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HomeMy Public PortalAbout9433 LONGDEN AVE_Electrical__ L- WORG901$COMPENSATIONDECLARATION 7D6A6GD�DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT hesi�t�:j aff'ir`fh'th'atfl have a certificate of consent'to self insure,. or a-certificate of WbPker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.4-111111QO Lab.C.) Policy No. Company. FOR APPLICANT TO FILL IN JOB ❑ Certified c. NO. EACH FEE ADDRESS 32> '� � Ave oW�hereby furnished. New Residential Bldgs.&Pools $ $ LOCALITY ❑ Certified caWl is filed with the county building inspection 1 &2-Family,Sq.Ft. departmenft.; Multi-.family Sq.Ft. NEAREST .CROSS ST. Residential Swimming Pools ASSESSOR Date _ Applicant .- MAP BOOK �� PAGE O PARCEL .4 CERTIRMTE OF EXEMPTION FROM WORKERS' OWNER OR COMPENSATION INSURANCE Outlets:Rec. Light Sw. e� O FIRM NAME U VI (This section need not be completed if the work Involved by the First 20 MAIL permit Is for one hundred dollars($7'00)or less.) Total No. Additional ADDRESS 4-3 �(J �lONE•, 1 certify that in the performance of the work for which this permit CITY �IrM� Tel.No.2 1B 17 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 Ni. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO•APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,you should-become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions.of the Labor Code,you must forthwith comply with such- PERMIT A' provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT Oar LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR / ADDRESS I hereby affirm that 1 am licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000)of Division 3 of the Business and CITY Tel.No. Professions Code,and my license is In full force and effect. Over 10 to 50 Incl. Over 50 to 100 Inc[. LICENSE OR Class. REG.NUMBER 0. + Over 100 DISTRICT NO. P SED BY 0 - Lic.Class License Number Q 4 Se bd.,MC ana{b�oard��J p �. ell 0-399 7 der" 600 Vr O FINAL / 0 Contractor. Date DATE ❑ 400-1000 Amp.Under 600'V , �� ��' I am exempt under Sec. VALIDATION V Over 100o Amp.-or Over 600 V. FINALll l B.&P.C.for this reason BRANCH CIRCUIT FEES 13Y CO) Date: 1:5Aw or 20A,120V,Lighting or Recept. Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Exemption for Reg.Maint,Elect. 15A,20A,2 V To 277V Lighting•Br.Circuits 2 SINGLE FAMILY Temp.Power Pole&.Appurtenances A\ rT04 JL HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ,303 161 20 hereby affirm that 1 am exempt from the Contractor's License Law for t)following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits ITEMS Code I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors TOTAL 161 o 20 Is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule). and Professions Code). C,HE�r,{S �b iQ0, H L CONSTRUCTION LENDING AGENCY CHANGE a00 I hereby affirm that there is a construction lending agency for the Civ.Cance of the work for which this permit is issued(Sec. 3097, PERMIT FEE (Sub-Total) 0000'0001 8/22/9 PLAN CHECKING FEE I43 AM Sp 1$ Lender's Name PERMIT ISSUING FEE Q Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL'FEE 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 Inspection purposes, SEE REVERSE FOR EXPLANATORY LANGUAGE At 2 SIGNATU �F M RMITTEE ATE TEMPLE cflTv 76A,M-'�16 8-62 APPLICATION 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,SUPT OF BUILDING LOCALITY N-iEAREST FOR APPLICANT TO FILL IN .Ross ST. __z 7 NO. EACH FEE • REC EPT, TOTAL '�. 6[-_' OUTLETS FIRST 20 S.2o $ i OWNER 'f'f . ea -•:r LIGHT, (+y MAIL SWITC4. -OiCe I - OVER 20 .10 LIGHTING TOTAL FIRST 20 .20 CITY �✓-�)G= ifi '',nc TEL.NO. FIXTURES '} ADD'L OVER 20 10 ELECTRICIAN, RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS GARB.DROP. BTA.COOK I: J CITY :�� ::., ��: TEL.NO.61 ©d yO D18HWASH. AUTO.-WASH. STATE u '' BPArj HIng� STA.APP.(V=H.P.MAX.) ,50 LICENSE NO. T '7V MOTORS: OVER NOT OVER H.P. DISTRICT NO. GR UP ZONE PR ES$ED BY O 1 1.00 I , a 1.50 INSPEC ION RECORD S a 2.00 S 13 12.50 1s so s.o0 ' ��'. so loo s.00 tr O SIGNS: NO:TRANS. JF�J NO.LAMPS /Xf " '41� %�I /[r• L_ '(�Ojt�' SERVICE 0=600V-Nor OVER 200A 1.00 I' td'[✓ ,�r�s� I r +"tel' CJ �G/ Yi"LI SERVICE O.60OV-OVER 200 A. 2.00 +I r 9 f7 SERVICE OVER 600V 5.00 ' F' Z MISC. I PERMIT ISSUING FEE 2.00 17-1 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE >8 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS A LIGATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE I8 CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL-COUNTY ORDINANCES AND STATE LAWS REGULATING ,/J ,}•� � ELECTRICAL WIRING. WIRING 7n�. J/ ,t/j,•�„j�'./' 1 HEREBY"'CERTIFY THAT 1 AM PROPERLY REGISTERED ANDIOR I' v/ �• ;f- LICENSED AS REQUIRED BY LOB ANGELES COUNTY AND STATE OF FIXTURES ' CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABCVE I DESCRIBED RESIDENTIAL PROPERTY. , POWER 0 PE TORE � �r(i"��`�.y l c�G•Z �•(°e k�o UTILITY CO.NOTIFI OF'PERMITTEE <ff��� FINAL. ,—VALIDATION A HVEIT SUI� C.PERVV ELECTRICAL ELECTRICAL ENGINEER CK MO CASH ,I 1 L'lf1t� �}M iJ�.:lJd 4 I5 6 Y `l 2 D .,I., 0•1 L r' 1