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Home My Public Portal About9849 FLAHERTY ST_Electrical__ WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) L� 76A663 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, 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. 3800 Lab. C.) Policy No. SCOr�pany - FOR APPLICANT TO FILL IN JOB U3 `.: ADDRESS., i. Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE — Certified copy is filed with the county building inspection 1 ul 2-Family,Sq. Ft. $ $ LOCALITY department. Multi-family Sq.Ft. CROSS ST. I-emp C. IL '� Date Applicant Residential Swimming Pools ASSESSOR V MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. OWNER OR COMPENSATION INSURANCEFIRM First 20 MAIL (This section need not be completed if the work involved by the ADDRESS permit is for one hundred dollars(S100)or less.) Total No. Additional I certify that in the performance of the work for which this permit CITY ►`t / �.' ('.A t" - 6'Tel.No, is issued, I shall not employ any person in any manner so as to PLAN CM A;. t-# become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certificate of CITY 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 provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP,KW, KVA,or KVAR ADDRE �; I hereby affirm that I am licensed under provisions of Chapter 9r E.Over 3 to 10 Incl, a (commencing with Section 7000) of Division 3 of the Business and CITYTel.No. A Professions Code, and my license is in full force and effect. Over 10 to 50 Incl. LICENSE 0R Over 50 to 100 Incl. REG.NUMBER -. , 3 r, Class. U Over 100 DISTRICT NO. PROCESSED BY W License Number .; , ' Lia Class�.� J Services,Swbd.,MCC&Panelboards Lt. Contractor Date 0-399 Amp. Under 600 V DATE >_ 400-1000 Amp.Under 600 V Q I am exempt under Sec. VALIDATION Q Over 1000 Amp.or Over 600 V FINAL cc B.&P.C.for this reasonBRANCH CIRCUIT FEES BY 0 fl Date: 15A,or 20A, 120V,Lighting or Recept. 1 To 10 Branch Circuits W Signature 11 To 40 Branch Circuits El Exemption 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 is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , 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 Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE that the 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 SIGNATURE OF PERMITTEE DATE WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) 76A663 APPLICATION FOR ELECTRICAL PERMIT ' I hereby'affirn7 that I have a certificate of consent to self insure, or a dertiflcate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec 3800 Lab. C.) Policy NO - Company FOR APPLICANT TO FILL IN - JOB O/jf,� f/�')j�D ADDRESS i (� AC Certified co is hereby furnished. NO EACH FEE PY Y New Residential Bldgs.&Pools ❑ ,. _ $ $ LOCALITY • Certified copy Is filed with the county building inspection 1 &2-Family,Sq.Ft. department, Multi-family Sq. Ft. — CROSs 3T QMAI T S Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK �J 3 PAGE PARCEL 101" CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER OR ��I ' // Outlets:ReC. Light Sw. n FIRM NAME EA L 14J COMPENSATION,INSURANCE• First 20 V (This section need riot be completed if the work involved by the MAIL D 0, Box. permit'is for one hundred dollars'(S100)or'less.) Total No Additional d ADDRESS r` 47�/� I I certify that'In the performance of the work for which this permit CITY I0PCE Cz i. Tel No91W_9 is issued, I shall not employ any person In any manner so as to "+ become sub ect to the Workers' Compensation Laws Lighting Fixtures First 20 PLAN CHECK 1 P g APPLICANT Total No. Additional ' ADDRESS Date Applicant RESIDENTIAL APPLIA S 0 ER 3 HP NOTICE TO-APPLICANT If, after making this Certificate of CITY Tel No Exemption,youu 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 provisions or this Power Apparatus&Large Appliances APPLICANT 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 Professions Code,and my license is in full force and effect. Over 10 to 50 Incl } Over 50 to 100 Incl LICENSE OR Class• a. REG.NUMBER O Over 100 DISTRICT NO O ESSED BY License Number Lic.Class V Services,Swbd.,MCC&Panelboards dJj�0 Contractor Date 0-399 Amp Under 600 V FINAL DATE O ❑T I am exempt Ovvee under Sec. -1000 Amp.Under 600 V �� VALIDATION W Over 1000 Amp or Over 600 V FINAL 13- B B&P C.for this reason BRANCH CIRCUIT FEES 7BY C/) Date. 15A,or 20A, 120V,Lighting or Recept. Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuts ❑ 41 Or More Branch Circuits Exemption for Reg. Maint:Elect. 15A,20A,208V To 277V Lighting Br Circuits :} SINGLE FAMILY Temp. Power Pole&Appurtenances ,a, HOME OWNER-BUILDER DECLARATION Ai k ,q I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit for the following reason (Section 7031 5, Business and Professions Additional Sign Branch Circuits !'j=0! Code): " �•-yI_:i I, as owner of the property, will do the work and the structure Misc.Conduits&Conductors _ � s not Intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) i CI}AI d a -" and Professions Code) CHECT -7 CONSTRUCTION LENDING AGENCY tl i 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 ;};;; ;?-;t}il!'f �y;° Lender's Name PERMIT ISSUING FEE a� 25-20f F AIL lit Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE that the 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 SIGNATURE OF P&rITTEE DATE A 76A663:CE806 11/70 APPLICATION FOR ELEC I A 1 0 lJ COUNTY OF 'LOS ANGELES DEPARTMENT OF COUNTY ENGINEERBUILDING BUILDING AND SAFETY DIVISION ADDRESS �� j- 7� •�3! LOCALITY COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING NEAREST FOR APPLICANT TO FILL IN CROSS ST. OUTLETS NO EACHI FEE {� ) $ $ - OWNER RECEPT._ MAIL ADDRESS' LIGHT TOTAL FIRST 20 25. „ CITY >� � TEL. NO.�d�.7,° �/ SWITCH OVER 20 10 PLAN CHECK , LIGHTING FIRST 20 25 APPLICANT TOTAL FIXTURES OVER 20 10 ADDRESS APPLIANCES CITY TEL. N0. PERMIT RANGE DRYER_WTR. HTR. APPLICANT ' STA. COOK DISP. -F.A.U. ADDRESS ' SPACE HTR. AIR COND. CITY 17 TEL. NO. CLOTHES WASH. DISHWASH. LICENSE NO. - CLASS. FAN OTHER 100 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND,'HEATERS, ETC. HP. KW KVA. ELECTRICAL WIRING SIZE & TYPE- OVER TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR O - 1 10p LICENSED AS RED IRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO } 1 - 10 300 RESIDE IN, THE ABOVE DESCRI ED RESIDENTIAL PROPERTY O 10 - 50 500 SIGNATURE U OF PERMITT SO - 100 1000 DI,§ZT ICT N0. RO SS ED BY`, Q 100 - 500 1500 15,'56 CL �.CLASS Lu SIGN, GAS SIGN AND ONE CIRCUIT 500 NOTES: H TUBE, OR ^Z� r MARQUEE ADDITIONAL CIRCUITS . 1 00IVA 16 SERVICE NOTOVER 600 VOLTS OR 200 AMP 1 '3.00 D APPROVALS DATE INSPECTOR'S SIGNATURE SERVICEOVER600VOLTS OR200AMP 1000 TEMP.POWER POLE , TEMP SERVICE,,POLE, &APPURTENANCES 500 UNDERSLAB WORK TEMP LIGHT OR RECEPT. SYSTEM 300 ROUGH CONDIUT " WIRING FIXTURES - - POWER AUTHORIZED PERMIT FEE (SUB TOTAL) UTILITY CO. NOTIFIED PLAN CHECK FEE FINAL PERMIT ISSUING FEE 300 JOSEPH C. ROOHAN TOTAL FEE �� SUPERVISING ELECTRICAL ENGINEER, PLAN CHECK VALIDATION CK M 0 CASHPERMIT VALIDATION CK M 0. CASH LACo, 1 01. AFS.21 2.,a 6.&0, SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE ' 76A663-CE806 4"65 AP 1.26 TION FOR ELECT ICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS H� JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY _ NEAREST FOR APPLICANT TO FILL IN CROSS ST. 1� RECEPTACLE TOTAL NO. EACH FEE r t� LIGHT �' 1 OUTLETS FIRST 20 $.20 $ MWNER AIL SWITCH J( ADD'L 1O ADDRESS OVER 20 _ 1 TOTAL FIRST 20 / .20 CITY TEL. NO. LIGHTING l FIXTURES FIXTURES )( / ADD'L 10 CONTRACTOR ^ OVER 20 J RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS /0 GARB.DISP. STA.COOK CITY TEL. NO. � DISHWASH. AUTO.-WASH. q/^�y STATE SPACE HTRS. STA.APP.(1/.H.P.MAX.) / .50 v " LICENSE NO. /41 MOTORS: OVER NOT OVER H.P. DI r FjI NO. GROUP Z N P CESSED BY O 1 1.00 ((,� bt01V kC� 1 3 1.5o INSPECTION RECORD 3 8 2.00 8 15 2.50 --- > d 15 50 3.00 O 50 100 5.00 im SIGNS: NO.TRANS. - 1 O NO.LAMPS '""I1t �► H V w SERVICE 0.600V-NOT OVER 200A 1.00 _ '1S 'F N SERVICE 0.60OV-OVER 200 A. 2.00 Z SERVICE OVER 600V 5.00 OTHER (SEE COMPLETE FEE SCHEDULE) PERMIT ISSUING FEE 2.00 O SUPPLEMENTAIRY PERMIT ISSUING FEE 1.00 TOTAL FEE a APPROVALS DATE INSPECTOR'S SIGNATURE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION UNDERSLAB WORK AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING 1 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 POWER RESIDE IN,THE ABOVE D SCRIBE RE ENTIAL PROPERTY. SIGNATURE UTILITY CO.NOTIFIED F OF PERMITTEE FINAL LIDATION JOSEPH C. ROOHAN CK- MO CASH SUPERVISING ELECTRICAL ENGINEER AW 9 2 4 1'120 JAN 2 8 2 0 2 S 0- 76A663-CE806 9-64 APPLICATION FOR ELECTRIC;L/Wgg 01T COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER F111RIESSINGG r/ / BUILDING AND,SAFETY DIVISION JOHN A. LAMBIE, COUNTY ENGINEERCOLEMAN W JENKINS, SUPT OF BUILDING LITYESTFOR APPLICANT TO FILL IN sr. RECEPT• TOTAL i NO. EACH FEE -/� OUTLETS FIRST 20 $20 $ OWNER LIGHT p2 " r (C7 MAIL UX ADD'L 1O ADDRESS SWITCH. 3 OVER 20 E-- CITY TEL. NO. LIGHTING t FlasT 20 .20 FIXTURES ADD'L , ov R 20 10 ELECTRICryIAJN�7 T RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS,-;1A9 V GARB.DISP. STA.COOK j1 CITY _ TEL-.NO. D DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP. + H.P.MAX.j .50 LICENSE NO. MOTORS: OVER NOT OVER H.P. "DIS ICT O. GROUP E I PR ESSED O 1 1.00 1 3 1.50 INSPECTION RECORD --- 3 8 2.00 O 8 15 2.50 u 15 50 3.00 O 50 100 5.00 H u NO.TRANS UJ SIGNS' NO.LAMPS H Z 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 QO " SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE $ 1HEREBY ACKNOWLEDGE THAT 1 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 AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT THE LEGAL OWNER OF, AND INTEND TO RESIDE IN, THE ABOVE DES RI D RESIDENTIAL PROP TY POWER SIGNATURE UTILITY CO.NOTIFIED OF PERMITTE FINAL �r!— ,si r ALIDATION JOSEPH C. ROOHAN CK' MO CASH SUPERVISING ELECTRICAL ENGINEER LAU09578'%-o FEB10 2 D' 5,00N 76A663 DBB SA 25M SETS 11-4e AP'PLICATION FOR PERMIT ,DEPARTMENT OF BUILDING AND SAFETY ELECTRIC �� , COUNTY OF LOS ANGELES WILLIAM J. FDX CHIEF ENGINEER DISTRICT NO. GROUP ZONE PERMIT NO. FOR APPLICANT TO FILL IN 0 -,/? RECEIVED BY READY`FOR DATE ISSUED ELECTRICIAN y 1 FIRST INSPECTION 0 ADDRESS }9'0.1'yg R �✓' 4 CITY TEL. NO. �/ /br ' LICENSE NO. �-I- EXPIRES -.010 ADDRESSG S DESCRIPTION OF WORK FEES LOCALITY NUMBER OUTLETS EACH r CROSS LIGHTS Sc $ �r STREET RECEPTACLES 5 J FIXTURES 5 D OWNER WALL SWITCHES 5MAIL ADDRESS ,� /i /y ELEC. RANGES 25 6 ELEC. HEATERS 25 CITY _ • TEL. NO. misc. I 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS NUMBER OF CIRCUITS INSTALLED: ANGELES COUNTY LICENSE. LIGHTS RECEPTACLES MOTORS ELECT f IAN. NUMBER HORSEPOWER .FEE NEW MVD. HP OVER I INC. EACH - _ IAM THE LEGAL OWNER OF THE REBID NTI%AL PR I/2 & LESS $ .25 ERTY DESCRIBED ABOVE. %2 2 .50 V2 5 1.00 OWNER. 5 is 1.so INSPECTION RECORD is 50 2.501 50 200 5.001 1 200 500 10.001 500 1 000 1 s.00 J Q OVER 1000 20.00 Z rMtG. /FREQ. CHANGER-HP 0 WELDERS: AC-KVA Q GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (75% OF ORIG•) MOVED MOTORS (7S% OF ORIG.) MISC. SIGNS TYPE: NO.TRANS. TYPE: NO. LAMPS APPROVALS PERMIT FEE DATE INSPECTOR'S NAME FOR ISSUING PERMIT: CONDUIT WITHOUT FIXTURES $1.00 I WIRING WITH FIXTURES 1.25 3' FIXTURES SUPPLEMENTARY .50 �L Q POWER TOTAL FEE $ 7 /g UTILITY CO. NOTIFIED { FINAL 76A663-CE80610-61 APPLICATION FOR ELECT CAL PERMI 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING j BUILDING AND SAFETY DIVISION ADDRESS 7 JOHN A. LAMBIE. COUNTY ENGINEER WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. 1 T E M NO. I EACH FEE OUTLETS: (FIRST 20) $20 S C OWNER LIGHTS RECEPT. SW. �� MAIL OUTLETS: (ADD'L UNITS) 10 ADDRESS . LIGHTS RECEPT. SW. 2 LIGHTING FIXTURES: (FIRST 20) .20 CITY L�— TEL. NO.` — Q y20 3 LIGHTING FIXTURES: (ADDITIONAL) .10 ELECTRICIAN -'f RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS GARB.DISP. STA.COOK CITY ��li{Z - ( CGz� TEL.NO. �{(O/— 711fe0 DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.(:/s H.P.MAX.) .SO LICENSE NO. MOTORS: OVER NOT OVER H.P. DISTRI T G OUP NE P ESSED BY O 1 3� 1.00 to: L 1 3 1.50 INSPECTION RECORD } D_ 3 s 2.00 O V 8 15 2.80 DC 18 50 3.00 - W 50 100 5.00 d. SIGNS: NO.TRANS. — --- N NO.LAMPS Z I SERVICE O.600V-Nor OVER 200A 1.00 SERVICE 0-60OV-OVER 200 A. 2.00 SERVICE OVER 600V 5.00 MISC. t PERMIT ISSUING FEE 2.00 QQ SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE $ 3 V 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 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 DESCRIBED RESIDENTIAL PROPERTY. POWER SIGNATURE UTILITY CO.NOTIFIED OF PERMITTEE FINAL VALIDATION ARTHUR C. VEIT CK MO CASH SUPERVISING ELECTRICAL ENGINEER �. 101s 3.8