APPLICATION FOR ELECTRICAL PERMIT O I hAFeby affirm that,I have a certificate of consent to self Ce 8006G nsure, or a Certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lab. C.) PLI&C ST olicy N6. Company FOR APPLICANT TO FILL IN JOB r��Q Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS d Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ _ $ LOCALITY 7Zc tion department. Multi-family Sq. Ft. � NEAREST CROSS ST. Residential Swimming Pools OWNER OR / Date Applicant FIRM'NAME C Ca I /y CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec�Light�Sw.Q—_ AMAIL DDRESS Q S' COMPENSATION INSURANCE First 20 / a (This section need not be completed if the work involved by Total No. r CITY Tel. the permit is for one hundred dollars ($100)or less.) Additional I certify that in the performance of the work for which this PLAN CHECKAPPLICANT 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 Additional Total No.� CITY Tel. No. 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—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. Hood — Fan —Other— 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 Business Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY >_ and Professions Code, and my license is in full force and effect. O Size &Type HP, KW, KVA, or KVAR a License Number Lic. Class Up to 1 Incl. FINAL U Over 1 to 10 Incl. DATE IS q VALIDATION cc Contractor Date Over 1,0 to 50 Incl. FIN ' F_ BY U a I am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C. for this reason Over 100 12- Services, 1Services, Swbd., MCC& Ponelboards , a) Date: 0-200 Amp. Under 600 V Z Signature 201 - 1000 Amp. Under 600 V aExemption for Reg. Mainz. Elect. Over 1000 Amp, or Over 600 V SINGLE FAMILY Temp. Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION a I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit '_•t•:i =•c Aure he followingreason Section 7031.5, Business and Additional Sign Branch Circuits _ s Code): owner of the property, will do the work and theMisc. Conduits 8 Conductors Other See Com lete Fee Schedule is not intended or offered for sale(Section 7044, ( P )— , , ;,;-,;.,, ,t•,� m ;�� Business and Professions Code). -. CONSTRUCTION LENDING AGENCY NEICK ��. I hereby affirm that there is a construction lending agency for w•i::°i�t:t 4 -the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEEj/ PERMIT Lender's Name -' PERMIT ISSUING FEE �, 7 lili•_;s-; 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 property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ' Sign re of rrmie Date WORKERS'COMPENSATION DECLARATION ;2o-ootvDPW 3iaz APPLICATION FOR ELECTRICAL PERMIT t hereby affirm that I have a certificate of consent to self ce eobc insure, x a certifictbte of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS 0(o cAfied copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. AX T New Residential Bldgs. & Pools EACH NO. FEE ADDRESS70 ,�f S. F Certified copy is filed with the county-building inspec- 1 &2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. — NEAREST CROSS ST. Date Applicant Residential Swimming Pools OWNER OR ( �/ FIRM NAME /V CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ AMAIL DDRESS COMPENSATION INSURANCE First 20 CITY I. N the permit is for one hundred dollars ($100)or less.) (This section need not be completed if the work involved by Total No. Additional ' I certify that in the performance of the work for which this PLAN CH CKAPPLICANT permit is issued, I shall not employ any person in any manner Lighting Fixtures First 20 ADDRESS so as to become subject to the Workers'Compensation Laws. Total No. Date Applicant Additional CITY Tel. No.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—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. CITY Tel. No. Hood Fan —Other LICENSED CONTRACTORS DECLARATION LICENSE OR Disp. — Room Air Cond. — REG. NUMBER Class. I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY a and Professions Code,and my license is in full force and effect. Size HP, KW, KVA, or KVAR �(� 0 License Number Lic. Class Up to 1 Incl. FINAL 0 Over 1 to 10 Incl. DATE VALIDATION Contractor Date Over 10 to 50 Incl. 0 D FINAL U BY I am exempt under Sec. Over 50 to 100 Inc. UJ Over 100 B.&P.C. for this reason Services, Swbd., MCC& Panelboards , Date: Z 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 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 ! ;z Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits PrP festions Code): o LEI-! /LI1dlX as owner of the property, will do the work and the Misc. Conduits &Conductors - f 3 i \\\JJJ structure is not intended or offered for sale(Section 7044, Other (See Complete Fee l?Schedule)_ 20 = 00Business and Professions Code). • - CONSTRUCTION LENDING AGENCY .',F o'•'i } 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) �j C•:sf4 GE n= 1 (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name C,0 0—J.Aul"i _ PERMIT ISSUING FEE Lender's Address D �� I A l35 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-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ©s Signa r i re of ttee Date 76A663-CE806 9-64 APPLICATION FOR E.LECTRICA PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY' ENGINEER BUILDING �O BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT. OF BUILDING LOCALITY i ee NEAREST FOR APPLICANT TO FILL IN CROSS ST. RECEPT, TOTAL NO. IEACH FEE /I LIGHT OUTLETS FIRST 2O $,LO $ OWNER MAIL AOD'L 1O ADDRESS F SWITCH. OVER 20 TOTAL , CITY TEL. NO. LIGHTING FIRST 20 .20 FIXTURES } _ ADD'L 10 ELECTRICIAN L OVER 20 RANGES CLO.DRYERS WTR.HTRS. 1.00 r/ 46ADDRESS GAR P. STA.COOK CITY TEL. NO. DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.(yi H.P.MAX.) .50 LICENSE NO. MOTORS: OVER NOT OVER H'.P. DISTRICT 0. GROUP1 ONE P OF- BY O 1 1.00 ../rJ 1 3 1.50 INSPECTION RECORD 3 8 2.00 C° 8 15 2.50 15 50 3.00 O H so too 5.00 V W SIGNS: NO.TRANS N NO.LAMPS SERVICE 0.600V-Nor OVER 200A 1.00 SERVICE 0.600V-OVER 200 A. 2.00 SERVICE OVER 600V 5.00 MISC. PERMIT ISSUING FEE 2.00 6 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE $ 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS 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 I HEREBY .CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF _ CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN, THE ABOVE DES [BED RESIDENTIAL ROPERTY. POWER JJ SIGNATURE UTILITY CO.NOTIFIED OF PERM ITTEF��Z-4� �7 y�- FINAL 9..�d"J i.7f'+ � f�LJ1fi,/•i LIDATION JOSEPH C.'ROOHAN y v CK MO CASH SUPERVISING ELECTRICAL ENGINEER -FIL;-,, 0 7 5 4 4i Ilvl i 0 2 D 5.5 0� 76A663-cE806 9:64 APPLICATION ICATIOI� AORCTRICAL ELE / RMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT. OF BUILDING LOCALITY (�> NEAREST FOR APPLICANT TO FILL IN CROSS ST. / .�/�"✓ RECEPT• TOTAL NO. EACHI FEE J OUTLETS FIRST 20 $20 $ OWNER LIGHT / z MAILC7 r �/' AOWL ADDRESS 10 SWITCH. OVER 20 ,6+ TOTAL CITY ' C. TEL. NO. LIGHTING r (FIRST 201 .20 FIXTURES } I ADWL 1O ELECTRICIAN G i�ffl� LAG ple OVER 20 11 J J A I RANGES CLO.DRYERS WTR.HTRFsS. 1.00 ADDRESS '4e "�//C. rW e' GARB.DISP. STA.COOK CITY TEL. DISHWASH�i� ?O.-WASH. STATE a W CEJ SPACE HTRS. STA.APP.('/.H.P.MAX.) .50 LICENSE NO. MOTORS: OVER NOT OVER H.P. DISTRICT "7 GROUP ONE PR�OCES D BY O 1 1.00 (� v(/ 1 3 1.50 INSPECTION RECORD 3 B 2.00 '14 In 16� < I ^k,9fr'iYA..�/�yy-='� 8 is 2.50Ftp- : 15 50 3.00 - e w -4 , 50 100 5.00 W SIGNS: NO.TRANS. 0- NO.LAMPS N SERVICE 0.600V-NOT OVER 200A 1.00 SERVICE 0.60OV-OVER 200 A. 2.00 SERVICE OVER 600V 5.00 MISC. PERMIT ISSUING FEE 2.00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE $ 1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS 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. 7� �' > ..t✓J ,:T WIRING ,,.. //.1� ''��� I HEREBY RTI Y THAT I AM ROPERLY ISTERED AND/OR FIXTURES !A'1/,.r•'I dv LICENSED A REQ RED BY LO NG I,. S CO Y AND STATE OF CALIFORNIA OR TH T - M T OWNER F, AND INTEND TO RESIDE IN, HE AB ESCR E TIAL ROPERTY. POWER SIGNATU E UTILITY CO.NOTIFIED OF PERM( �� FINAL LIDATION JOSEPH C. ROOHAN ~ ' C MO CASH SUPERVISING ELECTRICAL ENGINEER L ilio 9 0 6 4 iv;A R 2 2 D 3.10 N