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Home My Public Portal About10159 LOWER AZUSA RD_Electrical__ 76A6£3-CE806 ,Q,74 APPLICA OELECTRICAL PERMIT ♦� N R COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER roe BUILDING AND SAFETY DIVISION ADDRESS �, % p ",✓ dz LOCALI TY �' L-,- �•: i--v r,. C•�- J NEAREST FOR APPLICANT TO FILL IN CROSS ST, r hr' FE TS NO. EACH FEE OWNER OR $ $ FIRM NAME "j'' �,9�,.1 -( MAIL FIRST 20 ADDRESS -1 •i tl f�`i /��✓,i 11, TOTAL 'CITY ( TEL. N0. OVER 20PLAN,CHECK FIRST 20 APPLICANTTOTAL OVER 20 ADDRESS �j,__l- .10 RESIDENTIAL APPLIANCES clrY TEL. tA N0:j. RANGE DRYERWTR. HTR. PERMIT l APPLICANT � �'/� p--La.c.r4~ STA. COOK DISP. F.A.U. ADDRESS l e, �% 'J � • SPACE HTR, AIR COND. CITY TEL. NO.'71k 1 k A, CLOTHES WASH. L/- DISHWASH. LICENSE OR - CLASS. --J REG. NUMBER FAN OTHER 1.00 U D I 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 1.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF }, CALIFORNIA ORTHAT I AM THE LEGAL OWNER OF THE ABOVE a- 1 - lO 3.00 DESCRIPED RES IDEENNTIAL PROPERTY. CD PTEE c:)10 - 50 5.00 SIGNATURE �/ r�•� /� �;, /�� F.., U 50 - 100 10.00 LLL DISTRICT No. l.P SED BY N 100 - 500 15.00 55049 Z SIGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE INSPECTO 'S SIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE SERVICENOTOVER600VOLTS OR200AMP 3.00 UNDERSLAB WORK. SERVI CE OVER 600 VOLTS OR 200 AMP 10.00 ROUGH CONDUIT TEMPSERVICE, POLE, &APPURTENANCES 5.00 - WIRING - fZ�+�,� //r•� `"�'��.. TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED FINAL 7 ' PERMIT FEE (SUB TOTAL) NOTES; PLAN CHECK FEE PERMIT ISSUING FEE 3.00 TOTAL FEE 2-0 PLAN CHECK VALIDATION CK. M.O. CASH PERMIT.VALIDATION CK. M.O.l� CASH �6 EP 11 2 n 13.20 ®98 SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE W3'1KERS'COMPENSATION DECLARATION 76-663 10/81 CE-806G APPLICATION FOR ELECTRICAL PERMIT �. <b here�y�a9ffirm that I have a certificate of consent to self insure, `fl or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab. C.) �i �,�A Policy�N� 103 4 � Company,r��`^'■'^' �`�' FOR APPLICANT TO FILL IN JOB' ) p ❑. EACH NO. FEE ADDRESS/® / J�ClWr Z kL&SA Certified copy is hereby furnished.. New Residential Bldgs.&Pools ❑ Certified —'copy is filed wit the, county building inspection 1 & 2-Family,Sq.Ft. $ $ LOCALITY department. Multi:family Sq.Ft. — NEAREST CROSS ST. Sf / _ pp Residential Swimming Pools OWNER OR Date 1 3 �� A lic FIC IX/Y`ti+ .. FIRM NAME � LR/T�•C J�i�'4��CP� CERTIFICATE OF EXEMPTION FROM WORKERS' , Outlets:Rec Light _ Sw. MAIL �J COMPENSATION INSURANCE ADDRESS - V (This section need not be completed if the work involved by the First 20 ID pA Total No. Additional CITY /,3, permit is for one.hundred dollars ($100) or-less.) PLAN CHEC I.certify that in the performance of the work for which this permit APPLICANT K 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 N . Date Applicant Fixed Appliances Not Over 1 HIP PERMIT o NOTICE TO APPLICANT: If, after making this Certificate of M/7 d Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APP UCAI� 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�� /"01q �`� y P�o, (� LICENSED CONTRACTORS DECLARATION Hood Fan Other_ I hereby•affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR r� (commencing with,Section 7000) of Division 3 of the Business and REG.NUMBER Class. 6' Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. /{ ROCESS D BY Size& Type HP,KW,KVA,or KVAR License Number Lic.Class "1 Up to 1 Incl. FINAL { p Over 1 to 10 Incl DATE LIDATION C0 —d Date V 13 d _ 0 Over 10 to 50 Incl V El am exempt under Sec. Over 50.to 100.Inc. FINAL BY W Over 100 IlL B.&P.C. for this reason U N Services,Swbd.,MCC&Panelboards , Z Date: 0- 200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V ❑ Over 1000 Amp.or over 600 V ;0 9 6 Q 4 A Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole &.Appurtenances J # o h o o o 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit. o - 2550 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): o 0 o 2 5.5 0 ❑ I,as owner of the property,will do the work and the structure Misc.Conduits & Conductors (].5 12-8 8 is not intended or offered for sale (Section 7044, Business Other(See,Complete Fee Schedule) _ 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 U Lender's Address �S l I certify that I have read this application and state that the above TOTAL FEE U 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 Sature of e itteeof e ittee Dae • WORKERS'COMPENSATION DECLARATION 76-663 10/81 CE-e06G APPLICATION FOR ELECTRICAL PERMIT I'hereby eLnirm that I'h'ave a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec. 38 alb. C.) f� Policy No. [_;,,Z Company 3/AT' R4 `•' FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs.& Po Ls EACH NO. FEE ADDRESS �Q.f r/ ❑ Certified copy is filed with the co ty in inspection 1 & 2-Family, Sq.Ft. $ $ LOCALITY NEAREST dep rtmen Multi-family Sq.Ft CROSS ST. .fir, Date J Applicant Residential Swimming Pools OWNER OR j� f FIRM NAME l��Cx x /�1 ✓-�%�/� . CERT ICATE OF EXEMPTION ROM W KERS' Outlets:Rec— Light Sw. MAIL COMPENSATION INSURANCE ADDRESS PV ✓ � (This'section need not be completed if the work involved by the First 20 Total No. Additional CITY ��— �(j3Tel.No. permit is for one hundred dollars($100)or less.) 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 Wotkers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional. Total No. CITY Tel.No. Date Applicant Fixed Appliances Not Over,1 HP NOTICE TO APPLICANT: If, after making this Certificate of PERMIT Egemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. APPLICANT J pr?visions 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 11 I hereby affirm that I am licensed under.provisions of Chapter 9 LICENSE B J� � (con;mericing with Section 7000) of Division 3 of the'Business and Disp. -Room Air Cond. REG.NUMBER 7�'�� Class. G�� DISTRICT NO Profefasions Code,and my license is in full force and effect. . PROCESSED BY Power Apparatus& Large Appliances j;— ,- � Size& Type HP,KW,KVA,or KVAR ` O License Number Lic.Class Up to 1 Incl. FINAL y9 U Over 1 to 10 Incl. DATE ALIDATION O Contract rl�� Y ate FINAL/ Over 10 to 50 Incl. I a.i exempt under Sec. Over 50 to 100 Inc. gY LU B.&P.C.for this reason Over 100 N 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 tl at I am exempt from the Contractor's License Law Additional Sign Branch Circuits for the following;eason (Section 7031.5, Business and Professions Code): ❑ ' I,as owner ci`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) ®. and Professions Code). CONSTOUCTION LENDING AGENCY I hereby affirm that thEse 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.). .. I 1...1 '"T:; ....! i;d. s -• PLAN CHECKING FEE, ;� • , �"'{ 1_+ Lender's Name t5 r .�,.` ��? j.r.f "I p, i PERMIT ISSUING FEE (�J r.".1 Lender's Address =•jI I certify that I have read this application and state that the above TOTAL FEE f'` fr information is correct. I agree to comply,with all County ordinances - +-� �41 (J.f and State laws regulating Electrical wiring, and hereby authorize rep��to enter upon the above-mentionedprbs. A SEE REVERSE FOR EXPLANATORY LANGUAGE 1 K,l Cra ,•�j _„I 1.,,•I �ai pr,t S' na e ittee to P.J »�"f �y• f"sf •n f r1