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HomeMy Public PortalAbout9100 LAS TUNAS DR_Electrical__ 76A663 DSS'SA 25M SETS 11-4e APPLICATION FOR PERMIT - DEPARTMENT OF BUILDING AND SAFETY �������� COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER DISTRICT NO. GROUP ZONE PERMIT NO. FOR AP LICANT TO FILL IN /� ELECTRICIAN RECEIVED BY READY FOR DATE ISSUED ADDRESS L FIRST INSPECTION CITY R TEL. NO. /-73 � � ' C� BUILDING LICENSE NO. EXPIRES ADDRESS DESCRIPTION OF WORK FEES LOCALITY NUMBER OUTLETS EACH LIGHTS Sc CROSS $ Z.0 STREET RECEPTACLES 5 „_ Q FIXTURES s OWNER WALL SWITCHEB 5 I MAIL ADDRESS ELEC. RANGES 2s ELEC. HEATERS 25 CITY TEL. NO. MISC. 1 CERTIFY THAT 1 PO SESS THE ABOVE VALID LOS NUMBER OF CIRCUITS INSTALLED: ANGELES COUNTY LICE LIGHTS RECEPTACLES MOTORS ELECTRICIAN. NUMBER HORBEPOWER FEE NEW MvD. HP OVER INC. EACH 1 AM THE LEGAL OWNER OF THE RESIDENTIAL PROP- V2 6 LESS $ .25 ERTY DESCRIBED ABOVE. I/2 2 .50 2 5 1.00 OWNER. 5 is 1.50INSPECTION RECORD is so 2.50 5O 200 5.00 200 500 10.00 Soo 11300 15.00 J Q OVER 1000 20.00 Z M.G. SET/FREQ. CHANGER-HP n WELDERS:AC-KVA O GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (75% OF ORIGJ MOVED MOTORS (75% OF ORIG.) MISC. SIGNS TYPE: NO.TRANS. TYPE: N0. LAMPS APPROVALS PERMIT FEE DATESPEE�CTORIS NAME FOR ISSUING PERMIT: CONDUIT J{ a. WITHOUT FIXTURES $1.013 WIRING WITH FIXTURES 1.25 FIXTURES SUPPLEMENTARY .50 POWER TOTAL FEE $ UTILITY CO. NOTIFIED A I FINAL / �r // T-e- /�W' '6A663-CE806 5-62 APPLICATIO FO/u CTRI A4IT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS ov 77 JOHN A. LAMBIE. COUNTY ENGINEER WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY i NEAREST FOR APPLICANT TO FILL IN CROSS ST. _ RECEPT. TOTALNO. EACH FEE OUTLETS FIRST 20 20 $ D.l OWNER LIGHT - _ MAIL ' SWITCH2 OVER 20 .10 2/) ADDRESS TOTAL vv CITY TEL. NO. LIGHTING FIRST 20 .20 FIXTURESADD L 10ELECTRICIA OVER 20 RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS C/ GARB.DISP. STA COOK CITY r EL. NO. J �� DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.(ys H.P.MAX ) .SO LICENSE NO. MOTORS OVER NOT OVER HP. DIST G OUP ZONE P SSED BY O 1 1.00 �� .� 1 3 ' 1.5o INSPECTION RECORD 3 a 2.00 a 15 2.50 d O is So 300 V 50 100 Soo O H SIGNSs NO.TRANS U NO LAMPS a N SERVICE 0.60OV-Nor OVER 200A 100 Z SERVICE 0.60OV-OVER 200 A. 2.00 SERVICE OVER 600V 500 MISC. PERMIT ISSUING FEE 200 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLIC TION APPROVALS DATE INSPECTOR'S SIGNATURE AND HTATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING , ELECTRICAL WIRING. WIRING 1HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED A9 REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY `_7,v K' POWER SIGNATURE �I UTILITY CO.NOTIFIED OF PERMITTEE t g� p FINAL acl LIDATION ARTHUR C. VETT MO CASH SUPERVISING ELECTRICAL ENGINEER 11 Lr ,o 5 5 8 0 NOV 4 2 D 9,Li G 17 "was 5 -46 = �i AMLYCATION FOR. PER`1$ff DEPARTMENT OFF LOS A G AND $AI�'E'I'Y EW4d J • COUNTY OF LOS ANGELES 1 MA. J. FOX CHIEF ENGINEER Q NAME DISTRICT NO. GROUP ZONE PERMIT NO. � ADDRESS 62 X67 U CITY TEL.NO. RECEIVED BY READY FOR DATEISSUED A CERT.NO. 7q3K,X40 LIS EXPIRES i� FIRST INSPECTION APPLICANT FILL IN HEAVILY foul TLINED PORTION ONLY JOB DESCRIPTION OF WORK ADDRESS / 7 NUMBER OF OUTLETS ON CIRCUITS LOCALITY LOCATION BY ROOMS NEAREST LIGHT OUTLETS SW. PLUGS FIXT CROSS ST- C T. CIRCUIT A B C D I E F G H Ir NAME I Z MAIL ADDRESS O CITY TEL.NO. 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CER ELECTRICIAN. I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE OWNER. CORRECHONS J Q • Z_ 0 O [TOTAL, NO. OF OUTLETS $ ( APPROVALS NO. OF FIXTURES $ V� DATE INSPECTOR'S NAME NO. OF MOTORS H.P. $ CONDUIT NO. OF SIGNS TRANS. $ WIRING NO. OF EATERS $ y J FIXTURES MISCELLANEOUS $ / POWER PERMIT FEE $ L L� UTILITY CO.NOTIFIED TOTAL FEE 17 ® FINAL 76A663 DBS SA 3-60 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES �������� 1 WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO. p RECEIVED Y 00 READY FOR DATE ISBII D ADDRESS �� ,� �g, �® � )FIRST INSPECTION �;;p CITY �/ty - TEL NO. t9'ft e� U COUNTY LICENSE NO. ® - , EXPIRES �S-eY BUILDING ADDRESS PERMIT FEES NUMBER EACH FEE LOCALITY '�7 LIGHT OUTLETS NEAREST CROSS ST. RECEPTACLES WALL SWITCHES , OWNER TOTAL OUTLETS Sc MAIL r `-•`- ELEC. RANGES 25 ADDRESS ELEC. HEATERS 25 CITY �� TEL NO. FIXTURES 5 1 HEREBY ACKNOWLEDIfE THAT 1 HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. MOTORS 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOB NUMBER HORSEPOWERFEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER New MVD. HP OVER I Z INL.ESS !S EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. SIGNATURE OF I�2 2 .50 PERMITTED 125-0-4114e'G(� 2 5 1.00 INSPECTION AECORD 5 15 1.50 15 SO 2.50 50 200 5.00 200 500 10.00 J 500 1000 15.00 Z OVER 1000 20.00 d M.G. SET/FREQ. CHANGER-HP WELDERS: AC-KVA D GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (7S% OF ORIG-) - MOVED MOTORB (75% OF ORIG.) MISC. SIGNS 4 e NO. NO.TRANS APPROVALS NO. NO. LAMPS 1 FOR EACH PERMIT: DATE INSPECTOR'S NAME // WIRING $1.00 CONDUIT �f FIXTURES $1.00 WIRING SUPPLEMENTARY .50 FIXTURES ®/7 POWER TOTAL FEE r�A —UTILITY CO.NOTIFIED FINAL a DBS-BS-5A 12-54 53 A [ LiCAT�ON ■ O \ ELECTRIC PERfli� i ■ 1 D DIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles BUILDING WM. J. FOX, COUNTY ENGINEER ADDRESS i. CASSATT D. GRIFFIW,SUP'T OF BUILDING ,!� FOR APPLICANT TO FILL IN LOCALITY C'6 PERMIT FEES NEAREST CROSS ST — — FEE NUMBER EACH {� LIGHT OUTLETS OWNER ,z2W/,7 fioQ C�-�"�'� j1�i4C'.0 RECEPTACLES MAIL,ADDRESS WALL SWITCHES TOTAL OUTLETS 5d $ CITY TEL NO ELEC. RANGES 25 ELECTRICIAN r% ELEC HEATERS 25 ADD14ES5 rJ / �+O��✓I KW EA _ CITY Ff;t;5 P'pTEL NO�.'�+ -Z�a'-S/•7 FIXTURES 5 LICENSE NO. t� NUMBER OF LIGHT CIRCUITS NUMBER OF RECEPTACLE CIRCUITS DISTRICT NO GROUP ZONE READY FOR INSPECTION � J� MOTORS p NUMBER HORSEPOWER FEE INSPECTION RECORD NEW MVD HP OVER INC EACH _ I�&LESS $ 25 1/2 2 50 2 5 1 00 5 15 1 50 15 50 2 50 1 50 200 5 00 , MISC NO SIGNS NO TRANS NO SIGNS NO LAMPS FOR EACH PERMIT: WIRING - $100 FIXTURES $100 - SUPPLEMENTARY 50 APPROVALS TOTAL'FEE $ .rG Q V DATE INSPECTOR'S SIGNATURE I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS-ANGELES COUNTY AND STATE OF POWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY - UTILITY CO NOTIFIED - SIGNATURE ""Z) FINAL OF PERMITTEE WILLIAM J. FOX,COUNTY ENGINEER _VALIDATION In �4_ 9 4- JM8 2 2.00 DEPUTY 76AS63 DBB SA 3—s0 APPLICATION FOR PERMIT � DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES ELECTRIC 1 WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP �ZONE PERMIT NO. ELECTRICIAN / C RECEIVED BY READY FOR DATE ISSUED ADDRESS ZD 17/E'. "} / FIRST INSPECTION CITY 9-r4 S` IJ TEL NO.S' 2 P Vid6�.� 3o-3 COUNTY LICENSE. NO. ^D` EXPIRES . 46-tr BUILDING PERMIT FEES ADDRESS 9/B D S./419-sS 14- NUMBER NUMBER EACH FEE LOCALITY /� 40 LIGHT OUTLETS NEAREST CROSS ST. RECEPTACLES WALL SWITCHES OWNER 000. TOTAL OUTLETS 5C ELEC. RANGES 25 ADDRESS 9//Q:0 �. V�� G/�''�J ELEC. HEATERS 25 CITY 7 / EL. NO. FIXTURES 5 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS 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 LOB -NUMBER HORSEPOWERANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER FEE NEW MVD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. %2 a REBS $ .25 SIGNATURE OF o' %2 2 .50 - PERMITTEE- .00 2 5 1.00 INSPECTION nCORD 5 15 1.50 15 50 2.SO 50 200 5.00 200 BOO 10.00 JQ ..500 1000 15.00 Z OVER 1000 20.00 (3 M.G. BET/FREQ. CHANGER-HP - Q' WELDERS:AC-KVA G GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (75% OF CRIB-) MOVED MOTORS (75% OF ORIS.) MISC. SIGNS NO. to NO.TRANS. NO. NO.LAMPS l APPROVALS FOR EACH PERMIT: D 1 ECTO 'S NAME WIRING $1.00 CONDUIT Q FIXTURES $1,00 WIRING A. SUPPLEMENTARY .50 -FIX TURES �1 N 7POWER e I t � v1 TOTAL FEE $ L— Q C UTILITY CO.NOTIFIED FINAL IIA663 6B.-SA r APPLICATION FOR ELEC 0 RIC ,P6_ ■ ■MI ■ 1 12.54 DIVISION OF BUILDING AND SAFETY Department of County Engineer County of'Los Angeles BUILDING WM. J. FOX, COUNTY ENGINEER ADDRESS/�DD/- fid /. ala CASSATT D. GRIFFIN, SUPT OF BUILDING FOR APPLICANT TO FILL IN LocauTv PERMIT FEES NEAREST CROSS ST FEE NUMBER EACH LIGHT OUTLETS � OWNER RECEPTACLES MAIL y ADDRESS WALL SWITCHES TOTAL OUTLETS (0:1 50 S �_ CITY TEL NO ELEC RANGE 25 ELECTRICIAN f ELEC HEATERS 25 ADDRESS /ZV06LS 9P &hN j4D K7,n J6_[P La >' KW EA A CITY ` -Q[//N Ci TEL NO E.D 23CP FIXTURES 5 6 LICENSE NO. Q NUMBER OF LIGHT CIRCUITS DISTRICT NO GROUP I ZONEREADY FOR INSPECTION NUMBER OF RECEPTACLE CIRCUITS MOTORS 10, NUMBER HORSEPOWER FEE INSPECTION RECORD NEW MVD HP OVER INC EACH I/2&LESS $ 25 I12 2 2 5 100 5 15 1 50 15 50 2 50 50 1 200 5 00 " MISC ,Oyeee NO SIGNS NO LAMPS FOR EACH PERMIT' WIRING sl 00 FIXTURES st 00 SUPPLEMENTARY .50 APPROVALS TOTAL FEE s 1J DATE INSPECTOR'S SIGNATURE 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CONDUIT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ./1 A WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING IHEREBY 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 OWNER OF THE ABOVE POWER, DESCRIBED RESIDENTIAL PR TY' SIGNATURE UTILITY CO NOTIFIED ��j� /1 J5• OF PERMITTEE FINAL WILLIAM J. FOX, COUNTY ENGINEER VALIDATION ,my 2 2 8.2 5 In c� tc 32 Y u, BY DBS-SA 11-59 APPLICATION FOR ELECTRIC PERMIT 1 DBS-SA DIVISION OF BUILDING AND SAFETY Depas ent of County Engineer FEBUILDING //�Countp Of LOS Angeles SJOHN A. LAMB1E.COUNTY ENGINEER CASSATT D. GRIFFIN, SUPT OF BUILDINGTY FOR APPLICANT TO FILL IN NEAREST ST. 1(�i PERM FEES �/ NUMBER OWNER f 11 MAIL LIGHT OUTLETS RECEPTACLES ADDRESS WALL SWITCHES FEE CITY TEL. NO. TOTAL OUTLETS @ s¢ $ ELECTRICIAN J Y') =�� ` ELEC. RANGES 25 ADDRESS ELEC. HEATERS 25 CITY TEL. NO.. KW EATATE FIXTURES g LICENSE NO. D—4 �/ / MOTORS DISTRICTNO. I GROUP I ZONE READY FOR INSPECTION E NUMBR HORSEPOWER FEE /I/'r✓�G C NEW MVD. HP OVER INC. EACH >�$LESS $ .25 INSPECTION RECORD Yz 2 .50 �? 2 5 1.00 s 1s 1.50 is 50 2.50 50 200 5.00 MISC. NO.SIGNS NO.TRANS. NO. SIGNS NO. LAMPS FOR EACH PERMIT: WIRING $1.00 J(� FIXTURES $1.00 SUPPLEMENTARY .50 APPROVALS TOTAL FEE $ C3 DATE INSPECTORS SIGNATURE IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING O ELECTRICAL WIRING. 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE POWER DESCRIBED RESIDENTIAL PROPERTY. SIGNATURE / UTILITY CO.NOTIFIED OF PERMITTEE ' ' FINAL JOHN A.LAMBIE.COUNTY ENGINEER ATION ARTHUR C.VETT.CHIEF ELECT.INSPECTOR C8 CASH AUG 6 3.0 U DB S-A 12-43 2SM �Py14H01\ FOA rE .. DEPARTMENT OF BUILDING AND-SAFETY COUNTY OF LOS ANGELES ELECTRIC WM. J. FOX CHIEF ENGINEER'- _a NAME DISTRICT NO, GROUP (/ZONE PERMIT NO U ADDRESS L� E 1' 69 RECEIVED BY READY FOR DATE'ISSLIED UW CITY /�, L.NO. -q- e�' FIRST-JNSPECTION J COUNTY rgW .CERT.NO. EXPIRES Jtl�� ✓ APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY , DESCRIPTION OF WORK joe ADDRESS .2 NUMBER OF OUTLETS ON CIRCUITS LOCALITY LOCATION BY ROOMS NEAREST LIGHT OUTLETS JSW. PLUGS jFliT CROSS ST. CIRCUITSs A B C D E F G H m NAME 34 © (. L 3 MAIL ADDRESS/ O CITY � �II.e TEL.NO. r 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIF1pATE OF�U L1FI TION.. ELECTRICIAN. I AM THE LEGAL OWNER.OF THE PROPIKRTY DESCRIBED ABOYB OWNER. CORRECTIONS 7- J Q _Z L7 (Y O TOTAL NO. OF OUTLETS 0 $ / (�� APPROVALS NO. OF FIXTURES $ / o DATE INSPECTOR'S NAME NO. OF MOTORS H.P. $ CONDUIT NO. OF SIGNS TRANS. $ WIRING LPERMIT F RANGES OR HEATERS - $ FIXTURES LLANE US �j $ POWER FEE rY ! U $ + UTILITY CO.NOTIFIED FE +�' FINA t 'fl 76A663-CE80611_71 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES 1 DEPARTMENT OF COUNTY ENGINEER t BUILDING BUILDING AND SAFETY DIVISION .1 ADDRESS • LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. OUTLETS NO EACH I FEE $ $ OWNER RECEPT._ MAIL LIGHT TOTAL FIRST 20 Z5 ADDRESS SWITCH OVER 20 10 CITY TEL. NO. PLAN CHECK LIGHTING TOTAL FIRST 20 25 APPLICANT Icsp FIXTURES 10 OVER 20 ADDR SS RESIDENTIAL APPLIANCES CITY + TEL. N0. PERMIT RANGE DRYER_WTR. HTR. APPLICANT STA. COOK DISP F.A U. ADDRESS SPACE HTR. AIR COND CITY TEL. NO. CLOTHES WASH. DISHWASH LICENSE NO. CLASS. FAN OTHER 100 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 PROPER RE I ERE AND/OR Q - 100 LICENSED AS REQUIRED BY L09 ANOELE U AND STATE OF } CALIFORNIA OR THAT I AM THE LE L E NO INTEND TO d - 1O 300 RESIDE IN, THE ABOVE DESC B E L R Y O / U SIGNATURE 10 - 50 500 OF PERMITTEE Q 50 - 100 1000 C DISTRICT NO ClA eNE 100 - 500 1500 PRO ED B W _508 - Z ` a SIGN, GAS SIGN AND ONE CIRCUIT 500 v NOTES: ? TUBE, OR MARQUEE ADDITIONAL CIRCUITS 100 SERVICE NOTOVER 600 VOLTS OR 200 AMP 300 APPROVALS DATE INSPECTOR'S SIGNATURE SERVI CE OVER 600 VOLTS OR 200 AMP 1000 TEMP.POWER POLE TEMP SERVICE,POLE, &APPURTENANCES 500 UNDERSLAB WORK TEMP LIGHT OR RECEPT, SYSTEM 300 ROUGH CONDIUT yam' WIRING FIXTURES Y POWER AUTHORIZED PERMIT FEE (SUB TOTAL) UTILITY CO. NOTIFIED PLAN CHECK FEE PERMIT ISSUING FEE 300 U FINAL TOTAL FEE PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION CK M 0 CASH } r� 1 1 2 673 MAY 15 2 D 8. ONcv SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE WORKERS' COMPENSATION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT f 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 C` BUILDING AND SAFETY or a c�ti ed coQy�tS�of(Sec 3800, La Policy o C� /�iCompany W I dt:A84A FOR APPLICANT TO FILL IN 'OB a ,,i ❑ Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS �O L L,15:7 /v (Y`1 1 82-Famil S Ft $ _ $ LOCALITY PLS C �7e JCJ Certified copy is fled with the my builds g i spec- Y. q ti departmenQt Jl Multi-family Sq Ft NEACROREST .,� �J �V Residential Swimming Pools OWNER OR ' Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Recc_.L-ght_4Sw� MAIL COMPENSATION INSURANCE U ADDRESS S �f G� (This section need not be completed If the work Involved by First 20 Total No�L_ Additional Ll CITY Tel No > the permit Is for one hundred dollars ($100)or less.) PLAN CHECK l 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 Date Applicant Additional CITY Tel No Fixed Appliances Not Over 1 HP PERMIT NOTICETO APPLICANT If, after making this Certificate of APPLICANT p G� >� NS 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 lAq vi, C with comply with such provisions or this permit shall be Top _ FAU —W H — deemed revoked Hood Fan _Other_ CITY Tel No32 1-I LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp — Room Air Cond REG NUMBER Class Rd (commencing with Section 7000) of Division 3 of the Business DISTRICT NO PROCES D BY Power Apparatus & Large Appliances i � and Professions Code, and my license is in full force and effect V �('2 �7 Size & Type HP, KW, KVA, or KVAR License umber� d 1c3 Gf Lic Class to 1 Incl FINAL U -/�j4e g 'C�ver�to 10 Incl DATE -� / VALIDATION Contrac 6 7�4�7�f/�4 Over 10 to 50 Incl ❑ FINAL U I am exempt under Sec Over 50 to 100 Inc. BY p„r LU Over 100 B &P C for this reason p� Date Services, Swbd , MCC& Panelboards , 0 - 200 Amp Under 600 V Signature 201 - 1000 Amp Under 600 V 3 ❑ Over 1000 Amp or Over 600 V Exemption for Reg Maint Elect SINGLE FAMILY Temp Power Pole&Appurtenances ;F 5 0 7. 1 A HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License # o o o 0 o 2 Law for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits Professions Code) .2,- o70,75 ❑ 1, as owner of the property, will do the work and the Mi sc Conduits&Conductors o p o 7 0 7 5 6 structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ , ^ 09,'0-9-83 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) (Sec 3097, Civ C ) PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE U Lender's Address 1 certify that I have read this application and state that the TOTAL FEE 2(?r' above information is correct I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereb uthori�resentatives of this County to enter upon the e-mepr perty for inspection purposes /tet o a SEE REVERSE FOR EXPLANATORY LANGUAGE nature of Permittee �/ Date' O J