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HomeMy Public PortalAbout8905 LAS TUNAS DR_Electrical__ WORKERS'COMPENSATION DECLARATION 76A663CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT ��" I hereby affirm that I have a certificate of consent to self CE-8066 sure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES ! BUILDING AND SAFETY a certified copy thereof (Sec 3800, Lab. C )) �- P i y A.� 1 l y d Company�, A`��� FOR APPLICANT TO FILL IN JOB Certified copy is herew AA by furnished. New Residential Bldgs. & Pools EACH NO FEE ADDRESS ❑ 1 & 2-Family, S Ft $ _ $ LOCALIT Certified copy is filed with the county b Iding insp c- y- q tion department. Multi-family Sq. Ft NEAREST CROSS ST. �� Residential Swimming Pools OWNER OR Date plica FIRM NAME CERTIFICATE OF EXE ION FROM WORKER Outlets• Rec Light Sw._ MAIL COMPENSATI INSURANCE First 20 ADDRESS (This section need not be completed If the work involved by Total No Additional CITY936&6Tel. N 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 Total No. CITY Tel No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT- If, after making this Certificate of APPLICAN 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.— ADDRES with comply with such provisions or this permit shall be Top FAU —W.H — CIT Tel. d3• deemed revoked. Hood Fan _Other_ AM— LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp — Room Air Cond. REG NUMBER Clcs (commencing with Section 7000) of Division 3 of the BusinessDISTRICT NO. PROCESSED BY Power Apparatus 8 Large Appliances A/ ^� and Professions Code,and my license is in full force and effect. 4VL SvCJ �. — I n Size & Type HP, KW, KVA, or KVAR i O License Number 'S1��0 Lic. Class L1 Up to 1 Incl. FINAL �j �; �-��aA1....Date Over 1 to 10 Incl. DATE `� VALIDATION O Contractor ��-���� Over 10 to 50 Incl ` ❑ FINAL (� I am exempt under Sec Over 50 to 100 Inc. BY Over 100 B.&P C for this reason Services, Swbd , MCC & Panelboards Date: 0 -200 Amp Under 600 V , -20 Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint Elect Over 1000 Amp or Over 600 V SINGLE FAMILY Temp. Power Pole&Appurtenances L 4 9 G 8 A HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 0 c o 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 2 0 0 2S 5 0 Professions Code)• ❑ I, as owner of the property, will do the work and the Misc. Conduits &Conductors o c o 2 5. 5 0 5- structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)— ► 7044, Business and Professions Code) 031 -83 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 Flo PERMIT ISSUING FEE Lender's Address 1 certify that I' have read this application and state that the TOTAL FEE ZJ, fit/ above information is correct. I agree to comply with all County ordinances and State laws regulate ctrical wiring, and hereby authorL resentatives of s C unty to enter upon the above-meproperty�forUspect, npurposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of e Date BO� WORKERS'COMPENSATION DECLARATION 76A663CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-8066 insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY o((/�l(�e,[tifiefd copy thereof (Sec. 3800, Lab. C )/`�j PolicIi y NOS` I, `�' Company LIAVIC,`C FOR APPLICANT TO FILL IN JOB ADDRESS 7 Certified copy is hereby furnished New Residential Bldgs. & Pools EACH NO FEE R W1 1 & 2-Family, S Ft. $ _ $ LOCALITY io`L Certified copy is filed with the cou ty building inspec- Y. 4• tion departni. Multi-family Sq. Ft. 'NEAREST Residential Swimming Pools CROSS ST Dqy� � Applica OWNER OR ' �/����''�� QQ FIRM NA CERTIFICATE OF EXEM ION FROM WORKERS' Outlets Reff-yLight�SwC/D MAIL COMPENSATI N INSURANCE ADDRES This section need not be completed if the work involved b First 20 ( p y Total No� Additional CITY l..c Tel. the permit is for one hundred dollars ($100)or less.) FTECK I certifythat in the performance of the work for which this PLAN C P erAPPLICANT permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws Lighting Fixtur s First 20 ADDRESS Total No. Additional CITY Tel. No. Date Applicant 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' 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 7:Other_ CIT Tel. LICENSED CONTRACTORS DECLARATIONLICEN E 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 PROCESSED BY and Professions Code,and my license is in full force and effect. License Numberh�-y /Jes� Size &Type HP, KW, KVA, or KVAR % 0 � ` �7� Lic ClassUp to 1 Incl FINAL V '7;EL ��- Over 1 to 1011ncl DATE 0� ��� VALIDATION C�ontracto �d dam• Date/� Over 10 to 50 Incl FINAL /J I am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C. for this reason Over 100 VVV Services, Swbd , MCC& Panelboards 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 HOME OWNER-BUILDER DECLARATION �- Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License C ^ n 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 Other (See Complete Fee Schedule)— ► - % % ci l^ 0 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 7E1 Lender's Address I certify that I have read this application and state that the TOTAL FEE above information is correct I aqating ply with all County ordinances and State laws regtrical wiring, and hereby author'ze representativunty to enter upon the above-me boned propertyon purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date ��� WORKERS'COMPENSATION DECLARATION CE-663 10/81 APPLICATION FOR ELECTRICAL PERMIT {� I hereby affirm that I have a certificate of consent to self insure, CE-806G (� or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY �Q� he of Sec 100,Lab C // 1�7L� ��` d { �" a/ �i FOR APPLICANT TO FILL IN JOB Policy No. Company ADDRESS (�/_J ,(,��y ❑ Certified copy is hereby furnished. New Residential Bldgs &Pools EACH NO FEE ❑ 1 & 2-Family, Sq Ft. $ _ $ LOCALITY Certified copy is filed with the county building inspection NEAREST department Multi-family Sq Ft CROSS ST 3 Date Applicant Vn• ��r © C Residential Swimming Pools OWNER OR 9 7� f!hJ a • FIRM NAME I� S CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec v, Light --L Sw. I MAIL �f COMPENSATION INSURANCE ADDRESS ! , h 0/-. This section need not be completed if the work involved b the First 20 I,_ ( P Y CITY Tel No permit is for one hundred dollars($100)or less.) Total No Additional PLAN I certify that in the performance of the work for which this permit APPLICANT CHECK 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 Total No Additional 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_ HeaterD 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 le LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ CITY . Tel No I hereby affirm that I am licensed under provisions of Chapter 9 Disp — Room Air Cond LICENS R ell/ (commencing with Section 7000) of Division 3 of the Business and REG.NUMBER " Class Professions Code,and my license is in full force and effect Power Apparatus& Large Appliances DISTRICT N PROCES D BY ��,,`` Q Size& Type HP, KW,KVA,or KVAR / 4 License Numbery�(�(D 74 l �f Lic Class Up to 1 Incl. FINAL V � a�1 �ri✓(1 Date /U-9iJ Over 1 to 10 Incl DATE ' VALIDATION Contractor _—r ) ) � 0 Over 10 to 50 Incl If FINAL TNV ❑ I am exempt under Sec Over 50 to 100 Inc BY W If B&PC.for this reason Over,,100 CL co Services,Swbd,MCC& Panelboards Z Date 0- 200 Amp Under 600 V Signature 201 - 1000 Amp.Under 600 V El Exemption 1000 Amp or Over 600 V Exemption for Reg Maint.Elect m SINGLE FAMILY Temp Power Pole & Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ACCT0 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 3307 16 60 Code) ❑ I,as owner of the property,will do the work and the structure Misc Conduits& Conductors 1 ITEMS is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ ® TOTAL 16 -60 and Professions Code) CONSTRUCTION LENDING AGENCY CHECK 1 I I hereby affirm that there is a construction lending agency for the COHAMGE a(10 performance of the work for which this permit is issued(Sec 3097, PERMIT FEE (Sub-Total) Civ C) Lender's Name PLAN CHECKING FEE n�n�ny �n� ttttt��' 1r 1�f?�) PERMIT ISSUING FEE 0539 1 AM 7:43 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 egulating Electrical wiring, and hereby authorize representative f this County enter upon the above-mentioned pr pert for ion purpo s - SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 76-8010/81 APPLICATION FOR ELECTRICAL PERMIT {� I hereby„pffirm t1 at I have a certificate of consent to self insure, CE-80 6G IJ 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 ❑ ADDRESS C.J G_ O KJf3� Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE �#ERTI tif d cop is •filed with the co bud specUo 1 & 2-Family,Sq Ft. $ — $ LOCALITY R-o,,,e; C{ tment Multi-family Sq Ft NEAREST CROSS ST Date Applicant Residential Swimming Pools OWNER OR 7 FIRM NAME �� U IC OF EXEMPTION FROM WORKERS' !G Sw AIL COMPENSATION INSURANCE Outlets Rec Light J ADDRESS ttt C (This section need not be completed if the work involved by the NFirst 20 permit is for one hundred dollars($100) or less.) Total No Additional CITY ��a� Tel No I certify that in the performance of the work for which this permit PLAN APPLICANT CHECK 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 ! 9k 2, Additional Total No. �� CITY��� Date Applicant 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_ DW _ _ e provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W M. _ ADDRESS ^�ypjind 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 B 6 Z Clas "� (commencing with Section 7000) of Division 3 of the Business and REG NUMBER Professions Code,and my license is in full force and effect DISTRICT NO,,y O PROCESSED BY a Power Apparatus& Large Appliances vC 7j Size& Type HP,KW, KVA, or KVAR License Number %-two ye~ — �Lic Class Up to 1 Incl FINAL V �-�1`�'G"`"— �"" 'pate v ✓ Over 1 to 10.Incl. DATE VALIDATION 0 Contractor Over 10 to 50 Incl. U ❑ FINAL I am exempt under Sec Over 50 to 100 Inc BY W d B&PC. for this reason Over 100 N Date Services,Swbd,MCC& Panelboards 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 Temp.Power Pole&.Appurtenances 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch,Circuit �+G+1 S I hereby affirm that I am exempt from the Contractor's License Law A a'R - for the following reason (Section 7031 5,Business and Professions Additional Sign Branch Circuits ive7J Code) I,as owner of the property,will do the work and the structure. Misc Conduits & Conductors 1 I TM is not intended or offered for sale (Section 7044, Business Other (See Complete Fee Schedule) , �yqp'IAL '- ql I ® � and Professions Code) TVicy CONSTRUCTION LENDING AGENCY - COC18 K .75 1 hereby affirm that there is a construction lending agency for the CW4GE e0[1 performance of the work for which this permit is issued(Sec 3097, PERMIT FEE (Sub-Total) Civ C) Lender's Name PLAN CHECKING FEE T 8, 3/89 L u Q •/ a G Lender's Address 1 2 PERMIT ISSUING FEE L% q M14E26 � `1117126 1 certify that I have read this application d state that the above TOTAL FEE information is correct. I agree to comply h all County ordinances and State laws reg n ctrical wir g, and hereby uthorize representatives o ounty to enter pon th abov mentioned pr ty for insp urpo �. SEE REVERSE FOR EXPLANATORY LANGUAGE i ure of ermitt a e WORKER'S COMPENSATION DECLARATION DPW 9/89 APPLICATION FOR,►,ELECTRICAL PERMIT 76A663 I hereby affirm that I have a certificate of consent to self Insure, 76A&63 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.) IR,90S y NO. Company 7-eta )-t FOR APPLICANT TO FILL IN JOB $ ADDRESS ADDRESS CJ Certified co is hereby furnished EACH NO FEE PY Y New Residential Bldgs.&Pools LOCALITY ❑ $Sq Ft. — $ Certified copy is filed with the county building inspection 1 &2-Family, _ NEAREST dd tment Multi-family Sq Ft CROSS ST Date (3 Applicant -c Residential Swimming Pools ASSESSOR 0. PAGE PARCEL CERTIFICATE OF EXEMPTION FRO WORKERS' Outlets:Rec _Light Sw First 20 MAIL FlRM NAME ► ` WNER OR COMPENSATION INSURANCE' �fl "� on O (This section need not be completed if the work involved by the Total No. Additional ADDRESS 490 0 %049r LA Mae permit Is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit _ CITY W dql Tel No is Issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers'Compensation Laws. Lighting Fixtures'f� First 20 APPLICANT r Total No. Additional ADDRESS Date I Applicant 15 OR 20A120V BRANCH CIRCUITS NOTICE TO APPLICANT: If, after m ,aking Is Certificate of CITY Tel No Exemption,you should become subject to the W kers' Compensation 1 TO 10 INCLUSIVE EACH provisions of the Labor Code, you must forthwith comply with such 11 TO 40 INCLUSIVE EACH PERMIT APPLICANT provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH , LICENSED CONTRACTORS DECLARATION ADDRESS ' /�O �` l d I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH O (commencing with Section 7000) of Division 3 of the Business and CITY Aiv a will, Tel No �►I�3 V Professions Code,and my license Is In full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR /'*7 r d to C[ G Power Apparatus&Large Appliances REG NUMBER (0�( 6 Class L O License Number�Z-/�� Lic.Class Size&Type HP,KW,KVA,or KVAR DISTRICT NO VPREY F- U�d C) Up to 3 Incl. W Over 3 to 10 Ind FINAL d Contractor a-rr� Date 7 ( L DATE ❑ Over 10 to 50 Incl. Q�7 Z I am exempt under Sec Over 50 to 100 Incl Over 100 VALIDATION FINAL v AL B.&P.C.for this reason t�i.-k•1 n� Services,Swbd.,MCC&Panelboards Date 0-200 Amp.Under 600 V Signature 201 -1000 Amp.Under 600 V tiif.- Over 1000 Amp.or Over 600 V - - ❑ Exemption for Reg.Maint.Elect - f(I � °�,-a SINGLE FAMILY Temp. Power Pole&Appurtenances _ 56. `_ = HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law ;_ Sign with One Branch Circuit 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 Mlsc Conduits&Conductors I'I fi:I�E—: f ."f�'� P P Y, , 3_ :r_._. is not Intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ ;h.,o'-- and Professions Code) 439! 1 f I! 1= 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 certify that I have read this application and state that the above TOTAL FEE 0� 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 pr erty for inspection pur oses SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE Of APPLICANT OR AGENT �� DATE WORKERS' COMPENSATION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-8066 insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 38000, Lab C ) Policy No Company Co-tPi(, Conr -T FOR APPLICANT TO FILL IN JOB Ic- (� Certified copy is hereby furnished �L New Residential Bldgs. & Pools EACH NO FEE ADDRESS TJ r J Ta� S S = G' Certified copy is filed with the county building inspec- 1 & 2-Family, q� Ft $ $ LOCALITY T � tT tion depart ent Multi family Sq Ft NEAREST �1 /�Or S�Z� Residential Swimming Pools CROSS ST o Date Applicant OWNER OR n J a FIRM NAME QQ�� S� S CERTIFICATE OF EXEMPTION FROM WORK S' Outlets- Rec Light Sw_ MAIL COMPENSATION INSURANCE ADDRESS CJZ� S TUBS This section neenot completed if the work involved b First 20 ( tid t b p Y Total No. Additional CITY Gt � Tel No the permit is for one hundred dollars ($100)or less.) PLAN CHECK ,,(('�� p I certify that in the performance of the work for which this APPLICANT V( Gof(MIL4 U00 permit is issued, I shall not employ any person in any manner G !�J p -. so as to become subject to the Workers'Compensation Laws Lighting Fixtures First 20 ADDRESS eZo T k3 N` r Additional � Total No CITY , CR, Tel. No.-J 'Z Date Applicant 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' Range_ Heater_D.W. — Compensation provisions of the Labor Code, you must forth- Oven _ Dryer — W M — ADDRESS ` --�b with comply with such provisions or this ,permit shall be Top FAU —W.H. — deemed revoked Hood _ Fan _ Other— CITY r G Tel. No. 1a3 LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp Room Air Cond REG. NUMBER D_L:_79 O2- Class.G- (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 9L Size &Type HP, KW, KVA, or KVAR O License Number 2-190"7-` Lic Class � Up to 1 Incl. FINAL � �j�b(� s�S. 8 Over 1 to 10 Incl DATE J p,!J VALIDATION Contractor �r ` Date Over 10 to 50 Incl. ( v 1 O FINAL E] I am exempt under Sec Over 50 to 100 Inc. BY 0. B&P.C. for this reason Over 100 A' Date Services,'Swbd , MCC & Ponelboards ► — 0 - 200 Amp Under 600 V Signature 201 - 1000 Amp. Under 600 V F-1Exemption 1000 Amp. or Over 600 V 1 7 A Exemption for Reg Maint. Elect SINGLE FAMILY Temp. Power Pole &Appurtenances ;} 0.0 0 0 0 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's LicenseAdditional Sign Branch Circuits 2 0 - 40,5 0 Law for the following reason (Section 7031 5, Business and Professions Code) 'c.0 n 4 0, rj Q ❑ 1, 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)_ ► 0 5 0 2'-8 4 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 Amp 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 jaws 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 Signatui of Permittee Date WORKER S'COMPENSATION DECLARATION CE-806G (2-80) CAPPLICATION FOR ELECTRICAL PERMIT CE-806 I hereby affirm that I have a*eonsent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate of Workesurance, 2 . a certified copy thereof(Sec. 38FILL JOB Policy No. Company FOR APPLICANT TO EACH N NO. FEE DDRESSNew Residential Bldgs.&PoolsCertified copy is hereby fur 1 &2-Family,Sq. Ft. $ — $ LOCALITY Multi-family Sq. Ft. — NEAREST Certified copy is filed with building i coon CROSS ST _ e at t Residential Swimming Pools OWNER ORK FIRM NAME `[/! 04 Da ppli ant O s. Rec_Light_Sw. MAI L First 20 ADDRESS CERTI CATE OF EXEMPTION FROM WOR RS' Total No Additional CITY I Tel No. COMPENSATION INSURANCE } PLAN CHECK d APPLICANT (This section need not be completed if the work involved OU by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First io ADDRESS Total No. Additional � I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No 0 permit is issued, I shall not employ any person in any Anne PERMIT //'' // '' V so as to b come su ject tot orce om ensat� ' aws. Rang _ Heater_D.W. APPLICANT /!�® d Ove _ Dryer_W.M._ ADDRESS N D pli nt FAU _W.H. Hood _ Fan _Other_ CITY el o. NO ICE T AP ICA after making this Certi icate of Disp. _ Room Air Cond-_ LICENSE OR �1 Exemption, you should become subject to the Workers' REG.NUMBE Class G/ Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT N PR ESS BY with comply with such provisions or this permit shall be Size& ype HP,KW, KVA,or KVAR ��� deemed revoked. Up to 1 Incl. FINAL' Over 1 to 10 Incl. DATE !y7 –Z .�� VALIDATION LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL BY 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 ness and Professions Code,-and my license is in full force and effect. Services License Num ic.Class C� 0-200 Amp. Under 600 V 201-1000 Amp. Under 600 V Contracto �+' •Date Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATIO Temp. Power Pole&Appurtenances I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit -0 1 7 1.5 A License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): 0 0 0 0 o 2 Misc.Conduits& Conductors I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— 2 ° ° 1 200 structure is not intended or offered for sale (Section 7044, Business and Professions Code). o,0'0 1 2 0 0= U CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency Q 2 8_8 for the performance of the work fog which this permit is PERMIT FEE (Sub-Total) issued (Sec. 3097,Civ.C.). Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE 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 ordinancesto laws regul 'ng Electric wiring, and hereby or.__ __ esentative f this County to enter upon thea ve-men o pro r i spection p poses. SEE REVERSE FOR EXPLANATORY LANGUAGE Sign ure&Permit Da �� 10 • WORKERS'COMPENSATION DECLARATION CE 806G (2-80) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that Fhave a certificate of consent to self COUNTY OF LOS ANGELESBUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or a certified copy Pereof(Sec. 3800,Lab.C.) �/ 3/ _ ! FOR APPLICANT TO FILL IN ,JOB Policy No. 6111 (O o pany ADDRESS New Residential Bldgs.&Pools EACH NO. FEE Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY ❑ NEAREST Multi-family Sq. Ft. — Certified.copy is filed with the county building inspection CROSS ST department. Residential Swimming Pools OWNER OR FIRM NAME Date Applicant Outlets Rec_Light Sw MAIL First 20 ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' Total No Additional CITY Tel No22Z } COMPENSATION INSURANCE PLAN CHEQ1K CL APPLICANT 0 (This section need not be completed if the work involved Lighting Fixtures First 20 ADDRESS () by the permit is for one hundred dollars ($100) or less.) - Additional cc Total No._3 O I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No U permit is issued, I shall not employ any person in any manner PERMIT _- � W so as t bec;me subJect to the Workers' Compensation Laws. Range_ Heater D.W. APPLICANT ad r ��. ,, rOven _ Dryer_W.M. ADDRESS NDate � Applican CGks�f Top — FAU —W.H. z Hood _ Fan _Other_ CITY Tel No.2S7 NOTICE TO APPLICANT: If, after making this Certificate of Disp. — Room Air Cond._ LICENSE 049 Exemption, you should become subject to the Workers' REG NUMBER Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCE SED BY with comply with such provisions or this permit shall be Size&Type HP,KW, KVA,or KVAR deemed revoked. Up to 1 Incl. FINAL LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATE . 3 _ VALIDATION Over 10 to 50 Incl. I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc FINAL BY 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 ness and Profess* ns Cod d my license is in full force and effect. �{j Services / License Numb e ic.Class 0-200 Amp. Under 600 V 63a 0 201-1000 Amp. Under 600 V Contractor Date Over 1000'Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits ness and Professions Code): Misc.Conduits&Conductors _ 1 v 6.4 A I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— structure is not intended or offered for sale (Section i o „ c 0 0 2 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 0.0 0,00 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is PERMIT FEE (Sub-Total) 3 o c issued (Sec. 3097,Civ.C.) �' ~ Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE 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 up the ab re-ment*oned pr a for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE lmla Signature of Perm' ate -WORKERS;,COMPENSATION DECLARATION 76A663 CE-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT I✓heteby"affirm that I have a cert' ca of consent to self COUNTY OF LOS ANGELES ING AND SAFETY insdre, or a certificate of Workers' m en ation Insurance,or l a certifi o y the r o Sec.,3�00, � FOR APPLICANT TO FILL IN JOB tom_ Po is Comp ny EACH NO. EE ADDRESS New Residential Bldgs.&Pool s Certified copy is hereby fu rshed.�Z , (tea 1 &2-Family,Sq. Ft. $ _ $ LOCALITY Multi-family Sq. Ft. NEAREST Certified copy is filed with the county building inspection CROSS ST Ay`'-' aepar ent esidenUal Swimming Pools OWNER OR FIRM NAME Date riCpplican Outlets. Rec.—Light— Sw MAIL First 20 ADDRESS RTIFI ATE OF EXEMPTION FROM WO KERS' Total No. Additional CITY TeI No >_ COMPENSATION INSURANCE 0- PLAN CHECK 0 �j� PPLICANT V (This section need not be completed if the work involved / �V by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS cc Additional 0 Total No. I certify that in the performance of the work for which thisFixed Appliances Not Over 1 HP CITY Tel No. U permit is issued, I shall not employ any person in any manner - PERMITa /�� so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT "'lY ' Oven _ Dryer_W.M. ADORES to � ate Applicant Top FAU _W.H. Hood Fan _Other_ CITY o. TICE TO APPLICANT: If, after making this Certificate of Disp. Room Air Cond.— LICENSE OR emption, you should become subject to the Workers' REG. NUMBER !� Class mpensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PRWED BY ith comply with such provisions or this permit shall be Size&Type HP,KW, KVA,or KVAR � Q� emed revoked. O Up to 1 Incl. ' FINAL Over 1 to 10 Incl. DATE / LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. ! a �V VALIDATI reby affirm that I am licensed under provisions of ChapterOver 50 to 100 Inc. FINAL ommencing with Section 7000) of Division 3 of the Busi- Over 100 BY and Professions Code, and my license is in full force and t. Services C / e NumbOZ 0-200 Amp. Under 600 V U se ic.Class 201-1000 Amp. Under 600 V ctg� �✓l a e Over 1000 Amp.or-Over 600 V HOME OWNER-BUILDER DECLARATION Temp.Power Pole& Appurtenances by affirm that I am exempt from the Contractor's Sign with Orie Branch Circuit e Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits d Professions Code): s. 1 4 7. 6 A Misc.Conduits&Conductors as owner of the property, will do the work and the Other (See Complete Fee Schedule)— # o ° 0 0 0 2 cture is not intended or offered for sale (Section 2 ° ° 2�5 0 4, Business and Professions Code). CONSTRUCTION LENDING AGENCY affirm that there is a construction lending agency ° r 2 b. C' erformance of the work for which this permit is PERMIT FEE (Sub-Total) . 3097,Civ.C.). Q 0 7—�. ame PLAN CHECKING FEE (One-Fourth Permit Fee) ,kddress PERMIT ISSUING FEE that I have read this application and state that the TOTAL FEE ormation is correct. I agree to comply with all County to laws regulating Ele icaI wiring, and thorize re sentatives of this C u y to enter upon menti a perty for inspec on urposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE r•re of Permittee 15ate �r WORKERS'COMPENSATION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-806G insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or (s�]ert cL1 e (Sec. 3800, LLobb1 ICI) Pp �/ • Compan;: QJ�+(il t)5R-S FOR APPLICANT TO FILL IN JOB -7a--- ❑ Certified copy is hereby furnished. New Residential Bldgs & Pools EACH NO FEE ADDRESS �(�{ �Certrfie co y is filed with the county building inspec- I & 2-Family, Sq Ft $ _ $ LOCALITY tion d part ent Multi-family Sq. Ft NEAREST /'�,��/,F Residential Swimming Pools CROSS ST Date ? Applicant 02?a OWNER OR gyp` PP FIRM NAM �7et�r9 CERTI ICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ AMAIL DDRESS If}O �72Ct3 COMPENSATION INSURANCE First 20 (This section need not be completed if the work involved by Total No Additional CITY- � p Tel No the permit is for one hundred dollars($100)or less.) I certifythat the performance of the work for which this PLAN CHECK in e 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 Additional Total No. CITY Tel. No. Date Applicant 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' Range_ Heater_D.W. — Compensation provisions of the Labor Code, you must forth- Oven _ Dryer — W.M.— ADDRESS 3a�SC with comply with such provisions or this permit shall be Top _ FAU —W H — 7 deemed revoked. Hood _ Fan _Other_ CITY �3 Te N, 3 7/T LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG NUMBER � 35 Classys=� (commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT IyQ PRO ED BY and Professions Code,and m license is in full force and effect. S Size &Type HP, KW, KVA, or KVAR' License Numb r Lic Class v Up to 1 Incl. FINAL I.) �-�J Over 1 to 10 Incl. DATE / 'J ` ALIDATION Contracto vim+ Date Over 10 to 50 Incl ` G 0 ❑ FINA V I am exempt under Sec Over 50 to 100 Inc. BY � B&P C for this reason Over 100 Date: Services, Swbd , MCC & Panelboards ► - 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 Temp. Power Pole & Appurtenances ;26 1 1.4A HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 1 .8 0 (�.g I hereby affirm that I am exempt from the Contractor's License its o n Branch Circ0 - 40,506 Sigu Law for the following reason (Section 7031 5, Business and Additional Professions Code): ❑ I, as owner of the property, will do the work and the Misc Conduits & Conductors 1 2 1 6-8 6 structures not intended or offered for sale (Section Other (See Complete Fee Schedule)_ pop7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for '7 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) 30 v (Sec 3097, Civ C.) PLAN CHECKING FEE Lender's Name l_r PERMIT ISSUING FEE !(� Lender's Address I certify that I have read this application and state that the TOTAL FEE r above information is correct. I agree to comply with all County ordinances and State jaws regulating Electrical wiring, and hereby authors a Ives of this County to enter upon the above-mthe above-m per for ins ins urp ses SEE REVERSE FOR EXPLANATORY LANGUAGE - Signat e f m Date WORKERS'COMPENSATION DECLARATION 76A66310,81 CE-806G APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-806 insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES Bl1ILDING AND SAFETY qr a certified copy th reof (Sec. 3800, Lab. C.) T, Ysu E o LSd:a tti'l l �l _ 'f Polic No. -Company��� C _� A FOR APPLICANT TO FILL IN JOB .-T /� ❑ yCertified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS .. � L1VJllst t 1 & 2-Family, 5 Ft. $ — $ LOCALIT " � [` Certified copy is filed with th c nt i*�9"rns Y- 4 _ �\ on e riment. Multi-family Sq. Ft. CROSS ST 65P-J�1�•0 L ��_ � � Residential Swimming Pools OWNER OR !! 6 Date Applicant FIRM NAME p .0 F evGJS CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAILADDRESS J,� COMPENSATION INSURANCE .First 20 r-'�/ (This section need not be completed if the work involved by Total No. Additional CITY i ^� Tel. 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'Compensation Laws. Lighting Fixtures First 20- ADDRESS - Total No. Additional CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT �+t -�-. f �t NOTICE TO APPLICANT: 1f, after making this Certificate of �" APPLICANT V'1/y'[L.•rg3 j 0-q�.V 'h.a Exemption, you should become subject to the Workers' Range_ Heater_D.W. — ,�J Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS l AJ_ i.l A-( with comply with such roJisions or this permit shall be �f� ��t p y p p Top FAU —W.H. 4 deemed revoked. Hood _ Fan _Other— `-�+ CITY 13 �'�1 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 t d _/ Class.C-i IID (commencing with Section 7000) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. PROCESS BYE >, and Professions Code,and my license is in full force and effect. tZ Size &Type HP,,KW, KVA, or KVAR' s 0 . License Number G Lic. Class (2,-1 0 Up to I Incl FINAL W R aci�� R L, . 9 -13 Over 1 to 10 Incl. „� VALIDATION 0 DATE Contractor C•4 DateINAL (~j Over 10 to 50 Inc].l ❑ 1 am exempt under Sec. Over 50 to 100 Inc. BY �� � ► ILW B.BP.C. for this reason Over 100 Date: Services, Swbd., MCC & Panelboards , 0 - 200 Amp. Under 600 V 7 Signature 201 - 1000 Amp. Under 600 V ® 6 ` ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole&Appurtenances z 5 0 7. AHOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits #,. 0 0 0 0 Law for the following reason (Section 7031.5, Business and , Professions Code): 2,'o o 2 5,5 0 ❑ 1, 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)_ o o o 2 E-E 0 6: 7044, Business and Professions Code). , vQ 0 9-8 7? 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 X56 above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and . 4reby authorize re resentatives of this County to enter upon "e abovn io, rtyforinspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE nature of Permittee Date 1 WORKERS' COMPENSATION DECLARATION 76A663CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT hereby affirm that I have a certificate of consent to self CE-806G (� nsure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY ,\ or a certified copy thereof (Sec 3800, Lab. C.) kvl �(�DI!1�{ b p yL4AJ 1 —Aim =_ P o. Com an FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO FEE ADDRESS ❑ 1 & 2-Family, S Ft. $ — $ LOCALITY Certified copy is filed with the co ty building inspec- y- q tion department. Multi-family Sci Ft. NEAREST CROSS ST. Date ! A Lica Residential Swimming Pools OWNER OR pp FIRM NAM CERTIFICATE OF EXEMP ION FROM WORKERS' MAIL COMPENSATION INSURANCE Outlets: Re Ligh w. ' a'7 1 6-— ADDRESS First 20 (This section need not be completed if the work involved by Total No. Additional . mil s — CITY T.I. UCJffg-� Al-10) 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 S' f so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No Additional CITY Tel. No. Date Applicant Fixed Appliances Not Over I HP PERMIT NOTICE TO APPLICANT. If, after making this Certificate of APPLICANT 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. N LICENSED CONTRACTORS DECLARATION — LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp — Room Air Cond. REG NUMBER Cl-s (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 @t Size &Type HP, KW, KVA, or KVAR .J�,D S D RTSE�-rel License Number l Lic. Class I U to 1 Incl. a FINAL C"rl ��Ar���� Over 1 to 10 Incl. DATE � i Contractor C.. TZL ate " FINAL °� ��� VALIDATION ❑ Over 10 To 50 Incl. I am exempt under Sec. Over 50 to 100 Inc. BY Over 100 B&P C for this reason Date. Services, Swbd , MCC & Ponelboards ® �� 0 -200 Amp. Under 600 V 61 Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg MaOver 1000 Amp. or Over 600 V mt Elect - 493.7A SINGLE FAMILY Temp. Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ifi o o o 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 2 0 10800 Professions Code): _ ID1, as owner of the property, will do the work and the Mi Conduits& Conductors U 1 0 u O Q structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)— , 0'9 01 —83 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) 9 7 (Sec 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address f 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 *the ances a d State laws regulating Electrical wiring, and y autho ze representatives of this County to enter upon bove-m tioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ture of ermittee Date i WORKERS'COMPENSATION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of�seo1 jp self CE-8066 A insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a}certified cop thereof (Sec 3800, Lab C.) i Poick y No ( i%6;; Sy FOR APPLICANT TO FILL IN JOB 1W M� ) �5 7o I,65 Certified co is hereby furnished. EACH NO FEE ADDRESS (r� (, 0~,1 PY Y New Residential Bldgs & Pools Certified copy is filed with the county building inspec- 1 & 2-Family, Sq Ft $ — $ LOCALITY tion department Multi-family Sq. Ft — NEAREST CROSS ST. Residential Swimming Pools OWNER OR Date / Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw_ MAIL COMPENSATION INSURANCE First 20 ADDRESS (This section need not be completed if the work Involved by Total No. Additional CITY Tel. 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'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No Additional CITY Tel. No Date Applicant 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' 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 Q Z Class. (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 Size & Type HP, KW, KVA, or KVAR d O License Number ;27q6 Z Lic. Classes Up to 1 Incl FINAL Over 1 to 10 Incl c g e VALIDATION O Contractor Date DATE ®/ Over 10 to 50 Incl Im- FINAL I am exempt under Sec. Over 50 to 100 Inc. BYtom• B &P C for this reason Over 100 H Date Services, Swbd.,, MCC& Ponelboards , 0 - 200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V Exemption for Reg Moint. Elect Over 1000 Amp or Over 600 V 52& 1 A SINGLE FAMILY Temp. Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 01-3 -4. a o o o o2 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 and2 0 0 4 Q 5 0 Professions Code) o c 0 I, as owner of the property, will do the work and the Misc Conduits&Conductors 4 0 5 0 50, structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ , 7044, Business and Professions Code). 0 Q 14-83 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) Q (Sec 3097, Civ. C ) PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE %U r 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 70, ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon thea ve-mentioned prop irqy for inspection urposes. ✓/ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Per ittee ye lI COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELEC'T'RICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0906110023 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID BUILDING ADDRESS: I ITR: 362 LT: 01 I I 8905 LAS TUNAS DR I I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 91780 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: I 15387-012-028 IA1 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl I IK1 SIGNS, OUTLINE LGT 1.00 SIG 38 85 I 1 (TENANT: I TOTAL FEES 66.60 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1 1 1 106/11/09 SR 12/08/09 1 I I I I (OWNER: TEL. NO: I IFINAL DATE FI ABY: CODE: I ICANOIS IPSWITCH (626) 792-1156- 1 1 I 1301 E. COLORADO BLVD (PASADENA, CA 91106I D-E RT OF WORK I I (INSTALL ONE ILLUM POLE SIGN, THREE ILLU SINGS, ONE ILLUM, I I I (AWNING ONE ATM SURROUND, TWO ILLUM ATM TOPPER AND TWO ATM I (APPLICANT: TEL NO: I ICABINETS I ISTEVE THERRIAULT (619) 527-6100- I 1 I 14444 FEDERAL BLVD. I ISPECIAL CONDITIONS: I ISAN DIEGO, CA 92102 1 I 1 I I I I I I I I (CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE I ISIGNTECH ELECTRICAL ADVERTISING, IN (619) 527-6100- 1 1 1 14444 FEDERAL BLVD. LIC. NO I ITEMPORARY POWER POLE I I I ISAN DIEGO, CA 92102-2505 457406 C45 I I I I I (UNDERGROUND CONDUIT I I I I I I I I I (ARCHITECT OR ENGINEER: TEL. NO. I IUFER GROUND I I I I LIC. NO: I IROUGH CONDUIT 1 I I I I I I I I I I IROUGH WIRING I I I I I I I I I I IMAIN WATER LINE I I I I 1 IPLASTIC Y/N METAL Y/N I I I I I I I I I I I (UTILITY COMPANY NOTIFIEDI I I I I I I I I I I I I I I I I I I I I I I I I I I I i I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I f I I I I I I I I I I I I I I I I I I I I I I IREPORT ID. DPR265 ROUTE TO: BSO508 I I I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1009220040 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT ILEGAL ID: I FEES PAID BUILDING ADDRESS: ITR: 362 LT: 01 1 1 8905 LAS TUNAS DR 1 I IFEE DESCRIPTION: QUANTITY: UOM- AMOUNT- 1 TEMP CA 91780 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 1 15387-012-028 1A1 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE. 596 GRID. H3 LOCALITY: TEMPLE CITY, Cl I IF1 120V, 15/20A BR CKTS 3 00 BR 51.90 1 (TENANT- IG1 OUTLETS-LGT,SW,RECP 7.00 OUT 13.60 (ISSUED ON PROCESSED BY- PLAN BY: 1 IJP MORGAN CHASE BANK IG2 LIGHTING FIXTURES 7.00 LGT 13.60 109/22/10 SR 1 I i TOTAL FEES 106 90 1 1 (OWNER: TEL NO: (FINAL DATE FINAL BY CODE. IJP MORGAN CHASE BANK I I I 15ESCRIPTION OF WORK u1 1 1 13 BRANCH CIRCUITS, 7 OUTLETS AND 7 LIGHT FIXTURES i I I I I (APPLICANT• TEL. NO 1 1 IBURNHAM NATIONWIDE, TASIA KALLIES (213) 840-8292- 1 1111 W. WASHINGTON ST 1 ISPECIAL CONDITIONS: 1 1CHICAGO, IL 60602 I I I I I I I I I ICONTRACTOR: TEL. NO: 1 1APPROVALS DATE INSPECTOR SIGNATURE 1 ICE FRY CONSTRUCTION CO INC. (909) 920-5015- 1 I 1 1286 CORPORATE WAY LIC. NO I ITEMPORARY POWER POLE I I 1 UPLAND, CA 91786 299051 B 1 I 1UNDERGROUND CONDUIT I 1 I I I I I I (ARCHITECT OR ENGINEER: TEL. NO: I IUFER GROUND I IDESIGN FORUM ARCHITECTS - I I I 1 1 17575 PARAGON ROAD LIC. NO: I (ROUGH CONDUIT I 1DAYTON, OH, 45459 C-28464 I I I I 1 1 I IROUGH WIRING I I I I I I I I I (MAIN WATER LINE I1 1 I 1 1PLASTIC YIN METAL YIN I 1 I 1 I 1 I 1UTILITY COMPANY NOTIFIEDI I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 1 (REPORT ID: DPR265 ROUTE TO BS0508 1 I I 1 I 1 I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0912150024 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID. FEES PAID BUILDING ADDRESS: ITR: 362 LT: 01 8905 LAS TUNAS DR 1 1FEE DESCRIPTION: QUANTITY: UOM. AMOUNT: TEMP CA 91780 ASSESSOR INFORMATION NUMBER: 1 1 NEAREST CROSS STREET: 15387-012-028 1A1 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl IF1 120V, 15/20A BR CKTS 18.00 BR 289.05 (TENANT: I TOTAL FEES 316.80 (ISSUED ON. PROCESSED BY: PLAN BY- EXPIRES ON: 1 1 112/15/09 SR 12/15/10 1 1OWNER: TEL. NO: (FINAL AT FINAL BY: CODE: 1 1CHASE BANK - � '(� I 18905 LAS TUNAS DR. 1 V ITEMPLE CITY CA 91780 1 SCRI IOR OF WORK I I ITENANT IMPROVEMENT LIGHTING POWER FOR CHASE BANK 1APPLICANT: TEL. NO: I ITERRELL LANGSTON (PERMIT PLACE INC. (818) 786-8960- I 1 I 113400 RIVERSIDE DR. ISPECIAL CONDITIONS: 1 1SHERMAN OAKS 91423 1 1 I � I I 1CONTRACTOR: TEL. NO: I 1APPROVAILS DATE INSPECTOR SIGNATURE 1 1DBSI INC (602) 264-7263- 1 1 1 16950 W MORELOS PLACE LIC. NO - 1 1TEMPORARY POWER POLE I I I 1SUITE 1 931142 B 1 CHANDLER, AZ 85226 1 (UNDERGROUND CONDUIT 1 1 1ARCHITECT OR ENGINEER: TEL. NO: 1UFER GROUND I I I 1NUDELL ARCHITECTS (714) 979-8100- 1 I 1 1 1950 SOUTH COAST DRIVE LIC. NO- I IROUGH CONDUIT 1 I 1 ISUITE 150 C-30699 I I 71 ICOAST MESA, CA 92626 IROUGH WIRING 1 I 1 IMAIN WATER LINE I 1 I 1 IPLASTIC YIN METAL YIN 1 1 _ 1UTILITY COMPANY NOTIFIEDI 1 1 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 1 IREPORT ID: DPR265 ROUTE TO: BS0508 1 1 1 I I I I I I ` COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1208300025 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID- I FEES PAID BUILDING ADDRESS: ITR: 362 LT: 01 1 8905 LAS TUNAS DR I IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT: TEMP CA 91780 ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET- 15387-012-028 IA1 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl I IF1 120V, 15/20A BR CKTS 6.00 BR 103.80 (TENANT: IF2 208, 277V LGT BR CKT 2.00 BR 54.60 (ISSUED ON: PROCESSED BY: PLAN BY: ICHASE BANK IG1 OUTLETS-LGT,SW,RECP 6.00 OUT 12.00 112/03/12 SR IG2 LIGHTING FIXTURES 9.00 LGT 18.00 1 OWNER: TEL. N0: TOTAL FEES 216.20 IFINAP DATE FIDIAL $Y: CODE: (CHASE BANK (714) 308-6982- 11107 S. HARBOR BLVD. I I IFULLERTON, CA 92832 I ESCRIPT ON OF WORK (ADD LIGHTING FIXTURE TO NEW OFFICE AND HALLWAY CHASE BANK IT/I APPLICANT: TEL. NO: IYAM, JUDY (626) 675-9882- I 1392 N. LE MAY COURT ISPECIAL CONDITIONS: ORANGE, CA 92867 1 I 1 I 1 (CONTRACTOR: TEL. NO: I JAPPROVALS DATE INSPECTOR SIGNATURE I IDBSI INC (602) 264-7263- I I 16950 W MORELOS PLACE LIC NO I ITEMPORARY POWER POLE I I ICHANDER AZ 85226 931142 * I I I I I I (UNDERGROUND CONDUIT I 1 I I I I I I (ARCHITECT OR ENGINEER: TEL NO I IUFER GROUND I I 1 IMORFORD, PAUL (949) 863-9434- I 1 I 1 14675 MACARTHUR CT, STE 350 LIC. NO: I IROUGH CONDUIT INEWPORT BEACH, CA 92660 931142 * * I 1 I I ROUGH WIRING I A IMAIN WATER LINE I I 1PLASTIC Y/N METAL Y/N I I I I I I (UTILITY COMPANY NOTIFIED( I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 1* ADDITIONAL DATA ON FILE I 1 I I I I I I I I (REPORT ID: DPR265 ROUTE TO:- BS0508 I I I I I I