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HomeMy Public PortalAbout6152 IVAR AVE_Electrical__ 76A 663-CE806 10/72 4-111 ll UCG= T OU V FO m C dC C��G�BC�Qd pC G3�nn1�4 / COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER JOB BUILDING AND SAFETY DIVISION ADDRESS �? LOCALITY l•r•* /� NEAREST FOR APPLICANT TO FILL IN - CROSS ST, OUTLETS NO. EACH FEE OWNER OR ' $ $ FIRM NAME / RECEPT._ MAIL o- i 7 ADDRESSQ ,5 (9,! AL. LIGHT TOTAL FIRST 20 25 . OVER 20 CITY ,a TEL. N0.r`✓ �d - <U SWITCH .10 PLAN CHECK LIGHTING TOTAL FIRST 20 25 APPLICANT . ' FIXTURES OVE �10 R 20 ADDRESS � RESIDENTIAL APPLIANCES CITY TEL. NO. PERMIT RANGE DRYERWTR. HTR._ APPLICANT CJ STA. COOK DISP. F.A.U. ADDRESS SPACE HTR. AIR COND. . CITYlelTEL. N0. CLOTHES WASH. DISHWASH. LICENSE OR - .� REG. NUMBE CLASS. '� FAN OTHER 1.00 1 HEREBY ACKNOWLEDGE THAT'I HAVE READ THIS APPLICATION _ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH A:LL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS,:.ETC. HP. KW. KVA. ELECTRICAL WIRING. SIZE & TYPE OVER TO 1 HEREBY CERTIFY THAT I AM PROPERLY REGIS7 D AND/OR 0 - 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY ND STATE OF CALIFORNIA OR Al AM LEGAL OWN OF - H ABOVE } 1 - 10 \ 3.00 DESCRIDED' R IDEN L PERT a O PERMIT V 10 - 50 5.00 SIGNA RE 50 - 100 - 10.00 DIS CT N P D BY W 100 - 500 15.00 /j , s N SITUBE, OR 1GGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE INSPECTOR' NATURE , MARQUEE ADDITIONAL CIRCUITS 1.00 - TEMP. POWER POLE SERVICENOTOVER60OV6LTSOR200AMP I 3.00 3 "C7 UNOERSLAB WORK . SERVI CE OVER 600 VOLTS OR 200 AMP 10.001 ROUGH CONDUIT TEMP SERVICE,POLE, &APPURTENANCES 5.00 WIRING ���^ •7.� 3 t � R TEMP LIGHT OR RECEPT, SYSTEM 3.00 FIXTURES POWER.AUTHORIZED UTILITY CO. NOTI FIED r FINAL a/ t PERMIT FEE (SUB TOTAL) NOTES:. PLAN CHECK'FEE - PERMIT ISSUING FEE 3.00 TOTAL FEE PLAN CHECK VALIDATION CK. M,O. CASH i 1 PERMIT VALIDATION Cl,. O. CASH 3 (5 5r-_iiH2G u SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 1 WORKERS'COMPENSATION DECLARATION '76A66eDPw3iaz APPUCQ�' N FOR ELECQ�CAL PERM .I h%reby' affirm that I have a certificate of consent to self `CE-806G ensure, 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 - lo vL� ❑Certified copy is hereby furnished. New Residential Bldgs. & Pools - EACH NO. FEE ADDRES $ _ $ LOCALITY' �� ❑Certified copy-is filed with the county building inspec- 1 &2-Family, Sq. Ft. _ - tion department. Multi-family Sq. Ft. NEAREST Residential Swimming Pools CROSS ST. Date' Applicant OWNER OR FIRM NAME (' ..:�r�- CERTIFICATE OF EXEMPTION FROM WORKERS', Ouflets: RecL � MAIL COMPENSATION INSURANCE ightSw. ADDRESS _ First 20 I (This section need not be completed if the work involved by Total No. JAddional ® CITY Tel. No. the permit is for one hundred dollars ($100)or.less.) PLAN CHECK -1 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 Total No. CITY ( Tel. No. Dare Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO 'APPLICANT: If, after making 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 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 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. PRO ESSED BY >_ and Professions Code,and my license is in full force and effect: I --q—� �/ O Size&Type HP, KW, KVA, or KVAR O License Number Lic. Class Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE VALIDATION cr Contractor Date ❑ Over 10 to 50 Incl FINAL \' ~ I am exempt under Sec. Over 50 to 100 Inc. gY U B.&P.C. for this.reason Over 100 '' d Date: Services,'Swbd., MCC& Panelboards D Z 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 HOME OWNER-BUILDER DECLARATION Temp. Power Pole &Appurtenances - I hereby affirm that I am exempt from the Contractor's License Sign with One Blanch Circuit y Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): .K,.Mt_•1 � ❑ a �r 1, as owner of the property, will doMisc..Conduits &`Conductors 'the work and the _ `: 'f �'" structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ - Business and Professions.Code). D "A'Ia' ra CONSTRUCTION LENDING AGENCY _ t - 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)�sxip (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name - PERMIT ISSUING FEE ±40 Lender's Address :r? I certify that I have read this application and state that the TOTAL FEE -- above information is correct..1 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-n,,pntioned p op ty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ' X24 Signature of Permittee D e ©s WORKERS' COMPENSATION DECLARATION -2o-ooiaDPW 3is7 nn�n ��n��Or�� �O� pp �������� ���nn�� O F Piereby',gffirm that I have a certificate of consent to self CE806G G�111- L� Gd NUJ E �Vf�] •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 ❑Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY f'G cf / tion department. Multi-family Sq. Ft. NEAREST Residential Swimming Pools CROSS ST. Date Applicant OWNER,OR /,+ /�f FIRM NAME -? 2G7 /2 G CERTIFICATE OF EXEMPTION FROM WORKERS' 1� MAIL Outlets: Rec Li ht Sw. COMPENSATION INSURANC11 E g � /&P ADDRESS6,152— (This � First 20 (This section need not be completed if thwwork involved by Total No. Additional �'dd CITY �GlT Tel. No. the permit is for one hundred dollars ($100)or less.) PLAN CHSCK 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 Lighting Fixtures First 20 ADDRESS so as to become subject to the Workers'Compensation Laws. Additional Total No.. CITY Tel No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after,making this Certificate of APPLICATION -L�i��V 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 with comply with such provisions.or this permit shall be Top FAU W.H. — deemed revoked: Hood — Fan CITY Tel. No. Other LICENSED CONTRACTORS DECLARATION Disp. — Room Air Cond. � 0 LICENSE OR 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 and Professions Code,and my license is in full force and effect. d Size&Type HIP, KW, KVA, or KVAR O License Number Lic. Class Up to 1 Incl. FINAL U r Contractor Date Over 1 to l0 Incl. DATE �_ L�2 VALIDATION 0 Over 10 to 50 Incl F- ❑ I am exempt under Sec. Over 50 to 100 Inc. FBY INAL LJJ B.&P.C. for this reason Over.100 . N Date: Services, Swbd., MCC& Ponelboards D Z 0-200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V D Exemptionfor Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole &Appurtenances _ HOME OWNER-BUILDER DECLARATION r 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 TT;-`._` - structure is.not intended or offered for sale(Section 7044, 'Other (See Complete Fee Schedule)_ `-' , Business and Professions Code). D "ni - sI;IHL r I C 3 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) ' v L. fti3s�_ (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name �);_;�«I_-"; ,g a 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"representatives of this County to enter upon the bove-men ned property for,inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Os— g ature of Permittee Date