Loading...
HomeMy Public PortalAbout9456 LAS TUNAS DR_Electrical__ �G%�IrzG� (7,- � 76A663-CE8061/70 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING ESS �-� ao/ BUILDING AND SAFETY DIVISION ADDR7" JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING NEAREST 1,7 FOR APPLICANT TO FILL IN CROSS ST. OUTLETS NO. EACHI FEE $ � OWNER RECEPT._ MAIL LIGHT TOTAL FIRST 20 20. ADDRESS CITY TEL. NO. SWITCH OVER 20 .10 PLAN CHECK LIGHTINGFIRST 20 20 APPLICANT TOTAL ADDRESS FIXTURES OVER 20 10 APPLIANCES ICITY TEL. N0. PERMIT RANGE DRYER_WTR. HTR. APPLICANT eel J STA. COOK DISP. F.A.U. ADDRESS SPACE HTR, AIR COND. CITY TEL. NO. CLOTHES WASH. DISHWASH. LICENSE NO. p?��/� CLASS. Ci—/,9 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 - 1 100 LICENSED AS RED IRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO 1 - 10 3.00 RESIDE N, THE AB VE DESCRIDED RESIDENTIAL PROPER Y. SIGNATURE a 10 - 50 5.00 OF PERMITTEE �Gw✓ Q 50 - 100 10.00 DISTRICT NO LASS GROUP ZONE ROCESSE Y OC 100 - 500 15.00 d SIGN, GAS SIGN AND ONE CIRCUIT 3.00 NOTES: Ud CL TUBE, OR Z MARQUEE ADDITIONAL CIRCUITS 1.90 SERVI CENOT OVER 600 VOLTS OR 200 AMP 2.00 APPROVALS DATE INSPECTOR'S SIGNATURE SERVI CE OVER 600 VOLTS OR 200 AMP 5.00 TEMP.POWER POLE TEMP SERVICE,POLE, &APPURTENANCES 3.00 , UNDERSLAB WORK TEMP LIGHT OR RECEPT. SYSTEM ' 3.00 �T v ROUGH CONDIUT WIRING FIXTURES PERMIT FEE (SUB TOTAL) POWER AUTHORIZED PLAN CHECK FEE (50% PERMIT FEE) UTILITY CO. NOTIFIED PERMIT ISSUING FEE 2.00 OCJ SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL ,� JOSEPH C. ROOHAN TOTAL FEE SUPERVISING ELECTRICAL ENGINEER, PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIONCK.' M.O. _ CASH All1 1 2 o- sUN 2 9 2 U ,0 -/v SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE , 76A663-CE8061s68 APPLICATION FOR ELECTRICAL PERMIT e' COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER p ,tom T COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. FNO. EACH FE++�� $ S OWNER ''RECEPTs7� MAIL ADDRESSLIGHT (TOTAL FIRST 20 .20SWITCH / OVER20 .10 CITY >t(1 TEL. NO.PLAN CHECKLIGHTING TOTAL FIRST 20 .20 (j APPLICANT pf a� . FIXTURES f OVER 20 V� .1046 ADDRESS Z. RANGE DRYER WTR.HTR— CITY f� TEL. NO. Z - i2- STA.COOK_DISP. F.A.U.— .CONTRACTOR r f5lae- SPACE HTR. AIR COND. ADDRESS iSS; CLOTHES WASH. DISHWASH.— CITY TEL. NO. -- lz FAN_OTHER 1.00 LICENSE NO. pZja CLASS. e-10 MOTORS,TRANSFORMERS RATING IND. HEATERS, ETC. HP. KW. KVA. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY SIZE & TYPE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING O 1.00 ELECTRICAL WIRING. — .1 (ij� I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR 1 — 10 3.00Cp LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF �, CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO 0 - 10 — 50 5.00 RESIDE IN, THE ABOVE DESCRIFED RESIDENTIAL PROPERTY. O .SIGNATURE "Z/ /', V 50 - 100 10.00 OF PERMITTEE 100 - 500 15.000 DISTRICT NO. GROUP ZONE 'P OCESSED BY, �J TUBE, OR SGAS C-7 IGN AND ONE CIRCUIT 3.00. Ss+ — IPZI=•ate �,� WR IE ES: MARQUEE ADDITIONAL CIRCUITS 1.00 '? ~4 NOTs Qpm'" SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 SERVICE OVER 600 VOLTS OR 200 AMP 5.00 , TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE TEMP. POWER POLE UNDERSLAB WORK ROUGH CONDUIT PERMIT FEE (SUB TOTAL) WIRING FIXTURES PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED PERMIT ISSUING FEE 12.00 -- Q_� UTILITY CO.NOTIF Dl6/ SUPPLEMENTARY PERMIT ISSUING FEE 1.00 ` J O FINALdea— ° TOTAL FEE JOS PI'1"C. ROOHAN SUPERVISING ELECTRICAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK. M.O. CASH 2 D IEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE - / 76A663-CE806 9,,C7 -,APPLICATI N F R LECTRICAL PERMIT COUNTYlOF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS • Rs JOHN A. LAMB1E, COUNTY ENGINEER a _ COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY J �L NEAREST FOR APPLICANT TO FILL IN CROSS ST. NO. EACH FEE OWNER rT - KGs RECEPT._ MAIL LIGHT TOTAL FIRST 20 .20 ADDREJJSS .3 � G-- SW ITCH_ OVER 20 .10 CITY C� TEL. NO.A LGHTING TOTAL FIRST 20 .20 CONTRACTOR FXTURES OVER 20 .10 ADDRESS RANR. CITY TEL. NO. 3�' STA.COOK_DISP. F.A.U.- LICENSE NO. CLS SPACE HTR. AIR CON D. 1 HEREBY ACKNOWLEDGE THAT I HA E READ THIS APPLICA ION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CLOTHES WASH._DISHWAS H._ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. FAN_OTHER' 1.00 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERE AND LICENSED AS REQUIRED BY LOS A• GELES COUNTY AN ATE OF MOTORS,TRANSFORMERS RATING CA LI F.ORNIA OR THAT I AM GAL OWNER OF, NT END TO IND, HEATERS, ETC. HP. KW. KVA. RESIDE IN, THE ABO IBED RES EN PROPERTY. SIZE & TYPE OVER TO SIGNATURE O - 1 1.00 OF PERMITTEE IV - a 1 — 10 3.00 DISTRICT NO. GRO P ZONE PROCESSED BY •0 S� g Si Ix 10 — so 5.00 0 50 - 100 10.00 NOTES: U W 100 - 500 15.00 1 �- N TUBE,SIGN,GA SIGN AND ONE CIRCUIT I 3.00 MARQUEE ADDITIONAL CIRCUITS 1.00 SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 SERVICE OVER 600 VOLTS OR 200 AMP 5.00 TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE TEMP. POWER POLE UNDERSLAB WORK ROUGH CONDUIT WIRING ISSUING FEE 2.00 FIXTURES SUPPLEMENTARY ISSUING FEE 1.00 POWER AUTHORIZED PERMIT FEE - UTILITY CO.NOTIFIED PLAN CHECK FEE (50% PERMIT FEE) FINAL TOTAL FEE JOSEPH C. ROOHAN SUPERVISING ELEC CAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK M.O. CASH SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE ' WORKER S'COMPENSATION DECLARATION CE-806G (2-80) APPLICATION. FOR ELECTRICAL PERMIT I hereby affirin that I have a certificate of consent to self COUNTY OF LOS ANGELES BUI LDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,ori G, a certified copy thereof(Sec. 3800,Lab.C.) FOR APPLICANT TO FILL IN SOB Policy No. Company ADDRESS New Residential Bldgs.&Pools EACH NO. FEE ❑ Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY Multi-family Sq. Ft. — NEAREST Certified copy is.filed with the countybuilding inspection CROSS ST ❑ Residential Swimming Pools. department.' PWNEROR RM NAME Date ApplicantOutlets: Rec._Light_Sw. ADDRESS�Gt First 20 CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY ; ti Tel No. COMPENSATION INSURANCE } PLAN CHECK 1 (This section .need not be completed if the work involved-,, APPLICANT 0 by the permit is for one hundred dollars. ($100) or less.) Lighting Fixtures First ADDRESS U ' Total No. Additional. � I certify that in the performance of the work for which this CITY Tel No. O Fixed Appliances Not Over 1 HP 000 permit is issued, I shall not employ any person in any manner PERMIT \\ so as to become subject to the Workers' Co ensation Laws. Range_ Heater_D.W. APPLICANT V L, —1, W Oven _ Dryer_W.M._ ADDRESS '7� ` V_`\ ` Top _.FAU —W.H.. Z >0ate�s`, �� Applicant �� It Hood _ Fan _Other_ CITY � i� Tel No: % .7Sq�. NOTICE TO APPLICANT: If, after making this Cbrtificate of Disp. — Room Air Cond.— LICENSE OR 6 Exemption, you should become subject to the Workers' REG. NUMBER Class Compensation .provisions ofLabor Code, you must forth- , power Apparatus& Large Appliances DISTRICT NO. PROD e� with comply with such provisions or this permit shall be Size&Type HP,KW, KVA,or KVAR � deemed revoked. Up to 1 Incl. FINAL " Over 1 to 10 Incl. DATE VALIDATION LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. ^ I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL.BY 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 p ness and Professions Code, and my license is in full force and effect. Services 0-200 Amp. Under 600 V ke License Number Lic.Class 201-1000 Amp. Under 600 V Contractor Date Over 1000 Amp.or Over 600,V HOME OWNER-BUILDER DECLARATION Temp.Power Pole& Appurtenances I hereby affirm that I am exempt from 'the Contractor's Sign with One Branch Circuit License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits ness and Professions Code): z '1 1,Q•a Misc.Conduits&Conductors ❑ I, as owner of the property, will 'do the work and the Other (See Complete Fee Schedule)— # o`o o o o 2 structure is not intended or offered' for sale (Section 7044,,Business and Professions Code). 2 ° ° 1'0.0j0 CONSTRUCTION LENDING AGENCY I hereby affirm that there.is a construction lending agency °'O, ° 1:a 00 q for the performance of the work for which this permit is PERMIT FEE (Sub Total) issued (Sec. 3097,Civ.C.). - 0;6 2 9-8 1 Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE "I certify that I have read this application and state that the TOTAL FEE J 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 4 thg above-mentioned roperty for inspection purposes . SEE REVERSE FOR EXPLANATORY LANGUAGE V11 \ t r` / h�{ Signatu a of t Permittee Date �~ W1)RKERS' COMPENSATION DECLARATION 76A663 10/81 h relay' affirm that I have a certificate of consent to self CE-806G APPLICATION FOR ELECTRICAL PERMIT insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN. JOB Certified co is hereby furnished. EACH NO. FEE ADDRESS copy Y New Residential Bldgs. & Pools ❑ 1 &2-Famil S Ft. $ _ $ LOCALITY Certified copy is filed with the county building inspec- Y� q• tion department. Multi-family Sq. Ft. CROSS ST Residential Swimming Pools OWNER OR Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAII COMPENSATION INSURANCE , ADDRESS (This section need not be completed if the work involved by First 20 Total No. Additional CITY �-� Tel. No�O 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 Work Compensation Laws. Lighting Fixtures First 20 ADDRESS \ J Total No. Additional CITY Tel. No. Date, Applicant , FA Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this C rti icate of APPLICANT Exemption, you should become subject to the orkers' Range_ Heater_D.W. < r 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 R I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REG. NUMBER Class. (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. CE ED BY and Professions Code, and my license is in full force and effect. Power Apparatus& Large Appliances Size&Type HP, KW, KVA, or KVAR- c r/ License Number_ Lic. Class Up to 1 Incl. FINAL _ Over 1 to 10 Incl. DATE` Z9 /� VALIDATION o Contractor Date Over 10 to 50 Incl. FINA ❑ I am exempt under Sec. Over 50 to 100 Inc. BY 1 B.&P.C. for this reason Over 100 of Services, Swbd., MCC& Panelboards / 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 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): ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)- 7044, Business and Professions Code). _ :2 2 j 3.3 A CONSTRUCTION LENDING AGENCY I hereby affirm that there is a.construction lending agency for ;# o 0 o o,e 2 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) ( o o.1 S 5 0 (Sec. 3097, Civ. C.). PLAN CHECKING FEE o a o.1 5 Jr O v Lender's Name PERMIT ISSUING FEE :0 626-85 Lender's Address / �l 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 "at6re tion d property for ins ection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE r it ee Date WORKERS' COMPENSATION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-806G insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB / ,� c' Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS Sjp IAS 7411vh J Certified•copy is filed with the county building inspec- 1 8 2-Family, Sq. Ft. $ — $ LOCALITY F-1 tion department, Multi-family Sq.i LVF-leVF-leDate Applicant Ft. CROSS ST. 4f 0 v ` Residential Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RecLight $w.— MAIL COMPENSATION INSURANCE - u. ADDRESS © )L/�N� /t'�e , (This notbe completed First ( s section neenopeted if the work involved b Y Total No. Additional . onal CITY/� �i C� Tel. No the permit is for one hundred dollars'($100)or less.) 1 certifythat in the performance of the work for which this PLAN CHECK P APPLICANT permit is issued, 1 shall not employ any person in any manner so as to become subject to the Wo ers'Com Pens tion Laws. Lighting Fixtures First 20 ADDRESS Additional 6rr46 Total No. Date Applican CITY Tel. No. Fixed Appliances Not Over 1 HP PERMIT d NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT /f 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 ` D� with comply with such provisions or this'permit shall be Top _ FAU —W.H.'— ��1� �` - j deemed revoked. Hood _ Fan _Other_ CITY Tel. No. 6 LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. Class. REG. NUMBER �. (commencing with Section 7000) of Division 3 of the Business DISTRICT NOPower Apparatus& Large Appliances PROC BY LL and Professions Code,and my license is in full force and effect. ' ,/y Q� 0Size &Type HP, KW, KVA, or KVAR' o I License Number Lic. Class Up to 1 Incl. cc FINAL , Over 1 to 10 Incl. DATE _� ��/ O Contractor Date (� VALI TION 0 ❑ Over 10 to 50 Incl. FINA ttl I am'exempt under Sec. Over 50 to 100 Inc. BY B.BP.C. for this reason Over 100. z Date: Services, Swbd., MCC & Panelboards 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 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): ❑ I, as owner of theproperty, will do the work and the Misc. Conduits&Conductors , structure is not intended or offered for sale (Section Oth�(See.CompleT�Fee Schedule)_ @4864A 7044, Business and Professions Code). # © ® ®,® ® 2 CONSTRUCTION LENDING AGENCY ' ® ®r rj 5 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) 5 cJ _ (Sec. 3097, Civ. C.). o •®io v PLAN CHECKING FEE Q 23 -86 Lender's Name PERMIT ISSUING FEE 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 laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon t e above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of �rmittee Date �''\ WORKERS'COMPENSATION DECLARATION 2o-ooivDPW 3ie7 "gloom APPLICATION FORELECTRICAL PERMIT i,hereby.�ffirm that I have a certificate of consent to self CE-806G ftvs e, 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 ��(tiY FOR APPLICANT TO FILL IN JOB ❑Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS 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 OWNER OR Date Applicant FIRM NAME AA r CE TIFI ATE OF EXEMPTION FROM WO ERS' 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.) I certifythat in the performance of the work for which this PLAN CHECK P 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 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. ' .Zj -)3' LICENSED CONTRACTORS DECLARATION Disp. — Room Air Cond. — LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER Class. (commencing with Section 7000)of Division 3 of the Business Power Apparatus & Large Appliances DISTRICT O. PR CESSED BY >- and Professions Code,and my license is in full force and effect. Q� a0 �, Size &Type HP, KW, KVA, or KVAR License Number ����I/1 Lic:Class Up to 1 Incl. FINAL ((�� � -- } Over 1 to 10 Incl. DATE _ f� VALIDATION Cc Contractor ALI A4%. 2 as Over 10 to 50 Incl FI0 ❑ NAL U I am exempt under Sec. Over 50 to 100 Inc. F Over 100 i' 2e9 9.5 3 A a B.BP.C. for this reason , U) Services, Swbd.., MCC& Panelboards +';o 0 o,e 0 2 Z Date: 0-200 Amp. Under 600 V — Signature 201 - 1000 Amp. Under 600 V 'e o.,l 5,5 0 Over 1000 Amp. or Over 600 V El Exemption U. Exemption for Reg. Maint. Elect. o'o o r1 5 0, SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp' Power Pole &Appurtenances o-6 2 3.,i . 8 8 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): ❑ I,.asowner of the property, will do the work and the Misc. Conduits&Conductors structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ Business and Professions Code). If CONSTRUCTION LENDING AGENCY "f � 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 r—�l I certify that I have read this application and state that the I 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 Signature of Pe mittee Pate I ©s WORKER S'COMPENSATION DECLARATION CE-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT CE-806 I .hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or, a certified copy thereof(Sec. 3800,Lab.C.) ( � FOR"APPLICANT TO EFILL ACH N JOB Policy No. Company H NO. FEE DDRESS clv /1G 4/43 14A.5 ./ New Residential Bldgs.&Pools �'Ue Certified copy,is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY 'rei`, r C aMulti-family Sq. Ft. — NEAREST Certified copy is filed with the county building inspection CROSS ST "v OAC14 department. Residential Swimming Pools OWNER OR FIRM NAME i Date Applicant Outlets`. Rec.____Light Sw. MAIL First 20 ADDRESS i CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY'-7— r, Tel No.4 G cr COMPENSATION INSURANCE } PLAN CHEC t1. APPLICANT Q (This section need not be completed if the work involved Lighting Fixtures First 20 U by the permit is for one hundred dollars ($100) or less.) Additional ADDRESS � Total No. Q I certify that in the performance of the work,for which this Fixed Appliances Not Over 1 HP CITY Tel No. permit is issued, I shall not employ any person'in any manner PERMIT p� W so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT F—C," A Oven _ Dryer_W.M._ ADDRESS Date Applicant _ Top FAU W.H. T _ Z ' Hood — Fan _Other_ CITY l Tel No. NOTICE TO APPLICANT: If, after making this Certificate of Disp. — Room Air Cond.— LICENSE OR Exemption, you should become subject to the Workers' REG, NUMBER 362. Class C —/5 . Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCES ED BY with comply with such provisions or this permit shall be Size&Type HP,KW,KVA,or KVAR deemed revoked. ' Up to 1 Incl. FINAL LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATE VALIDATION Over 10 to 50 Incl. �r0� I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINALBY � V 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 ness and-Professions.Code, and my license is in full force.and, effect. p/ Services License Number 201 Lic.Class 0-200 Amp. Under 600 V �(Q�. �t `` 201-1000 Amp. Under 600'V Contractor) i<�lA ?-Z�l�/4)D to 2— Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's Additional Sign Branch Circuits 4 b a 9 A License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): # o o o 0 o 2 Misc.Conduits&Conductors , E] I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— 2 0 0'� [�5 0 structure is not intended or offered for sale (Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 0 0o 1 IL 5.0,5 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is PERMIT FEE (Sub-Total) D;i ,2'9'-8 2 issued(Sec. 3097,Civ.C.). Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE 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/la-ho State laws regulating Electrical wiring, and jj� ntatives of this County to enter upon oned property for inspection pur/14, ses. SEE'REVERSE FOR EXPLANATORY LANGUAGE 0 8 Z Are of Permi tee Date } WORKERS'COMPENSATION DECLARATION 76A663 10/81 JI hereby affirm that I have a certificate of consent to self insure; CE-806G APPLICATION FOR -ELECTRICAL PERMIT or a`certificate of 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 f �n ❑ Certified copy is hereby.furnished. New Residential Bldgs. & Pools EACH, NO. FEE ADDRESS ❑ - LOCALITY 'Certified 'copy is 'filed with the county building inspection 1 & 2-Family, Sq.Ft. $ — $ department. Multi-family Sq.Ft. NEAREST CROSS ST. CeGrlC Residential Swimming Pools OWNEROR Date .Applicant - FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS'- MAIL Outlets:Rec Light Sw. �� COMPENSATION INSURANCE First 20 ADDNESS' <• _ (This section need not.be completed if the work involved,-by the CITYTel.No. 0� may) permit is,for one-hundred dollars ($100)or less.) Total No. Additional C: PLAN CHEC I certify that in the-performance of the,work for which this,permit APPLICANTK ..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 v Tel.No. Date Ap:1.,ca,,�nFixed Appliances Not Over 1 HP NOTICE TO APPLICANT.' a4king,.this Certificate of PERMIT Exemption,you should becomectto the Workers Compensation Range_ Heater— D.W. APPLICANT G / provisions of the Labor,Cod ou must forthwith comply with such Oven _ Dryer W.M._ ADDRESS provisions or this permit shall be deemed revoked. Top . _ FAU W.H. _ CITY eGL"_-C Tel.,.No. Z/7 LICENSED•CONTRACTORS DECLARATION Hood — Fan Other_ I hereby affirm that 1 am licensed 11 under provisions of Chapter 9LICENSE OR (commencing with Section 7000) of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER G`O/ G j Class. Professions Code,and my license is in full force and effect. DISTRICT PROCESS BY Power Apparatus&Large Appliances _ `` �/ / Size& Type HP,KW,KVA,or KVAR U License Number �! Lic.Class GUp to 1 Incl, FINAL 7 Over'1 to 10,Incl. DATE ✓���}� VALIDATION Contractor Date Over 10 to 50 Incl. C/ U FIN ❑ I am exempt under Sec. Over 50 to 100 Inc. BY W BAP.C.for this reason Over 100 n- N Services,Swbd.,MCC & Panelboards �, Z Date: - 0- 200 Amp.Under 600 V r-s Signature 201 -1000 Amp.Under 600 V r Over 1000 Amp.or Over 600 V . Exemption for Reg.Maim,Elect. SINGLE FAMILY Temp.Power Pole & Appurtenances ry HOME OWNER-BUILDER DECLARATION' Sign with One Branch Circuit. G I hereby affirm that I am exempt from the Contractor's License Law �t a for the following reason(Section 7031.5,Business and Professions Additional Sign'Branch,Circuits ACCT e T Code): ❑ 1,as owner,of the property,will do the work and the structure Misc.Conduits& Conductors is not intended or offered for'sale (Section 7044, Business Other(See Complete Fee Schedule) 1 ITEMS .' . and Professions Code).. TOTAL 15 !�O CONSTRUCTION LENDING AGENCY CHECK 155.% 1 hereby affirm that there is a construction lending agency for the tf.LfA1k�'l'rr performance of the work for which this permit is issued(Sec.3097, PERMIT,.FEE (Sub Total) S �rrg9i7VL Civ.C.). PLAN CHECKING FEE Lender's Name � 1 6/27/89 PERMIT ISSUING FEE !� Lender's Address 41" 1 AM $:38 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 authorize representatives of,this County to enter upon the above-mentioned ' ;�for insp tion purpo s: of' SEE REVERSE-FOR,EXPLANATORY LANGUAGE of ermi tee Date 5