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HomeMy Public PortalAbout4919 KAUFFMAN AVE_Electrical__ 76A663:CE806 1/70 A' UIPUCA° MH FOP, ELEC U D CCad PEOWT COUNTY OF LOS ANGELES / DEPARTMENT OF COUNTY ENGINEER BDDRESS J' �r N A-V6 BUILDING AND SAFETY DIVISION JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING NEAREST FOR APPLICANT TO FILL IN CROSS ST, OUTLETS NO. EACHI FEE /] � OWNER l//. RECEPT._ $ Is MAIL /l9 /l Ayr���,� /'✓f �L.v� // LIGHT TOTAL FIRST 20 '20ADDRESS ' CITY ��i G I+ TEL. NO.J'Q"�7 �u SWITCH_ OVER 20 10 PLAN CHECK LIGHTINGFIRST 20 20 APPLICANT TOTAL FIXTURES �10 OVER 20 ADDRESS APPLIANCES CITY TEL. NO. RANGE DRYER WTR.. HTR. PERMITAPPLICANT STA. COOK DISP. F.A.U. ADDRESS y SPACE HTR. AIR CONO. 'CITY .TEL. NO. CLOTHES WASH. DISHWASH. LICENSE NO. 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 ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. SIZE & TYPE OVER TO - I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR O - 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT BIAM THE LEGAL OWNER OF, AND INTEND TO 1 - 10 3.00 RESIDE IN, THE AOVE DDEESCCRRIIP/ED RESIDENTIAL PRO ERTY. SIGNATURE 10 - 50 5.00 OF PERMITTEE 0 V 50 - 100 10.00 DISTRICT NO. CLASS GROUP NE OCESS D BY 0 100 - 500 15.00 'S ® I SIGN, GAS SIGN AND ONE CIRCUIT 3.00 NOTES: b DCL TUBE, OR N MARQUEE ADDITIONAL CIRCUITS 1.00 z SERVI CENOTOVER 600 VOLTS OR 200 AMP 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE SERVI_CEOVER600VOLTS OR200AMP 5.00 TEMP.POWER POLE TEMP SERVICE,POLE, &APPURTENANCES 3.00 TEMP LIGHT OR RECEPT. SYSTEM 3.00 UNDERSLAB WORK h( ROUGH CONDIUT WIRING ) PERMIT FEE (SUB TOTAL). FIXTURES POWER AUTHORIZED PLAN CHECK FEE (50% PERMIT FEE) UTILITY CO. NOTIFIED 01 PERMIT ISSUING FEE �00 � � SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL/ ' JOSEPH C. ROOHAN TOTAL FEE a D SUPERVISING ELECTRICAL ENGINEEP, PLAN CHECK VALIDATION CK. M.Q. CASH PERMIT VALIDATION CK. M.O. CASH SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE ' AUG' 9 z a 6_c c N 76AS63 DBS 5A 11-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER -DISTRICT NO. GROUP ZONE PERMIT NO. FOR APPLICANT TO FILL IN ELECTRICIAN g0 J ✓ EQEIVED,BY READY FOR DATE ADDRESS �U7� _ )coo q FIRST ISSUED INSPECTION CITY � 1"1 ?EL. NOAV G COUNTY LICENSE NO. 2.0 EXPIRES BUILDING / PERMIT FES ADDRESS FEE NUMBER EACH LOCALITY LIGHT OUTLETSNEAREST /1 /J CROSS ST. �/ - RECEPTACLES WALL SWITCHES OWNER • ® A m TOTAL OUTLETS Sc $ -15= MAIL ELEC. RANGES 2S ADDRESS - ELEC. HEATERS 25 �bCITY TEL. NO. , . FIXTURES 5 =-1- I HEREBY ACKNOWLEDGE THAT 1 HAVEy READ THIS MISC. APPLICATION AND STATE THAT THE- ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS '3 Gi AND AGREE TO COMPLY WITH ALL COUNTY. ORDINANCES NUMBER OF'RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL-WIRING. MOTORS I CERTIFY THAT I POSSESS THE ABOVE VALID LOS NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER � NEW MVD. HP OVER I INC. EACH OF THE RESIDENTIAL PR PERTY D SCRIBED ABOVE. /r1/z a LESS $ 25 SIGNATURE OF A 1/2r - 2 .50 PERMIT TE "' -�` dl 2 5 1.00 INSPECTION RECORD S. 15 1.50 - 1s so 2.50 a /9 2 �R� 6iOQ A/.•!n F='®-0- so 200 5.00 - «Nb 5TH .'Asdn ✓.q 200500 10.00 Soo 1000 15.00 Q OVER 1000 20.00 (� M. G. SET/FREQ. CHANGER-HP WELDERS: AC-KVA /L!. 2 / O GENERATORS-KW /LYS 74LL 90oas�'L�!l.�600 Gc�S Q TRANSFORMERS-KVA TEMP. MOTORS (75%OF ORIG.) MOVED MOTORS 75%OF ORIG.) L�?� cs'-042.• 0034 " MISC. SIGNS NO. NO. TRANS. APPROVALSNO. NO. LAMPS DATE INSPECTOR'S NAME FOR EACH PERMIT: CONDUIT WIRING $1.00 Imo. WIRING ,y;,q�Yv. FIXTURES $1.00 01 FIXTURES .SUPPLEMENTARY •50 . POWER TOTAL 'F,EE $ TILITYCO.-NOTIFIED ® � FINAL WORKERS' COMPENSATION DECLARATION 76-663 to/ai 6"�tr�r�ll� CAMON 2®R ELECTRICAL LECTj RICA PERMIT I hereby affirm that I have a certificate of consent to self insure, CE-806G i�i�' p\5 Ir L� �0 11 t� 6!!9 � .. or a 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 /�f ❑ Certified co s hereby furnished. EACH NO. FEE ADDRESS Wv� PY Y New Residential Bldgs.& Pools Certified copy is filed with the county building Inspection 1 & 2-Family,Sq.Ft. $' — $ LOCALITY de art •nt. Multi-family Sq. Ft. NEAREST CROSS ST. Residential Swimming Pools OWNER OR Date Applica .FIRM NAME CERTIFICATE OF EXEMPTION FROM.WORKE Outlets: Rec / /)Light $w. • MAIL, COMPENSATION INSURANCE . /O ADDRESS This section need not be completed if the work involved b the First 20 ( p y Total No. Additional CITY Tela No. _ permit is for one hundred dollars($100).or less.) I certifythat in the performance of the work for which this permit PLAN'CHECK P 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 Additional Total No. CITY Tel.No. Date Applicant Fixed.Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of 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 W.M: ADDRESS provisions or this permit shall be deemed revoked., Top FAU W.H. LICENSED CONTRACTORS DECLARATIONHood — Fan Other_ CITY Tel.No. I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR (commencing with Section 7000) of Division 3 of the Business and Disp. Room Air Cond.; REG._NUMBER Class.' Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances . DISTRICT NO. PROC SED BY Size & Type HP;KW,KVA,or KVAR ` D.� a License Number Lic.Class Up to 1 Incl FINAL U .� ' DATE O . 7 f � Over 1 to 10 Incl. VALIDATION. 0 Contractor 14 ate - Over 10 to 50 Incl. ❑ FINAL V I am exempt under Sec.- Over 50 to 100 Inc. BY B.&P.C. for this reason Over 100 IL Services,-Swbd;,MCC &Panelboards Date: 0- 200 Amp.'Under 600 V - "y 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 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit Thereby 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 i s : a s Code): ❑ _ E g 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) T r=.+ .and Professions Code). D 27 80 CONSTRUCTION - CONSTRUCTION LENDING AGENCY ra a41-•=; I hereby affirm that there is a construction lending agency for the = =`-f _• °:'i-I performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) /, CHANGE Civ.C.). n PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEEI?fs=i' il_=f 1W. Lender's Address .g 1_ I certify that I have read this application and state that the above TOTAL FEE d information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representa' s of this County to enter upon the above-mentioned prope y ms,e-tion pure ses. f ,n 4-1 SEE REVERSE FOR EXPLANATORY LANGUAGE , 6 L Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 76A663 DPW 3 87 _ n nnn C n IWN FOR En ECT'ROCA PERM7 O 76A663 G�11f�Il"L� G�1 (J�J LL LL (!✓ Uvu (J I hereby affirm-that I have a certificate of consent to self CE-806G insure, or o'certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof ( ec *800, Lab, C. _ Policy Na? ' ompany Q {� FOR APPLICANT TO FILL IN JOB ❑Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS r J, $ — $ LOCALITY j Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. Q G tion departme t. Multi-family Sq. Ft. — NEAREST r� CROSS ST. rf�l�l g! ©� r ZN .61 Date ZZ Applicant 7 Residential Swimming Pools OWNER OR CERTIFICATE OF EXEMPTION.FRO WORKERS' 4 FIRM NAME �7 1!h �l,�p COMPENSATION INSURANCE Outlets: RecLightSw. O (/ ADDRESS h� V� First 20 � o • (This section need not be completed if the work involved by Total No. _ Additional CITY Tel. Noll 3c, 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 1{I C44 (/(J��/ 1e1. permit is issued, I shall not employ any person in any manner 1 so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 4 ADDRESS Additional Total No. 2 CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION rpt i�dGt � �• n�c f`(�t 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 provision's 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 T72 0 Class. (commencing with Section 7000)'of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY d and Professions Code,and my license is in full force and effect. ;r f Size &Type HP, KW, KVA, or KVAR 0 License Number LZ4 �10ic. Class Up to 1 Incl. FINAL U �.1 f =�0.11 Over 1 to 10 Incl. DATE l`ZL `; VALIDATION 0 Contractor —`I Date Over 10 to 50 Incl. _"l F- ❑ I am exempt under Sec. Over 50 to 100 Inc. FINAL U BY W B.&P.C. for this reason Over 100 IZ Services, Swbd_MCC& Panelboards D U) Date: Z 0,-200 Amp. Under 600 V Signature 201 - 1'000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION ' Sign with One Branch Circuit -. y I hereby affirm that I am exempt from the Contractor's License Sig 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 1 1"f i, structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ D W w Business and Professions Code). _ a-» _ (-' -» ' s` 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) t"�f'4 E x`-11! (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name ! if i-(i[l : _1,', -' PERMIT ISSUING FEE Lender's Address �� &t5 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 ©s gnature f ermittee Date WORKERS'COMPENSATION DECLARATION 76-663 to/st A Pp �CAMON FOR ELECT�� A PERNTj I he.pby, affirm that I have a certificate of consent toy self insure, CE-6o6G I� LIQ lSo II rl LS �b lB L� A II or a ce•tificate of workers' Compensation Insurance, or a•certified COUNTY OF LOS.ANGELES- copy AND SAFETY copy thereof(Sec.3t00,Lab.C.) Policy No. Company ;' FOR APPLICANT TO FILL'IN - JOB' ❑ Certified copy is hereby furnished. New Residential Bldgs.&.Pools EACH NO. FEE ADDRESS `�-( t-` � L FF �lV ❑ Certified copy is filed with unty uildi nsp on 1 & 2-Family,Sq.Ft. $ — $ LOCALITY • !1 f-)no pa en I Multi-family.Sq.Ft. — NEAREST A ►'\ Residential.SwimMing Pools CROSS ST. �/�' Date Applica, - - - OWNER OR 1 C ��•y�' _ FIRM NAMEC}SP CERTIFICATE OF EXEMP BION FROM WOR RS' Outlets:Rec"' Light °S-2 ) MAIL COMPENSATI INSURANCE ' First 20: I� ADDRESS. (This section need not be completed if the or involved by-the I f- CITY n Tel.No. permit is=for one hundred,dollars($400)or less.) Total No. Addltionai; I certify that in the•performance.of the work for which this permit APPLICANT CHECK issued,is ; becomesub ectllto the Workers'Compensation Laws , as to manner-soLighting Fixtures• First 20 ADDRESS Additional TotalNo: CITY Tel.No. - ' .. . Date.' Applicant Fixed Appliances Not Over 1 HP PERMIT. NOTICE TO, APPLICANT: If, after making-this, Certificate-of Exemption,you should become subject to the Worker's'Compensation Range__ Heater__ D.W APPLICANT ' provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W:M._ ADDRESS provisions or this permit shall be deemed revoked., v Top:. — FAU, W.H. r LICENSED CONTRACTORS DECLARATION Hood — Fan Other CITY Tel.No. I hereby,•affirm,that l am licensed under provisions of Chapter 9 Disp. Room Air Cond. Class.'. LICENSE OR (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 PROC BY Size&Type HP,KW,KVA,or KVAR License Number. Lic.ClassUp to 1 Incl. FINALU Over 1 to 10 Incl. DATE _ ( 7( VADATION Contractor DateOver 10 to 50 Incl. FINAL 0 r - ❑ I am exempt under Sec. Over 50 to 100 Inc.i' BY W B.&P.C. Over 100for this reasbn �(. ` �-• - Services,Swbd',MCC& Panelboards Date: 0- 200 Am Under 600,V D Z: . Signature 201 - 1000 Amp.Under 600 V Over 1000 Amp.or Over 600 V El Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit �,9 3 5 9 A I herbby affirm'that I am exempt from the,Contractor's License,Law, Additional Sign Branch Circuits for the following reason(Section 7031.5, Business and Professions #-o f0'o,0 0 2 Code): 'e Misc.Conduits & Conductors ,�'0,o 2 G,0 0 I,as owner of the property,will do the work and the structure Other(See Complete Fee Schedule) x `. is not intended or offered+for sale (Section 7044,Business- '" D o'l o.0 2 O v and Professions Code). 4'.0 CONSTRUCTION LENDING AGENCY 10$ $8 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) 3 Civ.C.). PLAN CHECKING FEE Lender's Name PERMIT.ISSUING FEE, Lender's Address 1 certify that ave read this application and state that the above TOTAL FEE information i orrect. I agree to comply with all County ordinances and State ' s regulating Electrical wiring, and hereby authorize represe a es of this C my toe r upon the above-mentioned proper r inspection urpo -'SEE REVERSE FOR EXPLANATORY LANGUAGE Si ature of Permit a Date ;WORKERS'COMPENSATION DECLARATION CEA663 10/81 `lea Ili ll�an ��{j��@ry/��I� I hdreby affirm that I have a certificate'of consent to self'.insure, APPL� AT�®N ®R ��� v��� �� ��" """�� Qr'a certifieate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY' cop; thereof(Sec.3800,Lab. C.) Policy No. Company ,5 - FOR.APPLICANT TO FILL IN " JOB': ❑ Certified copy is hereby furnished. EACH NO. :'FEE ADDRESS f r"�V► New Residential Bldgs.& Pools �/y LOCALITY " ,� - , CA 1 I " ,Certified: copy is�filed with the county' building inspection 1 & 2-Family,Sq..Ft l� � $ — $ L� department. Multi-family Sq.Ft. — 'NEAREST' CROSS ST.."e/_r Date Applicant Is ResidentialSwimming Poo OWNER OR pp A FIRM NAME f✓Z :CERTIFICATE OF EXEMPTION FROM.WORKERS' ' b '•� MAIL Outlets:Rec— Light Sw. COMPENSATION.INSURANCE, ; 3ADDRESS 0 (This,'section need not be completed if the work invoFirst 2 lved,by the CITY Tel.No. permit is for,one hundred dollars($100) or less;) . , Total No. Adddional I certify,that in the performance�of the'work for;which this'permit PLAN CHECK is issued, l shall.not employ any._•person,,in any manner so as to APPUCAN7. become'subject to the Workers'Compensation•'Laws .Lighting Fixtures First 20 ADDRESS' Additional Total No. ' `CITY Tel.No. Date Applicant NOTICE. TO i APPLICANT; If, after making this ,Certificate of Fixed Appliances Not Over 1 HP PERMIT v' 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 W.M., ADDRESS , provisions or this permit„shall be deemed revoked., Top., FAU 1N.f 1. LICENSED CONTRACTORS DECLARATION ood — Fan _.Oth r_ CITY ” H e Tel:No.' I hereby affirm that•I am.licensed under provisions of.Chapter 9 LICENSE OR ' Disp.••— Room Air Cond. Class.. (commencing with'Section'7000) of Division 3 of the Business an REG.NUMBER'' Professions Code;andm license is in full force and'effect. "' DISTRICT NO.'. P CE P ED BY y Power Apparatus& Large.Appliances Size& Type HP,KW XVA,or KVAR. 0�.. p License Number Lic.Class. Up to 1 Incl.. FINAL V-' +, Over 1 to 10 Incl. ' DATE Gl Contractor Date .O. VALIDATION / 0 • ver 10 to`50 Incl. IN V ElI am' fezempt under Sec. Over 50 to.p00 Inc. FINAL Y Over 100 d f B.&P.C.for this reason Date: s Services Swbd. MCC& Panelboard Z 0-200 Amp.Under.600 V Signature -201.- 1000'Amp-Under 600 V" ` t " Over-1000 Amp.or Over 600 V -Exemption for Reg. Maint.Elect. " 51NGLE FAMILY:: , Temp.Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ,8 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. /L ITY,- Misc.Conduits& Conductors I as owner of the property,will do't ie'work and the structure' is not intended or offered for sale (Section 7044,_Business" Other(See Complete Fee Schedule) D IPOITAL 2 7 =47 and Professions Code). _ CONSTRUCTION LENDING AGENCY _I� ) 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 =T I�ji! j Jul "ZZ t ender's Name / l PERMIT ISSUING FEE _'(�/ r8;48 i'1 =5"4 nder's Address ertify that I•have read this application and state that the above TOTAL FEE ormation is correct. I agree to comply with all County.ordinances d State laws regulating Electrical wiring, and hereby authorize resentatives of this County'-to enter upon the above-mentioned ^' erty for inspecti n urposes. .SEE REVERSE FOR EXPLANATORY LANGUAGE _ „. • ;nature of Permittee F /Date 'WORKERS'COMPENSATION DECLARATION CE-806 10/81 FOR. � ELECTRICAL n ����n�� I hereby'affirm that I have a certificate of consent to self insure, CE-806G , A Lh u�u or a 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 - - ❑ Certified co is he*reb furnished. EACH NO. FEE ADDRESS Vxc Lvi .vLrA U��im A N copy Y New Residential Bldgs.& Pools 1 & 2-f anvil S Ft. $ $ LOCALITY - Y ` Q El Certified copy is filed with the county building inspection y q• — � C l –1 department. Multi-family'Sq.Ft. — NEAREST Residential SwimmingPools CROSS ST. �-L)t-- . Date Applicant OWNER OR FIRM NAME., e ,. _ .. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE, DRESS Outlets:Rec Light Sw. MAIL (This section need not be completed•if the,work involved First 20,by the ��y� CITY Tel.No. permit.is'for one hundred dollars($100)or less.) Total No. Additional I'certify tHat•in the performance of the work for which•this•permit PLAN CHECK is issued, I•shall not employ any person 'n any manner so to APPLICANT become subject to the Workers'Compen do aws. Lighting Fixtures First 20 ADDRESS l'::` .•� Total No. Additional CITY Tel.No. Date' Applicant Fixed Appliances Not Over Q HP NOTICE TO APPLICANT: If, after making this Certif e of PERMIT Exemption,you should become subj t to the Workers'Co ensation Range_ Heater_ D.W. APPLICANT 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. ' LICENSED CONTRACTORS DECLARATION Hood —"Fan Other_ CITY Tel.No. I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR (commencing with Section 7000) of Division"3 of the Business and Disp. Room Air Cond. REG.NUMBER Class. Professions Code,and my license is in full force and effect. - DISTRICT No. PROCESS 'BY Power Apparatus&-Large Appliances Size& Type HP,KW,KVA,or KVAR 0. License Number tic.Class Up to 1 Incl. FINAL V Over 1 to'.10 Incl.. DATE. Contractor Date l VALID N– O ❑ Over 10 to 50 Inc!. FINAL I-- I am exempt under Sec. Over 50 to 100 Inc..Over 100 gY U W B.&P.C.for,this reason �.. Services,Swbd.,MCC& Panelboards UX Date: Z 0- 200 Amp:Under 600 V D. � 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 8 7 5''2 A HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit # 0 0 0 0 0 2 I hereby affirm that I am exempt from the Contractor's License Law' for'the following reason'(Section.7031.5, Busihess and Professions Additional Sign Branch Circuits Code): Vo 0l 4,25 Misc.Conduits& Conductors o o.o Q 2 5= I,as owner of the property,will do the work and the structure is not intended or offered for sale (Section 7044, Business .Other,(See Complete Fee;Schedule) _ and Professions Code). o"1 2 • 8 7 D 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 n PERMIT ISSUING FEE [/Y S 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 ws regulating Electrical wiring, and hereby authorize represen ves of this County.to enter upon the above-mentioned prop It r spection pur ses. SEE.REVERSE FOR EXPLANATORY LANGUAGE i Sign ure of Permittee Date �• WORKERS'COMPENSATION DECLARATION 76-806 . 10/81 A I�IP C/MON FOR EL�L�CTIf"fl C L� I�LSIf`flu�1u0T j-hereby.affirm that I have a certificate of consent to self insure, CE-806G I� I�L� LW or a certificate of Workers' Compensation Insurance,or a certifiedCOUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800;Lab. C.) Policy No: Company' FOR APPLICANT TO FILL IN - JOB -9 E.+ ❑ Vr- Certified co is hereby furnished. EACH NO... FEE ADDRESS (-M PY Y, New Residential Bldgs.&Pools ' •Certified copy is filed,with the county building inspection 1 & 2-Family,Sq.Ft. $ — $ LOCALITY, 'r�' �� C► .T department. Multi-family Sq.Ft. — NEAREST , Residential Swimming Pools CROSS ST Q V L R, 2'tLS A+ Date Applicant OWNER'OR. '• ' - !FIRM NAME �A Vl1 C:. '- CERTIFICATE OF EXEMPTION FROM WORKERS'. ;MAIL COMPENSATION INSURANCE Outlets:Rec Light _ Sw. — ADDRESS .«, KAP FE"A IQ First 20 (This section need not be completed if the work involved by the CITY Tel No.. . permit is'for one hundred dollars ($100)or less.) .Total No. Additional 6 j certify that in the performance of.the work for which this permit PLAN CHECK ;I shall not employ an APPLICANT is issued p y y person in any manner so, to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS _ Additional tional 1 ►� L` (c� (R (,d Total No: CITY Tel No.: .Exemption, o ' Applicant_ Fixed Appliances Not Over 1 HP PERMIT Date NOTICE TO APPLICANT. If, after making this Certificate of APPLICANT C - TFR p y u should become.subject to*the Workers'Compensation Range_ Heater_ D.W.._ . provisions of the Labor Code,`you must forthwith comply with-such Oven. Dryer — W.M._ ADDRESS Cid V provi-dris or this permit shall be deemed revoked. Top FAU W.H. _ Q LICENSED CONTRACTORS• Hood Fan Other DECLARATION CITY J�� ;` Tel.No.3Q — _ I hereby.affirm that I am licensed under.provisions,of Chapter,9 LICENSE OR hereby. with.Section 7000)'of Division'3`of the"Business and Disp. —'Room Air Cond. REG.NUMBER IS Class.': Professions Code,an&my.license is ih'full force and effect: DISTRICT NO._ PROCESSED BY' Power Apparatus,&,Large Appliances _ Size&,Type HP,KW,KVA,or KVAR f V Q 0 License Number SI�011F7 Lia Class `` O 'Up to 1'Incl.. FINAL U lL r'I ���CTR l°� a o. Over 1 to 10 Incl. DATE �8 VALI -TION Contracto0 Date -' Over 10 to 50 Incl. FIN U ❑ I am exempt under Sec. Over 50 to 100 Inc. BYLLj a. B.&P.C.for this reason Over 100 N Servi e Swbd.,MCC&'Panelboar s J Z ate: 200 Amp.Under 600 VP�r Signature �� G 201 - 1000 Amp:Under-600 V Over 1000 Amp.or Over 600.V ❑ Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole& Appurtenances HOME OWNER.-BUILDER-DECLARATION Sign with One Branch Circuit I hereby affirm that I am 6empt,from the Contractor's License Law :9.0 9,315 A for the•following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits , Code): #p 6;0,o o'2 Misc.-Conduits& Conductors t� ❑ I,as owner of the property,will do the work and the structure' l :° o 3'a 5 0 is not intended or offered for sale (Section 7044, Business Other(See Complete Fee'Schedule) D and Professions Code). o 0 0.3 Q 5 0,O CONSTRUCTION LENDING AGENCY - a 8. . $8 a I hereby affirm that there is a construction lending agency for the ,{/7 performance of the work for which this permit is issued(Sec,3097, PERMIT FEE (Sub-Total) Uv ' Civ.C.). PLAN CHECKING FEE. Lender's Name PERMIT ISSUING FEE D 5 Lender's Address 'l I certify that I have read this application and state that the above TOTAL FEE �?v TO 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 propert fo inspect'ion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee' Date • r WORKERS'COMPENSATION DECLARATION 76-663 to/at APPLICATION FOR ELECTRICAL PERpt T I hereby affirm that I have a certificate of consent to self insure, CE-806G II u'�J LS �oPillle ulNu or a 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 �,^M�� ❑ Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS `�] ff(�( � ❑ 1 & 2-Family,Sq.Ft. $ _ $ LOCALITY �f Certified copy is filed with the county building inspection. NEAREST. department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools OWNER OR 1J°°f+�� ,Y^wCi ,,// FIRM NAME 6 .I I �--c4— CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec Light Sw. MAIL COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work involved by the First 20 Total No. CITY Tel.No. permit is for one hundred dollars ($100)or less.) Additional I certifythat in the.performance of the work for which this permit PLAN CHECK P APPLICANT is issued, I shall not. employ any person 'n any manner so as to become subject to the Workers'Compe ion Laws. Lighting Fixtures First 20 ADDRESS U -.-,Z Additional _ ` Total No. CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO. APPLICANT: If, aft ak' g this Certificate of r Exemption,you should become subj ct to the Workers'Compensation Range_ Heater_ D.W. _ APPLICANT ` ✓6'���-� provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M._ ADDRESS l[010 NJT provisions 10NJTprovisions or this permit shall be deemed revoked. Top — FAU _ W.H. LICENSED CONTRACTORS DECLARATION * CITY L�- C Tel. Hood — Fan Other Nej��� I hereby affirm that I am licensed under provisions of Chapter 9 Disp.��_Roo m�ir•KO LICENSE B Q R (commencing with Section 7000) of Divi sion 3 of the Business and {�,�(- f(/,J REG.NUMBER / � U Class:�! Professions Code,and my license is in full force and effect. Power A ara Us& Large Applianc s DISTRICT NO, PROCE BY �� � 0 Size&Type HP,KW,KVA,or. -� U License Number Lic.Class Up to 1 Incl. FINAL Ny! 1Z1 1 Over 1 to 10'Incl. DATE VALIDATION 0 Contractor l� 1 Date J / Over 10 to 50 Incl. U ❑ FINAL I am exempt under Sec. Lt- Over. to 100 Inc. BY W Over 100 �- B.&P.C.for this reason N Services, Swbd.,MCC & Panelboards D / Date: 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. SINGLE FAMILY Temp.Power Pole& Appurtenances } i HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit •f,%•T r• 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): =+1�i IE °I 0 ❑ I,as owner of the property,will do the work and the structure Misc.Conduits& Conductors 'I l !TEM-:3 • is not intended or offered for sale'(Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). I TOTAL 1� ® 00 CONSTRUCTION LENDING AGENCY " HEI K Is. If I 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) %..HANE °("l t Civ. C.). PLAN CHECKING FEE Lender's Name i 0f I-00 3' 3 PERMIT ISSUING FEE ov -,1-7 •1°Ir';j Lender's Address �'� I AM !_•'y I certify that I have read this application and state that the above TOTAL FEE /j� information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize represent es of this County to enter upon the above-mentioned proper r inspection puo es. SEE REVERSE FOR EXPLANATORY LANGUAGE Si#fikure of Fermittee Date / V