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Home My Public Portal About6267 LOMA AVE_Electrical__ s 7SA663C- CES06B 12/75 APPLICATION FOR ELECTRICAL PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN JOB 0 �� I New Residential Bldgs.& Pools EACH NO. FEE ADDRESS ff 1 &2 Finaily Sq. Ft. $ — $ LOCALITY �G JJ/''� Multi-family Sq. Ft. CROSS ST . TV�Y� Residential Swimming Pools OWNER OR e,� ?7O FIRM NAME 'VlAt Outlets: Light,Switch& Receptacle MAIL First 20 ADDRESS Additional CIT �� C Tel NoeQ6p (��l 7w PLAN CHECK APPLICANT Lighting Fixtures First 20 ADDRESS Additional CITY Tel. No PERMIT f �. Fixed Appliances Not Over 1 HP APPLICANT /V SL�IQ IL Range Heater_ D.W. r7J1/ /�vs11 Xr Oven Dry W.M. ADDRESSq'716, (sem �c Top G� fP� W.H. CITYSO ��v /rA07 OTSe1. No. %3 V/� Hood Fan LICENSE NUMBER Class.( �'/� 11- Dlsp. A.C. C_j I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 0 Power Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING I—. ELECTRICAL WIRING. V Size&Type HP, KW, KVA,or KVAR LU Up to 1 Incl. I HEREBY CERTIFY T AT I A ROPERLY REGISTERED AND/OR Over 1 to 10 Incl- LICENSED AS REQUIRED Y LO A GELES O NTY AND STATE OF CALIFORNIA ORTHAT IiAM T E LEGER OF THE ABOVE Over 10 to 50 Incl. DESCRIBED RESIDENTIA PROP Y, Over 50•to 100 Incl. PERMITEE Over 100 SIGNATURE DISTRICT NO. PROCESSED BY S yv+ s op r - .1 N-210f Q®0-200 Amp. Under 600 V INSPECTOR'S - 1000 Amp. Under 600 V APPROVALS DATE SIGNATURE- Over 1000 Amp.or Over 600 V TEMP. POWER POLE Temp. Power Pole&Appurtenances UNDERSLAB WORK Sign with One Branch Circuit ROUGH CONDUIT Additional Sign Branch Circuits (Other) WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (Sub-Total) LNA CO.NOTIFIED PLAN CHECKING FEE (One-Fourth Permit Fee) PERMIT ISSUING FEE TOTAL FEE PL//AN CHECK VALIDATION CK M.D CASH PERMIT VALIDATION C M.D CASH s `'I5S�4 91 OCT `7 2 ® 9.() 0.. GEG3Y � WORKERS' COMPENSATION DECLARATION -60 10/81 I hereby affirm that I have a certificate of consent to self insure, CE-80 6GAPPLICATION APPIC TION C®p ELECTRICAL PERMIT or a certificate-of WorkerF.Compensation Insurance, ora certified• COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab. C.) fl Policy No. t Company FOR APPLICANT TO FILL IN JOB ❑ - Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ADDRESS r ZW ❑ Certified copy is filed with the county building inspection 1 & 2-Family, Sq.Ft. $ — $ LOCALITY -VQc department. Multi-family Sq. Ft. — NEAREST CROSS S, Date Applicant Residential Swimming Pools OWNER OR y j FIRM NAME ALL- CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec— Light Sw. MAIL 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 . is issued, I shall not employ any person in any manner so as to APPLICANT become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS 1/ � � Total No. CITY Tel.No. Date ApplicantMT Additional Fixed Appliances Not Over 1 HP NOTICE TO A PLICANT: If, after making this Certificate of PERMIT 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. _ CITY Tel.No. LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ 1 hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE ORB (commencing with Section 7000) of Division 3 of the Business and REG.NUMBER Class. 0:10 Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO PROCES BY L� Size&Type HP,KW,KVA,or KVAR 0 License Number VLic.Class Up to 1 Incl. FINAL V / w ` Over 1 to 10 Incl. DAT ContractorB y VC�C— Date vL Jv f VALID- ON 0 . ❑ Over 10 to 50 Incl. FIN V I am exempt under Sec. Over 50 to 100 Inc. BY i W B.&P.C.for this reason Over 100 N Services,Swbd.,MCC&Panelboards ® `s Z Dater 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 r' HOME OWNER-BUILDER DECLARATION Sin with One Branch Circuit i I hereby affirm that I am exempt from the Contractor's License Law ACCT a Sign for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits n °g Code): SWtt�t 22°O ( ❑ 1,as owner of the property,will do the work and the structure Misc.Conduits & Conductors P P v. 1 iTENL is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). ® TOTAL 22.00 CONSTRUCTION LENDING AGENCY 4,.C1ECK ,,1.0 I hereby affirm that there is a construction lending agency for the - p performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) I'HANGE °0[! Civ.C.). PLAN CHECKING FEE Lender's Name 01300-0001 81 22/90 PERMIT ISSUING FEE Lender's Address 2526 1 AN 10 227, 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 I s regulating Electrical wiring, and hereby authorize enret ve of this County to enter upon the above entioned or' spec Ion poses. SEE REVERSE FOR EXPLANATORY LANGUAGE e of Permi tee e, Date - -' W YORKERS'COMPEN$ATFON DECLARATION 76A663CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT I*h ttrat I have a certificate of consent to self insure, CE-Bose ca a tificate of Workers' Compensation'Insurance, or a certified COUNTY OF LOS.ANGELES BUILDING AND SAFETY copy thereof(Sec 3800,1-ab C.) Policy No 'Company, - FOR APPLICANT TO FILL IN JOB ❑? Certified copy is hereby'furnished- EACH - NO FEE ADDRESS v , New Residential Bldgs.&Pools , n Certified 60'0y is filedwith' he county budding inspection 1 & 2-Family,Sq.Ft• Sw $ _ $ LOCALITY department:' Multi-family Sq.Ft. NEAREST CROSS ST Residential Swimming.Pools ,Date •. Applicant `;'•, ,', 4 ,� - �, OWNER OR n� j� CERTIFICATE OF EXEMPTION!FROM'WORKERS' /7 '7 ' k• "' FIRM NAME /TT/ C� /\ Outlets Rec a Light _ Sw. MAIL / COMPENSATION INSURANCE ADDRESS (This section need not be completedff the work Involved'by the First 20 CITY Tel.No. permit-is,for one hundred dollars($,100)1or less.), Total No Additional -�� I.certif that'm•the erformance'of`•the work for which-this ermit PLAN CHECK �- Y P P _,IlBPLICANT is'issued, I shall not employ any,person in•any-mariner so-as to _ become'sub' t t the Workers'Compe' atio La Lighting Fixtures First 20 ADDRESS � 7-ZeW ---^� " Additional ,�,� J. �'Gg . / Total No � - CITY 77/t Tel No ,fit ,Date - U Applicant' C! �� v —�� NOTICE O APPLICANT..`If;a after makin this•..Certificate of Fixed Appliances,Not Over 1 HP PERMIT /,. Exemption,you should become subject to the Workers'Compensation Range—-Heater_ DW APPLICANT �k provisions of the Labor Code, you must forthwith comply;wdh such Oven Dryer _ W.M ADDRESS Z(JrJq4 provisions,or--this permd•shall be deemed revoked -,Top FAU•-••_ WH. — •� '• CITY pp ,r �-�-•.,�•+ el�•No G LICENSED CONTRACTORS DECLARATION, .' . Hood Fan04 Other_ �� L� �a '�/� ' I hereby;.affirm'that I,am,licensed under•,provisions of,,Chapter 9 Disp Room Air Cond — ' 'S LICENSE OR Class �z (commencing.with Section 7000)).of Division 3 of-the Business and :• REG NUMBER Professions Code,and my license is ii5 full force and effect q Y� "`-"� - a -�=m DISTRIC PROC> SSED By. r 'r - •Power Apparatus,& Large Appliances -t• „ ,.--- _ Size& Type HP,KW,`KVA,or KVAR �'�` License Number Lic ClassUp to 1 Incl FINAL U Ovec-1 to 10 Incl DATE r !•l 2 VALIDATION Contractor Date Over 10 to 50 Incl O E] .I,am exempt under Sec Over 5,0.to_100 Inc BY- W B&P.0 for this reason Over 100 Ll. Services,Swbd.,MCC& Panelboards' Df260 Date 0-200 Amp.Under 600 V 0%Signature 201 1000 Amp.Under 600 V Over 1000 Amp or Over 600 V ❑ Exemption for Reg Maint Elect O 0�.1 A ' SINGLE FAMILY ` Temp Power Pole& Appurtenances.•. ," ; "; • -, HOME OWNER-BUILDER DECLARATION " Sign with One Branch Circuit # o 0;0 0 0 2 03 I hereby affirm_that I am exempt from the Contractor's License'Law o for the folldwing reason (Section 7031 5,,Business and Professions•" Additional Sign Branch Circuits. iI 7 5`. Code). i o X351755 Mise Conduits& Conductors - I,as owner of the property,will do'the work and'the structure w is not intended or offered for sale (Section 7044, Business -Other(See Complete Fee Schedule) 1,0)� 8 8` and Professions,Code). •CONSTRUCTION LENDING AGENCY I hereby,affirm,that•there is,a.construction"lend ing'agency for the , performance of the work for which this permit is issued(Sec 3097, PERMIT FEE (Sub-Total)" Civ C), t PLIAN CHECKING FEE Lender's Name 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, and hereby authonze, representatives of this County to enter upon the above-mentioned Prop erty i ech pu SEE REVERSE.FOR EXPLANATORY LANGUAGE Signature of'Permitte Date ,