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HomeMy Public PortalAbout4913 HELEO AVE_Electrical__ 76A663_CES06-11_51 APPLICATION F®R ELECTRIC PEFSMIT COUNTY OF LOS ANGELES DEPARTMENT OFD COUNTY ENGINEER ADDRESS � �C✓,ar� T/, �7 BUILDING AND SAFETY DIVISION' 7 CI A. LAMBIE, County Ea eer t CASSATT D. GRIFFIN;Sup t of Building LOCALITY F1' ; OR APPLICANT TO FILL IN CROSS ST. PERMIT FEES rr� nCOOKING TEM NUMBER EACH FEE OWNER : $ $ MAIL -? RECEPT. SW. .10 ADDRESS J 24 CVIXTURES .10 CITY TEL.NO. GES CLO.DRYERSELECTRIC NA T E R H EAT E R�S .50ADDRESS J {p rCE HTRS. DISHWASHERSDISPOSERS AUTO.- CITY � TEL.NOSTATE STA.COOKING UNITS ,25 LICENSE NO. G : OVER INC. H.P. O — I/x 25 DISTRICT NO. GROUP ZONE READY FOR INSPECTION +i2 — 2 .50 - INSPECTION RECORD 2 — 5 1.00 5 — 15 1.50 15 — 502.50 50— 200 5.00 ' \ SIGNS: NO.TRANS. - NO.LAMPS p ' SERVICE 0-600V / 1.00 SERVICE OVER 600V 5.00 iMISC. 9 r WIRING PERMIT 1.00 FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT .50' TOTAL FEE $ `� APPROVALS I 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. t WIRING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ++ -LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT 1 A THE LEGAL OWNER OF THE ABOVE POWER n , DESCRIBED RESIDENTIAL ERTY' SIGNATURE '+ dw UTILITY CO. NOTIFIED OF PERMITTEE FINAL LIDATION ARTHUR C.VEIT, MO CASH SUPERVISING ELECTRICAL ENGINEER CK � f AG 5 3 9' 6`0 OCT 1 2 A 2.J v n WORKERS'COMPENSATION DECLARATION 76A663 DPw3 87 APPLICATION FOR ELECTRICAL PERMIT O 1 hereby affirm that I have a certificate of consent to self ;ce e06c 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 ❑Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS 4913 FLCo A0'E ❑Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. — NEAREST y� ei Rw C- C 05A ` T-6m Pt- t T Date Applicant Residential Swimming Pools CROSS ST. S^LOWNER OR f FIRM NAME N L L A C L)4-&fJ CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL q91-3 COMPENSATION INSURANCE First 20 ADDRESS (This section need not be completed if the work involved by Total No. Additional CITYT, ClTel. No. (p�3�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 Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional Date Applicant Total No. CITY Tel. No. 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 complywith 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. REG. NUMBER 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. PR SSED BY and Professions Code,and my license is in full force and effect. CL Size &Type HP, KW, KVA, or KVAR ���;J �� � 0 License Number Lic. Class Up to 1 Incl. FINAL U Over 1 to 10 Incl. DATE 7 -7_q 2, VALIDATION Ir Contractor Date Over 10 to 50 Incl. FINAL G• ❑ I am exempt under Sec. Over 50 to 100 Inc. BY U d ' Over 100 B.&P.C. for this reason U)Services, Swbd., MCC& Panelbo`rc�s� / U , Z Date:' 0-200 Amp. Under 600 v WW Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. ,.. SINGLE FAMILY Temp. Power Pole &Appurtenances Y HOME OWNER-BUILDER DECLARATION _ 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, 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)_ , -[ _t: 7" Business and Professions Code). ='F•` "E`~ -. 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 PERMIT FEE .(Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE - •+ Lender's Name PERMIT ISSUING FEE _- Lender's Address I certify that I have read this application and state that the TOTAL FEE above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize re resentatives of this County to enter upon the above-mentio d pro erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE O Signature of Permittee ~ Daf�� ©s WORKERS' COMPENSATION DECLARATION 76-663 10/61 CE-806G APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, or a,certificatg of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec. 3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB ❑ Certified co is he furnished. EACH NO. FEE ADDRESS copy Y New Residential Bldgs.& Pools ❑ 1 & 2-Family,Sq.Ft. $ _ $ LOCALITY Certified copy is filed with the county building inspection NEAREST department. Multi-family Sq.Ft. CROSS ST.fAJ"TQC L\JD w zu Date A licant Residential Swimming Pools OWNER OR ", '/ PP 'FIRM NAME G'UJ SVe 1`� V/NCE G. —&#C -. CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL COMPENSATION INSURANCE Out Rec Light — Sw. ADDRESS 41 1 (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 Tel.N�dJ6..a3,? • PLAN CHECK I certify that in the performance of the work for which.this permit APPLICANT -is issued,.I shall not employ any person in any manner so as to become subject to the Workers'Compensation La Lighting Fixtures First 20 ADDRESS 1A(,fiC/° Date 11_;1_q.5- . `I_;I—RS Applicant 1 Total No. Additional CITY Tel.No. NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP 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 V.M._ /D O ADDRESS provisions or this permit shall be deemed revoked. . Top — FAU 42� W LICENSED CONTRACTORS DECLARATIONCITY Tel.No. Hood Fan Other_ I hereby affirm that I am licensed under provisions of Chapter 9 LICENSEOR Disp. B 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. PRC SED BY Size& T pe HP,KW,KVA,or KVAR ,d� U License Number Lic. Class _ Up to 1 Incl. FINAL Over 1 to 101ncl. DATE Contractor Date Over 10 to 50 Incl. FINAL VALIDATION O ❑ I am exempt under Sec. Over 50 to 100 Inc. . BY d B.&P.C.for this reason Over 100 fn Date: Services,Swbd.,MCC&Panelboards , Z 0- 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 SINGLE FAMILY Temp.-Power Pole& Appurtenances__ r�•. HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit A4\`TuV I hereby affirm that I am exempt from the Contractor's License Law �^ 040 for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits Code): 1 ITEMS tvlisc.Conduits & Conductors I,as owner of the property,will do the work and the structure TOTAL 63.40 is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). , CHECK 63.4b c n CONSTRUCTION LENDING AGENCY CHANGE a1.�Q• 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) Q Civ.C.). PLAN CHECKING FEE 0000'd001 11/2195 Lender's Name 3392 1 AM 9 0 33 PERMIT ISSUING FEE a 11 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 inspecti purposes. • _ / SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE-806G tD/St APPLICATION FOR ELECTRICAL PERMIT -1 hereby Arn that I have a certificate of consent to self insure, ora certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec. 3800,Lab.C.) Policy NO. Company FOR APPLICANT TO FILL IN JOB /j��� Certified copy is herebyfurnished. EACH NO. FEE ADDRESS "f New Residential Bldgs.&Pools ��^ ❑ 1 & 2-Family,S Ft. $ — $ LOCALITY /r" Certified copy is filed with the county building inspection Y� q department. Multi-family Sq.Ft. NEARESTa o �p CROSS ST. 1- 1 ROSA T•C�aUL��� Date Applicant Residential Swimming Pools OWNER OR FIRM NAME L, L /- p CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec to Light®• Sw. MAIL y� /� COMPENSATION INSURANCE )d� ADDRESS y 13 /��� m First 20 F— (This section need not be completed if the work involved by the CITY" /3 Tel.No. n vto--03 permit is for one hundred dollars($100)or less.) Total No. Additional ) pui (� ( vC PLAN CHECK I certify that in the performance of the work for which this permit APPLICANT is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20. ADDRESS l Total No. Additional CITY Date Applicant V Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT Exemption,you should become subject to the Workers'Compensation. Range_ Heater_ D.W. _ yJ provisions of the Labor Code, you must forthwith comply with such Oven Dryer_ W.M._ ADDRESS provisions or this permit shall be deemed revoked. Top FAU _ W.H. _ CITY Tel.No. LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. LICENSE OR Class. (commencing with Section 7000) of Division 3 of the Business and REG.NUMBER Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. //() PROCESSED BY Size& Type HP,KW,KVA,or KVAR t `-` 0 License Number Lic.Class Up to 1 Incl. FINAL U Over 1 to 10 Incl. DATE f� Contractor Date VALIDATION O ❑ Over 10 to 50 Incl. FINAL H I am exempt under Sec. Over 50 to 100 Inc. BY U�954.7A w B.&P.C.for this reason Over 100 IL Services,Swbd.,MCC& Panelboards ,` # o 010.0 0 2 Z Date: (J 0- 200 Amp.Under 600 V .•� o - 46600 Signature 201 - 1000 Amp.Under 600 V ❑ Exemption for Reg.Maint.Elect. Over 1000 Amp. or Over 600 V o 0,o (l. &Q Q 35 SINGLE FAMILY Temp.Power Pole& Appurtenances '0S 06-88 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) pop. 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 Lender's Address I O 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 DrQoerty for inspecti p poses. �� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date