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HomeMy Public PortalAbout10308 FREER ST_Electrical__ • WORKERS'COIv1PENSATION DECLARATION CE-806G �c/81 APPLICATION FOR ELECTRICAL PERMIT. `•I ereb !J%prm that,I have a certificate of consent to self insure, or a gertificate of Workers' Compensation'I nsu rance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof (Sec.3800, b.C) woo Cg8)g. ,t O ��`��C� POlic NO � Company O ti0 1 ,`•� FOR APPLICANT TO'FILL IN ADDRESS. Certified copy is hereby,furnished. New Residential Bldgs.& Pools ;,EACH NO. FEE n El1 & 2-Family,Sq.Ft., $ ' = $ LOCALITY V Certified copy'is ,filed .with,the counfy building inspection department Multi-family Sq.-Ft NEAREST A=L" C CROSS ST. Qr Date 2 N 50%� Apphcan��^'�" Re'sidential Swimming Pools OWNER OR f1 , ta1 FIRM NAME. a • 'CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rbc Light l�Sw ,� MAIL -COMPENSATION INSURANCE LADDRESS Q (This section need not be completed if the work-involved by the First 20 :permit is for one hundred dollars($100)or'less.) Total No. Additional CITY ._ rG Tel.No 3SQ I•certify',that in the performance*of the 'work for which this permit PLAN CHECK ,n .., is,issued, I shall,not employ an ? APPLICANT p y y.person in any manner so as to �(p �,�• become subject to the Workers'Com ensation Laws. Lighting Fixtures First,20' ADDRESS 5 11 PL` iM��13 2lf Np„8'1 ��• Total No. Additional _ CITY' `, Tel No Z27ON, Date Applicant Fixed'Appliances Not Over.1 HP NOTICE',TO' APPLICANT If, after 'making this Certificate of PERMIT Exemption,you should,become subject to the.Workers'Compensation Range_ Heater a. DW, APPLICANT ' provisions of the,Labor Code,,you must forthwith comply with such Oven Dryer WM._ ADDRESS � " j �1k �'>ta provisions or this permit shall be deemed revoked _ Top FAU W H. ^ CITY': `'Ti jv Tel.No. LICENSED CONTRACTORS DECLARATION Hood,-- Fan 'Other- 1 hereby affirm that I•am;licensed under provisions of Chapter 9 LICENSDOR (commencing with'Section 7000) of Division 3'of the Business and Disp — Room Air Cond REG NUMBER ©y Class 41 Professions Code,and'my license is in full force and effect.- DISTRICT NO PROCES BY . Power Apparatus& Large Appliances. , Size& Type HP,KW,KVA,or KVAR ' License Number Lic Class p Up to 1 Incl FINAL U (l� (` 2-14�1?C� Over 1 to'10Inc]. DATE iVALIDATION. Contractor t� Date OV Over 10.to 50 Incl- FI ❑ I am exempt under Sec, Over 50 to•100 Inc. W B&PC for this,reason Over 100 �- 0 D2LtNo') 'Services,Swbd,MCC&Panelboards ate , Z 70- 200 Amp Under 600 V Signature �.\ � 201 - 1000 Amp..Under 600 V - Over 1000 Amp.or Over 600 V ❑ Exemption for Reg.Maint Elect ;2'8 4 2 8 A SINGLE'FAMILY Temp._Power Pole&-Appurtenances„ #,0"16 0,0 02 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• 1,.o o-5 4 50 Code) . ❑ Misc Conduits&,Conductors 5 4,5,0 c=i I,as owner of the property,will do the work and the structure is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) 5 as 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) ; PLM,CHECKING-FEE Lender's Name PERMIT ISSUING FEE Lend er's'Address ; I certify that I have read this application and state that the above TOTAL FEE f 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 roperty for inspectio purposes. _^ SEE REVERSE FOR EXPLANATORY LANGUAGE a. gnature of.Permittee Date 76A663 DBS 5A 11-50 APPLICATION FOR PERMIT = DEPARTMENT OF BUILDING AND SAFETY ������� COUNTY OF LOS ANGELES 1 .WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO. ELECTRICIAN R. F. Walton 'Cl a / RECEIVED BY READY FOR -DATE ISSUED ACaC18 St. ADDRESS 5134 N. 1 FIRST INSPECTION /• CITY Sa.n Crabs TEL. NO. AT 68583 / ,� O `� COUNTY LICENSE NO. 1104 EXPIRES BUILDING 10308 E. Freer PERMIT FEES ADDRESS NUMBER EACH FEE LOCALITY Temple Cit'. LIGHT OUTLETS 11 NEAREST RECEPTACLES 14 CROSS ST. WALL SWITCHES a12 OWNER Celeste TOTAL OUTLETS 37 Sc $ 1 85 MAIL ELEC. RANGES 25 ADDRESS ELEC. HEATERS 25• CITY TEL. NO. FIXTURES 11 -5 55 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS MISC. APPLICATION -AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. MOTORS 1 CERTIFY THAT I ,POSSESS THE ABOVE VALID LOS NUMBER HORSEPOWER FEE I ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER NEW MVO. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. 1/2 a LESS $ .25 SIGNATURE OF 1/2 2 .50 PERMITTEE 2 s 1.00 INSPECTION RECORD 5 is 1.50 15 50 2.50 50 •200 5.00 - - 200 Soo 10.00 J Soo 1000 '15.001Q OVER 1000 20.00 • M. G. SET/FREQ. CHANGER-HP WELDERS: AC-KVA GENERATORS-KW � • TRANSFORMERS-KVA TEMP. MOTORS (75%OF ORIG.) MOVED MOTORS (75%OF ORIG.) MISC. _ SIGNS NO. NO. TRANS. I APPROVALS. NO. NO. LAMPS DATE INSPECTOR'S NAME FOR EACH PERMIT: - I CONDUIT -- WIRING $1.001 11 00 h FIXTURES $1.00 1 00 WIRING SUPPLEMENTARY .50 FIXTURES f4 40- POWER TOTAL FEE I $ I UTILITYCO. NOTIFIED ® / FINAL 76A663CE_806(11• APPLIC N 'R ELECTRIC COUNTY OF LOS ANGELES BUILDING AND SAFETY;,*_. • 4, - • FOR APPLICANT TO FILL IN JOB - New Residential Bldgs &Pool's EACH- _NO- FEE ADDRESS 1 0,308 Fr,e.E'.r 1 &2-Family,Sq Ft. $ 025 $ LOCALITY MP 9. Multi-family Sq Ft 02 — NEAREST ,Residential Swimming Pools 25 00 CROSS ST _^^ OWNER OR..'- Da 1,,e--P I I t fi18"n FIRM NAME Outlets..Rec Light Sw- MAIL First 20 50 ADDRESS , TO 3 U F r e e r -S*: . Total No Additwnal` 30 CIT Tel 'No.'' PLAN CHECK APPLICANT Lighting Fixtures First 20 '50 ADDRESS Additional 30 - - - - Total No CITY -Tei-No Fixed Appliances Not Over 1 HP - PERMIT ^- -- Range—Heater—D.W -APPLICANT . .• - OJen_Dryer'_ _ W M ADDRESS•-1 67 W': ethor ''e`'" Top _FAU' — WH v CITY p j a�.ent l.a „� .-. -;Tel,No 9.9,6`1 521 _•,_. Hood_Fan _Other—' LICENSE OR Disp _Room Ai[Con250 • _REG NUMBER__,34373 -- ,-- 'Class wC-2 C. I HEREBY'ACKNOWLEDGE THAT I;HAVE READ THIS APPLICA Power Apparatus&Large Appliances TION AND STATE-THAT THE ABOVE'IS'CORRECT AND AGREETO Slze&T ' 'COMPLY' WITH-ALL'COUNTY"ORDINANCES AND••STATE--LAWS I= ype HP, KW, KVA,or KVAR 2 50 REGULATING ELECTRICAL•WIRING Up to 1 Incl 01 I HEREBY'CERTIFY'THAT-I AM PROPERLY REGISTERED AND/OR' 1 5.00 Over 1 to 10 Incl ' LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE,OF � Over 10-to 50 Incl 1250 CALIFORNIA OR THAT I AM,THE LEGAL OWNER OF THE ABOVE• ,® DESCRIBED RESIDE ,PRO TY• Over 50 to 100 Inc 25 00 Over`100 .4000 TERMITEE-_ ! _ U SIGNATURE �,j' Services•• - DISTRICT PRO D - e 0-200 Amp Under 600 V 12 50 ..201=1000 Amp'Under-600 V' 25 00 1 -(•• - Over 1000-Amp or Over 600 V 5000 Z o ze.95. , 1, Temp Power Pole&Appurtenances ''10 00 { .. r_Q o o:o 0 0 Sign with,One Branch Circuit 1000 o d� Additional Si6n Branch Circuits 2 00 Q :' ?' 1;2,Q , " INSPECTION > 1 20 0 Misc-Conduits&Conductors 1000 ' INFORMATION v •o.to o . ON REVERSE" 'T - 0 3 2'7, '8 0 Other-(See Complete Fee Schedule) SIDE v Z PERMIT FEE •(Sub-Toial) 5 0- ¢ PLAN CHECKING FEE lone-Fourth Permit Feel O PERMIT ISSUING FEE $7 00 •7. 0 ''` T "- ••� TOTAL FEE > 'INSPECTI N FIN i i- •. W date /� I °