The URL can be used to link to this page

Home My Public Portal About10153 LYNROSE ST_Electrical__ WORKERS' COMPENSATION DECLARATION 20-0019 DPW 3/87 CE-8066 APP��CA`�I®ll V FOR ELSEV'�11�1�/� L PEIlUll�/ll�7 O I hereby affirm that I have a certificate of consent to self IC[/11 insure, or 5 certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or Q certifi opy thereof (Sec 3800, b C Policy No 2 Company FOR APPLICANT TO FILL IN JOB ❑Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS Certifie opy is filed with the county building inspec- 1 & 2-Family, Sq Ft $ — $ LOCALITY tion d p tme t Multi-family Sq Ft — NEAREST CROSS ST Residential Swimming Pools OWNER OR Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec Light Sw_ MAIL COMPENSATION INSURANCE ADDRESS This section need not be completed if the work involved b First 20 ( p Y Total No Additional CITY Tel No the permit is for one hundred dollars ( 100)or less.) PLAN CHECK ' 1 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 CITY Tel No Date Applicant Fixed Appliances Not Over 1 HP PERMIT `{ NOTICE TO APPLICANT If, after making this Certificate -of APPLICATION /f J 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 / j� with comply with such provisions or this permit shall be Top — FAU —W H — �- deemed revoked Hood — Fan —Other— CITY '' Tel No LICENSED CONTRACTORS DECLARATION LICENSE OR 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& Large Appliances DISTRICT NO P ESSED BY and Professions Code and m lice�e is in full for a and effect t1 ?�, Size&Type HP, KW, KVA, or KVAR 0 License Number Lic Cla vU Up to,l Incl INAL U Contractor ate l�f� Over 1 to 10 Incl. DATE ' Q VALIDATION ❑ Over 10 to 50 Incl" FINAL F_ I am exempt under Sec Over 50 to 100 Inc. gY U W B&P C for this reason Over 100 1 D Date Services, Swbd , MCC& Ponelboards J Z ` 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 I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Law for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits _ash fire�! Professions Code) ❑ 1, as owner of the property, will do the work and the Misc Conduits&Conductors _ �? structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ E 1�s AL Business and Professions Code) CONSTRUCTION LENDING AGENCY ,!!t I hereby affirm that there is a construction lending agency for C.H N63EI 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 t rn Lender's Address 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 theob me tioned property for inspection rpo es SEE REVERSE FOR EXPLANATORY LANGUAGE n Signature of Permittee Dclte Os 1 ° , 7SAISS3 DBS SA 3-5D APPLICATION FOR PERMIT v DEPARTMENT OF BIIII..DII1G AND SAFE ��- COUNTY OF LOS ANGELES ELECTRIC I WILLIAM J. FOX, CHIEF ENGINEER FOR`APPLICANT?TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO. VV "5 / C564-51c) ELECTRICIAN ` _ O 1y��J �}' RECEIV D BY READY FOR DATE IMBUED ADDREBB A/ � FIRST INSPECTION / CITY — TEL. NO. COUNTY LICENSE NO. le*e. EXPIRES 1477 BUILDING PERMIT FEES ADDREBB FEE NUMBER EACH LOCALITY ' i LIGHT OUTLETS '� NEAREST RECEPTACLES CROSS ST. WALL SWITCHES OWNER TOTAL OUTLETS 5'. $ MAIL J �/ ELEC. RANGES 25 ADDRESS 1/ ELEC. HEATERS 25 CITY TEL NO. FIXTURES S 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITSO AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. MOTORS 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, ORA AM THE LEGAL OWNER NEw MVD. HP OVER INC. EARN OF THE RESIDENTIAL PROPERTY, DEBFRIBaE1D®ABOVE. V2 s Less $ .25 SIGNATURE OFl � l�[U V2 2 .50 PERMITTEE.\\\\ Z. /P z 5 ''OO INSPECTION RECORD 5 15 1.50 15 SO 2.50 s0 200 5.00 200 500 10.00 J 500 1000 15.00 Z OVER 1000 20.00 (!) M.O. BET/FREQ. CHANGER-HP Q' WELDERS:AC-KVA O GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (75% OF DRIG.) - MOVED MOTORS (75% OF DRID.) MISC. SIGNS NO. NO.TRANS. APPROVALS NO. NO. LAMPS FOR EACH PERMIT: DATE INSPECTOR'B NAME WIRING $1.00 G CONDUIT FIXTURES $1.00 WIRING SUPPLEMENTARY .50 FIXTURES POWER TOTAL FEE $ UTILITY CO.NOTIFIED ilk .J FINAL ,76A6SJ3C_ CE806B 12/75 0PUUTI®N FOR ELECTRICAL PERMIT BUIL G AND SAFETY ISION FOR APPLICANT TO FILL IN JO New Residential Bldgs & Pools EACH NO FEE ADDRESS 0 Q- 1 &2 Finaily Scl Ft $ — $ LOCALITY /� C. Multifamily wi m NEAREST all G �h Residential Swimming Pools OWNER OR I FIRM NAME .A. Q Outlets Light,Switch&Receptacle ADDRESS S4 lyj e- First 20 Additional CITY Tel No PLAN CHECK Lighting Fixtures Ir APPLICANT First 20 ADDRESS Additional CITY Tel No IT Fixed Appliances Not Over 1 HP APPLICANT Range Heater_. D W. � /4 Oven Dryer W M. ADDRESS I Top FAU W.H. CITY C. Tel No Hood Fan LICENSE OR Q REG NUMBER Class Disp A C. v I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY O Power Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING H Size&Type HP, KW, KVA,or KVAR ELECTRICAL WIRING W a Up to 1 Inc[ I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR Z Over 1 to 10 Incl LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ` CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE Over 1O LO 50 Incl. DESCRIBED RESIDENTIAL PROPERTY Over 50 to 100 Incl I PERMITEE Over 100 SIGNATURE DISTRICT NO P OC �.ED BY Services �✓ �� s 0-200 Amp Under 600 V 201 - 11000 Amp Under 600 VAPPROVALS DATE INSPECTOR'S Over 1000 Amp or Over 600 V SIGNATURE TEMP POWER'POLE Temp Power Pole&Appurtenances UNDERSLAB WORK Sign with One Branch Circuit Additional Sign Branch Circuits ROUGH CONDUIT r (Other) WIRING 2-11-77 /��y FIXTURES POWER AUTHORIZED PERMIT FEE (Sub-Total) UTILITYCO NOTIFIED PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL PERMIT ISSUING FEE NOTES TOTAL FEE PLAN CHECK VALIDATION CK MO CASH PERMIT VALIDATION K M O CASH 5571ZFEB 9 2 D_ 21 .E0 � �