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Home My Public Portal About4925 KAUFFMAN AVE_Electrical__ 76A663-CE806 12-65 APPUCAMN FOR EIEC UR CCAL pMOU COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING Q� �� BUILDING AND SAFETY DIVISION ADDRESS 117 JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN-W. JENKINS, SUPERINTENDENT OF BUILDING-O LOCALITY I a - - NEAREST FOR APPLICANT TO FILL IN CROSS ST. S w1- RECEPT. j TOTAL NO, EACH FEE ' 2 LIGHT OUTLETS�IRST 20 $.20 $ / (� 0 OWNER MAIL SWITCH2 ADD'L1O ADDRESS OVER 20 TOTALFIRST 20 .20 �� CITY TEL. NO. LIGHTING 1 FIXTURES FIXTURES )( ADD'L 10 CONTRACTOR O Y`S Ividll•1 i 1 OVER 20 a �/ /��,// p RANGES DRYERS WTR.HTRS. 1.00 ADDRESS O 3 �LinNI�/,'J VG�`^1. p- GARB.DISP. STA.COOK �e^ TEL.NO. / 77.3 2 CITY DISHWASH. AUTO.-WASH. STATE / (� LICENSE NO. SPACE HTRS, STA. APDL. .50 MOTORS: OVER NOT OVER H.P. DISTRIC�IT� G OUP Z NE PR/O/,/C,E Y O 1 1.00 1 3 1.50 INSPECTION RECORD CL 3 8 2.00 U 8 15 2.50 ix a 0 F- 15 50 3.00 CJ W s0 100 5.00 a N Z SIGNS: NO.TRANS NO.LAMPS SERVICE 0.600V-NOT OVER 200A 1.00 SERVICE 0.60OV-OVER 200 A. 2.00 s SERVICE OVER 600V 5.00 OTHER (SEE COMPLETE FEE SCHEDULE) PERMIT ISSUING FEE 2.00 no SUPPLEMENTARY PERMIT ISSUING FEE 1.00 APPROVALS DATE INSPECTOR'S SIGNATURE TOTAL FEE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION UNDERSLAB WORK AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY -ROUGH CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. - 1 I r W RNG 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL WNER OF,AND INTEND TO POWER RESIDE IN,THE ABOVE D R ENTIA ROPERTY. SIGNATURE UTILITY CO.NOTIFIED OF PERMITTEE FINAL ALIDATION JOSE N C. ROOH CK MO CASH SUPERVISING ELECTRICAL ENGINEER Ao 53 .,O OCT 1 2 :0 3.4.0- cv WORKERS' COMPENSATION DECLARATION 76A663 10/81 n n n p IC n M N F O R E IZ CY R DC n p P IE R(� H I�h reby affnm that I have a certificate of consent to self CE-806G G SIT lT L� G�1 11�J lT ll� ISL�LS Il IJ�t G�1L5 Ir ISl1�IlVll insure, or a certificate of Workers' Compen=dation 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 �` . Certified co is hereby furnished. EACH PNO., FEE ADDRESS '9 Z Ir►`u�y 1/Y PY Y New Residential Bldgs. & Pools � c 1 & 2-Family, S Ft. $ $ LOCALITY Certified copy is filed with the county building inspec- q•, tion department. Multi-family Sq. Ft. 'NEAREST CROSS ST. Residential Swimming Pools Date Applicant OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE ADDRESS complete if the work involved b (This t be corn First 20 ( s section neenop y Total No; Additional CITY T,� el. No. 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' mpensation Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional CITY T o. Date 7/3. lgApplicant Fixed Appliances Not Over 1 HP ' PERMIT NOTICE TO APPLICANT: If, after making this Cer ificate of APPLICANT Exemption, you should become 'subject to the Workers' Range_ Heater_D.W. — Compensation provisions of the Labor Code, you must forth- I 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._ PROCES BY and Professions Code,and my license is in full force and effect. 0 - Size &Type HP, KW, KVA, or KVAR' 51 License Number Lic. Class Up to 1 Incl. FINAL r V Contractor Date Over 1 to 10 Incl. DATE (%/) VAL U ATION 0 ❑ Over 10 to 50 Incl. FI I am exempt under Sec. Over 50 to 100 Inc. BY � B.&P.C. for this reason Over 100 N Services, Swbd., MCC& Panelboards Z Date: 0 - 200 Amp. Under 600 V ;27568A Signature 201 - 1000 Amp. Under 600 V #:o o•o a o '� a Over 1000 Amp. or Over 600 V , Exemption for Reg. Moint. Elect. - 255.0 SINGLE FAMILY Temp. Power Pole & Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit - ° ° ° 2 5,5 04 I 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 0 7.30—,87 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 Other (See Complete_Fee Schedule)_ D 7044, Business and 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 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 representatives of this County to enter upon the e-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of P rmittee Date /ORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) 76A663 �f APPUCATI®n n FOR EL ECTMCAL PERMT L( I hereby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec. 3800 Lab-C.), Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS Certified copy is hereby furnished. ', New Residential Bldgs.&Pools NO. EACH FEE LOCALITY Ft Sq. . _ $ e Certified copy is filed with the county building inspection 1 &2-Family, $ NEAREST department.. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF,EXEMPTION FROM WORKERS'COMPENSATION INSURANCE O OWNER OR Cutlets:RBC. Light SW. FIRM NAME �� First 20 MAIL (This section need not be completed if the work involved by the Total No. Additional ADDRESS � . permit is for one hundred dollars(S100)or'less.) I certify that in the performance of the work for which this permit CITY ` Tel.No. is issued, I shall nbt employ any person in any manner so as t0 DPLAN CHECK became subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date �� Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOT IC TOA PLIC NT: If, after Adding this Certi ' aMof CITY Tel.No. Exemption,you should become subject to the Workers',Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS / I hereby affirm that I am'licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000) of Division 3 of the Business and CITY -A Tel. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE - Class. a Over 50 10 100 Incl. REG.NUMB ER / � �. Over 100 DISTRICT NO. P C ED BY O License Number Lic. lass Services,Swbd.,MCC&Panelboards v Com' 0-399 Amp.Under 600 V FINAL Contractor Date DATE F FT I am exempt under Sec. 400-1000 Amp..Under 600 V l—Lq W Over 1000 Amp.or-Over 600 V FINAL - VALIDATION Q fB.&P.C.for this reason�// �l6L BRANCH CIRCUIT FEES BY Date: 15A„or 20A, 120V,Lighting or Recept. If /� � , _ 1 To 10 Branch Circuits Signature___�— 11 To 40 Branch Circuits 41 Or More Branch Circuits - Exemption for Reg. Maint.Elect. 15A,20A;208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION n� 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): _ -T!E•,4y Misc.Conduits&Conductors ' 5'6 5 I, as owner of the property,will do the work and the structure �!}�t�L -_ems o •�-_ is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) # L, and Professions Code). D _ �;t�EE•ii 58.35 • CONSTRUCTION LENDING AGENCY CI'1!-rINE e3 ,f' 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) �- 70 ;} Civ.C.) 10 0 5/2 /4 PLAN CHECKING FEE I�"� )i�vl�tl Lender's NameT� Z. U PERMIT ISSUING FEE Ji `fa Lender's Address (I I certify that I have read this application and under penalty of purjury state TOTAL FEE a' that the above information is correct. I agree to complywith all County ordinances and State laws regulating Electrical wiring,and hereby authorize representatives of this County to enter upon the above-mentioned property for ins on purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE O PERMITTEE DATE