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Home My Public Portal About5658 LOMA AVE_Electrical__ WORKERS'COMPENSATION DECLARATION 76-663 10/81 APPLICATION ION FO® ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, CE-806G /� �l �1 L BVI or a'�eltificate of^Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy tflereof(Sec.3800,Lab.C.) • Policy No. Company FOR APPLICANT TO FILL IN - JOB• Lo ❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ADDRESS, •�Inspecfionpp��, . �/ 1 & 2-Family,Sq.Ft. $ — $. LOCALITY-r'�.�1/,� G 0 1 1 e Multi-family Sq.Ft. — NEAREST. F31c)W eu-/c)u _ - CROSS ST. D - Residential Swimming Pools OWNER OR FIRM NAME FW CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec Light I Sw. MAIL �.� COMPENSATION INSURANCE O O ADDRESS 46 This section need not be com leted'if the work involved b the First 20- ( p y 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 PLANCHET CHECK is issued, I shall not employ any pers n ' as to become subject to the Work ompensa' w Lighting Fixtures First 20 ADDRESS Additional e-1 �a 1 Total No. � CITY Tel.No. Date ` AppllFixed 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_ Heater_ D.W. _ APPLICANT provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M._ ADDRESS �® , provisions or this permit shall be deemed revoked. Top .— FAU W.H. CIT Tel.No. LICENSED CONTRACTORS DECLARATION Hood _ Fan J— Other_ 1 hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR ��2 (commencing with Section 7000) of Division 3 of the Business and REG.NUMBER ` Class. V Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. ` PROCE SED BY Size& Type G� HP,KW,KVA,or KVAR LicLic. Class ® enseUp to 1 Incl FINAL + Over 1 to 10 Incl. DATE 7// VALIDATION DOver 10 to 50 I 0 Can ate �`� ' ❑ ncl. FINAL F" I am exempt under Sec. Over 50 to 100 Inc. gY ` d U B.&P.C.for this reason Over 100 L p„ Services,Swbd.,MCC &Panelboards ® N _ 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 Pale& Appurtenances �F 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): ❑ I,as owner of the property,will do the work and the structure Misc.Conduits & Conductors =';=f is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) pp* and Professions Code). •j 2 is tAL r3-, m 40 CONSTRUCTION LENDING AGENCY 1 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) Q Civ.C.). CHANGE ,00 PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE ji11000-00011 Lender's Address ;;t [vl ,;i I certify that I have read this application and state that the above TOTAL FEET _= t information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize unty to enter upon the above-mentioned property s purp SEE REVERSE FOR EXPLANATORY LANGUAGE - I ee Date 76A663-CES0610.62 APPLICATION OR ELECTRpr.AL PERMIT � COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING A BUILDING AND SAFETY DIVISION ADDRESS f0 1 JOHN A. LAMBIE, COUNTY ENGINEER WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY CROSS[NEAREST � i FOR APPLICANT TO FILL IN CROSS ST. (�C RECEPT. TOTAL NO. EACH FEE �^ OUTLETS FIRST 20 "4D $.20 $ 0/1. OWNER LIGHT d"� - (/ MAIL /`� SWITCH. ADD,' 1O n ADDRESS �j �� • . OVER 2O � .3/ �f'''��j� f y� y-{ ,� '�.�p LIGHTING TOTAL FIRST 20 •20 n� CITY/ 2:-Ar �_ _(a(74 TEL. NO. Z}j FIXTURES ADD'L 70 ELECTRICIAN /./ 111 OVER 20 RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS GARB.DISP. STA.COOK �j CITY TEL. NO. DISHWASH. AUTO.-WASH.✓' 5 STATE SPACE HTRBJ-� STA.APP.(1/2 H.P.MAX.) -50 LICENSE NO. MOTORS: OVER NOT OVER H.P. DISTRI T NO. GROUP NE PR E ED BY O 1 , 1.00 ` 7 3 I A.50 INSPECTION RECORD }. 3 8 2.00 O 8 75 - 2.50 - V ad i5 50- 3.00 O 50 100 5.00 {��+ O_ SIGNS: NO.,TRANS. - H NO.LAMPS SERVICE 0.600V-NOT OVER 200A 1.00 - Q 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 $ 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APP'ICATI N APPROVALS DATE INSPECTOR'S IGNATURE 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 I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES A. CALIFORNIA OR THAT 7. AM THE LEGAL NE OF THE ABOVE / DESCRIBED RESIDEN�TIIAAL PROP7/RRTT-Y. POWER / (/ SIGNATURE //Jr' s� 1. 7� UTILITYCO.NOTIFIED r! I OFPERMITTE FINAL 31.1114'_11/09 VALIDATI ARTHUR C.'VEITF' I SUPERVISING ELECTRICAL ENGINEER,. CK MO GASH AUG 3:0 1. 0.1 C3~ 76A663-CE80610/72 APPLICATI® F®tt ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEBPULDING AND SAFETYTMENT OF YDIVISIONER X00 �� .` ADDRESS Kt LOCALITY7Zu:� aPt-E-_ NEAREST�: ' FOR APPLICANT TO FILL IN CROSS ST.- OUTLETS NO. EACH FEE pwNER•'L j $ $ .F-LBPA..NAME �f RECEPT.I� � MAIL l - LIGHT � TOTAL FIRST 20 25 7Gy ADDRESSA 44e: i 45 CITY TEL. NO / SWITCH7 OVER 20 ,1p PLAN CHECK LIGHTING � FIRST 20 .25 APPLICANT FIXTURES TOTAL .10 OVER 20 ADDRESS �_ ,RESIDENTIAL APPLIANCES clrv �.,J� TEL. N0. PERMT RANGE DRYER_WTR. HTR. APPLIICANT STA. COOK DISP. F.A.U. ADDRESS SPACE HTR. AIR GOND. CITY TEL. NO.� CLOTHES WASH.* DISHWASH. LICENSE OR CLASS. "'-- REG. NUMBER 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 CALIFORNIA OR THAI I AM THE LEGAL NE OF THE ABOVE 1 - 10 3.00 DESCRIPED RESIDENTIAL PR PERT��Yggq. V PERMITE E 10.- 50 5.00 SIGNATURE O I- 50 - 100 10.00 c.> DISTRICT NO. SSED BY W d 100 - 500 15.00 SIGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE INSPECTOR'S SIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE SERVICE NOTOVER 600 VOLTS OR 200 AMP 3.00 UNDERSLAB WORK SERVICEOVER 600 VOLTS OR 200AMP 10.00 ROUGH CONDUIT TEMP SERVICE, POLE, &APPURTENANCES 5.00 WIRING TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED FINAL PERMIT FEE (SUB TOTAL) NOTES: PLAN CHECK FEE F PERMIT ISSUING FEE 3.00 TOTAL FEE PLAN CHECK VALIDATION CK. M.O. CASH" PERMIT VALIDATION CK. M.0. CASH .9 8' L 12 2 o 6 0 O SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 76A663 DBS SA 3-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY qmw own ' COUNTY OF LOS ANGELES ZiLlAXAMIC WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT/TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO. ELECTRICIAN Sgo G!g T BG IC a ��53 �+ �J RECEIVED BY READY FOR DATE ISSUED ADDRESS 10 / G /��TL/► i BV1ti FIRST INSPECTION CITY Tib +�� Lf/STEL NO /3 (�/) COUNTY LICENBE NO. l EXPIRES .�•D �� BUI in PERMIT FEES NUMBER EACH FEE LOCALITY e�j .0.1e, LIGHT OUTLETS NEAREST Q,A1 T, / CROSS ST. q - t GYFff "T RECEPTACLES / ��ea v" jf WALL SWITCHES / OWN E bow "0 Y°o•F TOTAL OUTLETS S. $ .,r �' MAIL g ELEC. RANGES 25 !�, t ADDRESS77- ELEC. HEATERS 25 °'�'° CITY ice' !Pdg 0 3' q TEL. NO. FIXTURES 5 B I HEREBYd ACKNOWLED E THAT 1 HAVE READ THIS MI5C. 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 LOS NUMBER HORSEPOWERFEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER NEW MVO. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DE__ C= ��BOVE' �o R fR %z LESS $ 25 �� SIGNATURE O�?4— I 2 .50 PERMI E ` i 2 5 1.00 INSPECTION 119CORIT- 5 is l.so is so 2.50 50 200 5.00 200 500 10.00 J Soo 1000 15.00 Z OVER 1000 20.00 (9 M.G. HET/FRE(3. CHANGER-HP Q' WELDERS:AC-KVA O GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (75% OF ORIG.) MOVED MOTORS (75% OF CRIB.) MISC. SIGNS NO. NO.TRANS. NO. NO. LAMPSLl APPROVALS DATE INSPECTOR'S NAME FOR EACH PERMIT: CONDUIT WIRING $1.00 [ FIXTURES $1.00 WIRING` SUPPLEMENTARY .50 FIXTURES POWER TOTAL FEE $ � UTILITYCO:NOTIFIEDi_ �b FINAL /�"��r