HomeMy Public PortalAbout8748 LONGDEN AVE_Electrical__ +aCOMPENSATION DECLARATION 76A66310/81
h'er6by affirm that I have a certificate of consent to self CE-8066 n PPLECnMN FOR E 2CMCteL PER
T
'InsJre,
oc a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
6r a cdrtified 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 O 6
—
Certified copy is filed with the county building inspec- 1 & 2-Family, Sq Ft $ $ LOCALITY Gh
tion department Multi-family Sq Ft — CROSS ST NEAREST
tf5 7-6 1—
OWNER OR
Residential Swimming Pools
Date Applicant FIRM NAME l.S ��� S
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec—i6_1 Svv3 MAIL
COMPENSATION INSURANCE ADDRESS N(���
First 20
(This section need not be completed if the work involved by Total No CITY �� ) s Tel IN `�
the permit Is for one hundred dollars ($100)or less.) Additional
I certify that in the performance of the work for which this PLAPLICANTK
permit 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
Date �- 9 Total No e-0Applicant CITY Tel No
NOTICE TO APPLICANT If, after making this Certif to of Fixed Appliances Not Over 1 HP PERMIT
Exempt ion, you should become subject to the orkers' Range_ Heater_D W — APPLICANT
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 Hood Fan _Other_ CITY Tel No
LICENSED CONTRACTORS DECLARATION LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 D sp _ Room Air Cond REG NUMBER Class
(commencing with Section 7000) of Division 3 of the Business Power ffApparatus& Large Appliances DISTRICT NO OC SSED BY O
and Professions Code,and my license is in full force and effect
p 1
Size &Type HP, KW, KVA, or KVAR Q O V
License Number Lic Class Up to 1 Incl DATE — i/ O
Over 1 to 10 Incl VALIDAT N L,.,
Contractor Date Over 10 to 50 Incl FINAL W
❑
I am exempt under Sec Over 50 to 100 Inc BY j1.
B&P C for this reason Over 100 0
Z
Dote Services, Swbd , MCC& Panelboards D
0 - 200 Amp Under 600 V
Signature 201 - 1000 Amp Under 600 V
Over 1000 Amp or Over 600 V
Exemption for Reg Moint Eject
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 Additional Sign Branch Circuits
Law for the following reason (Section 7031 5, Business and
Professions Code)
Misc Conduits&Conductors
I, as owner of the property, will do the work and the
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ D
7044, Business and Professions Code) 5 4 7.4'A
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for #,o o'o,o 0'2
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
(Sec 3097, Civ C ) ,I o • 2 4,7 5
PLAN CHECKING FEE
Lender's Name o 0 0 2 4,7 5,=
PERMIT ISSUING FEE d
Lender's Address 09. 1 9 86
1 certify that I have read this application and state that the TOTAL FEE 62
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 o -Permittee 61
Date U
_tea,
>eAaaa Deei!A ++-a, APPLICATION FOR PERIII
DEPARTMENT OF BUILDING AND SAFETY ±'•
COUNTY OF LOS ANGELES ,.,Jg
WILLIAM J. FOX, CHIEF ENaiNErn
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
f f) E '2 ) d
ELECTRICIAN
RECEIVED BYEADY FOR DATE MOVED
ADCR[5!1 riR4RT INSPECTION
CITY TEL. NO It f— —
COUNTY LICENSE NO EXPIRES BUILDINa
PERMIT FEES •00RESS 2F7•-1-,Q
rEE
NUMBER EACH I LOCALITY .
LIGHT OUTLETTI i NEAREST
CROSE ST. (%�I 1 1. b 1.G
RIICEPTACLES 5 -
WALL QWITCHED I OWNER It1(1 (r,�
TOTAL OU1rLRT9 7 _ SC I S 13 5MAIL
----
CLEC. R�NOEn 25 AOORE84 i 4
ELEC. HEA-SRO 23 I tf
:•... N0.
FIXTURES I 3 - I OS I I HERESY ACKNOl4LEOG£ THAT I HAVE READ THit
Ft
® I«ti11C. I ; ( APPLICATION AND STATE TNAT Tii£ AOOVE IS CORRECT
NUMBER OF LIGHT CIRCUITS '
AMD AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
e X,
NUMRao C! R£CFYfACLE CIRCUITS I AND STATE LAWS REGULATING ELECTRICAL WIRING. a
MOTORS i CERTIFY THAT 1 POSSESS THE AAOVE VAUD LOS
HORSEPOWER ER FEE
ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
NuwecR bb
N><w Mvo. HP ovcta i++c.
[AC. O- THE RESIDENTIAL PROPERTY DE�CFSoro A30VE. .2
1! a LEIS 25 SIGNATURE OF
.30 R^ /
I P E R M I TT L E=1_MMCLAAZil
2
3 + oo I INSPECTION RECORD
s
6 15 1 1.501
15 30 2 30
SO 2003 001'
I 200 Snr+ _ CIO!
Boo I I000 i is oo� Z
k
I OVE1000 20 OO
M G. SET/FRXO. CHANGER-HP
I Yr
WCL6 ER41 AC-KV4
GENERATORS-KW
TRANSFORMII-KVA
TEMP. MOTORS 7 OF OMa. _
MOVED MOTORS I7IIr or Okla. 1 --
SIGNS
NO. LAMPS A2'1�ItOVAI...._ ,.1.:
1 Z 4
NO OATS INp PECTOR`II NAVE
FOR EACh::RMIT:
wlaiNe s, oe
FIXTURZ.- 11 00
SUPPLEMENTARY 5O FIXTURES ?' LI - t•
TOTAL FEE I c UTILfT Co HOT:r;<`OI
ffif----,--- ,x
FINAL � ' f------ �M /
rt. a
COUNTY OF Los Aacrlrs .�PPI.ICATI02�* FOR PE�34IT �=
Department of Coun!T Engineer
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOX. Cbvi^ 1-rinrrr
FOR APPLICANT TO 1-111 IN
DISTRICT NO. i ORGUP ZOITE �RMIT NO. '
6, r—
ELEG7RtC1AN
R[CCIVCD BVREAr7Y rOF► CFaTr Issuro
rIR6T INDPCCTI:•.
CCTV TLL NQx(f( (C'/ {L~L• i �J Q
COUNTY SctNBE NO, p M,-,r9 p' 3 i BUIt"IVa t' V
PERMIT FEES Aooarna �?���
_I NUNPCVICACH� LOCALITY t -
_ICON? NCARCBT
RCCEPTALi.L.ta 'T i CROPR 9T, /�/// �• j"R
WALL eWr'rCH CB _ OWNER / , CC r' �/7 C ,•6�
TOTAL CUTLETS { Sc S MAIL .Al _
CLEC. 0AUQC9 ys I •t
[LEC. MCATLLrs �^ 1 31 �
MtBtl I `j^-1 I r+CREgY =?-'--WLf vu[ THAT 1 HAViC >:('EA9 THIS
^I APPLICATION AND STATE THAT THE A8OVY to CO?4ECT� �"�
I NUMBER EW LIOHT CIRCUITD ! «F.
I I GPEE TO Cn Pt.Y \:':Tri ALL COUNTY C13WIMANCCB s
NVMLLJit Cr ALCC7TACr• �.o_�•
1 �_
AND BTATC LA" R£AUI.ATIHQ ELECTRICAL CT1WtOtr_l_
rFai
MOTORS 1 CERTIrY TAA? 1 P088E88 THE ABOVY L]
WAD LMS
Nut:ftsr HQRBCPQwC.. rrr _ AND[Lr2 COUNTY UC ENSC. OR 1 ATHE LrZA& CrWN[R
NCw Mvo. HIP ovca IHo. X.C. I Or THZ RE810ENTIAL PROPERM TY OCOCR(BED A00%-r_
35' i VOMATURE Or
N 2 .50I FLRHITTL[ r __ r
_ ' °O I INSPECTION RECORD'
I s 15 sol
is ISO 2.501 v
so 200 i 5.001
Tz.- ADO ta.A01 ` J
Sao 1 ►acro s.00
OVER 1000 Sn.oO 1 � � �"•
M.O. 9>'7/T7 r= CHANGER-HP
O[N[WATDWS KW
TRANGrCWHCR3 - KVA •'��
JY
?L)4P. MQTems (7s% Cr ORIO.) �� r
MQV[D M&MNQ (755 Or awls.`
misc. �
SIGNS
APPROVALS
NQ. N0.LAMPS
rOR LAC), IM"rTt ^A_L YrAwfr
WtRINt9 - •. _ In s] CC1ttOVCT j / -••1 I � I •.+�f
rIxTURrs `Y b�.00J I/T/T ::�rtrr.y •_ ' I
M ART ,SDI I rrx-rustre
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TOAGM}V=GA rr-ts ' ,jgYj APPLICATION FOR f PEFam.- -�3
DEPARTMENT OF BUILDING AND SAFETY`
ccUNTY LQS �ES LT !C �
WILLIAM J. FOX, CH+£r EnaincEa
r
FOR I-2LICANT TO FILL IN DISTRICT NO. GROUP ZONE PERWrT NO.
ELECT►:-IAN
ADD COS, RCC IVCD BY READY 1-02D
o ATE UMMM
ripaT INSPEL'TIDH
CITY TCL..NO,
CCU"Tv LlCCNSL NO. CIAPIRCS BUILDING 7yrsj !�
PEnbuT FEES :D, _
t NL;ka EmR 1 OUTLETS EACH + LOCALITY
f J Y•
LIGHT Sc m SS CROBT.
RECEPTACLES S I
s 14fOWNER
WALL SWITCHES S 0 MAIL
CLEC. RAHOCS ZS I AODR=S® -
CLEC. HCATERS SS I CITY Tit N0. 7
1 MISC.I ` 1 HEREBY ACKNOWL£DO£ THAT 1 HAVL READ THIS t
MUMSCR Or CIRCUITS INSTALLED:
'rest APPLICATION AND STATE THAT THE ASOVC rg C17RRECT _
IL 10 RECCPTACLC3 AND AGREE TO COMPLY WITH ALL COUNTY ORDINAMCCII y4
MOTORS AND STATE LAWS RCGULATINO EL£^.TRICAL WSRIHD.
MU.Iv�w I HORS[POW[R rE[ I 1 CCRTIrY T`iAT 1 POSSESS THC ASCVE VALID LDS >li
New Mv7. HP! ovCR I IMc. "CN ANGELES CauKTY LICENSE. OR I A►1 THC LEIIAL C*4'uEa - -
.��9 .25 Or THE RESIDENTIAL PROPCRTY DCSCR'D£D A --VlL n
'l; 2 - SIONATURC Or1.00
I i PCRMITTEr
w:d
s ,s ,.sG INSPECTION RECORD
so 200 S OD; 4}
Sud
SOO 1000 i 5.001 J •'
OVER 1000 2G.00! 1 Z
M.O. SCT/rRCO. CHANUER•HP I
L2
WCLD[RSi AC-KVA ! N
DCNCRATORS - KW
T.'IAMSrDRMZR9 - KVA
TrMP. MOTORM (73% or
MOVED MOYOPS (75% Or 0*10.)
l�t�iNg I ,
TYPCL HO.TRANS. `
T' ee• N'L LAMPS
APr;RQVA:S
MR LACK P"mfrl _ _ATC I-+SPECTD4^9'YANC
WIRING
riXTURP" 51.00 ' r WIRING
f
6UPPLE:dENTARY Sp rtXTU RC?1 � I
POWER
TC T iia. FEC S « Y UTILITY CO. NCTI►ICD,
t rlHr.tiL!Sl'73 tl/rr �1 f`r"'ttln�'�Lt�. y 541 'aL