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Home My Public Portal About5626 MCCULLOCH AVE_Electrical__ 0, " i "VI(O that J. ave a certificate of consent to 78"808 10/81 APPLICATION FOR ELECTRICAL P&MIT r "� .CE-806G. R I,here4Yaaff�rn?that,I have a certificate of consent to self insure, ; �' q �cert Rcate of *rkers'Compensation Insurance, dr a certified COUNTY OF LOS ANGELES BUILDING AND•SAFETY ' cgpy th�reof�(Sec,3800,Lab.C,) : n , ,r Poli No. f� Company FOR APPLICANT TO FILL IN DDRESS,� a f ❑ ertifiad copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ❑ $ _ $ LOCALITY Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. department. Multi-family Sq.Ft. NEAREST - CROSS Si Residential Swimming Pools OWNER OR r Date Applicant FIRM NAME. L , P, U, Q CERTIFICATE OF EXEMPTION FROM WORKERS` MAIL COMPENSATION INSURANCE Outlets:Rao — t 2 — ADDRESS Q(J First 20 (This section need not be completed if the work Involved by the C31TY � )� Tel.No. permit.is for one hundred dollars($100)or less.) Total No. Add(tional I certif that in-the performance of the work for which this permit PLAN CHECK Y is issued,.I shill not employ any person in any manner.so as to APPLICANT become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 �DDRESS Total No. Additional CITY Tel.No. Date ApplicantFixed Appliances Not Over 1 HP NOTICE TO,APPLICANT: If; after making this Certificate of PERMIT A Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. APPLICANT provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M.— ADDRESSd " provisions or this permit shall be.deemed revoked. Top _ FAU W..H: _ 61T Tel:No. LICENSED CONTRACTORS DECLARATION Hood — Farr Other_ Y . . I I hereby affirm. that I am.licensed.under provisions of Chapter-9LICEN E OR (commencing with Section 7000)of Division 3 of the Business and Disp. — Room Air Cond. REG.,NUMBER Class + Professions Code,and my,license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO. CESSE_D BY Size&Type HP,KW,KVA,or KVAR O License Number Lic.Class. Up to'1 Incl. FINAL Q Over 1 to 1.0 Incl. DATE — C VALIDATION Ccnttactor Date I �� Over 10 to 50 Incl.. FINAL 0 I am exempt under Sec: tl Over 50 to 100 Inc. BY BAP.C.for this reason •I• Over 1.00 N Services,Swbd.,MCC&Panelboards /� , Z. Date:: if 0-200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V , Over 1000 Amp.or Over 600 V QExemption for Reg.Maint.Elect. SINGLE FAMILY Temp,Power Pole&Appurtenances 7 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit /�/+/+ a I hereby affirm that I am exempt from the Contractor's License Law ACCTA for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits Code): 3307 25.511 Mist.Conduits&Conductors 1 ITEMS I„as owner of.the property,will.do the work and.the structure Other(See Complete Fee Schedule) _ ' is not intended or offered for sale(Section.7044, Business Poo. T�'r� 25.50 and Professions Code). *ECK 25 CONSTRUCTION LENDING.AGENCY q ' � 1•hereby affirm that there is a construction lending agency for the. i M M Civ. r ante of the work for which this permit.is issued(Sec.3097, PERMIT FEE (Sub Total) J• PLAN CHECKING FEE am0-041 9/22/89 Lender's Name PERMIT ISSUING FEE ! 1 966 1 W11139 Lender's Addres§ ; I certify that I have read this application and state that the above TOTAL FEE information is correct.'I agree to comply with all County ordinances i and'State laws regulating Electrical wiring, and hereby authorize i representatives of this County to enter upon the above-mentioned, l property r jnspectiorLpurp SEE REVERSE FOR EXPLANATORY LANGUAGE "A ake?_ igna u of .rmit ee. ate I J I ,"IftfirORhat 14 COMPENSATION DECLARATION �s/CG �,to/S1 APPLICATION FOR ELECTRICAL PERMIT t,"I hilreby 8ffirm;that 1+haVe.a certificate Of consent to self insure, 80 or a certificate of Workers' Compensation Insurance, or a certified, COUNTY OF LOS ANGELES BUILDING AND SAFETY - aopylhereofA(Sec.3800,Lab.C.) PolicyNO. 9Uompanyv` b,�' ��[ + FOR APPLICANT TO FILL IN JOB E] Certified copy is hereby furnished. EACH NO. FEE ADDRESS S �Gtru ✓� New Residential Bldgs.&Pools ❑ Certified copy is filed with-the county building inspection 1 &2-FamilyLOCALITY,Sq.Ft. $ _ $ e, department. Multi-family Sq.Ft. NEAREST r �/� Residential Swimming Pools C)iOSs 3OR T Q, Oak,Date -17 V 90 ApplicantAh1hdiz COf4� FARM NAME LAS d CERTIFICATE OF EXEMPTION FROM WORKERS' �Li n +� ® MAIL ' Outlets:Relic-0 Light—Sw. p Ab COMPENSATION INSURANCE DRESS ctrn (This section need not be completed If the work Involved by the First 20 CITY Tel.No.. permit is for one hundred dollars($100)or less.) Total No. Additional i Ty �/ 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. I Lighting Fixtures First 20 ADDRESS ' Additional Total No. 31' CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of PERMIT Exemption,you should become subject to the Workers'Compensation " Range_ Heater D.W. APPLICANT L{ provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W M.. ADDRESS 02 !e r provisions or this permit shall be deemed revoked. Top — FAU j_ W.H. CITY � Tel !S LICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other— l/ C- O* I hereby affirm that I am licensed under provisions of Chapter 9 14CE..NSE OR (commencing with Section 7000)-of Division 3 of the Business and Disp. J_ Room Air Cond. REG.NUMBER -9-905'310 Class• Professions Code,and my license is in full force and effect. DISTRICT NQ.,� P C SED Power Apparatus&Large Appliances ' J{� //�� ,)] Size&Type HP,KW,KVA,or KVAR I , License Number.�9V5��^t-.1 _LLim Class I Up to 1 Incl. FINAL f Contractor �r �[]pt5 I Over 1 to 10 Incl. DAAf �/� VALIDATION 0 '� ,Date ® i Over 10 to 50 Incl.❑ FINAL 7��...'...I am exempt under Sec. Over 50 to 100 Inc. BY fyt B.&P.C.for this reason I Over 100 i N, D a Services,Swbd.,MCC&Panelboards ® Z �® f 0-200 Amp.Under 600 V Signatu 20.1 - 1000 Amp.Under 600 V ❑ I Over 1000 Amp.or Over 600'V xemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole&Appurtenances 7 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit pp.� I hereby affirm that I am exempt from the Contractor's License Law " Additional Sign Branch Circuits AG41 e98 for the following reason(Section 7031.5,Business and Professions Code): ' 3307 122.40 Misc.Conduits&Conductors ❑ I,as owner.of the property,will do the work and the structure 1 ITEMS is not.intended or offered for sale (Section 7044, Business i Other(See Complete.Fee Schedule) _ loop _ and Professions Code). TOTAL AL 122. 40 CONSTRUCTION LENDING AGENCY : CHECK 1ri,411 I hereby affirm that there is a construction lending agency for the ;I performance of the work,for which this permit is issued(Sec:3097, PERMIT FEE (Sub-Total) CHANGE .00 Civ.C.). PLAN CHECKING FEE II Lender's Name -[�(JJ 1 +� ft) PERMIT ISSUING FEE Lender's Address 2479 1 AM'9e45 I certify that I have read this application and state that the above TOTAL FEE information is correct.I agree to comply with all County ordinances i I� and State laws regulating Electrical wiring, and hereby authorize I I representatives of this County to enter upon the above-mentioned p for insp: tionur oses. '?� I SEE REVERSE FOR EXPLANATORY LANGUAGE i ure f Permittee Date ,