The URL can be used to link to this page

Home My Public Portal About9574-9576 LOWER AZUSA RD_Electrical__ 76AE69 DBS-SA 12-54 APPLICATION FOR ELECTRIC PERMIT 1 DIVISION OF BUILDING AND SAFETY Dep.tasout of County Engineer County of LOB Angeles BUILDING ^7� WM.J. FOX. COUNTY ENGINEER ADDRESS ! G{ CASSATT D. GRIFFIN,SUPT OF BUILDING v. FOR APPLICANT TO FILL IN LOCALITNEARESTY PERMIT FEES CROSS ST. ...; FEE NUMBER EACH LIGHT OUTLETS OWNER RECEPTACLES MAIL c� ADDRESS WALL SWITCHES TOTAL OUTLETS 5d $ CITY TEL. N ELEC. RANGES 25 ELECTRICIAN ELEC. HEATERS 25 ADDRESS KW EA CITY y, TEL. NO. FIXTURES 3 LICENSE NO. NUMBER OF LIGHT CIRCUITS DISTRICT NO. I GROUP ZONE READY FOR INSPECT ION � NUMBER O RECEPTAC E CIRCUITS MOTORS NUMBER HORSEPOWER FEE INSPECTION RECORD NEW MVD. HP OVER INC. EACH _ 1�2 @ LESS $ .25 11/2 2 .50 __2 5 1.00 I 5 15 1.50 15 50 2.50 - 50 1 200 5.00 MISC. NO. SIGNS f NO. TRANS. NO. SIGNS NO. LAMPS FOR EACH PERMIT: WIRING $1.00 —77 FIXTURES $1.00 SUPPLEMENTARY .50 �" APPROVALS TOTAL FEE $ DATE INSPECTOR'S SIGNATURE I HEREBY ACKNOWLEDGE THAT 1HAVE READ THIS APPLICATION _CONDUIT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING. 1HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF POWER CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENT PRO ERTY. r UTILITY CO.NOTIFIED SIGNATURES �'.� OF PERMITTEE FINAL u N "WILLIAM J. FOX,COUNTY ENGINEER VAL'DI 3 1 3N; FEB 7 2 Q O 0 BY �f DEP TY 1� ` . WORKERS COMPENSATION DECLARATION 63 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE CE 8 8066 insure or a certificate of Workers Compensation Insurance, COUNTY OF LOS ANGELES , BUILDING AND SAFETY or a certified copy thereof (Sec 3800 Lab-CC) Polic o ftf67J opany �"" ' K/� FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished New Residential Bldgs 8 Pools EACH NO FEE ADDRESS 1 8 2-Family S Ft $ — E LOCALITY L Certified copy is filed with the county building inspec- Y 9 tion depcIrtment Multi-family Sci Ft — NEAREST CROSS ST C4 13 JVb Date Applicant Residential Swimming Pools OWNER OR ,�pp • .}. • FIRM N ,s Gr Ol / CERTIFICATE OF EXEMPTION FROM RKERS' Outlets RecmLight�Sw a MAIL �� /1 COMPENSATION INSURANCE First 20 .S O ADDRESS t (This section need not be completed if the work involved by Total No Additional - CITY ` LEP Tel NgW3 03 qV— the permit is for one hundred dollars($100)or less) PLAN CHECK y�-. I certify that in the performance of the work for which this APPLICANT r� d LJ. Ale 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 U Total No 44 Additional Date Applicant CITY G s Tel N .� NOTICE id APPLICANT If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption you should become subject to the Workers Range_ Heater_D W _ APPLICANT 5A..."457 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 T deemed revoked CITY Tel No LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_ _ LICENSE Tj q 7 I hereby affirm that I am licensed under provisions of Chapter 9 Disp Room Air Cond REG NUMBER � / �/ % Class 1/ (commencing with Section 7000)of Division 3 of the Business DISTRICT NO PROLES BY and Professions Code and my license is in full force and effect Power Apparatus 8 Large Appliances �� )0- Size P KW, Incl or KVAR S 0 License Numb �• Lic Class � V Up toll Incl FINAL /^w r'fj Contractor Date S Over 1 to 10 Incl DATE `/S_ �(if}�fTs VALIDATION 0 1:1 Over 10 to 50 Incl FINAL ~ I am exempt under Sec 50 to 100 Inc BY �..e..e1 B&P C for this reason Over 100 usZ Date Services, Swbd , MCC&Ponelboards ,� ► [/� ` 0 -200 Amp Under 600 V 7 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 - 0 9 a 9 A 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 # • • • • • 2 Professions Code) i ❑ 1, as owner of the property, will do the work and the Misc Conduits 8 Conductors Q�• • ] ] 5 Q structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ • • • ,7 7 5 0 U 7044 Business and Professions Code) ► , i CONSTRUCTION LENDING AGENCY 0504-84 1 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 rn PERMIT ISSUING FEE O 10" Lender s Address �/ I certify that I have read this application and state that the TOTAL FEE 7 /�9 above information is correct I agree to comply with all County ordinances and State jaws 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 # 5-W .K6- Signature of Pe otee Da(e •VIffirm that COMPENSATION DECLARATION CE 10/81 APPLICATION FOR ELECTRICAL PERMIT �I F;'�reby affirm that I have a certificate of consent to self CE t106G insure or a certificate of Workers Compensation In urance COUNTY OF LOS ANGELES BUILDING AND SAFETY or#,,r fie opy�,thergpf (Sec 38 L C ) i ,o Company FOR APPLICANT TO FILL IN JOB ❑ Certified copy is hereby fur New Residential Bldgs &Pools EACH NO FEE ADDRESS Certified copy is filed unty wilding inspec- 1 &2-Family Sq Ft $ — $ LOCALITY tion department Multi-family Sq Ft — NEAREST ,� Residential Swimming Pools CROSS ST Date Apphco OWNER OR FIRM NAME CERTIFICATE OF EXEMPTIO FRO WO KERS Outlets Rec Light Sw_ MAIL COMPENSATION SURA CE ADDRESS This section need not be com I ed a work si First 20 ( p y Total No Additional CIT Tel No the permit is for one hundred do ars($100)or less) VJ 1 certify that in the performance of the work for which this AP LICANTK 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 Total No Additional CITY Tel No Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT If after making this Certificate of APPLICANT Exemption you should become subject to the Workers Range_ Heater_D W IN 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 _WH _ deemed revoked Hood _ Fan _Other_ CITY 'Un Tel No LICENSED CONTRACTORS DECLARATION LICENS I hereby affirm that I am licensed under provisions of Chapter 9 Disp _ Room Air Cond REG NUMBER CIO (commencing with Section 7000)of Division 3 of the Business power Apparatus 8 Large Appliances DISTRICT NO PROCE E Y ll and Professions Code and my license is in full force and effect /� O Size&Type HP KW KVA, or KVAR s V V LicenseTreason Lic Clas FINAL 0 Up to 1 Incl O Over 1 to 10 Incl DATE —` � VAL ATII Co rDate Over 10 to 50 Incl FINAL !/ OWO.. I am exe pt Over 50 to 100 Inc BY N B 8 C r thOver 100 Z Dote Services, Swbd MCC 8 Panelboards 0 -200 Amp Under 600 V Signature 201 - 1000 Amp Under 600 V ❑ Exemption for Reg Maint Elect Over 1000 Amp or Over 600 V SINGLE FAMILY Temp Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit .3 91.4 A 1 hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits # • e e e,e 2 i Law for the following reason (Section 7031 5, Business and ( e e 2 5 5 0 Professions Code) ❑ I, as owner of the property, will do the work and the Misc Conduits 8 Conductors • e -25505 structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ , 7044 Business and Professions Code) 01.24-86 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) (Sec 3097 Civ C ) /Q PLAN CHECKING FEE Lenders Nome ( _ PERMIT ISSUING FEE Lender s Address I certify that I have read this application and state that the TOTAL FEE above info anon rrect I agree to comply with all County es nd State s regulating Electrical wiring and eby a o e represen trves of this County to enter upon nti ed prope y for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Sy natu a of rmrttee` Date IiKF, S COMPENSATION DECLARATION CE-806G (2 80) " APPLICATION FOR ELECTRICAL PERMIT 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 Insuran or afi d gyh ,(,Se p n800 b C.) ADDRESS rrff/b` 6 �m FOR APPLICANT TO FILL IN 30grpolicy /�� J �o`-'� 2 v New Residential Bldgs &Pools EACH NO FEE 7 Ll 40 Certified copy is hereby furnished 1 &2 Family Scl Ft $ — $ LOCALITY lam P ry Certified copy is filed with the county building inspection Multifamily Sq Ft CROSS ST` depart ent ��, /// Residential Swimming Pools OWNER OR /� n n �� Y FIRM NAME V t�/'�1f7'Er Date ppl►cant /-/ Outlets Rec_Light Sw MAIL — /1 First 20 ADDRESS,,f (_ CERTIFICATE OF EXEMPTION FROM WORKERS Total No Additional CITY /v (�jr Tel No 4�g�Sl� >, COMPENSATION INSURANCE PLAN CHECK CL APPLICANT (This section need not be completed if the work involved U Lighting Fixtures First ADDRESS by the permit to for one hundred dollars ($100) or leas) Additional W No I certify that in the performance of the work for which this FixTotal Appliances Not Over 1 HP CITY Tel No O permit is issued I shall not employ any person in any manner PERMIT W so as to become subject to the Workers Compensation Laws Range_Heater D W APPLICANT IL Oven _ Dryer_W M .0!2 W — ADDRESS t7 Z Date Applicant Top _ FAU _W H Hood _ Fan _Other_ CITY ?a-L--AJ Tel No NOTICE TO APPLICANT If after making this Certificate of Disp _Room Air Cond_ LICENS OR /1`/Q Exemption you should become subject to the Workers REG NUMBER Cless C Compensation provisions of the Labor Code you must forth Power Apparatus&Large Appliances DISTRICT NOPROCES ED BY V Type with comply with such provisions or this permit shall be Size&T HP KW KVA or KVA deemed revoked I Up to 1 Incl � FINAL Over 1 to 10 Incl DATE/,o —A A1— LICENSED CONTRACTORS DECLARATION Over 10 to150 Incl VALIDATION I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc FINAL f tar�"7r�j • 9 (commencing with Section 7000)of Division 3 of the Busr Over 100 BY ness and Professions Code and my license is in full force and , effect Services V 0 200 Amp Under 600 V License Number Lic Class— 201 1000 Amp Under 600 V Contracto16 o4 Date 6 Over 1000 Amp or Over 600 V c3 HOME OWNER BUILDER DECLARATION Temp Power Pole&Appurtenances ' I hereby affirm that I am exempt from the Contractors Sign with One Branch Circuit License Law for the following reason (Section 7031 S Buse Additional Sign Branch Circuits ness and Professions Code) 4 2 7 6 2 A Misc Conduits&Conductors ElI as owner of the property will do the work and the Other(See Complete Fee Schedule)— # • • • • • 2 structure is not intended or offered for sale (Section 7044 Business and Professions Code) i� • • 1 7 0 0 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency • • 9 17 0 0-65 for the performance of the work for which this permit is PERMIT FEE (Sub Total) % �^ issued(Sec 3097 Civ C) 1 023-80 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 and State laws regulating Electrical wiring and hereby authorize representatives of this County to enter upon the move ti ed property for inspection p rp es SEE REVERSE FOR EXPLANATORY LANGUAGE o/ � .;�a Signature of Per"Wee Date r i WORKERS COMPENSATION DECLARATION CE76A663 (2 80) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure or certificate of Workers Compensation Insurance or a certified copy thereof(Sec 3800 Lab C) //// JOB Policy No Compan FOR APPLICANT TO EACHFILL NO FEE ADDRESS ,�Jr7S,L �(,f7�—K� ZL� New Residential Bldgs &Pools Certified copy is hereby furnished 1&2 Family Sq Ft $ —' $ LOCALITY IC- C 4 Certified copy is filed with the county building inspection Multifamily Sq Ft — A Residential Swimming Pools CROSS ST department , OWN R / FIRM NAME Date Applicant Outlets' R —Light 10 Sw� Q 0 MAIL n^� ,7� First 20 ADDRESS�6 CERTIFICATE OF EXEMPTION FROM WORKERS Total No I No COMPENSATION INSURANCE Additional CITY AK, PLAN CHECK it APPLICANT 0 (This section need not be completed if the work involved Lighting Fixtures by the pemAdditional O Ir I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No O permit is issued I shall not employ a n in any manner PERMIT () so a to b come subject to t Co ensation Laws Range_Heater D W APPLICANT 6_�G.�"G W Oven _ Dryer_W M _ ADDRESS U) D e O Applican / Top _ FAU _W H _ Hood _ Fan _Other_ CITY 4� t Tel Nose37.- p NOTICE TO APPLICANT of r akins Certifi to of Disp — Room Air Cond_ L CENSE OR Exemption you should beco uble the W rkers REG NUMBER ZO Class �I Compensation provisions of the or Co a you must forth Power Apparatus& Large Appliances DISTRICT NO / PROCESSED BY th comply with such provisions or this permit shall be Size&Type HP KW KVA or KVAR S�Q r deemed revoked Up to 1 Incl FINAL Over 1 to 10 Incl DATE VALIDATION LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl ' 1 I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc FINAL /^ 9 (commencing with Section 7000)of Division 3 of the Busi Over 100 BY ness and Professions Code and my license is in full force and effect Services 200 Amp Under 600 V — License Number is Class /tis Q 01 1000 Amp Under 600 V Contractor Date O Over 1000 Amp or Over 600 V T CJ HOME OWNER BUILDER DECLARATION Temp Power Pole&Appurtenances I hereby affirm that I am exempt from the Contractors Sign with One Branch Circuit License Law for the following reason (Section-7031 5 Busi Additional Sign Branch Circuits ' 26C ` A ness and Professions Code) � Misc Conduits&Conductors I as owner of the property will do the work and the Other(See Complete Fee ScheduJe)— structure is not intended or offered for sale (Section 2 a 9 5 0 C G 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY C 1 O L C' 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) (} 2 0— r' 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 i w above information is correct I agree to comply with all County ordmanto State &rtyr Electrical wiring and he epresCounty to enter upon I e abn tion purposes SEE REVERSE FOR EXPLANATORYLANGUAGE gn t e f r e kate