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HomeMy Public PortalAbout9517 GIDLEY ST_Electrical__ woRlffRs'ctNnPENSATION DECLARATION , ,9DPW a/m APPLICATION FOR ELECTRICAL PERMIT O .I here eff4rm that Y have a certiflcale of consent to splf.. ,Vjure, or'a certlf7cate of IYerkers''£ompensatIon Intiuraflce, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS oTr a certV*c!copy therepf (Sec. , Lab. C) Nlc�?No • Company FOR A"UCANf TO 191E LN Certifled copy Is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADORES5 ❑Certified copy Is filed with the county building Inspec- 1 &2-Famlly, Sq. Ft. $ — b LOCALITY LR� tion department. Multi-famlly Sq. Ft. � `✓ Date Applicant J Residential Swimming Pools PADDRESS A� YTS CERTIFICATE OF EXEMPTION FROM WORKERS' e�— COMPENSATION INSURANCE Outlets: R Light Sw. o First 20 (This sectlon need not be completed If+a work Involved by Total No.�_ Additional T.I. No. ?Q the permM Is for one hundred dollars (=100)or leu.) c 1 certify that In the performance of the work'for which this �j permit Is Issued, I shall not employ person In any anner Lighting Fixtures First 20 to as to become subject to the W k Compensatl Laws. Addltlonal Total No. CITY Tel. No. Date Appllmnt Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after makln his Certificate of APPtJCATK)N Exemption, you should become subject to the Work" Range— Heater—LD.W. — Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS 7;�`7 with comply with such provisions or this permit shall be Top — FAU —W.H. — deemedrevoked. Hood — Fan —Other— CITY Tel. No. f 7 � LICENSED CONTRACTORS DECLARATION) LICENM OR Disp. — Room Air Coed. UMBER Class. I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. P BY and Professions Code,and my license Is In full force and effect. 5 0 Size 8 Type HP, KW, KVA, or KVAR Q Ucense N ber Llc. Class Up to 1 Incl. FINAL 8 I� Over 1 to 10 Incl. DATE VALIDATION O RA Contracto a Over 10 to 50 Incl. F1 NAL U ❑ I am exempt under Sec Over 50 to 100 Inc. BY % W B.BP.C. for this reason Over 100 a Services, Swbd., MCC& Panelboards , CA Drrt e: z 0-200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Malnt. Elect. SINGLE FAMILYM7 124.(X0 HOME OWNER-BUILDER DECLARATION Temp. Power Pole 8 Appurtenances W. I hereby affirm that 1 am exempt from the Contractors License Sign with One Branch Circuit 1 ITEMS Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits TOTAL 124 . 00 Professions Code): .00 ❑ I, as owner of the property, will do the work and the Mlsc Conduits 8 Conductors �CHECK 124 structure Is not Intended or offered for sale(Section 7044, Other (See Complete Fee Schedule.... , 14R 11�17G o00 Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for 0444-001 11l2�/84 the performance of the work for which this permit Is Issued PERMrr FEE (Sub-Total) 1 A�11�� (Sec. 3097, Ov. C.). 6886 PLAN CHECKING FIE Lender's Name PERMIT ISSUING FEE Lenders Address I certify that I have read this application and state that the I TOTAL FEE s above Infornxrtlon Is correct. I agree to comply with all County tc,u,s and State aws regulating Electrical wiring, and thorize repntatives of this County to enter upon en operty for InspectIan purposes. SEE REVEW FOR PJC({L"ATORY LANGUAGE es Sig tur4rof Permittee Date WORKERS' COMPENSATION DECLARATION 76A663 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT (� I hereby affirm that I have a certificate of consent to self CE 806G e insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB 4S-/ 7 r F]Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS "7 / I F Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY PL cA tion department. Multi-family Sq. Ft. NEARESTCROSS ST. Ly') Date Applicant Residential Swimming Pools OWNER OR FIRM NAMEDA Y CERTIFICATE OF EXEMPTION FROM WORKERS' j MAIL COMPENSATION INSURANCE Outlets: Rec��—Light < Sw.T•— .} ADDRESS �� �� (This section need not be completed if the work involved by rst 20 CITY Tel. No. the permit is for one hundred dollars (S100)or less.) Total No. Additional PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ y person in any manner so as to become subject to the W rWrs'Compensati 'Laws. Lighting Fixtures First 20 777 ADDRESS Additional / `t Total No. CITY Tel. No. Datell l— -J`t 1 Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after makin this Certificate of APPLICATION -� Exemption, you should become subject to the Workers' Range— Heater_D.W. — Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS T., 2 2 ^' 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 LICENSE OR Disp. — Room Air Cond. Class. I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER } (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY a nd Professions Code,and my license is in full force and effect. Size &Type HP, KW, KVA, or KVAR ense N}—ber„S a{ `r Lic. Classy..-' `) Up to 1 Incl. FINAL J 7 t� "C Over 1 to 10 Incl. DATE ntractoA S;.-J C � y Y�} Date I' 2 ' : VALIDATION LL Over 10 to 50 Incl. FINAL } I am exempt under Sec. Over 50 to 100 Inc. BY B.&P.C. for this reason Over 100 Services, Swbd., MCC& Ponelboards , a Date: 0-200 Amp. Under 600 V LU Signature 201 - 1000 Amp. Under 600 VLU Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION affirm that I am exempt from the Contractor's License Sign with One Branch Circuit the following reason (Section 7031.5, Business and Additional Sign Branch Circuits , liu �s Code): s'owner of the property, will do the work and the Misc. Conduits&Conductors acture is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)— , usiness and Professions Code). CONSTRUCTION LENDING AGENCY reby affirm that there is a construction lending agency for performance of the work for which this permit is issued PERMIT FEE (Sub-Total) c. 3097, Civ. C.). PLAN CHECKING FEE ender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the TOTAL FEE A above information is correct. I agree to comply with all County inances and State laws regulating Electrical wiring, and eleby authorize re {4sentatives of this County to enter upon eabove- en n dproperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SignatuA of Permittee Date tom- 76AS63 DBS SA 25M SETS 11-as APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY ELECTRIC i COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER DISTRICT NO. GROUP ZONE PERMIT NO. FORZPLICANT TO FILL IN : rp ELECTRICIAN.-' RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION ADDRESS V' 888 CITY TEL. NO. '_�,�� BUILDING LICENSE NO. EXPIRES ADDRESS DESCRIPTION OF WORK NUMBER OUTLETS EACH FEES LOCALITY CROBS LIGHTS Sc $ 1 STREET RECEPTACLES 5 � r FIXTURES 5 OWNER WALL SWITCHES 5 6 MAILADDRESS�12/ - � t - ^"`• rIl:- ELEC. RANGES 25 ELEC. HEATERS 25 CITY TEL. NO. MIBC. I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS NUMBER OF CIRCUITS INSTALLED: ANGELES COUNTY LICENSE. LIGHTS RECEPTACLES MOTORS ELECTRICIAN. NUMBER HORSEPOWER FEE NEW MVo. HP OVER INC. EACH I AM THE LEGAL OWNER OF THE RESIDENTIAL PROP- 1/2 a LESS $ .25 ERTY DESCRIBED ABOVE. , I/2 2 .50 2 5 1.00 OWNER- S 15 1.50 INSPECTION RECORD 1 15 50 2.501 50 200 5.00 200 I 500 10.00 1 500 I 1000 15.00 OVER 1000 I 20.00 _Z M.G. SET/FREQ. CHANGER-HP I (7 Q' WELDERS: AC-KVA O 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 _ WITHOUT FIXTURES $1.00 I WIRING WITH FIXTURES 1.25 _FIXTURES SUPPLEMENTARY .50 POWER TOTAL FEE $ UTILITY CO.NOTIFIED FINAL 76A663 DBS SA 3-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER ELECTRIC I FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO. _ELECTRICIAN RECEIVED BY READY FOR DATE ISSUED ADDRESS t FIRSTINSPECTIO.N CITY EL NO.' Q 2 COUNTY LICENSE N0. 95 EXPIRES 3. BUILDING /17 ADDRESS PERMIT FEES FEE NUMBER EACH LOCALITY LIGHT OUTLETS NEAREST 'O RECEPTACLES Z CROSS ST. WALL SWITCHES OWNER TOTAL OUTLETS 5C MAIL ELEC. RANGES 25 ADDRESS ELEC. HEATERS 25 "~ CITY TEL. NO. FIXTURES 5 1 HEREBY ACKNOWLEDGE THAT 1 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 HORSEPOWERFEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER NEW MvD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. I/2 & LESS $ .25SIGNATURE OF i•...•� IrJr I/p 2 .50 PERMITTEE_ - 2 1.00 INSPECTION RECORD 5 15 1.50 15 50 2.50 50 200 5.00 200 500 10.001 .J 500 1000 15.001 Z OVER 1000 20.00 E3 M.G. SET/FREQ. CHANGER-HP _ a WELDERS:AC-KVA 0 GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (75% Dr DRIG.) MOVED MOTORS (75% ar 011111a.) MISC. S113NS NO. NO.TRANS. APPROVALS PPROV&T S NO. NO. LAMPS tf� eai�. p-DATE INSPECTO R'B NAME FOR EACH PERMIT! WIRING $1.00 " CONDUIT O Z— FIXTURES $1.00 WIRING SUPPLEMENTARY .50 FIXTURES - / POWER TOTAL FEE UTILITY CO.CO. NOTIFIED V FINAL J r COUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of County Engineer ELECTRIC ��' DIVISION OF BUILDING & SAFETY WILLIAM J. FOX, County Engineer FOR APPLICANT TO FILL IN DISTRICT NO. Gf;�91JPJ ZONE" PERMIT NO. ELECTRICIAN ADDRESS <. RECEIVED BY FIRREADY FOR DATE ISSUED CITY COUNTY LICEPN9ERE NiIT FEES to EXPIRE NG ADDREBUILDIS13 V ,qI -tele±e NUMBER EACH FEE LOCALITY r L-' '`Z"�•" LIGHT OUTLETS NEAREST� RECEPTACLES CROSS 8T WALL SWITCHES _ _ OWNER '��t•, t �° � TOTAL OUTLETS5c $ MAIL ELEC. RANGES 25 _ ADDRESS ELEC. HEATERS 25 CITY ✓t ^I �'- " TEL. NO;� Y• > E FIXTURES 5 ! " 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE 19 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 HORSEPOWERFEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER NEW MVD. HP OVER INC. EACH OF THE RESIDENTIAL PPqPERTY RESCRIBED ABOVE. %2 6 LESS $ .25 SIGNATURE OF _ V2 2 .50 PERMITTEE - 2 5 1.00 '.� INSPECTION RECORD 5 is 1.50 15 50 2.50 50 200 5.00 evil Lt/ lT 4 i:( 200 500 10.00 ! I� SOO 1000 15.00 -,7 OVER IOOO 20.00 / r ,-..ylf•,,. ! �'.-r: 'Girl" 4 M.G. SET/FREQ. CHANGER-HP WELDERS:AC-KVA ,�.b RG•� ©_✓. ¢_� ^y, U)171q/!J GENERATORS - KW '.1_ !/L�•��;eI. / //t7(�- 4 VI/"�11-E�, TRANSFORMERS - KVA TEMP. MOTORS (75% or ORIG.) �t�- C! MOVED MOTORS (75% or ORIG.) , �L. !7. • 74 6 S/Z/ I '�• MISC. ?•.. ' /l/vI Cly't�'1J //1/ O !G/ SIGNS NO. NO.TRANS. APPROVALS NO. NO. LAMPS DATE INSPECTOR'S NAME FOR EACH PERMIT: WIRING 101.013 CONDUIT ,;r• FIXTURES -- -W $1.00 WIRING �` �` ~' • 7 - ' SUPPLEMENTARY .50 FIXTURES POWER _ TOTAL FEE $ (f UTILITY CO.NOTIFIED FINAL 7SA663 DBS#SA 2-53 If A oll I P 11 IgmAlill �t � M MINE ' '' I I :1 I 1 1 .1 1511 i I P 1 1 1 01 DESCRUMON OF WORK KUUMXR OF �W . i • . _ .S -.......... MIP � :■ Y 1 ■.■■■■■.MEN i► r ■■■■■■■■■.■ . ✓. +t . -ME■■.MM■■ .E ■■■■■■■■■ ■ ■■■■■■■■■ m �.■■■■■■■■ •■ ■■■■■■■■■■.. ` ■II■■■MINE■■■ -MIMM■ME■■■■EM■■ SME■EEM■■■■■ .EEE■■IN..E■ �MEE■■■■■M.•■ P • � rmo ... • •� �m • FEM■ FEE■ L ffiOM■ !lJ�1 ,• E7�iii��l�+r�