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Home My Public Portal About9020 LONGDEN AVE_Electrical__ D9 5-A 4-41 25M APPLICATION FOR PERMIT DEPARTMENT OF BUILWNG AND SAFETY ELECTRIC COUNTY OF LOS ANGELES WM. J. FOX, CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP I ZONE PERMIT NO. WIRING FIXTURES d— S ERVICE �» READY FOR -- RECEIVED BY DATE ISSUED RANGE HEATER 'I POWER �-�fp' FIRST INSPECTION � /-'y �r SIGNS MISCELLANEOUS APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY Z JOB 1./� '//� " y/ NAME ADDRESS /l.9 ( W v y - IA- 4.-.E''L.•4 L. K ADDRESS LOCALITY!" >4* •4''•f ..:� 4'"t•�` �' NEAREST W CITY TEL.NO. CROSS ST. '� 'E- •�" COUNTY CERT. NO. EXPIRES a NAMEIII fUy'Lr DESCRIPTION OF WORK 3 ADDRESS NUMBER OF OUTLETS ON CIRCUITS 0 LOCATION BY ROOMS CITY ' I 3 -E 1sTEL.NO.-77' ? r LIGHT OUTLETS SW. PLUGS Pix, I AM THE LEGAL POSSkiSOR OF THE ABOVE LOS CIRCUIT A B C D E F G H ANGELES COUNTY CERTIFICATE OF QUALIFICATION. _ LIVING ROOM ELECTRICIAN. '--------- I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED DINING ROOM ABOVE. BRFST.RM. OWNER. BATH �+ _ _ _ CORRECTIONS ENT.HALL HALL NO. FRONTPORCH OUTSIDE _ KITCHEN SERV.PCH. BDRM.NO, 1 / t 9 z CLOSET BDRM.NO. 0 CLOSET TOTAL NO. OF OUTLETS $ APPROVALS I NO. OF FIXTURES 7 $ DATE INSPECTOR'S NAME ' VVV NO. OF MOTORS H.P. $ CONDUIT I NO. OF SIGNS TRANS. $ WIRING III NO. OF RANGES OR HEATERS $ FIXTURES MISCELLANEOUS $ POWER �� R PERMIT FEE $ / '"` UTILITY CO.NOTIFIED TOTAL FEE $ �" FINAL ..y affirm that COMPENSATION DECLARATION 2000isDPW 3ie7 `n PPn �CAMN FOR ELEGY ICAL PERN7 O Ire,�y affirm that I have a certificate of consent to self CE-80 G (ia �L ns' 4 or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or{PP certified copy thereof (Sec 3800, Lab C ) Policy No Company FOR APPLICANT,TO FILL IN JOB ❑Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS Q n.) ❑Certified copy is filed with the county building inspec- 1 &2-Family, Sq Ft $ — $ LOCALITY tion department Multi-family Sq'Ft — NEAREST Residential Swimming PoolsCROSS ST O Date Applicant OWNER OR _FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets RecLight_��Sw MAIL COMPENSATION INSURANCE 0 First 20 ADDRESS (This section need not be completed if the work involved by Total No Additional CITY .c;1/ � b Lc- Tel No the permit is for one hundred dollars ($100)or less.) I certifythat the performance of the work for which this PLAN CHECK in P APPLICANT permit is issued, I shall not employ any person in any manner so as to become subject to the Worker 'Co pens tion Laws Lighting Fixtures First 20 O / ADDRESS Additional Date y`'7�' S� A licont Total No CITY Tel No PP Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT If, after m ng this Certificate of Exemption, you should become subject to the Workers' Range— Heater—D W — APPLICATION Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W M — ADDRESS with comply with suc�h provisions or this permit shall be Top FAU —VN/H — deemed revoked Hood Fan —Other— CITY Tel No ez. �{ •3Y2 J — LICENSED CONTRACTORS DECLARATION. LICENS Ys OR 2 REG J t'® I hereby affirm that I am licensed under provisions of Chapter 9 Disp Room Air Cond — NUMBER Class(Z' (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO PROCESSED BY d and Professions Code,•and my license is in full force and effect Size&Type HP, KW, KVA, or KVAR Q License Number Lic Class Up to 1 Incl FINAL U Contracto Date -9^ Over 1 to 10 Incl DATE �'/7 1 VALIDATION 0 Over 10 to 50 Incl F- -91 FINA ElL Q� U I am exempt under ec Over 50 to 100 Inc BY 4.LN�� ' 8 n�� Over 100 LL CL Date 0-200 Amp Under 600 V 100# Z �i'�� Services, Swbd , MCC& Panelboards U) Q D — Signature 201 - 1000 Amp Under 600 V ❑ Exemption for Reg Maint Elect Over 1000 Amp or Over 600 V SINGLE FAMILY Temp Power Pole &Appurtenances1=1t , 0HOME OWNER-BUILDER DECLARATION 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) 11 FAL , '� „ -.70 ❑ I, as owner of the property, will do the work and the Misc Conduits&Conductors. .;i"1ECK s�e?I E structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ D Business and Professions Code) I CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency fori�, 'f' •' the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) "" 4 (Sec 3097, Civ C ) �� _ ! 1 PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE / r7 Lender's Address I certify that I have read this application and state that the TOTAL FEE gg 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 OS VdOCOMPENSATION DECLARATION 76-663 DPW 3/87 APPUCAMN FOR ELEC TPUC AL PERNT O I hereby affirmrm that I have a certificate of consent to self cE-ttobc insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec 3800, Lab C ) Policy No Company FOR APPLICANT TO FILL IN JOB ADDRESS ❑Certified copy is hereby furnished New Residential Bldgs .& Pools EACH NO FEE r_1 Certified copy is filed with the county building inspec- 1 &2-Family, Sci Ft $ _ $ LOCALITY t tion department Multi-family Sci Ft NEAREST CROSS ST Date Applicant Residential Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec Light Sw_ MAIL COMPENSATION INSURANCE ADDRESS First 20 (This section need not be completed if the'work involved by Total No Additional CITY Tel No the permit is for one hundred dollars ($100)or less.)* 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 so as to become subject to the Workers'Compensation Laws Lighting Fixtures First 20 ADDRESS Additional Total No CITY Tel No Date U^ i / '7� Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT If, after making this Certificate of APPLICATION 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 Hood — Fan —Other— CITY Tel No�� S� e LICENSED CONTRACTORS DECLARATION LICENS R Class c=,Disp — Room Air Cond — O 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& Large Appliances DISTRICT NO PROCESSED BY d and Professions Code,and my license is in full force and effect /J _ n Size &Type HP, KW, KVA, or KVAR �d 0 p License Number-11 0 O / Y Lic Class �^ D Up to 1 Incl FINAL Over 1 to 10 Incl DATE VALIDATION 0 Contractor. Date - r Over 10 to 50 Incl FINAL r O ❑ Over 50 to 100 Inc BY U I am exempt under Sec W Over 100 EL B r s r s n (n ?� !� Services, Swbd , MCC& Panelbo ds 03 11O D 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 HOME OWNER-BUILDER DECLARATION Temp Power Pole 8 Appurtenances I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit `1 .1r -Law for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits 'Professions Code) Misc Conduits & Conductors s f Complete Fee Schedule)— } � L E] as owner of the property, will o the work and the Other See Com ' structure is not intended or offered for sale(Section 7044, ( pD �L 3 � � 00Business 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 PERMIT FEE (Sub-Total) 0C `•I�H�)�_ (Sec 3097; Civ C ) PLAN CHECKING FEE _ Lender's Name 0131301-1311-1131 t'•17. PERMIT ISSUING FEE Lender's Address i"s•- 1 Art 7,. 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 above-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE i �s Signature of Permittee Date