HomeMy Public PortalAbout9415 GIDLEY ST_Electrical__ C ,
' WORKERS'COMPENSATION DECLARATION � ,o,a, APPLICATION FOR ELECTRICAL PERMIT
•j herdl�y offs' that L have a certificate of consent to self
Insore, of a cArtiflcate of Workers' Compensation Insurance, COUNTY 40F LOS ANGELES BUILDING AND SAFETY
r or a tehtfled copy thereof(SeG. 3800, Lob. C.)
Policy No. Compqny POS To RU M
F Certified copy it hereby furnrshed. New Residential Bldgs. 8 Pooh EACH NO. [
Certified copy Is filed with the county building Inapec- 1 8 2-Family, Sq. Ft. 4 {^_ f LOCALITY [-&�-sAj C rL
tion department. Mvltl-family Sq. Ft. �
Residential Swimming Pools 032055 ST.
�
Data Applicant RM
CERTIFICATE OF ID AAPTION FROM WORKERS' Outlets: Rec�Llght?dtLSw. L �L 'C57COMPENSATI0N INSURANCE ` V
' Flrst•20 .
(This sectf*n need not bb completed If the work Involved br Total No Additional CITY ' r�, L; No, li6 C/
the pertnFt Is for one hundred dollar i ($100)or lea.)
I certify that In the performance of the Work for which this• ��
permll Is Issued, I shall not employ any Person In any manner
to as to become subject to the Workers Campensotlon Laws. Llghtlpg Fixtures First 20 ADDRESS
AddLllonal
Total No. CITY No.
Dai — pllcant Fixed ApplJanoes Not-Over 1 HP PERMIF
NOTICE TO APPLICANT: If, after making thls Certlfica AMXANL
Exemptloh, you should become subject to the Workers' Range— Heafer�_D.W. —
Cgtnpensotion provlslons of the Labor Code, you must forth- Oven Dryer — W.M.— ADDRESS
with comply with suc� provisions-or this perralt shall be Top FAU —W.H. —
deemed revoked. CITY Tel. No.
LICENSED CONTRACTORS DECLARATION HOp, — Fan —Room Air GondOtherOR
—
s hereby affirm teat I am Ilcenabd under provlslons of,Chapter 9 Dls . NUMBER Class.
(commencing with Section 7000) of DIVIfIon $ of the Business DISTRICT NO. BY
and Profealons Code,and my license Is In full force and effect.
power Apparatus 8 Large Appliances }
Size 8 Type HP, KW, KVA, or KVAR' J t t/ O
License Number . I Ic. Class Up to 1 Intl. FINAL V
T Over 1 to tO Incl. DATE VAI] TFON Im
Contrgctor DdteOver 10 to 50 Incl. O
Fl NAL rj
I am exempt under Sec. �_ Over 50 to IOQ Inc. BY ttTLs
d
v�
B.BP.C. for this reason Over 100 a
Services, Swbd., MCL 8 Panelboords '
Date: 0 -200 Amp. Under.600 V
Signature 201 - 1000-Amp. Under 600 V
Over 1000 Amp. or Over¢00 V '
Exemption for Reg. Malni. Elect.
SINGLE FAMILY Temp. Power Polp 8 Appurtenahces O 1 8 7
HOME OWNER-BUILDER DECLARATION Sign with One Brach CIrc4It
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
Law for the following reason (Seces
tion 7031.5, Buslos and
Profeulons Code):
1, oerty
s owner of the prop , will do the work and the, Misc. Conduit'8 Conductor
strUctUr6; Is not Intended or offered for saie (Section Other (See Complete Fee Schbdule)_ ;
X O.", Business and Profeaslons Code).
CONSTRUCTION LENDING AGENCY
1 hereby offlrm that there Is q construction lending agency for
the performance of the work for which this permit Is Issued PERMIT FEE {Sub-Total)
($et. 3697, Civ. C.).
PLAN CHECKING FEE 76 8 9 7
Lender's Name #•-• o • • o
PERMIT ISSUING Fly
Lender's Address ( 0 079.50
I cdrffy that I have read thls appllcation and state that the TOTAL FEE- �1 0 • o 7 95 0
ct.
above Infornoutlon Is correI agree to comply with all County
ordinances and State laws regulating EleChical wiring, and l� I �Q Q$'� 7 8 7
herebyp authorize representatives of this County to enter upon 1
the above-mentioned property for Inspection purposes. SEE REVERSE FOR.EXPLANATORY LANGUAGE
�7
Slgnatur offer 4m a Date i
7
*Aa"11-M APPLICATION FOR ELECTRIC PERMIT 1
DriMON OF MaDING AND SAFETY
D"- mmat of Cotmtr EnghLm 10wU I LD I N `
JOHN A LU�iBIM Com ENarnmt
CAIItATT D.(DR FFIN fur^r OF oUILDiNe Lmm -ry
mmmmoilFoi
FORAPPLICANT TO FILL IN NST
NUMBIM OWNER
uGHT OUTLirx BAIL
RIGJ:PTACLti ADDRI410
WALL tWTTCHLO Fitt �,
TOT O e
It ELECTRICIAN
ELM RANGSII IID
ADDRXW
fliC.HI ATERII 2D
KW MA CITY Td NO.
SPATE
�T•URtp 10 UCKNOX NO.
MOTORSDISTRICT NO. GROUP ZONE RAM wa uLsrmioi
kumoxg HORIKPOWER
1d7 MVD. HP omni tNa. ScAosl INSPECTION.HECO n
•Lss� .110
II
f 10 1.00
D 110 7.350
110 so 2.100
Db 200 10.00
N UDC.
NO.I♦IQNs NO.TRAHD.
NO.J01NO LA)LPD
FOR EA M.
WIRING 1.0o O
FDITURS10 t.00
9UPPL"ENT'ARY .100 APPHOYAiS
TOTAL CTO-' I AMRE
I HEREBY ACKNOWLEDGE THAT I HATS ROD THIS APPUYCATIOp777
AND DTl�TI T THE ADOVE ID CORRICT A)<D AGREB TO COIPL7 CONDUIT
13LRXIDT—RAT-o'"O
XC U ORp11{AICEI•ARD "ATE LAWS REaULATIYa WIRING �
�dCTRICAI 1110.
T CHRTIFT THAT I AS PROPERLT INGIDTERED AND/OR FDftURS10
l OIRM BT LOS AIQELp GOUNTT AID STATE OF
I Al LEWLL THE ABOTE POWER
I LITY CO.NOTIFIED
rrTu4—a E2.
FINAL 1 7
JOHN A.LAMOM COUNTY SNGINmm ATION ARTHUR Q VQIT,CWKF Eu=r-tm"= m
ak ro Q%m
',07 3 0 OL X122 2 2.5 0
7&A5= D=M 7-•1 APPLMATION POR P BIM
DEPARTMENT OF HVII, AN SAFETY
SAFErELECTRIC i
COMM OF LOS ANGEL
WILLIAM J. FOX, CHIEF ENSIMEER
FOR APPLICANT TO FILL IN DIS'T'RICT NO. GROOE
UP ZNP[RMrr NO.
ELECTRICIAN .� �- C
OS
70
REDS S'Y READY FOR DATE ISSUED
ADDRLM FIRETIN/r[DTION
OITY TEL. N I�
O NTY 10 0. IRER ADDRD 1 Q e
NUILDINN
PERMIT FEES
NUMO[R EACH
FQ LOCALITY City
LIGHT OUTLETo NEAR[1T n
REOEPTADL S GROSS BT. V
verlv
WALL SWITOHXE OWNER Palmer
TOTAL OUTLETS ir Bo III MAIL
[L[0. RANO[• >ZB
ADDRESS ssme
[L[0. HEATER2 Iii CITY TLL. N0.
FIXTURES S 1 HEW-VY ACKNOW-KDOE THAT I HAVE READ THIN
AP-PLI12ATION AND CTAT[ THAT THE ASOVE 10 CORRECT
NUMBER OF LIGHT CIRCUITS AND AORIE TO COMPLY WITH ALL COUNTY ORDINANOrS
NUMSER OF REOEPTADL[ CIRCUITS AND STATE LAWS RE>IULATINO ELECTRICAL WIRING.
MOTORH 1 CERTIFY THAT I POSSE• THE ASOVE VALID LOS
NUMBER HORSEPOWERFi[ TTANSELES COUNTY UDIENM OR I AM HE L 9A. OWNER
Nrw Mw. HP DV[R Ibm. rADN OF THE M IDENTU►L PRCL•rRTY D[SORIS[D OVE.
• Lm• 111 •25 ■IONATURE Or_.:V./
ya f w PERM
>a s 1.00 INSPECTION RECORDVol
6 1B 1.50
15 w L60
w 200 b.CO
am Boo 10.00 J
■oO 1000 18.00 Z
OVER 1 DOG 20.130 0
M.O. ■[T FR CHANGER-HP
WELD[RSIAO-KVA O
OEN[RATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75or oRi■
MOVED MOTORS ( or ORIRJ .
1w.
BIONO
NO. N O.TRAN L
P■ APPROVALS
No.
Fol! EACH P[RMIT� AT[ INSP R•M NAM[
CONDUIT
WIRING 91.00 /
FIXTURES 1.00 WIRING
*LJPPLEMKMTA" lap FI XTU Rr1
POWER
TOTAL FEE 111 4 50 UTILITY O0.NOTIFIED
F I NAL
TION
WORKER'S have
a caSAcateDEDI consent
to 7��°°P`"(,2 �' APPLICATION FOR ELECTRICAL PERMIT LJ
I heral2y attitm that I have a certlflcnte of conaant to self Insure,
or a certlfloct*.of Worker's Compensation.Insurance, or a cartlfled COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFELY DIV.
copl thergof,(SK.19•�I77am L-ab.C.) If
r�,s��1 7O1
/0' 'VJornpn POR APPLICANT TO FILL IN ir �S8
CenYfied copy Is hereby furnished. NO. EACH FEE
New Reeidentlal Bkigs.d Pooh LOCALITY
❑ Cerdw copy M fW with the county bul dng In$pection 1 f4 2 Family,6q•Ft — NEAFtEST
deparbnent. Multi-faml]y Sq.Ft CRAM ST.
. �' "Ic nt r ` Residential Swimming Pools A88E880R
EMAP BOOK PAGE PAIaCg
CEFMFICATE OF EXEMPTION FROM OWNER OR
COMPENSATION INSURANCE Oud":Rec• LJght SW' FIRM NAME
Fhtt 20
(This aecUon need not be completed if the work Invotvsd by the Total 2`7 ��� ADDFfE88 -��
pdrrfttt Is for one hundred dollars($100)or lass.)
I certify that In the performance of the work for which this permit ' lJtttl CITY TsLNo.
Is Issued, I shall not employ any person In any rnanner so as to
become eibjecP1-become to the Workers' Compeneatlon Laws. Lighting Fbduree first 20 P1-M CHE
CK
Total No.i:� Additional
Data ADDRESS
NOTICE TO APPLICANT: 11, n er making thl Certlflcate of RESIbENTIALAPPLIANCESNOTOVER 3HP. CITY T@LNo.
Exemption,you should bewme subject to the Workgrs' Compensatlon OTHER APPLIANCES NOT OVER 3 HP.
provisions of the Labor Code, you must forthwith comply with auoh PEIr
provIdIdns or this permit shall be deemed revoked. Power Appars"h L"Appliances AFPLICANr
LICENSED CONTRACTORS DECLARAT104 Size&Type HP,KW,KVA,or KVAR ADDRESS $ N06
I hereby affirm that I arh Ilcehaed under provisions of Chapter 8 Over 3 to 10 Ind.
(commencing with Section 7000) of Divislon 3 of the Business and CrfY � Tel. ?b�
Professions Code,and my Iloense Ia In full force and effect. Over 10 to 50 Ind. r
` 3 9 2 LICENSE 01
Over 60 to 100 Incl. BEA b�3 � a
License Number o�" �� f LJc.C'. 1J Over 100 DUP-FOOT NO. By 8
Services,Swbd.,MCC S Panelboards 5 O� a Q
Contractor Die O 3 0-399 Amp.Under 000 V � O
F-1400-1000 Amer WDp.Undo V 1
I am exempt unAmp.Sec. Over 1000 Am .or Over 800 V _2-T
• VALIDATION W
FINAL d
b.BP.C.for This reason BRANCH CIRCUIT FEES
Date: 18.4 or 20A, 12OV,lighting or Reoept. Z
1 To 10 Branch Clrcufts
Siem 11 To 40 Brinch Cta>ita
41 Or More Branch CTrouRs
❑ Exampdon for Reg.Matnt.Elect 164 20.4 20BV To 2T7V LVf&V Br.Circuits 2
SINGLE FAMILY Tamp.Power Pole d Appurtenances w
HOME OWNER-BUILDER bECm I_ARAT)ON Sign with One Branch Clrcuk rri+41
1 hereby affirm that I em exempt frothe Conce
Contractor's LJnea Law
JVL
for the following reneori (Section 7031.6, Business and Professions Addflonal Sign Branch Clrculls 33133 98.80
Coda): t TT[
❑ 1, as owner of the property, Mlac.Conduits&Conductors 1 I i E
p party,will do the work and the structure
KS
Is not Intended or offered for sale (Section 704 , Business Other(See Compute Fee Schedule) , TOTAL lIZ713 _ 80
and Professions Coda). CW41 36.80
pp.VL
CONSTRUCTION LENDING AGENCY F Ri�
I hereby affirm that there Is a construction landing agency for the C$ TL '
00
performance of the work for which this permit Is Issued (Sec. 3097, PERMF FEE (Sub-Total)
Civ.C.)
PLAN CHECKING FEE DCrOD-OW1 9/ 2/9`;
Landers Name
PERMrr ISSUING FEE 2�j 1 1 AM 8:29
Lenders Addrees
I certify that I have resdthle applbet)on end under penalty of purjury state TOTAL FEE
ttul the above tnforrnatbn is correct I agree to comply with all County
ordinances and State laws regulating Electrical wlrtng,and hereby authortw
repreeerttativea of this County enter upon The above-nnrttbr»d property
z
Inspection purposes ! SEE REVERSE FOR EXPLANATORY LANGUAGE
0 q o''1
eroNA OF DATE1