The URL can be used to link to this page

Home My Public Portal About6157-59 IVAR AVE_Electrical__ WJRKERS' COMPENSATION DECLARATION - 10i81 a;. CE-806G n nnICnIMM FOELEC MInL PE nTI hereby affirm that I have a certificate of consent to self insure, ora certificate of Workers' Compensation'Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab, C.) Policy No. Company FOR APPLICANT TO FILL IN JOB f0!/ 71 617 -9— / Q 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_°d"+- �(� c'. tion department. Multi-family Sq. Ft. — NEAREST /� Residential Swimming Pools CROSS ST, .i//�J•- :Oar JC^.�r c✓ Q Q Date Applicant OWNER OR // t FIRM NAME .(p fie" (�!i[/E G L �`t� n CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Svv_ MAIL COMPENSATION INSURANCE ADDRESS completed if the work involved b first 20 (This section need not be com p Y Total No. Additional ' CITY Tel. No.�fy,8a7!/o y(o ' the permit is for one hundred dollars ($100)or less.) I certifythat in the performance of the work for.which this PLAN CHECK P 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 C{ Total No. Additional, Date7&1 O , AppIA1_t� . ; CITY Tel. No. Fixed Appliances Not Over l HP. PERMIT' j NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT.�A�(�el�Oa [=jN vl C 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 iJ.w gCSTr7'� i9ls �a with comply with such provisions or this'permit shall be Top _ FAU —W.H.'— deemed revoked. CITY�,ry{��, ., Tel. No LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_ �1. 3 3� Di'sp. _ Room Air Cond. LICENSE OR 1 /l 3, Class. ell D (commencing with Section 7000) of Division 3 of the Business ppDISTRICT NO. PROCIED BY 11 Power Apparatus& Large Appliances and Professions Code,'and my license is in full force and effect., O Size 8 Type HP, KW, KVA, or KVAR t V License Number / Lic: Class r' O Up to 1 Incl. FINAL f —� �/� 0 DATE Contractor Date Over 1 to 10 Incl VA -TION CS Over 10 to 50 Incl. FINAL W ElI am exempt under Sec. Over 50 to 100 Inc.. BY B.&P.C. for this reason Over 100 Services, Swbd., MCC&Panelboards j1y9 Date: 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V I /40 1 / Over 1000 Amp. or Over 600 V I a Exemption for Reg, MainT. Elect. I 1 a SINGLE FAMILY ♦ -2 5;'1. 5 5 A Temp:Power'Pole & Appurtenances• HOME OWNER-BUILDER.DECLARATION Sign with One Branch Circuit #'o o'a o;o 2 1 hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Law for the.following reason (Section 7031.5, Business and o 0 Professions Code): 2550 FT1, Conduits&Conductors I, as owner of the property, will do the work'an d the -a'? 0 2 5 Dig' structure is not intended or offeredfor sale (Section Other (See.Complete Fee Schedule)_ D 7044,Business and Professions Code). '0829=86 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) G (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 representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE I_Ia� 7 Signature of Permittee Date r 'i`�4C,�+•L`7`"R1'+'Y.. �+7afL�'c...�'�� r�l X ,y`-�-��.,F^.'"°'"°Z �F��i � -�;°x`x �� T�•' -` -"'+ •�G i aY�"•n.y t a y r y, 4 M�. Sr i�..�: ii �` ►t,�.�`.�:c Tr a "-a rx�r''rF`q+'az,°" + - {^ !� >•t?vj> � yti•.T�.y 'o'yy .,.'s.�w'�.t ,.i�yr+�•i��.• "I.w".� ,�m..m TK3�+sc�'�'�''>...r. ..aC��,,. -s �"�a.•�e�s��y�•�',a.tL4 D-x:...ws sr.:`; -t''�14'l'L'��vw'��•,,a,`v - 1�...u;"'.'i�,!ac,:�i+4.r-T+= �YS.'�;' 'f+t'�'t,. .�.,.� .rrr.« �m'. DD a-A 7-40,er - APPLICATION FOR PERMIT DEPARTh1ENT OF BUILDING AND SAFETY �� COUNTY OF LOS ANGELES NATURE .1. FOX, CHIlF ENGINEER' 1r L1Ti1RE OF INSTALLATIONDISTRICT NO. GROUP ZONE PERMIT No. WIRING I. FIXTVRES I SERVICE I I RFL'CtVEO BY READY FOR DAT8188U6D RANGE HEATER POWER 11 PIRSr INSPECTION - SIGNS MISCELLANEOUS Ai=PLICANT FILL N HEAVILY OUTLINED' PORTION-ONLY ' 1 JOB NAM ♦DDR E98 �1 � �• �'�.', LOCALITY G ADDR E89 ►1-- i NEAREST m CITY Cl( TEL No. 4 CROSS ST. - y COUNTY If CERT, NO. EXPIRESJ �.f W NAME ' DESCRIPTION OF WORK X1 MAIL 3 NUMBER OF OUTLETS ON CIRCUITS ADDRESS6 LOCATION By ROOMS CITY TEL No. I LIGHT OUTLETS -I SW.I PLUGS IrfrT. I AM THE UiG L POSSESSOR OF THE yC) LOS CIRCUIT j A B C D E F ( G H ANGELES COUNTY T ATE OF;CU tF CAT{pN. LIVING RCJM I __----------T��--��------ ¢LIC RICIAN.'k-- IA ' 1E L AL OWNER OF THE PROPERTY DESCRIBED DINING ROOM it 1 ' ABOVE. BRFST. RM. I I' OWNtR. BATH CORRECTIONS ENT. HALL ---I--'-- HALL NO. I / FRONT PORCH OUTSIDE KITCHEN t 'i SERV. PCH. -- J� BDRN. NO. i CLOSET Borth. No. At CLOSET I s ^� e TOTAL NO. OF OUTLETS S f a APPROVALy- NO. OF FIXTURES L Q DATE IN¢V¢ROR•O NAMc 'r. NO. OF MOIORS H. P. a COMDUIT t'k - r. NO. OF SIGNS TRANS. 6. WIRING H^. OF RANGES OR HEATERS 0 FIXTURES MISCELLANEOUS 8 POWER 4{ PERMIT FEE )� UTILfCY CO.NOTINIMD r- J TOTAL FEEL S- �( FINAL .) ' n+- ' :1",1.,ti"'_'?�L'�A+•��t�r:i.` ...:rid` - '' t _ ��,• y f.' -9,�-:.L.e'i��^til'!:-�.11�a'.'„' �+-ai-'+�.a� � v 3� - i` �" - t N' Mrd'�1�1;�°'•,_��w�nt55-e4�..___tS31"�a�, b '� _ _ h r.-F.. - ?C�. '` Q -.O :QM LICAZTON FOR PERMIT - DEPARTMENT OF BUILDING AND SAFE ^; : COUNTY OF LOS ANGELES +. i SL E° CTR R WM J. FOX C41ZF ENGINEER NATURE OF INSTALLATION { I DISTRICT NO (GROUP ZONE''. PERMIT NO. WIRING �XTUREB I SERVICE t ; 1 RXCEIVED SY -READY FOR DATM ISSUED RANGE HEATER I POM'ER S 1 FIRST INSPECTION SIr Ns MISCELLANEOUll -' APPLICANT FILL N HEAVILY OUTLINED PORTION ONLY i` JOB _ ` NAM � �.I I ADDRESS C ADDRESS �/' t,..;l�— LOCALITY tl CITY /-, NEAREST Cl TEL No. CROSS ST. •j COUNTY7p r - CERT NO. EXPIRES }y - Ito NAME DESCIZIPTION OF WORK Z MAIL_ ; i ADDRESS NU!19ER OP OUTLETS ON, CS:C::7-0 I0 LOCATION BY ROOMSCITY TEL No. I L13HT OUTLETS I SW.I PLUGS IrItrt. 1 AMTHE L POS SSOR OF THE OV}E9 Los ( F I G I ANGELES COU TY ATE U AT N. CIRCUIT A F3 C D E _LIVING ROOM AW E L AL OWNER OP THE PROPERTY 0118C 113 OWING ROOM ABOVE. BRFST. RM. I - I OW MQR• BATH 12-4 ;CORRECTIONS 5 -ENT. HALL `j HALL NO. I II I 'll FRONT PORCHI �� { rD¢ OUTS KITCHEN. .. SERV PCH. � x .; DORM- No. I U CLOSET Q DORM. No. ~, CLOSET .!`. TOTAL APPROVALS _ No. OF OUTLETS NO. OF FIXTURES ' � ✓ 8 DI1Ttz INQr¢eTOR�D ftAme NO. OF MOTORS H. F. Q '. CONDUIT t NO. OF SIGNS TRANS. 13 WIRING NO. OF RANGES Ora HEATERS O PIXTUR,EL ' ` MISCELLANEOUS 8 POWER " PERMIT FEE 8 UTILITYCO.NOTIPIQD �• 44 K:• •TOTAL Fra S FINAL 3+� , ty1�5x,�a � .f,'•'�m'�'F' .TA-}C,.. 'x. `p - `L - � T DEPART.IENT OF BUILDING AND SAFETY APPLTCATTC:N FO�.X P81011k ' COUNTY OF LLOS.ANGELES ELE'��d RIC NATUREOf+ INSTALLATION DISTRICT No, GROUP TYPE �ryPERIaIT No. 1 j 2 i y�• / uJ .? i 1: WIRING' ,_-I ' FIXTVREffi 1i1 SERVILE gA''IGE t- HEATER POWER READY FOR RECEIVED 6Y DAT¢ 1"klco t FIRST INOPECTION , r 91SN13 - MISCELLANEOUS j APPLICANT FILL IN HEAVILY OUTLINED I'ORTlO O�LY {-Y7/JOB1 NAME AOORESQ ` i U ADDRESS 1 cJ ;�%�^,11-' -�( LOCALITY �• I . Ni:RCST t � CITY _ 4 1, T CROSS OT. tl IIII� STATE COUNTY }i rJ`11 LICENHE NO, REG. NO. NAMEId DESCRIPTION OF YORK Z MAIL NUMBER OF OUTLETS ON CIRCUITQ O LOCATION BY ROOMS CITY TEL No. tt LIGHT OUTLYT9 9W. PLUGS FIXT. CORRECTIONS CIRCUIT I A 1 O l C I D I E I F I G I F1 f LIVING ROOMI V I LJ I I I 1 I, _DINING ROOMI�I___. SRFST. RM. BATH ENT. HALL HkLL No. FRONT PORCHI ( ' Q fi OUTSIO ,... I - 1. I I 1 I Z KITCHEN_ ! ) I a SEP.Y. ,Roar. No. ( I I CLOSET Boat.. No. L i .. . ttosrtr �'jj I 1I ( 4 { APPROVALS DATE t%9paCMR•q %A" CONDUIT WIRING - TOTAL 17;.S I Farm T9 NO. OF OUTLETS Q _POWER NO. OF FIXTURES - UTILITY CO. NOTIFIED � Q � .�,�� NO. OF MOTORS H. P. _ Q I AM THE LEDAL OWNER OP 4HIT ABOVQ LOO ANQHLEII NO. OF SIGNS TRANS. Q COUNTY RE010TRATION NUMBER.. - NO. OF RANGES OR HEATERS fl Oad�ReC1AIa. MtSCELt_ANEUV90 t AM THEE L¢QAL O"URTHq QQ$iY'V CQ£K.'RIDRQ PCRMIT FEE O. •a ABOVE.. - .. h TOTAL FEE .•• 'i. G3n'tiw`KyJhV.ISLSCJi-+��' -iai.,�l(�_rt.[.GG Y'Z'•FtTt �•J}+ 4 �. �� iM�is�� _ i.[c ,,ntZ' "-!A� "-.2L'+-.,b+. c7?':: t'ie,tr +■_� YalYt'+ii .S't�+! ts - r+�i.71." ?Mit�t. \`' -- L01Q. �^c'stP.q,�e•-�e.�`+. .a;+t.v�<t,.`�" ,.rte ,d,l;i. f-. �:':�� ..: -- '� . �'K■•e+i'+t'i.S�"�F.1`r1*JiCo`�7'�,P TL ... hz \+++.a>,.� �_�� .. .-. �- "'1.r••+N:... "ss';aT•e`_,.e.11vZ'Se.---tea �,. _ •v^•• _ � . 'fF}.4 ,r- 'n`��y.��{;.� t.w� ..';a ,� -' to ' _ � �i � •• 1 :let;a 01 1' ow to' +' r� r 1 9 f• ■ . Y T -� Y 1 1• 'e� t \ • , • , } 1 inirciracIA P \ 3 ti • rrN .Y._ ■1 T t • v ` I rr ,. 1 ■Irrr C x `` •act - ' '.-o,