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HomeMy Public PortalAbout4925 FRATUS DR_Electrical__ .0+ WORKERS' COMPENSATION DECLARATION C - 70/81 APPLICATION FOR ELECTRICAL PERMIT � i hereby affirm that I have a certificate of consent to self insure, CE-806G � � I or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY I 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 ADDRESSGa�(� ❑ 1 & 2-Family,Sq.Ft. $ — $ LOCALITY TiM I V C'�T NEARECertified copy is filed w th the county building inspection /� department. Multi-family Sq. Ft. CROSS SST, ,Q U,l ho Date Applicant Residential Swimming Pools OWNMER OR FIRNAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec-1 Light Sw, ADDRESS Z It L COMPENSATION INSURANCE (This section need not be completed if the work involved by the First 20 Total No. Additional CITY L l:/JT Tel.No. permit is for one hundred dollars ($100)or less.) I certifythat 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'C,)ITL=nsation Laws. Lighting Fixtures First 20 ADDRESS /__`�'ti Additional 9& !� CITY Tel.No. Date Applicant Total No.Fixed Appliances Not Over 1 HP NOTICE TO APPL CANT: If, after making this Certificate of PERMIT ( Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APPLICANT .- ( ((�/ provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer W.M. _ ADDRESS Z /� �N I CcsAU. 4f ff provisions or this permit shall be deemed revoked. Top — FA W.H. CITY Tel.No. l_�9• LICENSED CONTRACTORS DECLARATION Hood — Fan Other I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR Disp. — Room Air Cond. REG.NUMBER 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,-- CE P CE SED BY Size& T HP KW KVA or KVAR `2 - v 1 S e Type 0 License Number Lic.Class Up to 1 Incl. FINAL U Over 1 to 10 Incl. DATE I=Contractor Date VALIDATION 0 El10 to 50 Incl. FINAL ~ I am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C.for this reason Over 100 N Date: Services, Swbd.,MCC& Panelboards ► _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 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 Q Lender's Address r I certify that I have read this application and stake that the above TOTAL FEE 7 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. 3 SEE REVERSE FOR EXPLANATORY LANGUAGE Si ature of Fermittee 'Da7e WORKERS'COMPENSATION DECLARATION 20-0019 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT I IieYeby affirm that I have a certificate of consent to self CE-806G insure,or a certificote of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lab. C.) P,Zlicy No. Company FOR APPLICANT TO FILL IN JOB / Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS zK Tlhaw� PIZ El Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. - $ — $ LOCALITYLT-Q tion department. Multi-family Sq. Ft. NEAREST CROSS ST. ( atJ'®O Residential Swimming Pools OWNER OR (� Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' � MAIL COMPENSATION INSURANCE Outlets: Rec Light Sw. ADDRESS Z..� us (This section need not be completed if the work involved by Total No.1— AddiFirst tional D CITY f r UTI T Tel. No. 2_V the permit is for one hundred dollars ($100)or less.) 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 any manner so as to become subject to the Work s'C mpensation Laws. Lighting Fixtures First 20 ADDRESS Additional 2/ Total No. _ CITY Tel. No. Date Applicant L�C�T 1-O 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. APPLICATION 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 /� D� 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. PRQCESSED BY >_ and Professions Code,and my license is in full force and effect. .0 O a- Size &Type HP, KW, KVA, or KVAR a Q License Number Lic. Class Up to 1 Incl. FINAL U Over 1 to 10 Incl. DATE d VALIDATION 0: Contractor Date �/ O QOver 10 to 50 Incl. FINAL F- I am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C. for this reason Over 100 d Services, Swbd., MCC& Panelboards Z, Date: 0-200 Amp. Under 600 V Z Signature - 201 - 1000 Amp. Under 600 V OExemption 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 Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): -- ?I I, 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)_ 4_7 r7, - act, .. I_ t, Business and Professions Code). ' CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for '-4j;:� the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) LoHt �� (Sec. 3097, Civ. C.). PLAN CHECKING FEE ,Lender's Name PERMIT ISSUING FEE � yC: Lender's Address I certify that I have read this application and state that the TOTAL FEEa 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 th ab ve-ment�dr inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Si nature of Permittee / Date ©s 7GA668-CE8067-58 APPLICATION FOR ELECTRIC PERMIT- COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING 4925 FratuS BUILDING AND SAFETY DIVISION JOHN A LAMBIE, COUNTY ENGINEERTemple Ci CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST PERMIT FEES CROSS ST I T E M NUMBERI EACH FEE OWNER Heiry AshleyHeir OUTLE $ $ MAIL SJ LIGHTS RECEPT SW6 37 10 ADDRESS ame LIGHTING FIXTURES 11 11 IO 1 10 CITY TEL NO ELEC RANGES CLO DRYERS ELECTRICIAN W A T E R H EATERS 5O ADDRESS � ELEC SPACE HTRS DISHWASHERS CITY TEL NO GARBAGE DISPOSERS AUTO - ED 117361 STATE 174520 WASHERS STA COOKING UNITS 25 LICENSE NO MOTORS OVER INC H P DISTRI O GROUP ONE Y O— +/z 2 5 1/2— 2 50 INSPECTION RECORD 2— 5 1 00 5— 15 1 50 15— 50 2 50 50—200 500 , SIGNS NO TRANS NO LAMPS 1 f SERVICE 0-600V 1 00 SERVICE OVER 600V 500 MISC WIRING PERMIT 100 11 no FIXTURE PERMIT 1 00 SUPPLEMENTARY PERMIT 50 TOTAL FEE $ 77 r APPROVALS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 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 I AM PROPERLY REGISTERED AND/OR LIC � ENSED AS REQUIRED BY S NGEL S COUNTY ND STATE OF FIXTURES CALIFORNIA OR THAT 1 �T LEG O ER F THE ABOVE DESCRIBED RESIDENTIAL P OP TY POWER SIGNATURE UTILITY CO NOTIFIED OF PERMITTEE - FINAL IdDATION ARTHUR C VEIT, c MO CASH SUPERVISING ELECTRICAL ENGINEER LAC6 1 2 6 1 DEC 2 2 2 A 7.8 0 A 76A669 CC006 756 APPLICATION FOR ELECTRIC PERMIT 1 BUILDING AND SAFETY DIVISION Department of County Engineer 7 BUILDINGFNEAREST I l County of Loa Angeles JOHN A LAMBIE. COUNTY ENGINEER CASSATT D GRIFFIN. SUPT OF BUILDING Y FOR APPLICANT TO FILL IN T PERbUT FEES NUMBER OWNER LIGHT OUTLETS MAIL j'— •. ADDRESS J RECEPTACLES WALL SWITCHES FEE CITY TEL NO Z TOTAL OUTLETS @ 52 $ ELECTRICIAN ELEC RANGES 25 ADDRESS ELEC HEATERS 25 CITY NO KW EA STATE LICENSE NO FIXTURES 5 MOTORS DISTRICT NOGR`O�-UP ZONE READY FOR INSPECTION NUMBER HORSEPOWER FEE I 1 I ACJ NEW MVD HP OVER INC EACH I12&LESS $ 25 INSPECTION RECORD l2 2 90 2 5 1 00 5 15 150 15 50 2 50 50 1 200 1 500 t MISC 41 NO SIGNS NO TRANS NO SIGNS NO LAMPS FOR EACH PERMIT WIRING PERMIT $t 00 FIXTURE PERMIT $100 SUPPLEMENTARY 50 APPROVALS TOTAL FEE $ ''v DATE INSPECTOR S SIGNATURE ] H ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CONDUIT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING FIXTURES I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF POWER 1 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PjtOPERTY UTILITY CO NOTIFIED SIGNATURE OF PERMITTEE FINAL JOHN A LAMBIE VALIDAT G*i ARTHUR C.VEIT. COUNTY ENGINEER SUPERVISING ELECTRICAL ENGINEER CK MO CASH �ACQ 5 7 € 9 MAR 5 2 1 0 0 10