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Home My Public Portal About9810 LAS TUNAS DR_Electrical__ 76A669 E 06 9-64 APPLICATION FOR ELECTRt"CAL PERMli' AUNTY OF L ANGELES GELES 'TMENT OF COUNTY ENGINEERfNEAREST UILDING j/`, JAS DING AND SAFETY DIVISION DDRESS C oe J A. ,LAMBIE. COUNTY ENGINEER CA/ W "AM.A.JENSEN, SUPT OF BUILDING OCALITY L/� OR APPLICANT TO FILL IN ROSS ST. RECEPT. TOTAL NO. EACH FEE OUTLETS FIRST 20 S 20 $ OWNER C.rG CL G;(j LIGHT MAIL �/ry� Box -7 q� SWITCH. ADD'L .10 ADDRESS G/• q�/� !� O O OVER 20 LIGHTING 1 TOTAL FIRST 20 .20 CITY ff. TEL.NO. FIXTURES 10 ELECTRICIAN Gam' R OVVER 2O 2 RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS O IV I K I7 GARB.DISP. STA.COOK !� CITY TEL.NO. T- DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.(/a H.P.MAX.) .50 LICENSE NO. 2-17-7-30 MOTORS: OVER Nor OVER H.P. DISTRICT N GROUP ff��ON P O B O 1 1.00 , l'! 1 8 1.50 INSPECTION RECORD >_ IL s s 2.00 0 8 15 2.50 D� Is 50 3.00 0 V 50 100 5.00 W CIL NO.TRANS 1— N SIGNS:/ Z NO.LAMPS SERVICE 0.60OV•NOT OVER 200A 1.00 SERVICE 0.60OV•OVER 200 A. 2.00 SERVICE OVER 600V 5.00 MISC. PERMIT ISSUING FEE 2.00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE a 1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION APPROVALS DATIL INSP! 'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT �'��:✓��'•• WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING _ ELECTRICAL WIRING. WIRING 1 HEREBY CERTIFY THAT 1 AM PROPERLY R ISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES CO TY WO5TEOF FIXTURES CALiFORN1A OR THAT I AM THE LFFFGAL O ER OFABOVE DESCRIBED RESIDENTIAERT POWER SIGNATURE UTILITY CO.NOTIFIED OF PERMITTEEFINAL VALIDATI ARTHUR C. VEIT CK MO CASH SUPERVISING ELECTRICAL ENGINEER LALG 5 8 1 4 ZS NOV 14 2 D 4.00- N .QOwN 76A663-CES06 4.65 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY 161L"f• NEAREST FOR APPLICANT TO FILL IN CROSS ST. RECEPTACLE TOTAL NO. I EACH F E / LIGHT /OUTLETS FIRST 20 $20 $ Qa OWNS { r, /v/� MAIL Q` /�t, SWITCH /�/ ADD'L 1O (/ ADDRESS (y! jolkUc� OVER 20 L 1---4r-r- TOTAL IRST 20 .20 CITY - L' TEL. NO. LIGHTING FIXFIXTURES ADD'L r !'O CONTR CTOR J" /s OVER 2 .10 RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS/ / GARB.DISP. STA.COOK � ) CITY 1y TEL.N DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.(+/y H.P.MAX.) •50 LICENSE NO. MOTORS: OVER NOT OVER H.P. DISTRICT O. GRO P Z E PROCESSED BY 0 1.00 C 1 3 1.50 INSPECTION RECORD 3 a 2.00 7 I� 8 15 2.50 15 50 3.00 p U 50 100 5.00 SIGNS: NO.TRANS- - O NO.LAMPS ,! ,.� Y .I T H - rr4,6& U ' W SERVICE 0.60OV-NOT OVER 200A 1.00 a - - N SERVICE 0.60OV-OVER 200 A. 2.00 ? SERVICE OVER 600V 5.00 OTHER (SEE COMPLETE FEE SCHEDULE) -- PERMIT ISSUING FEE 2.00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE !a ® ]FINAL APPROVALS DATE INSP R'S SIGNATURE r I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIUN DERS LAB WORK .L. AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPROUGH CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATI ELECTRICAL WIRING. WIRING 04)) 1 HEREBY CE Y AT I AM PR REGISTERED AND/ FIXTURES �(.•`C ✓ - -'�' LICENSED AS GUIR B OUNTY AND STATE CALIFORNIA THAT ER OF,AND INTEND POWER RESIDE IN,T A OV SI TIAL PROPERTY. SIGNATUR E UTILITY CO.NOTIFIED `� /f OF PERMITT < J`/, 4;� A�//L,,//IDATION JOSEPH C. ROOHAN CK /MO CASH SUPERVISING ELECTRICAL ENGINEER �!„y_ o J_ 6 u 3 0.5 u, 76A663-CE806 3-84 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEBARTMENT OF COUNTY BUILDING UILDING AND SAFETY DIVISION ADDRESS 810 LAS TUNAS OR. JOHN A. LAMBIE, COUNTY ENGINEER WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY TEMPLE CITY ST FOR APPLICANT TO FILL IN NCROSS S . GOLDEN WEST LIGHT , TOTAL FIRST 20 NO. $-_2OH IIIFEE OWNER AUTO CLUB OF S. CALIF. MAIL OUTLETS LIGHT ADD'L ADDRESS TERMINAL ANNEX BOX 2890 SWITCH. OVER 20 .10 LIGHTING TOTAL F1Rsr 20 .20 CITY L.A. TEL.NO. � FIXTURES AD)'L 10 ELECTRICIAN FEDERAL SIGN OV R 2O RANGES CLO.DRYERS WTR.HTRS. 1.001 ADDRESS 1100 N. AL ST GARB.DISP. STA.COOK CITY L.A. TEL. No. 221-61.41 DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.(y=H.P.MAX.) .50 LICENSE NO. 217730 MOTORS: OVER NOT OVER H.P. DISTRICROUP ONE P O nT 1 1.00 . tJ C I 3 1.50 I SPE ION RECORD 3 6 2.00 0 6 15 2.50 15 50 3.00 O V 50 1005.00 11J a SIGNS,1 NO.TRANS 2 Z NO.LAMPS 2 00 SERVICE 0.60OV-NOT OVER 200A 1.00 SERVICE 0.60OV-OVER 200 A. 2.00 SERVICE OVER 600V 5.00 MISC. PERMIT ISSUING FEE 2.00 2 00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE a 4 OO 1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING 1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT 1 AM THE LEGAyz OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY POWER SIGNATURE �,/J [ UTILITY CO.NOTIFIED OF PERMITTEE v - - F-777 INAL VALIDATi ARTHUR C. VETT CK MO CASH SUPERVISING ELECTRICAL ENGINEER CK MO 6�H LSO 9 5 8 6 JUL 13 w D 4.0 3 �� _� 76A663-CE806 1 1_71 APPLICATION FOR ELECTRICAL PERMIT LJ s COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING L BUILDING AND SAFETY DIVISION ADDRESS 981 ral-at Tunam Drive LOCALITY Temple Cit Ca, NEAREST FOR APPLICANT TO FILL IN CROSS ST, ti OUTLETS NO. EACHI FEE OWNER r RECEPT._ $ $ MAIL LIGHT TOTAL FIRST 20 25 ADDRESS OVER 20 CITYLO Angeles TEL. N0. 746-454 SWITCH_ .10 PLAN CHECK LIGHTING l TOTAL FIRST 20 25 APPLICANT FIXTURES 10 J} OVER 20 ADDRESS RESIDENTIAL APPLIANCES CITY TEL. NO. PERMIT RANGE ORYERWTR. HTR._ APPLICANT STA. COOK DISP. F.A.U. ADDRESS I SPACE HTR. AIR COND. CITY TEL. N0. CLOTHES WASH. DISHWASH. LICENSE NO. 266051 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 - 1 100 LICENSED AS REOU IRE LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT M HE LEGAL OW R OF, AND 'y END TO 1 — 10 3.00 RESIDE IN, THE OV ESCRIBED SIDEN IAL P OPERT 0 V SIGNATURE 10 - 50 5.00 OF PERMITTEE O 50 - 100 10.00 F DISTRICTNO. CLAS ZONE P CESS ED BY W 100 - 500 15.00 z a N SIGN, GAS ESIGN AND ONE CIRCUIT 5.00 NOTES: 7 ? TUBE, OR Xz lk MARQUEE ADDITIONAL CIRCUITS 1.00 2 SERVICENOTOVER600VOLTSOR200AMP r 3.00 o U SERVI CE OVER 600 VOLTS OR 200 AMP 10.00 APPROVALS DATE INSPECTOR'S SIGNATU TEMP.POWER POLE TEMP SERVICE,POLE, &APPURTENANCES 5.00 UNDERSLAB WORK TEMP LIGHT OR RECEPT. SYSTEM 3.00 ROUGH CONDI UT WIRING FIXTURES PERMIT FEE (SUB TOTAL) POWER AUTHORIZED UTILITY CO. NOTIFIED PLAN CHECK FEE FINAL L� PERMIT ISSUING FEE TOTAL FEE tJ PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. � M.O. CASH ^_ 3 5 =? 6-,3 OU 10 D 6.0 0 SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 76A663-CE606-H-57 APPLICATION FOR ELECTRIC PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS 11 gl o JOHN A. LAMBIE, County Engineer CASSATT D. GRIFFIN, Supt of Building LOCALITY NEAREST „t FOR APPLICANT TO FILL IN CROSS ST. vLtl/V PERMIT FEES OWNER 6O.rt�• �' u-� ITEM NUMBER EACH FEE OUTLETS: $ E MAIL / LIGHTS RECEPT. SW. .10 O ADDRESS LIGHTING FIXTURES .10 CITY TEL. NO. lJ II I ELEC.RANGES CLO.DRYERS ELECTRICIAN WATER HEATER'S .50 ADDRESS ELEC.SPACE HTRS. DISHWASHERS / GARBAGE DISPOSERS AUTO.- CITY `^: TEL.NO. ISI I 1 WASHERS STA.COOKING UNITS 25STATE LICENSE NO. MOTORS: OVER INC. H.P. O - 1/2 .25 DISTRICT GROUP�(Z�,E R DY FOR INSPECTION 1/2 — 2 .50 INSPECTION RECORD 2 — 5 1.00 5 — 15 1.50 15 — 50 2.50 50— 200 5.00 SIGNS: NO.TRANS. NO.LAMPS SERVICE 0-600V 1.00 % Q O SERVICE OVER 600V 5.00 MISC. WIRING PERMIT 1.00 l Q'p FIXTURE PERMIT 1.00 O SUPPLEMENTARY PERMIT .50 TOTAL FEE g 1-i6 APPROVALS I HEREBY ACKNOWLEDGE THAT 1HAVE READ THIS APPLICATION DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING �7 ELECTRICAL WIRING. WIRING I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES _ CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE POWER DESCRIBED RESIDENTIAL PROPERTY. SIGNATUREN ✓ AN4 _.�. UTILITY CO. NOTIFIED OF PERMITTE LLL___��' G _ FINAL DATION ARTH U R C.V EIT. SUPERVISING ELECTRICAL ENGINEER CK O CASH 0" 3 .20 Aw&lov ' / T7 0 � 7 &_ / vL_ c_ c/71 78A683-CESO6 <-65 � APPLICATION FOR ELECTRICAL PERMIT �J COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS clh�y JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN cRoSS ST. RECEPTACLETOTAL NO. EACH FEE OUTL TS j FIRST 20 $.20 $ MWNE V fjr ,V1/0 LIGHT -- SWITCH AIL ADD'L 10 ADDRESS U� 4/R) OVER 20 TOTAL FIRST 20 .20 CITY TEL. NO. LIGHTING 1S FIXTURES I FIXTURES r ADD'L CONTRA O• o " J OVER 20 •10 �,✓� /��/,^ /J /// RANGES CLO.DRYERS WTR.HTRS, 1.00 ADDRESS GARB.DISP. STA.COOK CITY ` C TEL.NO DISHWASH. AUTO.-WASH. SPACE HTRS. STA.APP.(+/p H.P.MAX.) .50 LICENSE NO. MOTORS: OVER NOT OVER H.P. DIST ICT NO. GRP P_ SSED BY O 1 1.00 / U + 3 1.50 INSPECTION RECORD 3 a 2.00 s 15 2.50 15 50 3.00 O 50 100 5.00 V d: SIGNS: NO.TRANS O NO.LAMPS I� SERVICE 0.60OV-Nor OVER 200A 1.00 i a. N SERVICE 0.60OV-OVER 200 A. 2.00 Z SERVICE OVER 600V 5.00 OTHER (SEE COMPLETE FEE SCHEDULE) PERMIT ISSUING FEE 2.00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE III APPROVALS DATE . INSPECTOWS SIGNATURE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION UNDERSLAB WORK AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING 1 HEREBY CER A 1 PROP REGISTERED AND/OR FIXTURES LICENSED AS R OUI E L OUNTY AND STATE OF CALIFORNIA O TH I HE ER OF, AND INTEND TO POWER RESIDE IN,TH RI SI IAL PROPERTY. SIGNATURE UTILITY CO.NOTIFIED ' OF PERMITT _ - FINAL 14 VALIDATION- JOSEPH C. ROOHAN SUPERVISING ELECTRICAL ENGINEER CK MOASH WORKERS'COMPENSATION DECLARATION '8-8*6 101e1 /,�nip OC n��®N FOR E ECT1��,61 L PERMIT.+ (;E-8U6G L�11!✓l>✓l� Ua Il Cl FOR LS L� U'h i'�1 9•"t OtIE 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 copy thereof(Sec.3800,Lab.C.) policy Nef � lam Company FOR APPLICANT TO FILL IN JOB G} E] Certified copy is hereby furnished. i EACH NO. FEE ADDRESS / 0 145 J-UJIJHs CertifiedRes•dential Bldgs &Pools t Certified copy is filed with the county building inspection 1 & 2-Family.Sq.Ft. $ _ $ LOCALITY NEAREST department. Multi-family Sq.Ft CROSS ST ire 100 Al W 11557 ,ST° Date��2` Applicant -� I� ,/ Residential Swimming Pools OWNER OR T 'T'-°—� '"�" FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec—Light_ Sw. — MAIL COMPENSATION INSURANCE ADDRESS O W I fI E This section need not be completedthe First 20 ( if the work involved b y Total No. Additional CITY (D Tel.No.$'?30�JSb permit is for one hundred dollars($100)or less.) I certifythat in the performance of the work for which this permit PLAN CHECK P I APPLICANT Q�j �!/v1�/r6(� is Issued, I shall not employ any person in any manner so as to I become subject to the Workers'Compensation Laws. I Lighting Fixtures First 20 ADDRESS II Date `G� Applicant (R•19• 6!6-til Total No. Additional CITY P060060V 09 Tel.No.g,/g Say 66 NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. _ APPLICANT$ rnaE C�D 6 provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W M _ I ADDRESS provisions or this permit shall be deemed revoked. Top — FAU _ WH _ CITY Tel.No. Hood — Fan Other LICENSED CONTRACTORS DECLARATION _ I hereby affirm that I am licensed under provisions of Chapter 9LICENSE OR (commencing with Section 7000)of Division 3 of the Business and Dlsp. — Room Air Cond. REG NUMBER Class. Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO p P OC�ESSED BY Size&Type HP,KW KVA,or KVAR !� 4 --��✓ 0 License Number yD0°1a 3- Lic.Class Up to 1 Incl FINAL V I tet- Over 1 to 10 Incl DATE �'/� + VALIDATION Contractor iA- �'6�F• Date Over 10 to 50 Incl FINJ ❑ I am exempt under Sec. Over 50 to 100 Inc. By AL ° W Over 100IL B.&P.C.for this reason J Services,Swbd.,MCC&Pans.coards D Date: 0-200 Amp.Under 600 V Signature 201 - 1000 Amp.Und:r 600 V ❑ Over 1000 Amp.or Over 600 V Exemption for Reg.Mairtt.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 Law I Additional Sign Branch Circuits the following reason(Section 7031.5,Business and Professions Code): El Misc.Conduits&Conductors I,as owner of the property,will do the work and the structure Other(See Complete Fee Schedule) _ is not intended or offered for sale (Section 7044, Business D and Professions Code). CONSTRUCTION LENDING AGENCY I heroby 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 FEC Lender's Name PERMIT ISSUING FEE 7 Lender's Address I certify that I have read this application and state that the ubova TOTAL FEE information is correct.1 agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize represent ti ves of this County to enter upon the abova-mentioned pro �ftmdt,�e es. SEE REVERSE FOR EXPLANATORY LANGUAGE ;gnat / Date I WORKERS'COMPENSATION DECLARATION 36"M DPW 3/87APPLICATI®N FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self � inlure, or aocertificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS a certified copy thereof Sec. 3800, La . C. „r Rc mpany a�/��-d'�S"(1 FOR APPLICANT TO FILL IN JOB T ❑Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS V S 7Q!/ Certified copy is filed with the ounty building inspec- 1 &2-Family, Sq. Ft. $ ._ $ LOCALITY /Lp tion de artm nt. Multi-family Sq. Ft. — NEARESTCROSS _ 8 Residential Swimming Pools OW RSOR T. C �,y p Date Applicant /+ FIRM NAME Gl/��/!✓C O� /cQ CERTIFICATE OF EXEMPTI N OM WORKERS' Outlets: Rec Light Sw._ MAIL COMPENSATION RANCE ADDRESS '1 / 4171 JIA tThis section need not be com leted Tf the work involved b First 20 CITY Tel. No. he permit is for one hundred dollars($100)or less.) Y Total No. Additional 4� 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 Lighting Fixtures First 20 ADDRESS so as to become subject to the Workers'Compensation Laws. Additional Date Applicant Total No. CITY LT 1. No. NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range— Heater—D.W. — APPLICATION WAI tPC Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS /Y A1F to,1_,1t/ with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. Hood — Fan —Other— CITY el LICENSED CONTRACTORS DECLARATION LICENSE OR Disp. _ Room Air Cond. REG.NUMBER ClassaA&64 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. P ESSED BY d and Professions Code,and my license is in full force and effect: Size&Type HP, KW, KVA, or KVAR ,QP ��. O License ber D&6_31.ic. Class ��= U Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE VALIDATION O Contra Date Over 10 to 50 incl. FINAL U ❑ exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C. for this reason Over 100 U) 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. i SINGLE FAMILY j HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit 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.I Conduits&Conductors structure is not intended or offered for sale(Section 7044, Other(See Complete Fee Schedule)_ T Business and Professions Code). CONSTRUCTION LENDING AGENCY a•.; "' thereby affirm that there is a construction lending agency for he performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAWCHECKING FEE Lender's Name PERMIT ISSUING FEE w 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 ve-mentioned prop rty for inspection purpo es. SEE REVERSE FOR EXPLANATORY LANGUAGE ®s , te.ignat re of Permittee Date WORKERS'COMPENSATION DECLARATION 78-810/81 CE-806G •A PPCAT�ON FOR ELECTRICAL PERMIT I her affirm.that I have a certificate of consent to self insure, I ' or.a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY dopy thereof (Sec.3800,Lab.,C.) Policy No. dr� �ompany FOR APPLICANT TO FILL IN JOB ADDRESS ❑ Certified copy is hereby furnished. e-/p 715;P New Residential Bldgs.&Pools EACH NO. FEE 1 &2-Family,Sq.Ft. $ — $ LOCALITY Certified copy is filed with the county building inspection _ NEAREST d a ment - 2 /q� � ,,rj. Multi-family Sq.Ft. NEARS ST mate ✓Applicant ' `p, Y• elclop—,-p-f Cl Residential Swimming Pools OWNER OR 7 f^ FIRM NAME /(� /Y 1 V�1F /n CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:ReJ Z7 Light 3.3 Sw.�`++ �/ MAIL COMPENSATION INSURANCE 7' o ADDRESS First 20 � (This section need not be completed if the work Involved by the �'L, CITY Tel.No. ,permit is for ohe hundred dollars($100)or less.) Total No. Additional I certify that in the performance of the work for which this permit PLAN NT is issued, I shall not employ any person in any manner so as to 11 become subject to the Workers'Compensation Laws.. Lighting Fixtures First 20 1� � �® ADDRESS Additional Total No. 3 CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT ti „ NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. provisions of the Labor Code,you must forthwith comply with such Oven. _ Dryer_ W.M._ ADDRESS Z o ,�_ �� ( � ok provisions or this permit shall be deemed revoked. Top FAU W.H. = CITYl��, T.I.No. t LICENSED CONTRACTORS DECLARATION Hood — Fan 4 Other_ QQ I hereby affirm that,] am licensed under provisipns of Chapter 9 Disp. — Room Air Cond. ,�TJ z LICENSE OR /7r+, y �s (commehcing with Section 7000)of Division 3 of the Business and REG.NUMBER Z4 Class. f Professions Code,'and my license.is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO. p PRO SSED BY Size&Type HP,KW,KVA,or KVAR �r ,QO tf License Number `ZV� 2� Lic.Class �`� Up to 1 Incl. xf O FINAL V' r� ,A, Fl(&-M-C ate ✓*I Z-7 !j Over 1 to 10 Incl. DATE 2`3 • O VALIDATION 0 Contracto Over 10 to 50 Incl. FINAL U ❑ I am exempt under Sec. Over 50 to 100 Inc. , UP By W B.&P.C.for this reason Over 100 N PV . 7 ! Services,Swbd.,MCC&Panelboards Z D te: 0-200 Amp;Under 600 V 30 20 Z � ❑ Signature n201 - 1000 Amp.Under 600 V ®ptiog.Maint.Elect. Fry f,p`T r�^�f Over 1000 Amp.or Over 600 V -- E y _:.,;. SINGLE FAMILY Temp.Power Pole&Appurtenances •21 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit z' I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits i+_ for the following reason(Section 7031.5,Business and Professions Code): -.73; =+ Misc.Conduits&Conductors ❑ I;as owner of the property,will do the work and the,structure is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ ® ..,'; Y., ,and Professions Code). - CONSTRUCTION LENDING AGENCY ytiyv =fw 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 •• +-.r,•, Lender's Name j.3V PERMIT ISSUING FEE `z i; 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, 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 I helreby affirm'that I have a certificate of consent to self Insure, 76A663' it,� or a certificate of Worker's Compe ation sur n oj� r' eid COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. ythheerr'e�of(Sec..380.0 Lab..C.) 1_ � v�/) P ll yy l�O' ompeny /�/� FOR APPLICANT TO FILL IN JOB did 5 1 NO. EACH FEE C Ce ifi c py I he y furnished. New Residential Bldgs.&Pools LOCALITY 1&2-Family,Sq.Ft. — $ $ Certified copy is filed wi coon _ NEAREST dep rq�nt. Multi-family Sq.Ft. CROSS ST. Dat e/ Applicant Residential Swimm(ng Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXE Outlets:Rec._L'ight Sw. 01NNEF OR ^ CTE OF E A FIRM NAME • First 20 MAIL (This section need not be completed if the work Involved by the Total No. Additional ADDRESS / _'L permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITY ` d 4. 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 First 20 APPLICANT Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certificate of CITY —., ,. Tel.No. 4 17 24f/4f/ Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code,you must forthwith comply with such PERMIT 0 p y p y Power Apparatus&Large Appliances APPLICANT provisions or this permit shall be deemed revoked. LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS3 C 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 4 To].No. 3 �� Professions Code.,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE •7� CIS'V/' }a Over 50 to 100 Incl. REG.NUMBER .,g Over 100 DISTRICT NO. P EBBED BY O License Number Lie.Class '�� (� Services,Swbd.,MCC&Panelboards �. Contractor Date �a 0-399 Amp.Under 600 V DATE ❑ 400-1000 Amp.Under 600 Vj I I VALIDATION V Over 1000 Amp.or Over 600 V FINAL U! B.&P.C.for this reason BRANCH CIRCUIT FEES BY fn Date: 15A,or 20A,120V,Lighting or Recept, Z_ 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits F-141 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits r, {iti i.•1:F SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION 6W,•1.5 I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit ev for the following reason (Section 7031.5,•Business and Professions Additional Sign Branch Circuits I T t_rV, Code): I,as owner of.the property,will do the work and the structure Misc.Conduits&Conductors `' is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) ® C:HEn:;'•, V•Jn i:I and Professions Code). a iJ 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) k;r( ; ;0. civ.C.) ( ;it JtS—Vu I L 6 .Li r': PLAN CHECKING FEE r=.`.i.0 1t;10:5 Lender's Name f r-W ; PERMIT ISSUING FEE Lender's Address // TOTAL FEE I certify that I have read this application and under penalty of purjury state (�� I 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 1.1 i purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE NA ER E MkTE '