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HomeMy Public PortalAbout9123, 9123 1/2, 9125, 9125 1/2 LAS TUNAS DR_Electrical__ 76A663 CE.-806 NF 6/78""" ' - • APPLIC �T.I®N R .ELECT -AL PER010vIT, COUNTY_OF LOS;ANGELES BUILDING AND SAFETY '. FOR APPLICANT TO FILL IN •• JOB /� �+u,y, New Residential Bldgs.&Pools' EACH NO. FEE ADDRESS 1 �V 1 &2-Family,Sq. Ft;:- A — $, LOCALITY ' C' Multi=family Sq'Ft- — NEAREST CROSS ST. Residential Swimming'Pools OWNER OR FIRM.NAME 1 Outlets:Rec.Light ' Sw. MAIL. p i First 20 ADDRESS-\1' '� U Total No. Additional CITYY ' PLAN CHECK, APPLICANT Lighting Fixtures First 20' ADDRESS. , Total No. Additional CITY -- Tel, No. Fixed Appl'iance's Not Over 1,HP PERMIT APPLICAN .,✓"C Range Heater D.W. — _ ADDRE55 �j r Oven Dryer W.M._ � � GT Top _FAU W H:• ` .; CI 4524�jy� v�/5'J21-No.�_ 7::S2a Hood_Fan' Other LICENSE OR Disp._Room.Air Cond. REG.NUMBER �7� Class.II f I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA. ` Power Apparatus&Large Appliances TION AND STATE THAT_THE ABOVE IS CORRECT AND-AGREE TO Size&Type HP; KW, KVA,or KVAR COMPLY .WITH ALL•COUNTY ORDINANCES AND,STATE LAWS Yp REGULATING ELECTRICAL WIRING. Up to 1 Incl. 0 I HEREBY CERTIFY THAT I'AM PROPERLY'REGISTERED AND/OR Over"1 to 10 Incl. - LICENSED AS'REQUIRED BY LOS ANGELES COUNTY AND STATE OF Over 10 to 50 Incl: CALIFORNIA OR THAT IAM TH LE R OF THE ABOVE Over 50 to l 00.Inc. D ESCR PROPERT 0 PERMIT Over-100 SIGNATURE Services - -DISTRICT NO. ROLES ED BY - 0-200 Amp. Under 600 V �^ 201-1000 Amp: Under,600 V• —��'C� Over 1000 Amp.or Over 600 Vim?y� Temp. Power Pole&Appurtenances Sign with One Branch Circuit Additional Sign Branch'Circuits INSPECTION > INFORMATION Zg Misc.Conduits&Conductors ON REVERSE'.- z Other(See Complete Fee Schedule) u SIDE' Z 8 4 5?'A PERMIT FEE- (Sub'-Total) , Z PLAN-CHECKING FEE.' )One Fourth`Permit'F.ee) O e"a a'e' Q 0.0 Ar- F PERMIT ISSUING FEE 0 0 it 0 3 _8 0 TOTAL-FEE > INSPECTION FINALED Q�< ✓�t!� 41fAC-SJ date: rvO By — ©s fir/ W 76A663A-CE806A 4/72 APPLICATION FOR ECTR&L PERMIT ' COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS .f LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST, OUTLETS NO. EACH FEE OWNER $ $ RECEPT._ MAIL > FIRST 20 ADDRESS fzoozol LIGHT � TOTAL CITY TEL. NO. SWITCH OVER 20 _ PLAN CHECK FIRST 20 APPLICANT ' LIGHTING TOTAL FIXTURES OVER 20 ADDRESS RESIDENTIAL APPLIANCES CITY TE NO. PERMIT -RANGE DRYER_WTR. HTR._ APPLICANT /] STA. COOK DISP. F.A.U. ADDRESS SPACE HTR. AIR COND. CITY J TEL. N0. CLOTHES WASH. DISHWASH. LICENSE`N0. e CLASS•.'L FAN OTHER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION pr„' AN STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY C MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING C7 IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. SIZE & TYPE OVER TO O I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR .V . 0 — 1 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF W CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO 1 — 10 RESIDE IN, THE ABOVE RESIDENTIAL� PROPERTY. Z SIGNATURE 10 - 50 OF PERMITTEE 50 - 100 DISTRICT NO. CLASS ZONE PRO SS ED BY 100 — 500 '5- '43 -3 SIGN, GAS SIGN AND ONE CIRCUIT NOTES: TUBE, OR MARQUEE ADDITIONAL CIRCUITS SERVI CENOT OVER 600 VOLTS OR 200 AMP L APPROVALS DATE INSPECTOR'SSIGNATURE SERVICEOVER600 VOLTS OR200AMP - TEMP.POWER POLE TEMP SERVICE,POLE, &APPURTENANCES UNDERSLAB WORK TEMP LIGHT OR RECEPT. SYSTEM ROUGH CONDIUT - WIRING FIXTURES POWER AUTHORIZED - PERMIT FEE (SUB TOTAL) UTILITY CO. NOTIFIED �> - PLAN CHECK FEE 1 FINAL PERMIT ISSUING FEE TOTAL FEE 00 PLAN CHECK VALIDATION CK. M.O. CASH PERMITVALIDATIONCK. M.O. CASH 4 3 3 rtt_FP 76A663-CE806 1.1-71- APPLICATION IOR . ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER FNEAREST /� j u «- -BUILDING AND SAFETY DIVISION , Ls. FOR APPLICANT TO FILL IN CROSS ST. OUTLETS N0. EACH FEE $ $ OWNER G' SLO RECEPT._ MAIL g C FIRST 2025, ADDRESS ` J LIGHT TOTALIr CITYCHECK G 1 TEL. N0. VgF- SWITCH OVER 20 .10 PLAN FIRST 20 .Z5 APPLICANT LIGHTING 1 TOTAL T OVER 20ADDRESS FIXTURES .10 RESIDENTIAL APPLIANCES CITY TEL. NO. PERIT RANGE DRYER_WTR. HTR. APPLICANT `N/�'� f`i STA. COOK DISP. F.A.U. ADDRESS,lod,13,1 SPACE HTR. AIR COND. CITY S / 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 0 --1 1.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY-AND STATE OF d CALIFORNIA OR THAT I AM.THE L l WN OF, AND INTEND TO O 1 - 10 3.00 RESIDE IN, THE ABO ES I E IDE NTIA ROPERTY. V SIGNATURE 10 - 50 5.00 OF PERMITTEE O 50- 100 . 10.00 ~ DISTRICT NO. CLASS ZONE P CESSED B W 1 00 - 500 .15.00 �j o9 N SIGN, GASSIGN AND ONE CIRCUIT 5.00 NOTES: ' l ? ? TUBE, OR r MARQUEE ADDITIONAL CIRCUITS 1.00 SERVI CENOT OVER 600 VOLTS OR 200 AMP 3.00 -3 1 100 APPROVALS DATE INSPECTOR'S SIGNATURE SERVI CEOVER 600 VOLTS OR 200 AMP 10.001 1 TEMP.POWER POLE TEMP SERVICE,POLE, &APPURTENANCES 5.00 UNDERSLAB WORK TEMP LIGHT OR RECEPT. SYSTEM 3.00 ROUGH CONDIUT WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (SUB TOTAL) UTILITY CO. NOTIFIED PLAN CHECK FEE FINAL PERMIT ISSUING FEE 3.00 TOTAL FEE --- PLAN CHECK VALIDATION CK. M.D. CASH PERMIT VALIDATION CK.' M.O. CASH LAW DEC, SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE , t .S 76A663A-C.`F1,. 06A 4,72 APPLICATIONF EHEC ICAL PERMIT - COUNTY OF LOS ANGELES ; DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS , LOCALITY ' NEARESTFOR APPLICANT TO FILL IN CROSS ST. OU T,L ETS N0. EACH FEE , (0!u fJp. OWN RECEPT. - $ $ MAI �J t FIRST 20 ADDRESS �'•``/" LIGHT�f TOTA SWITCH 2- � OVER 20 60 CITY TEL. NO. ; PLAN CHECK FIRST 20 'APPLICANT LIGHTING TOTAL - OVER 20 ADDRESS - FIXTURES - - RESIDENTIAL APPLIANCES CITY TEL. NO. ' - RANGE - DRYER_WTR. HTR. PERMIT APPLICAN101 STA. COOK DISP. F.A.U. - ADDRESS A). SPACE HTR. AIR COND. F CITY _ ✓ TEL. N0. CLOTHES WASH. 01SHWASH. 'LICENSE NO- 311 O 09 - CLASS. FAN OTHER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATETHAT THE ABOVE IS CORRECT AND AGREE TO COMPLY O MOTORS, TRANSFORMERS RATING. - WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING V IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. - SIZE & TYPE OVER -TO p I HEREBY, CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 1--. 0 - 1 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF `U CALIFORNIA OR,THAT I AM THE LEGAL OWNER Of,•AND IN NO TO a 1 - 10 RESIDE IN, THE ABOVEI �A/EgS,C/R�I PEED R ESIDE NTI P PERT Y. y ~1 SIGNATURE 10 - 50 OF PERMITTEE 50 100 ' D,ISTRICT NO. CLASS ZONE SS BD BY 100 - 500 lj SIGN, GAS SIGN AND ONE,CIRCUIT NOTES: TUBE, OR - MARQUEE ADDITIONAL CIRCUITS SERVICENOTOVER600VOLTS OR200AMP, ` Y _ APPROVALS DATE INSPECTOR'S SIGNATURE SERVICE OVER 600 VOLTS OR 200 AMP TEMP.POWER POLE - TEMP SERVICE,POLE, &APPURTENANCES - UNDERSLAB WORK TEMP LIGHT OR RECEPT.SYSTEM 19 ROUGH CONDIUT j t WIRING '0 -77 - FIXTURES POWER AUTHORIZED' ® 1 � PERMIT FEE (SUB TOTAL) - UTILITY CO. NOTIFIED ' • PLAN CHECK FEE FINAL $ PERMIT ISSUING FEE , TOTAL FEE PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH,, 32 16.3o �� WORKERS'COMPENSATION DECLARATION 76A663 oFw9 87 APPLICATION FOR ELECTRICAL PERMIT 7 herebyg dffirm that f have a certificate of. consent to self CE-806G' insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS oPa certified copy thereof_(Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL.IN JOB FICertified copy is hereby furnished. , New Residential Bldgs. & Pools EACH NO. FEE ADDRESS Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Fi. $ — $ LOCALITY tion,department. Multi-family Sq. Ft. NEAREST Residential Swimmirig Pools CROSS SO T. Date Applicant OWNER OR FIRM NAME QAIJ 6cc f CERTIFICATE OF EXEMPTION FROM WORKERS' �j MAIL Outlets: Rec-C -Light' COMPENSATION INSURANCE Q ADDRESS (This section need not be completed if the work involved by Total No. Additional CITY First 0 � P4rz- Tel. No. the permit is for one hundred dollars ($100)or less.)' I certify that in the performance Iof t k for which this PLANAPPLICANTCHECK permit is issued, I shall not employ, y pegs n in any ma r so as to become subjectto.the Wor C pensatio s. Lighting Fixtures First 20 ADDRESS Additional 1,70 1 > Total No. CITY Tel. No. Date co Applicant Fixed Appliances Not Over 1 HP ERMIT NOTICE TO APPLICANT: If, afte making this rtificate of APPLICATION 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 f '� �r O T'l A(?41• (_V? (, with comply with such provisions or this permit 'shall be Top —r'FAU H. \ deemed revoked. CITY O/U ( _ ��� Tel. No.bi -6 LICENSED Hood — Fan O her— LICENSED CONTRACTORS DECLARATION . Dis LICENSE OR I hereby affirm that I am licensed under provisions'of Chapter 9 p' oom A' Coad. — REG. NUMBER �/ w Class.c_)D (commencing with Section 7000)of Division 3'of the Business Power Apparatus& Large Appliances DISTRICT NO. PPOCSSED BY >_ and Professions Code,and my license is in full force and effect. �,/ GiG�f t1 j� Size&Type HP, KW, KVA, or KVAR �• G'O CyLi Q License Number '.1 Lic. Class 1, +w Up to 1 Incl. FINAL ��� U fr Contractor�r 1—�- � Date Over 1 to 10 dnc[. DATE VALIDATION ❑ �� Over 10 to 50 Incl.' _ FINAL IIITTT I am exempt under Sec. Over 50 to 100 Inc. By U Ov100 LU er BAP.C. for this reason t1 ,. Services, Swbd.; MCC & Panelboards Z. Date: •0- 200 Amp:Under 600 V G` Signature 201 - 1000 Amp.Under 600 V QOver 1000 Amp.pr'Over 600 V Exemption for Reg. Maint: Elect: ~SINGLE FAMILY Tempa Power Pole 8 Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt.from the Contractor's License g :it• ! �Ir Law for the following reason .(Section 7031.5, Business.and Additional Sign,Branch Circuits _ r_ Professions Code): Misc. Conduits,&Conductors j T7,7,z f;; I, as owner of the property, will do the'work and the - structure is not intended or offered for sale Section 7044, Other (See Complete Fee Schedule)_ ' _._,__c Business and Professions Code). - • - --= CONSTRUCTION LENDING AGENCY. RED`.' _ 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 €: il_ l^+st's;7•{ PERMIT ISSUING FEE < Lender's Address I certify that I have read this application and state that the TOTAL FEE above information is correct. I agree to comply with all County' ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter,upon the above-mentioned property for inspection,purposes.' SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Dote ©s WORKERS'COMPENSATION DECLARATION' CE-806 A'PPILICATIO,N .FO:R ELECTRICAL PERMIT- F hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate of,Workers'Compensation Insurance,or ' ertifc p ereof(Sec.-3800,Lab.'C.) Ins. 'Co. FOR APPLICANT TO FILL IN JOB 9125. Las Tunas _ Policy No. Company ADDRESS i Of the West New Residential Bldgs.&Pools EACH NO. FEE O Certified copy is hereby furnished. 1 &2-FamiIy,Sq. Ft. $ — $ LOCALITY Temple Cit Multi-family'Sq. Ft. - NEAREST Certified copy is filed with the county building inspection 7 CROSS ST Hart department. Residential Swimming Pools. _ OWNER OR , -6-81 Edwards EleAric • FIRM NAME _ Datz�j' Applicant Outlets: Rec._Light_'Sw. � MAIL- First 20 ADDRESS' CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY. Tel No. COMPENSATION INSURANCE } PLAN CHECK d. APPLICANT (This section need ,not be .completed if the work involved. U Lighting Fixtures First 20 ADDRESS by the permit is for one hundred dollazs ($100) or less.) 'k Additional Total NO. CITY Tel No. O I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP ♦— permit is issued, I •shall not employ any person in-any'mannerPERMIT so as to become subject-to the Workers' Compensation Laws." Range_Heater_D.W. W APPLICANT d Oven Dryer_W.M._ ADDRESSIn 2535 S z ' Date Applicant Top.Ii_ FAU _W.H.. CITY ' Tel(No Hood — Fan _Other— ArCadla 447-5096 NOTICE TO APPLICANT; If, after making this Certificate of Disp. _ Room Air.Cond__ LICENSE OR C-10 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 ( PROCESSED BY with comply with such provisions or this, permit shall be Size&Type HP,KW,KVA,or KV AR deemed revoked. -- _ Up to 1 Incl FINAL" - Over 1 to 10 Incl. DATE LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. VALIDATION 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 nes's and,Professions.Code, and my license.is in full force and effect.` Services License Number 2571'91 Lic.Class C-T� 0 200 Amp. Under 600 V `. Edwards Electric. July 1982 2,91,-1000,Amp.under soo v Contractor ate Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION ,Temp:Power Pole&Appurtenances i Sign with Orie Branch Circuit �,LI'7 4,"?'A I hereby affirm that I' am exempt from the Contractor's Additional Sigri Branch Circuits License Law'for the following reason (Section 7031.5, Busi-\. #.e ®.®•e o 2 , ness and Professions Code): ; Misc.Conduits&Conductors o 0 0, o°0'e 02 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 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 PERMITTEE r (Sub-Total) issued(Sec. 3097,Civ.C.). Lender's Name PLAN CHECKING FEE (One-Fourth Permit Feel' Lender's Address PER ISSUING FEE I _ r - I certify that I have read this application and statethatthe TOTAL FEE `NO -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 -81 4-6 "Signature of Permittee Date WORKER S'COM PENS ATION DECLARATION CE-806G (2:80) APPLICATION FOR .ELECTRICAL PERMIT � �• CE-806J�_ �j•' I hereby affirm that. I have/a certificate of consent,to selfCOUNTY OF LOS ANGELES BUILDING AND SAFETY insure, ora certificate of Workers'Compensation Insurance,or tifJQ c4Py ereof(Sec. 3800,Lab.C.) ) 1y —(1—}U&-2 FOR APPLICANT TO FILL IN JOB Policy No. ; Company T11S. CO. ADDRESS 9123 Las Tunas, ' of the West , New-Residential Bldgs.&Pools EACH NO. FEE' Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY Tem Multi-family Ft. — NEAREST Certiple City fied copy is filed with the county building inspection CROSS ST department. Residential Swimming Pools 14a-ri- OWNEROR 4-6-81. - Edwards Electric 1 FIRM NAME Date' Applicant Outlets: MAIL Rec._L',ight_Sw. First 20. ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY Tel No. } '.COMPENSATION INSURANCE PLAN CHECK d APPLICANT O (This section iteed 'not be completed if the.work involved U Lighting by the permit is for one hundred'dollars ($100) or less.) Fixtures First 20 ADDRESS Additional Total k1o.1 certify,that in the Fixed Appliances Not Over 1 HP. CITY" Tel No. O performance of.the work for which this i U .permit is issued,I shall not employ any person in any manner PERMIT LU so as to become subject to the Workers' Compensation Laws. Range_Heater_D:W. APPLICANT Edwards -E1eCtr1C CL U. Oven _ Dryer_W.M. J ADDRESS Z. Date Applicant Top ' FAP ,_W.H. Hood Fan _Other_ CITY Arcadia Tel"o447-5096 NOTICE.TO APPLICANT: If,,after making this Certificate of Disp. _ Room Air Cond__ LICENSE OR, Exemption, you should become subject to the Workers' REG.NUMBER Class; Compensation provisions of the Code, you must forth- Power Apparatus& Large Appliances DISTRICT N _ PROCESSED BY with comply with such provisions or this permit shall be Size&T ype HP,KW,KVA,or KVAR deemed revoked. Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE /� 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 witSection 7000) of Division 3 of.the Busi- Over 100 h ✓ r ness and Professions.-Code, and my license is in full force and effect. Services License Number 25'71.91- ' Lic. Class—'-C-10 0-200 Amp. Under 600 V 201-1000 Amp,Under 600 V Contractor Edwards ElectBU July 1982 Over 1000 Amp.or Over 600 V N HOME OWNER=BUILDER DECLARATION Temp.Power Pole&Appurtenances ' Sign with One Branch Circuit- I hereby -affirm that I am exempt from the Contractor's Additional Sign Branch Circuits 247'�8 A License Law for the following reason•(Section 7031.5, Busi- , ness and Professions Code): c ® ® a 2 Misc.Conduits&Conductors 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 '7044, Business and Professions Code). O �. +✓8 CONSTRUCTION LENDING AGENCY 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) 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 No, 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 Signature of Permittee Date WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm,that I have a certificate of consent to self insure, 76A663 or a.certificate of work'er's Compensation Insurance. or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.,38TO Lab. C.) Policy No Company FOR APPLICANT TO FILL IN JOB ADDRESS EACH FEE Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. LOCALITY , El 1 &2-Family,Sq.Ft — $ $ . Certified copy is filed with the county building inspection _ NEAREST department. Multi-family Sq.Ft. CROSS ST. Date A plicant Residential Swimming Pools ASSESSOR P MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rea_Light Sw. OianNn NAME COMPENSATION INSURANCE _ First 20 MAIL (This section'need not be completed if the work involved by the ADDRESS S L�✓`+ permit is for one hundred dollars($100)or less.) Total No. Additional I oertify that in the performance-of the work for which this permit CITY - Tel.No. is issued, I shall not employ any person in any manner so as t0 PLAN CHECK / become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT "& C- t Total No. Additional ADDRESS C /` Date 2' Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP NOTICE TO APPLICANT: If, afte akin his .ertificate of CITY .€`L 2�b Tel.No. Exemption,,you should become s1ct to.the rkers'Compensation OTHER APPLIANCES NOT OVER 3 HP. 7,1 IT 9 provisions of the Labor Code, you,must forth th comply with such P PLICANT provisiohs or this per'mit'shall be deemed revoked.'` Power Apparatus&Large Appliances '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 Tel.No. Professions Code, and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR Over 50 to 100 Incl. REG.NUMBER Class. d License Number Lia Class Over 100 DISTRICT NO. PAA SSED BY O � C� �? Services,Swbd.,MCC&Panelboards - •�Zi �. 0-399 Amp.Under 600 V FINAL _ O Contractor Date _ DATEIF ❑ I am ce pt under,Sec. 400-1000 Amp.Under 600 V .L9, ~ VALIDATION U Over 1000 Amp.or Over 600 V FINAL W B.& or.this reason' BRANCH CIRCUIT FEES BY CD P 'C.f Date: 15A,or 20A, 120V,Lighting or Recept. Z_ 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 �(�q SINGLE FAMILY8 L` p� Temp.Power Pole&Appurtenances �J l�iLlila'8'- aC)L) HOME OWNER-BUILDER DECLARATION 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): ❑ 1,as owner of the property,will do the work and the structure Misc.Conduits&Conductors M is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) t ITEM and Professions Code). TOT " � -63. aup CONSTRUCTION LENDING AGENCY CHECK I hereby affirm that there is a construction lending agency for the _ J performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) CHANGE eVLt Civ.C.) PLAN CHECKING FEE 0000-0DD1 &! 7/95 Lender's Name PERMIT ISSUING FEE Q Lender's Address s �� - d R 9e�rt I certify that I have read this application and under penalty of purjury state TOTAL FEE �' �� iU that the 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 vkid eSIGNATUR - P RMITTEE DATE ' f .J WORKERS' COMPENSATION DECLARATION CE-663 toga, 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 copy thereof(Sec. 3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN - 'JOB - ❑ Certified copy is hereby furnished.. EACH' NO. FEE. ADDRESS. �3 .: Y .� New Residential Bldgs.&Pools .1 & 2-Family,Sq.Ft. $ — $ LOCALITY- Certified copy is filed with'the county building inspection — department. Multi-family Sq.Ft. NEAREST ? CROSS ST. Date Applicant Residential Swimming Pools OWNER OR FIRM NAME_.. - 'CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL COMPENSATION INSURANCE Outlets:Rec Light Sw. —. - 'ADDRESS (This section need not be,completed if the work involved by the First 20 permit is for one hundred dollars($100)or less.) Total No. Additional CITY Tel.No. performance of the work for which this permit PLAN CHECK I certify , that in the P APPLICANT , is issued, I shall not employ-any person.in any maner so as to become subject,to the Workers'Compensation Laws., Lighting Fixtures First 20 ADDRESS �- Total No. Additional CITY Tel.No. 1,/Date0 ' Applicant Fixed Appliances Not Over 1 HP P IT NOTICE 'TO A PLICANT: -if -after' ma ' is.' 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 30 provisions or this permit shall be deemed revoked. Top FAU _ W.H.._ /. • LICENSED CONTRACTORS DECLARATION Hood _ Fan Other_ I hereby affirm that I am licensed under provisions of Chapter 9 -LICENSE OR Disp. Room Air Cond. REG.NUMBER �f>O ;/ l - .Class. (commencing with Section 7000) of Division 3 of the Business and Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. !' P �ESSED BY Size& Type HP,KW,KVA,or KVAR U License Number Z!V71 Lic.-Class_ 4a Up to)'Incl FINAL /Q, ,/ Over 1 to 10 Incl. DATE l0_ �_ VALIDATION 0 Contr Date Sf'7 Over 10 to 50 Incl. b' V I am exe_ pt under Sec. Over 50 to 100 Inc. BY AL 0.. B.&P.C.for this reason Over 100 Services,'Swbd.,MCC'&Panelboards ► Z 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• 7 HOME OWNER-BUILDER DECLARATION Sign with One Branch CircuitJL I hereby affirm that I am exempt from the Contractor's License Law additional-Sign Branch Circuits �{q`-T§ST 9 C 5 for the,following-reason (Section 7031.5;Business and Professions UJ ' .70 Code): ❑ I,as owner of the property,will do the work and the structure Misc.Conduits& Conductor's 1 ITEMS is not intended or offered for sale (Section 7044, Business O er (See Complete Eee Schedul J. and Professions Code). & -.. CONSTRUCTION LENDING AGENCY' � �- I hereby affirm that there is a construction lending agency for the t.f�A NGE ,M . performance of the work for which this permit is issued(Sec.3097, PERMIT FEEL (Sub-Total)' Civ. C.). R. r� n PLAN CHECKING FEE WO-0001 1OI 4I9 Lender's,Name PERMIT ISSUING FEE vl Q 2624 1 AMIi;20 Lenders Address I certify that I have read this applicationand state that the above TOTAL FEE. �`y _ information is correct. I agree to comply,with all County'ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this pounty to enter,upon the above-mentioned' property for inspection urposes. . , SEE REVERSE FOR EXPLANATORY LANGUAGE ✓ �-`fir ^ ' r _ . . Sign Date ` WORKERS'COMPENSATION DECLARATION 76-663 10/81 CE-806G APPLICATION FOR ELECTRICAL PERMIT •I hereby affirm that I have a'certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY cZpy thereof(Sec. 3800,Lab.C.) Policy No. "� Company FOR APPLICANT TO FILO IN . •" JOB ADDRESS Certified copy is hereby furnished. _ New Residential Bldgs.& Pools' EACH NO. ... FEE O - ' - — LOCALITY 'Certified copy is filed with the ,county building inspection 1 &2-Family,Sq.Ft. $ —• S ��-��� � • department. Multi-family Sq.Ft. CROSSNEAREST. Residential Swimming Pobls OWNER OR ) Date - + Applicant IRM NAME 'CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec Light Sw. — MAIL COMPENSATION INSURANCE.. -. ADDRESSs�? (This section need not be completed if the work involved,by the First 20 CITY /J Tel.No. p permit is for one hundred dollars($100)or less.): Total No. Additional t' O PLAN CHECK,- I certify that.im the performance,of,the'work•,for•which this permit 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 —yrs `� . Applicant TshDy Fixed Appliances Not Over 1 HP PERMIT i NOTICE •TO AP (CANT: If, after making this Certificate .of APPLICANT Exemption,you should.become subject to the Workers'Compensation Range_ Heater_ D.W. provisions oft 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. CITY Tel.No. ��3 LICENSED CONTRACTORS DECLARATION, Hood — Fan Other_ LICENSE OR pp .I,hereby.affirm that 1 am licensed under provisions o.Chapter 9 Disp. ­Room Air Cond. !.�LClass. �-- (comniencing with Section 7000) of Division 3 of the Business and REG.NUMBER C Professions Code,and my license is in full force and effect. Power A DISTRICT NO. PRO De: eY Apparatus& Large Appliances �� CL /Iy , ,' Size & Type HP,KW,KVA,or KVAR G�'�d— � License.Number rq'v Lic.Class Up to 1 Incl. FINAL U Over 1 to 10 Incl. DATE Contractor' Date �l x VALIDATION 0 —e?-24— — Over 10 to 50 Incl. - ❑ FINAL I am exempt under Sec. Over 50 to 100 Inc. BY W BAP.C.for this reason Over 100 U Services,Swbd.,MCC& Panelboards , rZ-+ Date:—, 0- 200 Amp.Under 600 V Signature ' ` 201 - 1000 Amp.Under 600 V Over 1000 Amp.or Over 600 V ElExemption for Reg.Maint.Elect. 2 SINGLE FAMILY Temp.Power Pole& Appurtenances T HOME OWNER-BUILDER DECLARATIONSign with One,Branch Circuit U Ap(�([+• } LC�b�� G!ti!}�b•s I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits 4 JJJ.....77777+ttrJ for the following reason(Section 7031.5,Business and Professions Code): 1 ITEMS I,as owner of the property,will do the work and the structure. Misc.Conduits& Conductors t�' is not intended or offered for sale (Section 7044, Business Other (See Complete Fee Schedule) p 6•,..r, O and Professions Code). NYU CONSTRUCTION LENDING AGENCY CHANGE,. eat 1 hereby affirm that there is a construction lending agency for the CfkANG performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) Civ. C.). +y PLAN CHECKING FEE QUQU OI�171`: 10/25/95 Lender's Name 2993 i AM 9:�? PERMIT ISSUING FEE . 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 'regulating Electrical wiring, avid hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY.LANGUAGE . h ` �9V_ Signa a of Permittee Date