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HomeMy Public PortalAbout9855 FLAHERTY ST_Electrical__ o WORKER'S COMPENSATION DECLARATION 63 9 DPW 9/89 APPLICATION FOR ELECTRICAL PERMIT 76A66 I herebyreby affirm)hat { have a certificate of consent to self insure, 76A6 o,r 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.) G �L Policy No. I O!CU Z Company —J�R FOR APPLICANT TO FILL IN JOB ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE $ _ $ LOCALITY ❑ Certified co Is filed with the count buildin Ins ection 1 &2-Family,Sq.Ft. PY� Y 9 P — NEAREST department. Multi-family Sq.Ft. CROSS ST. ma�yy.,, Date = F1Z– Applicant 111:A t 6 Residential Swimming Pools AssessOR – MAPBOOK c7 PAGEZ, A PARCEL��✓ CERTIFICATE OF EXEMPTION FROM WORKERS' � OWNER OR COMPENSATION INSURANCE Outlets:Rec. Light Sw. FIRM NAME First 20 MAIL (This section need not be completed if the work involved by the permit is for one hundred dollars($100)or less.) 11 Total No: � Additional ADDRESS I certify that in the performance of the work for which this permit CITY i Tel.No. is issued, I shall not employ any person in any manner so as to �}y� PLAN CHECK become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 © 9' APPLICANT Total No. Additional ADDRESS Date Applicant' 15 OR 20A,120V BRANCH CIRCUITS NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers'Compensation 1 TO 10 INCLUSIVE EACH provisions of the Labor Code, you must forthwith comply with such 11 TO 40 INCLUSIVE EACHRMIT APPLICANT Y�E'�"' 'r7�►1.X, provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH LICENSED CONTRACTORS DECLARATION ADDRESS 15 OR 20A,208V TO 277V LIGHTING EACH I hereby affirm that I am licensed under provisions of Chapter 9 S O (commencing with Section 7000) of Division 3 of the Business and CITY ,IP Tel.No. &� U Professions Code,and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR ^� r Power Apparatus&Large Appliances REG.NUMBER r✓Z Z Class. G f Q O License Number 52 1 ZZS Lic.Class _ Lt Size&Type HP,KW,KVA,or KVAR DISTRICT NO. (/ PROCESSED BY U w q 1,'lf, Date Up to 3 Incl. �(J LU Contractor T—try .� . Over 3 to 10 Incl. DATE Cl) Over 10 to 50 Incl. ^� •7' ❑ I am exempt under Sec. Over 50 to 100 Incl. .VALIDATION. FINAL B.&P.C.for this reason Over 100 BY Services,Swbd.,MCC&Panelboards Date: 0-200 Amp.Under 600 V Signature 201 -1000 Amp.Under 600 V El Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole&Appurtenances (_(_ y HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law �- i ,,=L 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 v =74 P P Y, is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). ;ASIH , y I�•t CONSTRUCTION LENDING AGENCY �' 'r•{ s aLFU t. F•tl='•.3�. 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. l'..) it•ei 31�'I Fji,f (d ti:•4i:° PLAN CHECKING FEE Lender's Namet`I a'_t ?Nk"'s 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 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 APPLICANT RAG aENT DATE WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT I hereby;affirm (het 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.3800 Lab. C.) Policy No. 1.n Q' 3' Company cjTA7" FOR APPLICANT TO FILL IN JOB ADDRESS -•(�y7 Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE $ $ LOCALITY ❑ Certified co Is filed with the count building inspection 1&2-Family,Sq.Ft. PY Y 9 P NEAREST department. Multi-family Sq.Ft. CROSS ST. Date 0'�� Applicant � ) ') - Residential Swimming Pools ASSESSOR MAP BOOK PAGE 4�a PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:RLi Sw. OWNER OR Rec._ ht COMPENSATION INSURANCE g FIRM NAME First 20 MAIL C (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 —f�r/i Qf 64"( Tel.No. ^�`�p is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date ` Applicant 7"��T' � .RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certi 'cafe 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 (•tPe y LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS ; f I.� 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. >_ LICENSE B Class. >_ Over a Over 50 t0 100 IRCI. REG.NUMBER �� 77"V— ,�- License Number Lic.Class F• �1 a Over 100 DISTRICT NO. PROC SED BY O , D ! � V �,_y�� ,� 'f� Services,Swbd.,MCC&Panelboards ccd Contractor I'I Tl V�I Date 0-399 Amp. Under 600 V FINAL DATE O El I am exempt under Sec. VALIDATION 400-1000 Amp.Under 600 V `-�. W Over 1000 Amp.or Over 600 V FINAL d B.&P.C.for this reason BRANCH CIRCUIT FEES BY Date: 15A,or 20A, 120V,Lighting or Recept. z Signature 1 To 10 Branch Circuits 11 To 40 Branch Circuits El 41 Or More Branch Circuits Exemption for Reg.Maint. Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances i HOME OWNER-BUILDER DECLARATION n with One Branch Circuit ,g I hereby affirm that I am exempt from the Contractor's License Law SigAC l-;T for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits �'�� � y ' Code): 1s��! i ITEMS❑ I, as owner of the property,will do the work and the structure Misc.Conduits&Conductors 1 I t E tS is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , q4 and Professions Code). TOTAL tTAL CONSTRUCTION LENDING AGENCY CASH 34.43 I - I hereby affirm that there is a construction lending agency for the t performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) CHANGE Civ. •: Civ. C.) PLAN CHECKING FEE l��t q ! Lender's Name r 000-ofao1 10 `-`t=� PERMIT ISSUING FEE 145 6276 1 AM 90. 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 7"663 DBB 5A 25M SETS 11-4B APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY ELECTRIC COUNTY OF LOS ANGELES WILLIAM J. FOX CHIEF ENGINEER DISTRICT NO. GROUP ZONE PERMIT N.D. FOR APPLICANT TO FILL IN S . t ��f 1 i — G J ELECTRICIAN �/, (�fl/ RECEIVEDIbHY READY FOR DATE ISSUED /L FIRST INSPECTION ADDRESS- CITY QDRE5 JS//., � ��)C.i{/(i�f,8' CITYNO.qq � LICENSE NO. �[�' U- EXPIRES(n' 36-LrU ADDRESSG I DESCRIPTION OF WORK !" FEES LOCALITY NUMBER OUTLETS EACH 1 CROSS C LIGHTS Sc $ L�,_LLQ STREET �rpJ RECEPTACLES 5 (✓r /! FIXTURES 5 (! OWNERMAIL WALL SWITCHES 5 /J ADDRESS �H C.Y 3 e ELEC. RANGES 25 P� ELEC. HEATERS 25 I CITY � V TEL. NO. MISC. I CERTIFY THAT I POSSESS THE ABOVE VALID LOS NUMBER OF CIRCUITS INSTALLED: ANGELES COUNTY LICENSE. LIGHTS RECEPTACLES �� . MOTORS " ELEECC TRICIAN.N. NUMBER HORSEPOWER FEE NEW MVD. HP OVER FI INC• EACH - IAM THE LEGAL OWNER OF THE RESIDENTIAL PROP- �� I2 6 LESS $ .25 ��qq GGr ERTY DESCRIBED ABOVE. e�J ' %2 2 .50 2 5 1.00 OWNER. 5 is 1.so INSPECTION RECORD 15 50 2.50 50 200 5.001 200 500 10.001 500 1000 15.00 J OVER 1000 20.001 Z PWE!L.SERTS'/:'AC-KVA . EREQ. CHANGER-HP Q' D GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (75% OF ORIG.) , MOVED MOTORS (75% OF ORIG.) MISC. SIGNS TYPE: NO.TRANS. TYPE: NO. LAMPS APPROVALS PERMIT FEE DATE _INSPECTOR'S NAME FOR ISSUING PERMIT: CONDUIT 3 y4 WITHOUT FIXTURES $1.001 l ��A WIRING WITH FIXTURES 1.25 v FIXTURES SUPPLEMENTARY .50 POWER TOTAL FEE $ UTILITY CO. NOTIFIED FINAL 76A663C- CE8068 12/76 -APPLICATION OR ELECTRICAL PERMIT BUILDING AND SAFETY DIVISION C FOR APPLICANT TO FILL IN FRential Bldgs. &Pools EACH NO. FEE ADDRESS !�f aily Sq. Ft. $ — $ LOCALITY La„ily Sq. Ft. — NEAREST al Swimming Pools CROSSSTOWNER ORFIRM NAME //j' �ht, Switch & Receptacle MAIL / . �i S ADDRE ,���// Cal CITY- 4-,P G�� Tel. No. �O PLAA CHECK Lighting Fixtures APPLICANT First 20 ADDRESS Additional CITY Tel'No. PERMIT Fixed Appliances Not Over 1 HP A P P L I C A N O Range Heater_ D.W. ADDRESS�� Oven Dryer W.M. Top FAU W.H. CITY ' Tel. N �— Hood Fan LICENSE OR �p REG. NUMBER Class. Disp. A.C. C' v I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION Q AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY V Power Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING LLI Size&Type HP, KW, KVA,or KVAR ELECTRICAL WIRING, rn Up to 1 Incl. Z 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR Over 1 to 10 Incl. LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE Over 10 to 50 Incl. DESCRIBED RESIDENTIAL PROPERTY. Over 50 to 100 Incl. PERMITEE Over 100 SIGNATURE a�" Services DISTRICT JO. PR ESL�D BY 0-200 Amp. Under 600 V 201 1000 Amp. Under 600 V APPROVALS D INSPECTOR'S Over 1000 Amp.or Over 600 V SIGNATURE TEMP. POWER POLE Temp. Power Pole&Appurtenances UNDERSLAB WORK Sign with One Branch Circuit Additional Sign Branch Circuits ROUGH CONDUIT (Other) WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (Sub-Total) UTI LITY CO.NOTIFIED PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL 77-17-9 PERMIT ISSUING FEE NOTES TOTAL FEE r�.ao PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH