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Home My Public Portal About9615 LAS TUNAS DR_Electrical__ 76A663-CE806 9-F4 APPLICATION FOR ELECTRICALC PERMIT 'COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JE NKINS, SU P'T. OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. f RECEPT TOTAL NO. EACH FEE OUTLETS FIRST 20 $2O $ OWNER_ LIGHT � MAIL � I ADD'L .f0 ADDRESS SWITCH.jOVER 2010— _-- AL CITY TEL.NO. 3-0 LIGHTINTOT G � IF1RST20 .20 Q FIXTURES } — I ovDRD20 10 Q ELECTRICIAf,(_= RANGES CLO.DRYERS WTR.HTRS. 1,00 ADDRESS D % •Q��L4� m, GARB.DISP. STA.COOK CITY 'L �✓LL� TEL.NO. o DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.0A H.P.MAX.) .50 LICENSE NO. MOTORS: ovER NOT OVER H.P. DISTRICT NO. GROUP ZONE P ESSE BY O 1 1.00 "o-4 1 3 1.50 INSPECTION RECORD 3 S 2.00 8 15 2.50 V 15 50 3.00 0 50 100 5.00CS c UW NO.TRANS- O_ SIGNS: NO.LAMPS Z SERVICE O.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 �I SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE $ 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI ATIONlll"��F -_ APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. RING 1 HEREBY _CERTIFY THAT I AM PROPERLY REGISTERED PND/ORIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INT TO RESIDE IN, THE ABOVE SCRIBED RESID NTIAL PROP Y. OWER SIGNATURE UTILITY CO.NOTIFIED _ OF PERMITTEE INAL �VAUDATION JOSEPH C. ROOHAN CK 40 CASH SUPERVISING ELECTRICAL ENGINEER ;�► 3 7 3 0 JUL 16 ? 0 1 SP.6 O N %cam%��?/��✓ II APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER ADDRESS ` / ?j BUILDING AND SAFETY DIVISION LOCALI TY`�' NEAREST FOR APPLICANT TO FILL IN CROSS ST. OUTLETS NO. EACH FEE OWNER OR $ $ FIRM NAM i RECEPT._ MAIL LIGHT TOTAL FIRST 20 .25 ADDRESS L OVER 20 CITY �j� TEL. NO. SWITCH_ _ 10 PLAN CHECKf IJ LIGHTING TOTAL FIRST 20 25 APPLICANT FIXTURES �10 OVER 20 ADDRESS RESIDENTIAL APPLIANCES CITY TEL. NO. PERMIT C' RANGE DRYER_WTR. HTR._ APPLICANT STA. COOK DISP. F.A.U. ADDRESS SPACE HTR. AIR COND. CI TY S, � 2 ;-�L= TEL. NO �:�� CLOTHES WASH. DISHWASH. LICESE OR REG.NNUMBER ��5CLASS. 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 REQUIRED BY LOS ANGELES COUNTY ANO STATE OF CALIFORNIA OR THAI I AM THE LEGAL OWNER OF THE ABOVE 1 - 10 300 DES CRIP.ED SIDE NTIA OPE RT Y. n' O PERMITEIE U I 10 — 50 5.00 SIGNATURE Q- L _ [� C:) 50 — 100 10.00 U DISTRICT NO. PROCESSED BY 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 SERVICENOTOVER 600 VOLTS OR 200 AMP 3.00 UNDERSLAB WORK SERVI CEOVER 600 VOLTS OR 200 AMP 10.00 ROUGH CONDUIT TEMPSERVICE,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 PERMIT ISSUING FEE TOTAL FEE �/1 PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALID TON cK., M.O. CASH SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 76AG63-CESOG-6-57 APPLICATION FOR ELECTRIC PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER6UILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A.LAMBIE,COUNTY ENGINEER CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITYNEAREST f/ / FOR APPLICANT TO FILL IN CROSS ST. V �_ yO PERMT FEES OWNER .5Gw T LIGHTS RECEPTACLES SWITCHES NUMBER __IT E M EACH FEE MAIL $ $ _ADDRESS TOTAL OUTLETS .10 ELEC. RANGES, WATER HEATERS, CITY TEL.NO. CLOTHES DRYERS .50 ELEC. SPACE HEATERS, STAT'Y. COOK- ELECTRICIAN Ei ING UNITS, GARBAGE DISPOSERS, ADDRESS AUTO WASHERS, DISHWASHER .25 LIGHTING FIXTURES .10 CITY.S/,'-'/ t /�/� TEL.N MOTORS STATE 1 LICENSE NO. HORSEPOWER H.P. OVER INC. DISTRICT NO. GROUP ZONE READY FOR INSPECTION y IN LESS -25 1/2 - 2 .50 INSPECTION RECORD 2 - 5 1.00 5 - 15 1.50 15 - 50 2.50 50 - 200 5.00 MISC. 1 4's j Ice �f Pkv v SIGNS NO.TRANS NO.LAMPS SERVICE O-600V 1.00 SERVICE OVER 600V 5.00 WIRING PERMIT 1.00 /` J FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT .50 APPROVALS TOTAL FEE $ GLI 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING, WIRING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY_LQS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT M TR LEGAL , NER OF THE ABOVE POWER DESCRIBED RESIDENTIA PR PE Y - SIGNATURE UTILITY CO.NOTIFIED OF PERMITTEE _ FINAL JOHN A.LAMBIE, VALIDATION ARTHUR C.VEIT. COUNTY ENGINEER CK MO CASH SUPERVISING ELECTRICAL ENGINEER 479 '6AG63-CE006 4-60 APPLICATION FOP, ELECTRICAL ERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER F.DLD' G q / BUILDING AND SAFETY DIVISION C JOHN A.LAMBIE. COUNTY ENGINEER WILLIAM A. JENSEN, SUPT OF BUILDING Y I FOR APPLICANT TO FILL IN NEAREST CROSS ST. I —1-lel PERMIT FEES OWNER L f -�-3�L�Lt-• ' I T E M NUMBER EACH FEE OUTLETS: $ MAIL LIGHTS RECEPT. SW. .10 ADDRESS LIGHTING FIXTURES 10 CITY TEL.NO ELEC. RANGES CLO. DRYERS ELECTRICIAN •�-C WATER H EATERS .50 ADDRESS L ELEC.SPACE HTRS. DISHWASHERS CITY l l 1 TEL.NO. GARBAGE DISPOSERS AUTO.- STATE �' ✓, WASHERS STA. COOKING UNITS •25 LICENSE NO. MOTORS: OVER INC. H.P. DISTRICT NO. GJj,OUP ZONEP CESSED BY� 1/2 - 2 50 Ll INSPECTION RECORD 2 5 1.00 D_ 5 15 1.50 0 15 — 50 2.50 O 50 — 200 _ 5.00 F- SIGNS: NO TRANS. CL W NO. LAMPS r N Z SERVICE 0.600V 1.00 SERVICE OVER 600V 5.00 misc. WIRING PERMIT 1.00 l -I FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT .50 TOTAL FEE S 1> �. LH BY ACKNOWLEDGE THAT f HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY LL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT CAL WIRING•EBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/ORWIRING D AS REQUIRED BY LOS AN GALES C UNTY AND STATE OF FIXTURES NIA OR THAT 1 AM THE VGAL OW EROFTHE ABOVE ED REBID/ ERT)/: POWER URE UTILITY CO. NOTIFIED MITTE 6 ` ti c FINAL ,,*AtIDATION ARTHUR C.VEIT, CK Mo CASH SUPERVISING ELECTRICAL ENGINEER Lr ,09 `l : DEC 13 6A665-CE6064-60 APPLICATi6N FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS -"- JOHN A.LAMBIE, COUNTY ENGINEER WILLIAM A. JENSEN, SUP'TOF BUILDING LOCALITY may/ i FOR APPLICANT TO FILL IN NEAREST 1 CROSS ST' PERMIT FEES I T E M NUMBER EACH FEE OUTLETS: $ $ MAIL / LIGHTS RECEPT. 1' SW. �'� .IO 2-C ADDRESS LIGHTING FIXTURES 10 CITY TEL NO ELEC. RANGES CLO. DRYERS ELECTRICIAN W A T E R H E A T E R S .50 ADDRESS S� ELEC.SPACE HTRS. DISHWASHERS CITY / f T LL NO2e GARBAGE DISPOSERS AUTO.- STATE WASHERS STA.COOKING UNITS .25 LICENSE NO. MOTORS: OVER INC. H.P. DISTgICTNO. IGROUP ZONEPR ESSED SY O — '/2 .25 G91 'L i2 - 2 .50 INSPECTION RECORD If 2 5 1.00 CL 5 15 1.50 0 15 — 50 2.50 CK O 50 — 200 5.00 U NO TRANS. w d SIGNS: NO. LAMPS / Z SERVICE 0.600V 1.00 ( G SERVICE OVER 600V 5.00 MISC. WIRING PERMIT 1.00 c FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT .50 TOTAL FEE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DDA�T/EE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT ELECTRICAL WIRING. WIRING 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED, BY LO ANGELES OUNTY AND STATE OF FIXTURES CALIFORNIA OR T - M T LEG INER OF THE ABOVE DESCRIBED RES E AL P RTY. POWER SIGNATURE/, UTILITY CO. NOTIFIED OF PERMITTE FINAL I //- � VALIDATION ARTHUR C.VEIT, MO CASH SUPERVISING ELECTRICAL ENGINEER CK, B663 DBS-5A 11-55 APPLICATION FOR ELECTRIC PERMIT 1 D DIVISION OF BUILDING AND SAFETY Department of County Engineer BUILDING County Of 1.08 Angeles ADDRESS �`'� ,� /7'ZS G/�Irf JOHN A. LAMBIE, COUNTY ENGINEER CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN sr. PERMIT FEES NUMBER OWNER _7 5 cy L/ LIGHT OUTLETS MAIL RECEPTACLES ADDRESS WALL SWITCHES FEE CITY TEL. NO. TOTAL OUTLETS @ 5¢ $ ELECTRICIAN C /t'' ELEC. RANGES 25 — —— ADDRESS sZ•5 ELEC. HEATERS 25 CITY hIi TEL. NO •� KW EA STATE FIXTURES 5 LICENSE NO. MOTORS DISTRACT NO. 1GROUP�ZONE I READY FOR INSPECTION NUMBER HORSEPOWER FEE NEW MVD. HP OVER INC. EACH 1�&LESS $ .25 7 INSPECTION ECORD f If2 2 .50 = 2 5 1.00 5 15 1.50 i 15 50 2.50 50 200 5.00 C] MISC. A.L.L. 't-__./ o yv_Fit' o S 47's -'� +" i� —t '{ �.: 1 •w,_t ,.��.�Ile r� NO. SIGNS NO.TRANS. h NO. SIGNS NO. LAMPS FOR EACH PERMIT: WIRING $1.00 r FIXTURES $1.00 / SUPPLEMENTARY .50 APPROVALS / TOTAL FEE $ I�"i' DATE INSPECTOR' SIGNATURE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATI AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING. I HEREBY CERTIFY THAT I ROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY l S A ELU COUNTY AND STATE OF CALIFORNIA OR THAT I�M T E EG OWNER OF THE ABOVE POWER i DESCRIBED RESIDENTIAL;PRO kx RT��-/// �.. SIGNATURE n, '/I UTILITY CO.NOTIFIED OF PERMITTEE '!� FINAL JOHN A.LAMBIE.COUNTY ENGINEER VALIDATJON ARTHUR C.VEIT,CHIEF ELECT. INSPECTOR CK MO (CASH L V;m that I COMPENSATION DECLARATION 76-806 10/81 APPLICATION FOR ELECTRICAL PERMIT {� I hereby affirm that I have a certificate of consent to self insure, CE-806G LJ or_a certificate of WoPKers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY cop; there'l,Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN 1� Y ❑ Certified copy is herebyfurnished. EACH NO. FEE ACQRESS �t � New Residential Bldgs.& Pools ❑ 1 & 2-Family,Sq.Ft. $ _ $ LOCALITY Z 4 Certified copy is filed with the county building inspection department. Multi-family Sq.Ft. NEAREST CROSS ST. � Date Applicant Residential Swimming Pools ER OR NAME fJ,VA CERTIFICATE OF EXEMPTION FROM WORKERS' L / MAIL COMPENSATION INSURANCE Outlets:Rec Light t 2 S ADDRESS (This section need not be completed if the work involved by the First 20 CITY Tel.No O[a permit is for one hundred dollars ($100)or less.) Total No. Additional PLAN CHECK I certify that in the performance of the work for which this permit APPLICANT is issued, I shall not employ any person in any manner so as to become subject to the Workers'C pensation La*Ce q Lighting Fixtures 5" First 20 ADDRESS [af �1-�/ Additional C, U Total No. CITY Tel. o Date /�/Jr � Applicant Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, afte making thate of PERMIT Exemption,you should become subject to the Workers'Compensation Range_ HeaterD.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_ I hereby affirm that I am licensed under provisions of Chapter 9LICENSE OR Disp'. Room Air Cond. REG.NUMBER Class. (commencing with Section 7000) of Division 3 of the Business and Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO(.� PROCESSED BY i Size& Type HP,KW,KVA,or KVAR l✓L 0 License Number Lic.Class Up to 1 Incl. FINAL U Over 1 to 10 Incl. DATE O VALIDATIQ Contractor Date Over 10 to 50 Incl. FINAL /� (ql I am exempt under Sec. Over 50 to 100 Inc. BY ! l P-86 G5 A W B.&P.C.for this reason Over 100 o 0 0 • 0 2 Services,Swbd.,MCC& Panelboards Z Date: 0-200 Amp.Under 600 V I o 0 2 Q 5 0 Signature 201 -1000 Amp.Under 600 V z ❑ Over 1000 Amp. or Over 600 V o 0 a 2 Q 5 0 v Exemption for Reg.Maint.Elect. 1 2 SINGLE FAMILY Temp.Power Pole& Appurtenances 1 5 -87 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): Misc.Conduits& Conductors I,as owner of the property,will do the work and the structure Other(See Complete Fee Schedule) is not intended or offered for sale (Section 7044, Business 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(Sec.3097, PERMIT FEE (Sub-Total) Civ.C.). PLAN 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 authorize representatives of this County to enter upon the above-mentioned prperty for inspection purposes. ° I SEE REVERSE FOR EXPLANATORY LANGUAGE C` Sig ature of Permitte Date 1f/ORKERSICOM?: NSATION DECLARATION zo-ooteDPW 3ie7 APPLICATION FOR ELECTRICAL PERnl11T I.hereby affirm 'tho7 I have certificate of consent to self CE 806c insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a:ertified co re (Sec. 3800, e C. I Policy Not ompany k FOR APPLICANT TO FILL IN JOB ❑Certified co s her b furnishe EACH NO. FEE ADDRESS fn PY Y New Residential,Bldgs. & Pools ❑Certified copy is filed with the county uilding inspec- 1 &2-Family, Sq. Ft. $ — $ LOCALITY tion d partme ^ Multi-family Sq. Ft. NEAREST , CROSS ST. Dotes a Applicant Residential Swimming Pools OWNER OR , FIRM NAME CERTI CATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light SwMAIL ._ 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' pen ation Laws. Lighting Fixtures First 20 ADDRESS ��•• Additional Dafen` �� A lica Total No. CITY Tel. No. PP Fixed Appliances Not Over 1 HP PERMIT NOTI TO APP (CANT: If, after mal ng 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 S with comply with such provisions or this permit.shall be Top — FAU —W.H. — deemed revoked. Hood — Fan —Other— CITY ' /�� Tel. LICENSED CONTRACTORS DECLARATION LICENSE OR 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 Power Apparatus& Large Appliances DISTRICT NO. P C S BY >_ and Professions Co Q,an my license is in full force and effect. a. _ Size &Type HP, KW, KVA, or KVAR Q License Number V Up lic. Class to 1 Incl. FINAL U �^ �- Contractor ! Date Over,l to 10 Incl. DATE O /Z VALIDATION Over 10 to 50 Incl. / r� F_ F-1I am exempt under Sec. Over 50 to 100 Inc. BY AL � %\ O _ W B.&P.C. for this reason Over 100 �✓ �` 0- Date Services, Swbd., MCC& Panelboards f 0- 200 Amp. Under 600 V f if1• 4 - Signature 201 - 1000 Amp. Under 600 V �- ❑ Over 1000 Amp. or Over 600 V Exemption for Req. Maint. Elect. � SINGLE FAMILY Temp. Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Ht•�• nv Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits 3307 j:_,nl lf! Professions Code): ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors 1 ITEMS structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ , T4!i AL 33 a C30 Business and Professions Code). CHECK 33.CI CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for CHANGE .00 the performance of the woik for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE llii�-i)i!~i Lender's Name PERMIT ISSUING FEE 00 92 19 3 HCI 9:L Lender's Address `� n I certify that I have read this application and state that the TOTAL FEE �.31 above information is correct. 1 agree to comply with all County ordinances and State laws.regulating Electrical wiring, and ry hereby authorize representatives of this County to enter upon the above- enti ed propert n r inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE O/I Da e Signa of Permittee WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT lJ I he9eby affirm that I have a certificate of consent to self insure, 76A663 or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. 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 NO. EACH FEE LOCALITY ❑ Certified co is filed with the count building inspection 1 &2-Family,Sq.Ft. — $ $ PY Y 9 _ NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR MAP PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._L,ht Sw. OWNER OR COMPENSATION INSURANCE G FIRM NAME First 20 /•�� (This section need not be completed if the work involved by the MAILTotal No. Additional ADDRESS j permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITY - Tel.No. is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT ✓ � Total No. Additional ADDRESS Date _ Q 72 Applicant ,19 , ' � � RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APP (CANT: If, after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers' Compensation OTHER APPLIANCES NOT OVER 3 HP. y- provisions of the Labor Code, you must forthwith comply with Such@RMITPower Apparatus&Large Appliances APPLICANT /�/-7 provisions or this permit shall be deemed revoked. LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS 0f I hereby affirm that'I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. v (commencing with Section 7000) of Division 3 of the Business and CITY ;7 Tel.Na. O _�/Cf Professions Code, and my license is in full force and effect. Over 10 to 50 Incl. �� y. LICENSE OR �� / C Class. Over 50 t0 100 Incl. REG.NUMBER O O �� I glt7Over 100 DISTRICT NO. PRO 6SSED BY V License Number Lic.Class �j Services,Swbd.,MCC&Panelboards —I j"� 3 0-399 Amp.Under 600 V FINAL o Contractor�� ate DATE El I am exempt under Sec. 400-1000 Amp.Under 600 V W VALIDATION Over 1000 Amp.or Over 600 V FINAL 1 B.&P.C.for this reason BRANCH CIRCUIT FEES BY Date: 15A,or 20A, 120V,Lighting or Recept. Z 1 To 10 Branch Circuits / Signature 11 To 40 Branch Circuits F-141 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances. r•r•- HOME OWNER-BUILDER DECLARATION hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits }r-' Code): 1 �TE�° El 1, Conduits&Conductors I, as owner of the property,will do the work and the structure _ z•-.T,: � is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) ! I`HL 3-_' - 40 and Professions Code). ^-SEC. �1 I.H K CONSTRUCTION LENDING AGENCYr•• t: G E J30 I hereby affirm that there is a construction lending agency for the �i�f. performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ. C.) _ PLAN CHECKING FEE U] i j-L9 4�ro j =,•` 1f'i,:r Lender's Name y ; I PERMIT ISSUING FEE � � �.;:i=- �• .26 tr tC Lender's Address ILYA I certify that I have read this application and under penalty of purjury state TOTAL FEE 7 that the 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 in p ction purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE PERMITTEE- T DATE