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HomeMy Public PortalAbout5402, 5410 LOMA AVE_Electrical__ I - WOCOMPENSATION DECLARATION 10/81 I her?by`affrm that I have.a certificate of consent to self CE-806G APnCU N FOR ELEC CAL PERW7 insure, or a certificate of Workers' Compensation Insurance, i COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certifIed,copy thereof (Sec 3800, Lob C ) Policy No Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS l Certified copy is filed with the county building inspec- 1 & 2-Family, Sq Ft $ — $ LOCALITY tion•deportment Multi-family Sq Ft — NEAREST Residential Swimming Pools CROSS ST Date Applicant OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' 1JtL Outlets RecLight�Sw MAIL COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work involved by First 20 Total No the permit is for one hundred dollars ($100)or less.) Additional CITY / Tel No I certify that in the performance of the wo k for which this PLAN CHECK APPLICANT permit is issued, I shall not employ any pe n in - manne so a's to become subject to the Workers mpe t n Law Lighting Fixtures First 20 ADDRESS Total No�` Additional Date y Applicant— CITY Tel No 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 CITY Tel No LICENSED CONTRACTORS DECLARATION Hood Fan _Other_ Disp _ Room Air Cond LICENSE Class I hereby affirm that I am licensed under provisions of Chapter 9 REG NUMBER �•; (commencing with Section 7000) of Division 3 of the Business power Apparatus 8 Large Appliances DISTRICT NO PROCES ED BY and Professions Code, and my license is in full force and effect Q Size&Type HP, KW, KVA, or KVARU License Number Lic Class Up to 1 Incl FINALd:Over 1 to 10 Incl DATE � Contractor Date VA ATIOIV L) r-1Over 10 to 50 Incl FINvl/ /� lrl I am exempt under Sec Over 50 to 100 Inc BY B&P C for this reason Over 100 Date Services, Swbd , MCC& Panelboards D 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 2.4 1 3.6 A HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits ;# o•0 0 0 0 2 Law for the following reason (Section 70315, Business and Prof sslons Code) I o a 1 4,50 I, as owner of the property, will do the work and the Misc Conduits 8 Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ o 0 0 1 4,5,0 cZi 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY O 2 2 8,t 8 6 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 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 ;tgnature Wermittee atives of this County to enter upon rty for inspection purposes yy/ SEE REVERSE FOR EXPLANATORY LANGUAGE 67--6N Date 4 76A663-CE806 4 65 APPUCAMN FOR ELBUMC AL pERNT' - COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADORES . d �G . JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS. SUPT OF BUILDING d LOCALITY e e- Cd "a cl•- NEAREST FOR APPLICANT TO FILL IN CROSS ST. RECEPTACLE1 TOTAL No EACH FEE ) LIGHT l OUTLETS FIRST 20 $.20 $ V O 5 1 MAIL SWITCH ADD'L 10 ADORES � v� . OVER 20 TOTAL FIRST 20 .20 CITY g C TEL NO. - LIGHTING 1 FIXTURES J FIXTURES J( 10 CONTRACTOR OVVERER 20 2 RANGES CLO DRYERS WTR HTRS 1.00 ADDRESS GARB DISP STA COOK CITY TEL NO. DISHWASH AUTO-WASH STATE SPACE HTRS STA.APP.(+/a H P.MAX ) 50 LICENSE NO , MOTORS OVER NOT OVER H.P DISTRI yN0 GROUP ZONE PROC SD BY 0 1 1.00 i 1 3 1.so INSPECTION RECORD 3 S 200 F 8 15 2.50 15 s0 300 O 50 100 5.00 V oe SIGNS NO.TRANS NO LAMPS O 0 f SERVICE 0.600V•NOT OVER 200A 100 I N r SERVICE 0.60OV•OVER 200 A. 200 z v SERVICE OVER 600V 5.00 c OTHER (SEE COMPLETE FEE SCHEDULE) PERMIT ISSUING FEE 2.00 SUPPLEMENTARY PERMIT ISSUING FEE 1 00 TOTAL FEE $ C,p APPROVALS DATE INSPECTOR'S SIGNATURE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION UNDERSLAB WORK ff' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT V r WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING WIRING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COON AND STATE OF CALIFORNIA OR THAT I THE LEGAL OWNER AND INTEND TO POWER RESIDE IN,THE AB CRIBED SIDENTI OPE RT Y, SIGNATURE UTILITY CO NOTIFIED OF PERMITTEE FINAL -� 4 6CK ALIDATION JOSEPH C. ROOHAN MO CASH SUPERVISING ELECTRICAL ENGINEER LAGO 1 1 9 7o APR 12 2 0 6.4 QN Jho , I76ASS3 DBB SA „-ae APPLICATION OR PERMIT� rI DEPARTMENT OF BUILDING AND SAFETY ���������3/'S9 COUNTY OF LOS ANGELES 7 WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRIC GROUP I ZONE PERMIT NO. ELECTRICIAN m RECEIVED BY READY FOR� DATE FBBU D ADDRESS .,, FIRST INBPfCT)ON CITY .. TEL. NN IIVV��VV// COUNTY LICENSE N13.912 Mp EXPIRES ' BUILDING •D ADDRESS PERMIT FEES NUMBER OUTLETS EACH FEE LOCALITY 777, LIGHT Sc $ NO.,N O89 BT. RECEPTACLES 5 �1 FIXTURES 5 "Iva OWNER ., WALL SWITCHES 5 MAIL ADDRESS ELEC. RANGES 25 ELEC. HEATERS 25 CITY TEL. NO. �j MISC. 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS NUMBER OF CIRCUITS INSTALLED: TOTAL APPLICATION AND STATE THAT THE ABOVE IS CORRECT LIGHTS RECEPTACLES AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES MOTORS AND STATE LAWS REGULATING ELECTRICAL WIRING. NUMBER HORSEPOWERFEE I CERTIFY THAT I POSSESS THE ABOVE VALID LOS NEW MVO. HP OVER INC. EACH ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER I� OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. I/z S LESS $ ,25 47 Al V2 2 .50 SIGNATURE OF 4 ne � 2 5 1.00 PERMITTEE 5 is 1.50 toINSPECTION RECORD is 50 2.50 50 200 5.00 200 SOO 10.00 SOQ 1 000" 1 5.00 J OVER 1000 20.00 y. �,.. a l� Z M.G. SET/FREQ. CHANGER-HP 19 WELDERS: AC-KVA �_ ap_� It GENERATORS - KW ,� �i 0 TRANSFORMERS - KVA TEMP. MOTORS (75% OF ORIGJ MOVED MOTORS (75% OF CRIB.) MISC, SIGNS TYPES NO.TRANS• TYPE: NO. LAMPS APPROVALS FOR EACH PERMIT: DATE INSPECTOR'S NAME WIRING $i,cOO CONDUIT -` FIXTURES $1.00 IRING � rs'� -T J V SUPPLEMENTARY .50 FIXTURES OWER TOTAL FEE $ UTILITY CO. NOTIFIED ��---- FINAL 'v 1 WORKERS'COMPENSATION DECLARATION 76A669oFw9 97 APPUC AMN FOR ELEC�T��° AL PERNT I here{ -,that I have a certificate of consent to self �aAda9 CE-806( nsure, r a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certifiesccooppyytthh�ereof/(Sec 3800, Lab C ) PoIlcg._ Company o5::5-x,61,fe,,yr FOR APPLICANT TO FILL IN JOB ADDRESS ��(� ❑Certified copy is hereby furnished -1-7-14 �^ New Residential Bldgs & Pools EACH NO FEE rtified 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 DateApplicant FIFIRM NAME g2 Ij 1:r ERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec Light Sw_ MAIL COMPENSATION'INSURANCE ADDRESS JD Ave— (This 20 _ (This section need not be completed if the work Involved by Total No Additional CITY re 14,Al t Tel No the permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which This PLAN CHECKAPPLICANT 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 Tel 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/Y,O•L. Compensation provisions of the Labor Code, you must forth- Oven DryerM — ADDRESS ear h/ with comply with such provisions or this permit shall be Top FAU W H — / 00 deemed revoked Hood Fan —Other— / CITY /41 V��yJ( Tel No 1G P67Y LICENSED CONTRACTORS DECLARATION Disp Room'Air Cond — LICENSE R I hereby affirm that I am licensed under provisions of Chapter 9 REG NUMBER-f74( 1 Class 6=M (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO PROC SS ED BY >_ and Professions Code,and my license is in full force and effect t1 r Size&Type HP, KW, KVA, or KVAR /P Q License Nu3 mber 1�7 7 Lic Class if— �- Up to 1 Incl FINAL U Contractor LAIC Date x Over 1 to 10 Incl DATE VALIDATION Cr ❑ 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 t1 Servic Swbd , MCC & Ponelboards Z Date / D _ Z 0-200 Am nder600V — Signature 201 - 1000 Amp Under•600 V ❑ Over 1000 Amp or Over 600 V y Exemption for Reg MaintElect L SINGLE FAMILY Appurtenances Power Pole &A Temp pp HOME OWNER-BUILDER DECLARATION ' i oT 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 Additional Sign Branch Circuits Professions Code) ❑ I, as owner of the property, will do the work and the Misc Conduits&Conductors -�a� structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ D Business and Professions Code) t if CONSTRUCTION LENDING AGENCYN, Et 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 3 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 thea o e- ton d roperty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE z ign ©_a of Permittee a e ' K � WORKERS'COMPENSATION DECLARATION 76A663CE-806 io/8t APPLICATION PP ICATION I! OR EILIG�1rTR1 CAL PERMIT 'I hereby affirr- teat A have a certificate of consent to self insure, CE-806G 9i1 Ir LL 'i.r tfld!/9 or a certific^f=WS'rkers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY cppy� reof ($ec 3800,1_ah C) Policy NO -company FOR APPLICANT TO FILL IN JOB ❑• Certified copy is hereby furnished EACH NO FEE ADDRESS O2 4,010/2 1577 New Residential Bldgs & Pools S l Famiy, q Ft $ — $ LOCALITY T • -� Certified copy is filed with the county building inspection 1 & 2- department Multi-family Sq Ft NEAREST, , CROSS ST Date AppI Residential Swimming Pools OWNER OR FIRM NAME ,rl nA �yGr� licant �CJ CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec— Light Sw MAIL �� A �� j� COMPENSATION INSURANCE ADDRESS ,� V (This section need not be completed If the work involved by the First 20 Total No Additional CITY Tel No permit is for one hundred dollars ($100)or less.) PLAN CHECK I•certify that in 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 Applicant Fixed Appliances Not Over 1 HPPERMIT _?;CT , NOTICE TO APPLICANT If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation Range_ Heater_ DW APPLICANT (A 2AILM 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 _ WH LICENSED CONTRACTORS DECLARATIONCITY Tel No Hood Fan Other_ I hereby affirm that I am licensed under provisions of Chapter 9 Disp-- Room Air Cond LICENSE OR (commencing with Section 7000) of Division 3 of the Business and REG NUMBER Class Professions Code,and my licen"se is in full force and effect DISTRICT NO PROC BY Power Apparatus& Large Appliances Size&Type HP, KW,KVA,or KVAR ok. License Number Lic Class IUp to 1 Incl FINAL U Over 1 to 10 Incl DATE Contractor Date VALIDATION. Over 10 to 50 Incl U ❑ FINAL I am exempt under Sec Over 50 to 100 Inc BY W 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 0 y, HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit r a I hereby affirm that-1 am exempt from the Contractor's License Law ACCT.It for the following reason (Section 7031 5, Business and Professions Additional Sign Branch Circuits Code), 33137 31.013 Tgf Misc Conduits& Conductors M Ty JLl` I,as owner of the property,will do the work and the structure 1 ITEM (=t 1� is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code) ® TTOTAL ,_ ® �� CONSTRUCTION LENDING AGENCY - CAN 31.00 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) t•�AN6E 'i"I Civ C) PLAN CHECKING FEE - Lender's Name PERMIT ISSUING FEE ✓ 00113-000 1 5116/9 ) - Leer's Address � 0 2431 1 AN 9:39 1 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 reg ating Electrical wiring, and hereby authorize represen ive is County to enter upon the above-mentioned property/ or in c es SEE REVERSE FOR EXPLANATORY LANGUAGE a � nat re O Vittee Date WORKERS'COMPENSATION DECLARATION C -663 10/81 APPUC MON FOR ELECTM L PERW I,hereby affirm that•I havera-cerhf:cate� of,consent to self.insure,- CE-806G /� ��f I�,i u Oil II'•6�!!@ ' 'or.a certificate d€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 furnishedNew Residential Bldgs &Pools EACH NO FEE ADDRESS. Certified copy is'filed with the county building inspection 1 & 2-Family,Sq Ft $ — $ LOCALITY department Multifamily Sq Ft — NEAREST1,� CROSS ST {� Date Applicant Residential Swimming Pools OWNER OR a� _ FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' 3—.! g � � [� MAIL , Outlets Rec Li ht t 2 b • COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work Involved•by the First 20 7rAl r, 6 Total No Additional CITY Tel No permit Is for one hundred dollars($100),or less) - , I certify that in,the performance of the work for which this permit PLAN CHECK Io an APPLICANT is issued, I shall not employ y y person in any manner so as to , become subject to the Workers'Compensation Laws Lighting Fixtures First 20 0 ADDRESS A Total No � dditionalCITY 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 HeaterL DW APPLICANT provisions of the Labor Code, you must forthwith comply with such Oven Dryer L W M ADDRESS provisions or this permit shall be deemed revoked Top FAU WH LICENSED CONTRACTORS DECLARATION CITY Tel No _� � _ I hereby affirm that I am Hood Fan Other — Ilicensed under provisions of Chapter 9XLICENSE OR Disp Room Air Cond REG NUMBER Class (comrriencing with Section 7000) of Division 3 of the Business and Professions Code,and my license is in full force and effect, DISTRICT NO P ESSED B Power Apparatus& Large Appliances a Size& Type HP, KW,KVA, or KVAR v(J 0 License Number Lic Class J G U Up to 1 Incl FINAL Over 1 to 10 Incl DATE Contractor Date VALIDATION O ❑ Over 10 to 50 Incl FINAL' I am exempt under Sec Over 50 to 100 Inc BY W B&P C for this reason Over 100 LL Services,Swbd,MCC& Panelboards I 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 i HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit s I hereby affirm that I am exempt from the Contractor's'License Law ANT°g for the following reason(Section 7031 5, Business and Professions Additional Sign Branch Circuits Code) 36 T c 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) and Professions Code) TOTAL �. ? m qu� CONSTRUCTION LENDING AGENCY CHECK 151.80 I hereby affirm that there is a construction lending agency for the �+t���� performance of the work for which this permit is issued(Sec 3097, PERMIT FEE (Sub-Total) 'vfltSt`GE °00 Civ C) PLAN CHECKING FEE Lender's NamePERMIT ISSUING FEE O�t►O' o-DOD 1 8/23/9r_1 ' • Lender's Address �•- �°+-4 1 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 represent five of this County to enter upon the above-mentioned propert ori on p rposes ' _ SEE REVERSE FOR EXPLANATORY LANGUAGE - Signa ure of Permittee Date , 4 76A663-CE806 4 65 APPUCAMN FOR ELBUMC AL pERNT' - COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADORES . d �G . JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS. SUPT OF BUILDING d LOCALITY e e- Cd "a cl•- NEAREST FOR APPLICANT TO FILL IN CROSS ST. RECEPTACLE1 TOTAL No EACH FEE ) LIGHT l OUTLETS FIRST 20 $.20 $ V O 5 1 MAIL SWITCH ADD'L 10 ADORES � v� . OVER 20 TOTAL FIRST 20 .20 CITY g C TEL NO. - LIGHTING 1 FIXTURES J FIXTURES J( 10 CONTRACTOR OVVERER 20 2 RANGES CLO DRYERS WTR HTRS 1.00 ADDRESS GARB DISP STA COOK CITY TEL NO. DISHWASH AUTO-WASH STATE SPACE HTRS STA.APP.(+/a H P.MAX ) 50 LICENSE NO , MOTORS OVER NOT OVER H.P DISTRI yN0 GROUP ZONE PROC SD BY 0 1 1.00 i 1 3 1.so INSPECTION RECORD 3 S 200 F 8 15 2.50 15 s0 300 O 50 100 5.00 V oe SIGNS NO.TRANS NO LAMPS O 0 f SERVICE 0.600V•NOT OVER 200A 100 I N r SERVICE 0.60OV•OVER 200 A. 200 z v SERVICE OVER 600V 5.00 c OTHER (SEE COMPLETE FEE SCHEDULE) PERMIT ISSUING FEE 2.00 SUPPLEMENTARY PERMIT ISSUING FEE 1 00 TOTAL FEE $ C,p APPROVALS DATE INSPECTOR'S SIGNATURE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION UNDERSLAB WORK ff' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT V r WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING WIRING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COON AND STATE OF CALIFORNIA OR THAT I THE LEGAL OWNER AND INTEND TO POWER RESIDE IN,THE AB CRIBED SIDENTI OPE RT Y, SIGNATURE UTILITY CO NOTIFIED OF PERMITTEE FINAL -� 4 6CK ALIDATION JOSEPH C. ROOHAN MO CASH SUPERVISING ELECTRICAL ENGINEER LAGO 1 1 9 7o APR 12 2 0 6.4 QN Jho , I76ASS3 DBB SA „-ae APPLICATION OR PERMIT� rI DEPARTMENT OF BUILDING AND SAFETY ���������3/'S9 COUNTY OF LOS ANGELES 7 WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRIC GROUP I ZONE PERMIT NO. ELECTRICIAN m RECEIVED BY READY FOR� DATE FBBU D ADDRESS .,, FIRST INBPfCT)ON CITY .. TEL. NN IIVV��VV// COUNTY LICENSE N13.912 Mp EXPIRES ' BUILDING •D ADDRESS PERMIT FEES NUMBER OUTLETS EACH FEE LOCALITY 777, LIGHT Sc $ NO.,N O89 BT. RECEPTACLES 5 �1 FIXTURES 5 "Iva OWNER ., WALL SWITCHES 5 MAIL ADDRESS ELEC. RANGES 25 ELEC. HEATERS 25 CITY TEL. NO. �j MISC. 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS NUMBER OF CIRCUITS INSTALLED: TOTAL APPLICATION AND STATE THAT THE ABOVE IS CORRECT LIGHTS RECEPTACLES AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES MOTORS AND STATE LAWS REGULATING ELECTRICAL WIRING. NUMBER HORSEPOWERFEE I CERTIFY THAT I POSSESS THE ABOVE VALID LOS NEW MVO. HP OVER INC. EACH ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER I� OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. I/z S LESS $ ,25 47 Al V2 2 .50 SIGNATURE OF 4 ne � 2 5 1.00 PERMITTEE 5 is 1.50 toINSPECTION RECORD is 50 2.50 50 200 5.00 200 SOO 10.00 SOQ 1 000" 1 5.00 J OVER 1000 20.00 y. �,.. a l� Z M.G. SET/FREQ. CHANGER-HP 19 WELDERS: AC-KVA �_ ap_� It GENERATORS - KW ,� �i 0 TRANSFORMERS - KVA TEMP. MOTORS (75% OF ORIGJ MOVED MOTORS (75% OF CRIB.) MISC, SIGNS TYPES NO.TRANS• TYPE: NO. LAMPS APPROVALS FOR EACH PERMIT: DATE INSPECTOR'S NAME WIRING $i,cOO CONDUIT -` FIXTURES $1.00 IRING � rs'� -T J V SUPPLEMENTARY .50 FIXTURES OWER TOTAL FEE $ UTILITY CO. NOTIFIED ��---- FINAL 'v 1 WORKERS'COMPENSATION DECLARATION 76A669oFw9 97 APPUC AMN FOR ELEC�T��° AL PERNT I here{ -,that I have a certificate of consent to self �aAda9 CE-806( nsure, r a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certifiesccooppyytthh�ereof/(Sec 3800, Lab C ) PoIlcg._ Company o5::5-x,61,fe,,yr FOR APPLICANT TO FILL IN JOB ADDRESS ��(� ❑Certified copy is hereby furnished -1-7-14 �^ New Residential Bldgs & Pools EACH NO FEE rtified 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 DateApplicant FIFIRM NAME g2 Ij 1:r ERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec Light Sw_ MAIL COMPENSATION'INSURANCE ADDRESS JD Ave— (This 20 _ (This section need not be completed if the work Involved by Total No Additional CITY re 14,Al t Tel No the permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which This PLAN CHECKAPPLICANT 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 Tel 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/Y,O•L. Compensation provisions of the Labor Code, you must forth- Oven DryerM — ADDRESS ear h/ with comply with such provisions or this permit shall be Top FAU W H — / 00 deemed revoked Hood Fan —Other— / CITY /41 V��yJ( Tel No 1G P67Y LICENSED CONTRACTORS DECLARATION Disp Room'Air Cond — LICENSE R I hereby affirm that I am licensed under provisions of Chapter 9 REG NUMBER-f74( 1 Class 6=M (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO PROC SS ED BY >_ and Professions Code,and my license is in full force and effect t1 r Size&Type HP, KW, KVA, or KVAR /P Q License Nu3 mber 1�7 7 Lic Class if— �- Up to 1 Incl FINAL U Contractor LAIC Date x Over 1 to 10 Incl DATE VALIDATION Cr ❑ 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 t1 Servic Swbd , MCC & Ponelboards Z Date / D _ Z 0-200 Am nder600V — Signature 201 - 1000 Amp Under•600 V ❑ Over 1000 Amp or Over 600 V y Exemption for Reg MaintElect L SINGLE FAMILY Appurtenances Power Pole &A Temp pp HOME OWNER-BUILDER DECLARATION ' i oT 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 Additional Sign Branch Circuits Professions Code) ❑ I, as owner of the property, will do the work and the Misc Conduits&Conductors -�a� structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ D Business and Professions Code) t if CONSTRUCTION LENDING AGENCYN, Et 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 3 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 thea o e- ton d roperty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE z ign ©_a of Permittee a e ' K � 'esthat WORKER'S I S COMPENSATION DECLARATION 2000,19 DPW(12-91) APP LICA Y N FOR E LEN��•��ICAL PERK . - I her y affirm that have a certificate of consent to self Insure, 76A663 or Vertificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof,(Sec(3800 Lab C} Policy No Company FOR APPLICANT TO FILL IN JOB Off/ ADDRESS Certified copy Is'hereby furnished New Residential Bldgs &Pools NO EACH FEE $ $ LOCALITY EDCertified copy Is filed with the county building Inspection 1 &2-Family,Sq Ft NEAREST department Multi-family Sq Ft CROSS ST Date Applicant Residential Swimming'Pools MAP BOOBOOK3 �{ 7 PAGE PARCEL Dry- CERTIFICATE OF EXEMPTION FROM WORKERS' �L OWNER OR Outlets Rec Light SW /+ryO ' COMPENSATION INSURANCE g L' dd FIRM NAME �°' �4. � w O�L First 20 MAIL (This section need not be completed if the work Involved by the Total No Additional ADDRESS permit Is for one hundred dollars($100)or less I ce�tify'that in the performance of the work for which this permit CITY 3 ° Tel No , � is Issued, I shall not employ any person In any manner so as to /Q PLAN CHECK U become subject to the Workers'Compensation Laws Lighting Fixtures First 20 APPLICANT Total No Additional Date Applicant ADDRESS NOTICE TO APPLICANT If, after making this Certificate of REST TIA A L N V CITY Tel No Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP rovisions of the Labor Code, you must forthwith comply with such PERMIT p 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 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 Class a• Over 50 t0 100 Incl REG NUMBER Over 100 DISTRICT NO P O SSED BY Q License Number Lic Class Services,Swbd,MCC&Panelboards Cr O 0-399 Amp Under 600 V FINAL Contractor Date DATEI— ❑ I am exempt under Sec 1 400-1000 Amp Under 600 V may, LL I 66 VALIDATION Over 1000 Amp or Over 600 V FINAL.. 01- B&P C-for this reasonBRANCH CIRCUIT FEES RY CD Date 15A,or 20A, 120V,Lighting or Recept Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits El 41 Or More Branch Circuits Exemption for Reg Malnt Elect 15A,20A,208V To 277V Lighting Br Circuits SINGLE FAMILY Temp Power Pole&Appurtenances 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) trt}� I,as owner of the property,well do the work and the structure Misc Conduits&Conductors- y ,TEE _ s not Intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) j;-i 2 Ai 67 = 30 and Professions Code) CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for theL '•:Y'{rii alar 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 p�(p 1 rr=1 i i ('E Lender's Address y1 I certify that I have read this application and under penalty of purjury state TOTAL FEE C/ 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 SIGNATURE OF PERMITTEE DATE , 'esthat WORKER'S I S COMPENSATION DECLARATION 2000,19 DPW(12-91) APP LICA Y N FOR E LEN��•��ICAL PERK . - I her y affirm that have a certificate of consent to self Insure, 76A663 or Vertificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof,(Sec(3800 Lab C} Policy No Company FOR APPLICANT TO FILL IN JOB Off/ ADDRESS Certified copy Is'hereby furnished New Residential Bldgs &Pools NO EACH FEE $ $ LOCALITY EDCertified copy Is filed with the county building Inspection 1 &2-Family,Sq Ft NEAREST department Multi-family Sq Ft CROSS ST Date Applicant Residential Swimming'Pools MAP BOOBOOK3 �{ 7 PAGE PARCEL Dry- CERTIFICATE OF EXEMPTION FROM WORKERS' �L OWNER OR Outlets Rec Light SW /+ryO ' COMPENSATION INSURANCE g L' dd FIRM NAME �°' �4. � w O�L First 20 MAIL (This section need not be completed if the work Involved by the Total No Additional ADDRESS permit Is for one hundred dollars($100)or less I ce�tify'that in the performance of the work for which this permit CITY 3 ° Tel No , � is Issued, I shall not employ any person In any manner so as to /Q PLAN CHECK U become subject to the Workers'Compensation Laws Lighting Fixtures First 20 APPLICANT Total No Additional Date Applicant ADDRESS NOTICE TO APPLICANT If, after making this Certificate of REST TIA A L N V CITY Tel No Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP rovisions of the Labor Code, you must forthwith comply with such PERMIT p 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 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 Class a• Over 50 t0 100 Incl REG NUMBER Over 100 DISTRICT NO P O SSED BY Q License Number Lic Class Services,Swbd,MCC&Panelboards Cr O 0-399 Amp Under 600 V FINAL Contractor Date DATEI— ❑ I am exempt under Sec 1 400-1000 Amp Under 600 V may, LL I 66 VALIDATION Over 1000 Amp or Over 600 V FINAL.. 01- B&P C-for this reasonBRANCH CIRCUIT FEES RY CD Date 15A,or 20A, 120V,Lighting or Recept Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits El 41 Or More Branch Circuits Exemption for Reg Malnt Elect 15A,20A,208V To 277V Lighting Br Circuits SINGLE FAMILY Temp Power Pole&Appurtenances 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) trt}� I,as owner of the property,well do the work and the structure Misc Conduits&Conductors- y ,TEE _ s not Intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) j;-i 2 Ai 67 = 30 and Professions Code) CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for theL '•:Y'{rii alar 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 p�(p 1 rr=1 i i ('E Lender's Address y1 I certify that I have read this application and under penalty of purjury state TOTAL FEE C/ 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 SIGNATURE OF PERMITTEE DATE , WORKERS'COMPENSATION DECLARATION CE-663 10/81 APPLICATION PP BCii'lj ION FOR ELECTRICAL P�'®p��j� II I here4 affirm that I have a certif&te of'consent to self Insure, CE-806G Q�If� lL 0'�II Y�l Ifllb9 or,a tificate of Workers' Compensation Insuran ora ified COUNTY OF LOS ANGELES BUILDING AND SAFETY IS IS POhCGDmpanyIsr FOR'APPLICANT TO FILL IN JOB' ❑ Certified copy is hereb furriished EACH NO FEE ADDRESS (� Y New Residential Bldgs & Pools -_ ;ertified cdpy is filed with' a building Inspection 1 & 2-Family,Sq Ft $ _ $ LOCALIT -471 Multi-family Sq Ft NEAREST CROSS ST Date Apphcan Residential Swimming Pools OWNER OR FIRM NAME RTIFICATE�OF EXEMPTION FROM WO <E S' AIL Outlets Red— Light — Sw — , M COMPENSATION INSURANCE 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 I certify that in the performance of-the work for which this permit PLAN CHECK i i •I•shall not employ an , .APPLICANT s Issued, p y. y 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 i Date Applicant Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT If, after making this Certificate of IT Exemption,you should become subject to the Workers'Compensation Range_ Heater_ DW _ AP 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 WH / LICENSED CONTRACTORS DECLARATION , CITY T Hood — Fan Other_ I hereby affirm that'l am licensed-under provisions of Chapter 9LICENSE O (commencing with Section 7000) of Division 3 of the Business and Disp Room Air Cond REG NUMBER lass Professions Code,and•my license Is in full force and effect DISTRICT No PR D BY Power Apparatus& Large Appliances Size& Type HP,KW,KVA,or KVAR v License Num r c Class Up to 1 Incl FINAL' U ,Over 1 to 10 Incl DATEt i VALIDATION Contractor Date ❑ Over 10 to 50 Incl FINAL I am exempt under Sec Over 50 to 100 Inc BY_ q/ W11 G.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 ❑ Over 1000 Amp or Over 600 V = 'Exemption for Reg Marnt,Elect q SINGLE FAMILY Temp Power Pole& Appurtenances '} HOME OWNER-BUILDER DECLARATION Sign with,One Branch Circuit Y 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 f` _ Code) i Y 1 . s_' Misc Conduits& Conductors ❑ I,as'owner of the property,will do the work andthe structure Is not Intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) 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(Sec 3097, 'PERMIT FEE (Sub-Total) U Q Civ C) PLAN CHECKING FEE Lender's Name O "�"_!7��� /`23 j3�c .+?f� ) PERMIT ISSUING FEE , ) ) 4, Lender's Address W 5,;`+; 1 certify thatI orrect ve ad this application and state that the above' TOTAL FEE, I- information is agree to comply with all County ordinances and State la s regu In Electrical wiring, and hereby authorize representativ s of t C unty enter upon t above-mentioned proper for Inspe on / � (_`/ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee bafe