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HomeMy Public PortalAbout9965 LOWER AZUSA RD_Electrical__ 76a6e3 Cs 906111! 110/77 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES FAD,R,E,DEPARTMENT OFCOUNTY ENGINEER SS BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN ITY New Residential Bldgs &Pools g EACH NO $ FEE ST 1 &2 Family Sq Ft OWNER T Multi family Sq Ft 02 — OR FIRM NAME d Residential Swimming Pools 25 00 ADDRESS Outlets Rec Light_Sw CIT /�'*0j % Tel No First 20 50 PLAN CHECK Total No Additional 30 APPLICANT .SST ADDRESS _§Z Lighting Fixtures First 20 50 CITY Tel No ACT 070 Total No Additional PERMIT T NT Fixed Appliances Not Over 1 HP ADDRESS l Range_Heater_D W CITY.5' ItVV g Tel Na-do"-0 Oven_Dryer_W M_ LICENSE OR Top —FAU —W H REG NUMBER =691-0 9P class -44 Hood_Fan _Other- 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Disp — Room Air Cond 2 50 THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDIN ANCES AND STATE LAWS REGULATING ELECTRICAL WIRING Power Apparatus&Large Appliances Size&Type HP,KW KVA or KVAR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM Up to 1 Incl 2 50 THE LEGAL OWNER OF THE ABOV ESCRIBED R DENTIAL PROPERTY Over 1 to 10 Incl 5 00 c� Over 10 to 50 Incl 1250 PERMITTEE ` o: Over 50 to 100 Inc 2500 SIGNATURE Over 100 4000 DISTRICT NO, PROC ED BY e 0 � Services 0 200 Amp Under 600 V 1250 CTAPPROVALS DATE IN NATURE 201 1000 Amp Under 600 V 2500 Over 1000 Amp or Over 600 V 5000 TEMP POWER POLE Temp Power Pole&Appurtenarces 1000 UNDERSLAB WORK 1000 ROUGH CONDUIT Sign with One Branch Circuit 200 WIRING Additional Sign Branch Circuits Misc Conduits&Conductors 1000 FIXTURES Other(See Complete Fee Schedules I POWER AUTHORIZED UTILITY CO NOTIFIED FINAL PERMIT FEE ISub Total) NOTES PLAN CHECKING FEE (One Fourth Permit Feel PERMIT ISSUING FEE $700 TOTAL,FEE, _ CASH PERMIT VALIDATION M O CASH POLICY HOLDER: '�/ 8 8 7 Ir.0JUL 25 2 0 -17.00 Az.S SPLWC F I " :POR COMPLETE SCHEDULE 's""'CK 6001-110"' APPLICAT O R L*fRICAL PERMIT 'fl COUNYY OF LOS ANGELES 019PAWMENT OF COUNTY ENGINEER ESS S BUILDING AND SAFETY DIVISION FOR APPLIGANTTO FILL IN LITY T New Residential Bldgs &Pools $EACH NO $ FEE17NEAREST r 1 &2 Family Sq Ft OWNER OR Multi family Sq Ft 02 — FIRM NAME Residential Swimming Pools 2500 MAIL 106 ADDRESS Outlets Rec Light—Sw CITY Te First 20 50 PLAN CHECK Sm Total No Additional 30 APPLICANT ADDRESS Lighting Fixtures First 20 50 CITY Tel No Additional 30 PERMIT Total No PP 1 NT Fixed Appliances Not Over 1 HP ADDRESS Range_Heater_D W CITY d. Tel No Oven—Dryer_W M, Top —FAU _W H REGNNUMBER Class Hood_Fan _Other__ 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Disp — Room Air Cond 2 50 THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDIN ANCES AND STATE LAWS REGULATING ELECTRICAL WIRING Power Apparatus&Large Appliances Size&Type HP KW KVA or KVAR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM Up to 1 Incl 250 THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY p Over "a 1�50 500 c.3 Over 10 t �Incl 12 50 RMITTEE Over 50 to 25U0 SIGNATURE Over 100 4000 DISTRICT NO EDB co a8 Services S 0 200 Amp Under 600 V 1250 IN PECTOR S 201 1000 Amp Under 600 V 2500 APPROVALS DATE SI NATURE Over 1000 Amp or Over 600 V 50 00 TEMP POWER POLE Temp Power Pole&Appurtenarces 1000 UNDERSLAB WORK Sign with One Branch Circuit 1000 ROUGH CONDUIT Additional Sign Branch Circuits 2 00 WIRING Misc Conduits&Conductors 10.00 FIXTURES Other(See Complete Fee Schedules POWER AUTHORIZED UTILITY CO NOTIFIED IV FINAL PERMIT FEE ISub Total) NOTES PLAN CHECKING FEE (One Fourth Permit Fee) / ZVAO PERMIT ISSUING FEE $700 TOTAL FEE . Q PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION M O CASH i 'p 2-JUN 26 2 0 1 7.0 0 a50 SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 76AGGS`g 808R 10'" APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES p DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION ev FOR APPLICANT TO FILL IN LOCALITY New Residential Bldgs &Pools $EACH NO $ FEE R RE EAR ST 1 &2 Family Sq Ft OWNER OR Multi family Sq Ft 02 — FIRM NAME Residential Sw niming Pools 2500 ADDRESS Outlets Rec :D,12 4r CITY Tel No 6Q first 20 50 PLAN CHECK- Total No Additional 30 APPLICANT ADDRESS Lighting Fixtures First 20 50 —F—CITY Tel No Additional 30 PERMIT Total No _ PPL NT e Fixed Appltonces Not Over I HP ADDRESS Range_Heater_D W — CITY Tel No Oven_Dryer_W M_ LICENSE 09 — Top —FAU —W H — REG NUMBER Class Hood_Fan _Other_ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Disp _ Room Air Cond 250 THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDIN ANCES AND STATE LAWS REGULATING ELECTRICAL WIRING Power Apparatus&Large Appliances Size�HP KW KVA or KVAR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS 2 REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM Up to 1 InclTHE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY p Over 1 to 10 Incl 5-5500-- A i� Over 10 to 50 Incl 1250 PERMITTEE CD Over 50 to 100 Inc 2500 ISIGNATURE Over 100 4000 DISTRICT N O,�� � EBB Services 0 200 Amp Under 600 V 1250 APPROVALS DATE I NATOURE 201 1000 Amp Under 600 V 2500 Over 1000 Amp or Over 600 V 5000 TEMP POWER POLE UNDERSLAB WORK Temp Power Pole&Appurtenarces 1000 Sign with One Branch Circuit 1000 ROUGH CONDUIT gias Additional Sign Branch Circuits 200 WIRING Misc Conduits&Conductors 1000 FIXTURES Other(See Complete Fee Schedulei POWER AUTHORIZED UTILITY CO NOTIFIED FINAL PERMIT FEE (Sub Total) NOTES PLAN CHECKING FEE (One Fourth Permit Fee) cn,"y � PERMIT ISSUING FEE $7 00 ?� ©� 7D TOTAL FEE a` /SOIL/ 10. 7 «72(r� >— PLAN CHECK VALIDATION CK; M 0 CASH PERMIT VALIDATION <CK M 0 CASH 9 9 2 9,1UL 20 2 0 8 6.5 0 4-% SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE _�� w_ ,WORKERS COMPENSATION DECLARATION CE 806G 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers Compensation Insuranc ,ora gertified A COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec 38 b C) Policy NO 1 // Company 14FOR APPLICANT TO FILL IN JOB - — fl qADDRESS q 19-2V 7— Certified Certified copy is hereby furnished New Residential Bldgs &Pools EACH NO FEE ❑ Certified copy is filed with the my bui g inspection 1 &2-Family,Sq Ft $ _ $ LOCALITY dep8 me Multi-family Sq Ft NEAREST CROSS ST Date Applicant AA Al Residential Swimming Pools OWNER OR FIRM NAME C IFICATE OF EXEMPTION FROM WORKERS Outlets Rec—Light_Sw MAIL q Z COMPENSATION INSURANCE ADDRESS (This section need not be completed B the work involved by the First 20 permit Is for one hundred dollars($100)or less) Total No Additional CITY-f' Tel No I certify that in the performance of the work for which this permit PLAN CHECK APPLICANT 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 HP01 4 NOTICE TO APPLICANT If, after making this Certificate of PERMIT Exemption you should become subject to the Workers Compensation Range_ Heater_ DW _ APPLICANT provisions of the Labor Code you must forthwith comply with such Oven _ Dryer_ W M _ ADDRESS J �� provisions or this permit shall be deemed revoked Top _ FAU _ WH _ LICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other_ CITY Tel No Z j I hereby affirm that I am licensed under provisions of Chapter 9Disp — Room Air Cond LICENSE OR ZZ Clasa��d (commenting with Section 70001 of Division 3 of the Business and REG NUMBER Professions Code,and my license is in full force and effect Power Apparatus&Large Appliances DISTRICT NO PROCESSED BY v vI 0 �J Size&Type HP,KW,KVA,or KVAR �G g License Number Lic Class Up to 1 Incl FINAL Contractor ///f r ` Over 1 to 10 Incl DATE v' VALI ATION �v `tea Over 10 to 50 Incl FIN AL ❑ 1 am exempt under Sec Over 50 to 100 Inc PL B&P C for this reason Over 100 A 8 3 21 A Services,Swbd,MCC&Panelboards # • • • • 0 2 Z_ Date 0-200 Amp Under 600 V Signature 201 - 1000 Amp Under 600 V 1 • e 2 5 5 0 Exemption for Reg Mamt Elect Over 1000 Amp or Over 600 V a • e 2 5505 SINGLE FAMILY Temp Power Pole&Appurtenances 1 1.09-87 HOME:OWNER-BUILDER DECLARATION Sign with One Branch Circuit to%by affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits following reason(Section 70315 Business and Professions Coder ❑ Misc Conduits&Conductors *n owner of the property,will do the work and the structure Other(See Complete Fee Schedule) not intended or offered for sale (Section 7044, Business , aid Professions Code) CONSTRUCTION LENDING AGENCY I hereby atirm that there is a construction lending agency for the performanci of the work for which this permit is issued(Sec 3097 PERMIT FEE (Sub-Total) Civ C) PLAN CHECKING FEE Lenders Namy PERMIT ISSUING FEE Lender s Address I certify that I have read this application and state that the above TOTAL FEE SS information is court 1 agree to comply with all County ordinances and State laws retulabng Electrical wrong, and hereby authorize represen of Isis Coun to enter u n the ab -mentioned proper I W,ion r se SEE REVERSE FOR EXPLANATORY LANGUAGE Signat of nni Date ,11_ .y affirm that COMPENSATION DECLARATION 7 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self a BO6G insure, of a certifitate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or„a certifierd copy thereof(Sec 3800, Lab C ) Policy No S t6�ompany S/ �- '00ai,�- FOR APPLICANT TO FILL IN JOB �AZ -SA- r Certified copy is hereby furnished New Residential Bldgs &Pools EACH rNO ADDRESS FEE O 'Certified copy is filed with the county buildin inspec- 1 &2-Family, Sq Ft S $ LOCALITY 7K tion deEpartment Multi-family Sq Ft CNEARESSTT 17..J ^aj� Residential Swimming Pools OWNER OR Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKER OO� Outlets Rec Light Sw MAIL COMPENSATION INSURANCE First 20 7S ADDRESS (This section need not be completed if the work Involved by Total No�2 Additional CITY Tel No the permit is for one hundred dollars($100)or less) I certify that in the performance of the work for which this AAPPPLI CA 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 51-5— Additional CITY Tel No Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT If, after making this Certificate of Exemption you should become subject to the Workers' Range_ Heater_D W _ APPLICANTp,� Z O tnJF46clotil Compensation provisions of the Labor Code, you must forth- Oven _Dryer _W M — ADDRESS U-7 Z �PoS� 371 with comply with such provisions or this permit shall be Top _ FAU WH — deemed revoked CITY Tel No i Q LICENSED CONTRACTORS DECLARATION Hood Fan �Other_ ���- 6�Z-I�!Z Disp Room Air Cond �vV LICENSE OR �A/O 1 hereby affirm that I am licensed under provisions of Chapter 9 • REG NUMBER 3 5's-re. G Class (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO PROCE D BY and Professions Code,and my license is in full force and effect Size&Type HP, KW, KVA, or KVAR l O License Number Lic Class Up to 1 Incl r �d O �' FINAL _ V c� Over Ito 10 Incl ' DAA '�� s VALID TION Q ❑ Contractor Date Over 10 to 50 Incl V FINAL I am exempt under Sec Over 50 to 100 Inc BY B t3P C for this reason Over 100 $1521 A Z Date Services, Swbd, MCC&Ponelboards ..00 r ► # e e s e s 2 0 -200 Amp Under 600 V # 4b g p 1 • 453100 S� nature 201 - 1000 Am Under 600 V ❑ Exemption for Reg Maint Elect Over 1000 Amp or Over 600 V e * 4530 SINGLE FAMILY Temp Power Pole 8 Appurtenances 0213-89 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit &1W 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) ❑ Misc Conduits 8 Conductors I, as owner of the property, will do the work and the Fee Schedule Complete See structure is not intended or offered for sale (Section Other( P )— ► 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 PERMIT FEE (Sub-Total) (Sec 3097, Civ C ) PLAN CHECKING FEE Lender s Name PERMIT ISSUING FEE Lenders Address I certify that I have read this application and state that the TOTAL FEE 3t above information is correct I agree to comply with all County ordinances and State laws regulating Electrical wiring, and h�athor repres ntatives of this Count to enter upon toned op ty r in ctio urposes SEE REVERSE FOR EXPLANATORY LANGUAGE 4 Signature of Permittee Date d VIS'COMPENSATION DECLARATION 7 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affffirmirm that I have a certificate of consent to self CE BobG 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 NoPC 974858 ComAM 11% Indemnity FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished New Residential Bldgs &Pools EACH NO FEE ADDRESS 9965 LoMr Azusa Rd. ® Certified copy is filed with the county building inspec- 1 8 2-Family, Sq Ft $ — E LOCALITY le Cit tion department Multi-family Sq Ft — NEAREST CROSS ST Residential Swimming Pools, OWNER OR Dote Applicant FIRM NAME -FOOD!lARBR Jack—in—the—Hoa CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets RecLight Sw' �� IL COMPENSATION INSURANCE First 20� ADDRESS p.O.Box783 (This section need not be completed if the work involved by Total No� Additional CITY San Diego T61jg071-2493 the permit Is for one hundred dollars($100)or less) I certify that in the performance of the work for which this PLANCHECK 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 Exemption, you should become subject to the Workers' Range_ Heater_D W — APPLICANT So.Calif.Raergy Systems, Inc. Compensation provisions of the Labor Code, you must forth- Oven _Dryer —W M — ADDRESS 1440 8 Arrow Bwy, Suite L with comply with such provisions or this permit shall be Top — FAU _WH _ deemed revoked CITY Irwind8� Irwindale 91706 Te1 /303-351 LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_ LICENSE OR I hereby affirm 7m that 1 am licensed under provisions of Chapter 9 Disp _ Room Air Cond REG NUMBER 348680 ClassHC10 (commencing with Section 7000)of Division 3 of the Business ppDISTRICT NO PROCE D BY LL Power Apparatus 8 Large Appliances and Professions Code,and my license is in full force and effect � V Size&Type HP, KW, KVA, or KVAR License Number Lic C�ass HC Up to 1 Incl FINAL So.Calif.8nergy Systems CArl a SC er DATE O Contractor Date T T/7 .; Over 1 to 10 Incl ..- Z VALIDATION U ❑ Over 10 to 50 Incl FIN W I am exempt under Sec Over 50 to 100 Inc BY N B 8P 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 ❑ Exemption for Reg Maint Elect Over 1000 Amp or Over 600 V &33a I A SINGLE FAMILY Temp Power Pole&Appurtenances # • • • e 2/1& HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit * * 2550 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 e • • 2 5 5 0 5 Professions Code) 1.04-85 ❑ 1, as owner of the property will do the work and the Misc Conduits 8 Conductors structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ ► 7044, Business and Professions Code) ('v 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 ) PLAN CHECKING FEE Lender's Name Lender's Address PERMIT ISSUING FEE I certify that I have read this application and state that the TOTAL FEE 1I 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 Permittee Date WORKER S COMPENSATION DECLARATION �t�9 DPW(t2 91) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self Insure, f- 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 JADDURESS /Lou .LLIOL���A 150 A ❑ Certified copy Is hereby furnished New Residential Bldgs &Pools NO EACH FEE LOCALITY Lot'i ❑ Certified copy Is filed with the county budding Inspection 1&2-Family Sq Ft _ $ $ NEAREST department Multifamily Sq Ft CRM ST6ALbVj' Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec —Light COMPENSATION INSURANCE FirstSw FlPM NAME �C 1LJ �' �� 7 (This section need not be completed If the work Involved by the 20 MAIL permit Is for one hundred dollars($100)or less) Total No Additional ADDRESS 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 aidto PLAN CHECK become ublect t the rkers'Compensation La Lighting Fixtures First 20 APPLICANT Total No Additional ADDRESS Dat ZZ Appllc RESIDENTIAL APPLIANCES NOT OVER 3 HP NOTI E TOA PLICANT If after making this Certificat 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 provisions or this permit shall be deemed revoked b Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP KW KVA or KVAR ADDRESS O �► I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl A (commencing with Section 7000)of Division 3 of the Business and CITY /'i Tel No31ob,403 Professions Code,and my license Is in full force and effect Over 10 to 50 Incl LICENSE OR C� CItMa } Over 50 t0 100 IRCI REG NUMBER J-1 C,��(� Q .� I Over 100 G_ License Number 106 v is Class ( DISTRICT No A SED By 0 Services,Swbd,MCC&Panelboards Cont to 0 399 Amp Under 800 V DATE a 0 400 1000 Amp Under 600 V �Z l—g ❑ I am exempt under Sec VALIDATION V Over 1000 Amp or Over 600 V FINAL a B&P C for this reason BRANCH O(BCUIT FEES BY Date 15A,clef 120V,Lighting or Recept � ry Z .�1 To 10 Branch Circuits r Signature 11 To 40 Branch Circuits AI_41.14 41 Or More Branch Circuits ❑ Exemption for Reg Maint Elect 15A,2DA,2DSV To 277V Lighting Br Circuits 3703 S3,211 SINGLE FAMILY Temp Power Pole&Appurtenances �� i 1� HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law TOTAL ® 4_F a �� for the following reason (Section 7031 5 Business and Professions Additional Sign Branch Circuits Coe) t:1 t�� moo. I,as owner of the property will do the work and the structure Misc Conduits&Conductors 1r is not Intended or offered for sale(Section 7044 Business Other(See Complete Fee Schedule) , HA0 ` and Professions Code) CONSTRUCTION LENDING AGENCY 01000-001014 rii`� 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) 5701 1 AM 9:43 Civ C) PLAN CHECKING FEE Lender s Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and under penalty of purlury state TOTAL FEE �0 that the above information Is correct I agree to comply with all County ordinances and State laws regulating Els rical wiring,and hereby authorize representatives of this County to enter n the above ention property action p rposes SEE REVERSE FOR EXPLANATORY LANGUAGE GIMMWEGFPERMITTEE DATE 1 WOm that COMPENSATION DECLARATION 7 10/81VA 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 of,�yypr c��pt or f(Sec 3800�LC aI c�y-N t ` FOR APPLICANT TO Hll IN JOB Certified co is hereby furnished EACH NO FEE ADDRESS PY Y New Residential Bldgs 8 Pools Certified copy is filed with the county buil g inspec- 1 8 2-Family, Sq Ft $ — E LOCALITY to de pa tment Multi-family Sq Ft — NEAREST CROSS ST Date A licant clential Swimming Pools OWNER OR pp FIRM NAME CERTIFICATE OF EXEMPTION OM WO4RKERS' Outlets Rec Light Sw_ MAIL 1_i� COMPENSATION INSURANCE ADDRE Y 7 ).hu"i4Aa ca A4 (This section need not be completed N the work involved by First 20 CITYTel No the 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 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 CITYCowyhkm Tel � 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 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 _ CITY Tel No ` deemed revoked Hood _Fan _Other_ LICENSED CONTRACTORS DECLARATION LICENSE OR112 I hereby affirm that I am licensed under provisions of Chapter 9 Disp _ Room Air Cond REG NUMBER /�y� Class >" (commencing with Section 7000)of Division 3 of the Business DISTRICT NO P BY IL Power Apparatus 8 Large Appliances and Professions Code,and my license is m full force a d effe� �` O �) Size&Type HP, KW, KVA, or KVAR L/� V License Number Lic CIa�S Up to 1 Incl FINAL DATEO a Over 1 to 10 Incl V (DATION (— Contractor &J)mA ..T Date I Y Over 10 to 50 Incl V ❑ FINAL W I am exempt under Sec Over 50 to 100 Inc BY N B&P C for this reason Over 100 Z Date Services, Swbd, MCC&Panelboords ► 0 -200 Amp Under 600 V r Signature 201 - 1000 Amp Under 600 V Over 1000 Amp or Over 600 V ❑ Exemption for Reg Mamt Elect A36 1 1 A SINGLE FAMILY Temp Power Pole&Appurtenances # e • • e • 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit * 93550 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 • • 3 5 5 0 5 Professions Code) 13I, as owner of the property, Misc Conduits 8 Conductors 206-85 p p tyr will do the work and the Fee Schedule Complete See structure is not intended or offered for sale (Section Other( P )— 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 PERMIT FEE (Sub-Total) 2,500 (Sec 3097, Civ C ) PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address FA I certify that 1 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 r presentatives of this County to enter upon the e-me icff property for inspection pur ses rL� SEE REVERSE FOR EXPLANATORY LANGUAGE Sivatuff of Permittee Date