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Home My Public Portal About5628 MCCULLOCH AVE_Electrical__ �� • ' , (—I—e !, 1 3/ 't WORKERS'COMPENSATION DECLARATION 78-808 10/87 APPLICATION FOR ELECTRICAL R �ereb •4m�, that I have a certificate of consent to self incurs, CE-808G y or u certtfi�ate of Workers' Compensation Insurance;.or a certified COUNTY OF LOS ANGELES BUILDING.AND SAFETY copy thereof(Sec.3800,Lab.C.) , Policy No. Company - FOR APPLICANT TO FILL IN JOB ❑ Certified copy is hereby furnished. New Residential Bldgs.&.Pools EACH NO. FEE ADDRESS ❑ Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. $ $ LOCALITY �` e department. Multi-family Sq.Ft. — NEAREST i Residential Swimming Pools CROSS O Date Applicant 1 FIRMNER NAME f , CERTIFICATE.OF EXEMPTION FROM WORKERS' f Outlets:Rec—Light—Sw.."—:— MAIL r, COMPENSATION INSURANCE ADDRESS First'20 (This section need not be completed if the work Involved by the Total No. Additional CITY I. permit is for one hundred.dollars($100)or less:) I certify that in the performance of the work.for which this permit PLAN CHECK is issued; I shall not employ any person in a manner so as-to, APPLICANT become subject to the Workers'Compensa Lighting Fixtures First 20 ADDRESS Additional �j - Total:No. CITY Tel.No. Date/ Applicant Fixed Appliances Not Over 1 HP " NOTICE TO APPLICANT: If, aft. making this Certificat PERMIT Exemption,youshould become su ' ct to the Workers'Compensa,. Range_ Heater_ D.W. APPLICANT LJOU 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: LICENSED CONTRACTORS DECLARATION Hood :Z Fan _ Other_ No I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with.Section 7000)of Division 3 of the Business and Disp: L Room Air Cond. LICENSE OR REG.NUMBS Professions Code,and my license is in full force and Affect. DISTRICT NO. PROCESSE Power Apparatus&Large Appliances 0.1 Size&Type HP,KW,kVA,or KVAR t JX License Number Lic..Class Up to 1 incl. FINAL 00 Over'1 to 10 Incl. DATE Q. Contractor Date .Over 10 to 50 Incl. El • . FINAV arr exempt under Sec. FI- . Over 50 to 100 Inc. IaZ2 AD 8 2 A a B.&P.C.for this reason Over 100 N Services,,Swbd.,MCC&Panelboards #'000002 Z Date:.. 0=•200 Amp.Under 600 V I o - 2.0.50 Signature. 201 - 1000 Amp.Under 600 V 13Over 1000 Amp"or Over 60.0 V o 0 0 2 Q 5'0 0 Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power.Pole&Appurtenances 1 a04-88 HOME OWNER-BUILDER DECLARATION Sign with.One.Branch Circuit 1 hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits for the following reason(Section 7031.5,Business.and Professions, Code): 1,as owner of the property,will do the work and the structureMisc.Conduits&Conductors 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 18SUING FEE Lender's Address ' 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 ' and Statelaws regulating Electrical wiring; and -hereby authorize representativge of this County to enter upon the above-mentioned property f9e1ris�i0FaM oses. SEE REVERSE.FOR EXPLANATORY LANGUAGE A9 7"t of Permittee Date Y APPLICATION FOR EL CTRIC ERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER /� �v BUILDING AND SAFETY DIVISION ADDRESS oe��/ o e✓ JOHN A. LAMBIE. COUNTY ENGINEER i WILLIAM A.JENSEIV,Sup'T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST PERMIT 4CROSS ST. ITEM NUMBER I EACH FEE OWNER OUTLE L4515 $ S MAIL LIGHTS RECEPT. SW. .10 ADDRESS LIGHTINI FIXTURES 10 CITY TEL.NO. ELEC.RANGES CLO.DRYERS ELECTRICIAN W A T E.R HEATERS .50 ADDRESS 8-9 2.d E. EL CE NTRS. DISHWASHERS CITY PJ��— TEL.NO. AM' !r4-0539 aReAGE DI Au STATE wasHERB STA,COOKIMfiNITS .25 LICENSE NO. .95 MOTORS: OVER INC. H.P. DISTWPTT N� I GROUP I ZONE PR CE D BY 0— °/2 .25 / 1• �1 +/a— 2 .50 INSPECTION RECORD A— S 1.00 - 5— IS 1.80 i5-- 50 2.50 50-200 5.00 SIGNS: NO.TRANS. NO.LAMPS SERVICE 0-600V 1.00 `. SERVICE OVER 600V 5.00 MISC. WIRING PERMIT 1.00 FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT .50 TOTAL FEE S I HEREBY ACKNOWLEDGE THAT I.HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL 'COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT _ ELECTRICAL WIRING. 1 HEREBY CERTIFY THA AM PROPERLY GI ED D/OR WIRING / / _ LICENSED AS REQUIRED LOS ANGELES O T ND E OF FIXTURES CALIFORNIA OR THAT 1 THE LE F 7 ABOVE DESCRIBED RE NTIA ROPE�T1f. POWER SIGNATURE UTILITYCO:NOTIFIED s..[/1l OF PERM I"rrEEWZ_A__,w" FINAL (L �v ATION ARTHUR C.VEIT. CK MO CASH SUPERVISING ELECTRICAL ENGINEER (tea 108O;ZJAN 16 20 10.35 ' WORKERS'COMPENSATIONDECLARATION ICE-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 Insurance,or I a certified copy thereof(Sec.3800,Lab.C.) J& (� O FOR APPLICANT TO FILL IN JOBO Policy No. Company EACH NO. FEE ADDRESS New Residential Bldgs.&Pools ❑ Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY ❑ Multi-family Sq. Ft. NEARS T Certified copy is filed with the county building inspection Residential Swimming Pools CROSS ST W4A department. ,r� FIRM NAME 7' Date Applicant Outlets: Re cL t Sw. �d a� gDDRESS � ` st 20 CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. •��/. AdAitional CITY/,a Tel No.-SW j® COMPENSATION INSURANCE LAN CHECK tl (This section need not be completed if the work involved PPLICANT V t 20 First Fix xtu rs by the permit is for one hundred dollars ($100) or less.) LigADDRESS Total No. Additional O Fixed Appliances Not Over 1 HP permit is issued, I shall not employ any person to any manner PERMIT U so as to become subject to the Workers'Compensation Laws. Range_Heater D.W. _ APPLICANT95�1 ca Oven _ Dryer_W.M._ ADDRESS Date Applicant Top _ FAU _W.H.._ 'CC Z Hood — Fen _Other_ CITY 1 , t✓_ Tel No.� �S� f NOTICE TO APPLICANT: If, after making this Certificate of Disp. _Room Air Cond— LICENSE OR Exemption, you should become subject to the Workers' REG.NUMBER Class Compensation provisions of the Labor Code, you must forth- Power Apparatus&Large Appliances DISTRICT NO. P B with comply with such provisions or this permit shall be deemed revoked. Size&Type HP,KW,KVA,or KVAR /�� % Up to 1 Incl. !FINAL VALI DA N (f Over 1 to 10 Incl. DATE 7 / LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. ! _ 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 License Number 0-200 Amp.Under 600 V Lic.Class 201-1000 Amp.Under 600 V Contractor Date Over 1000 Amp.or Over 600 V I HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances - I hereby affirm that I am exempt. from the Contractor's Sign With One Branch Circuit License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits ness and Professions Code): Misc.Conduits&Conductors I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)— Xstructure is not intended or offered for sale (Section 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 PERMIT FEE (Sub-Total) issued(Sec.3097,Civ.C.). LTC 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 andState laws regulating Electrical wiring, and hereby sutho representatives of this C unty to enter upon t a ove- Ione o e fo nspec n purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATIONDECLARATION 76AB63 CE-BO6G (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 Insurance,or a certified copy thereof(Sec.3800,Lab.C.) FOR APPLICANT`PO FILL IN JOB Policy No. Company ADDRESS New Residential Bldgs.&Pools EACH NO. FEE ❑ Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ 1 LOCALITY 01 C ❑ Multi-family Sq. Ft. NEAREST f Certified copy is filed with the county building inspection Residential Swimming Pools CROSS ST department. OWNER OR �^ /� FIRM NAME !/ Date Applicant Outlets: Rec._Light Sw: MAIL <��-• // �i First 20 ADDRESS r.c7^J' Cr CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CIT Tel N }a COMPENSATION INSURANCE PLAN CHECK (This section need not be completed if the work involved APPLICANT A V Fixtures First 20hting by the permit is for one hundred dollars ($100) or less.) LigADDRESS tr Additional I certify that in the performance of the work for which this Total No. CITY Tel No. O permit is issued, I shall not employ any person in any manner Fixed Appliances Not Over 1 HP i7 PERMIT so as to become subject to the Workers'Compensation Laws. Range_Heater D.W. _ APPLICANT a Oven _ Dryer_W.M._ ADDRESS U) Date Applicant Top _ FAU _W.H.._ Hood _ Fan _Other_ CITY Tel No. NOTICE TO APPLICANT: If, after making this Certificate of Disp. _Room Air Cond. LICENSE OR Exemption, you should become subject to the Workers' REG.NUMBER Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY with comply with such provisions or this permit shall be Size&Type HP,KW,KVA,or KVAR eemed revoked. Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE P17e, VALIDATION LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. tom`' G hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL (commencing with Section 7000)of Division 3 of the Busi- Over 100 BY � a•-�� as and Professions.Code,and my license is in full force and fact. Services / i 0-200 Amp.Under 600 V J cense Number Lic.Class 201-1000 Amp.Under 600 V ntractor Date Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances ereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit ense Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits s and Professions Code): 3 33 6 7 F Misc.Conduits&Conductors I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)— o 0 0 0 0 structure is not intended or offered for sale (Section 7044,Business and Professions Code). 0 0 2 ? C CONSTRUCTION LENDING AGENCY ereby affirm that there is a construction lending agency the performance of the work for which this permit is ° ° c •- Lt PERMIT FEE (Sub-Total) ed(Sec.3097,Civ.C.). der's Name PLAN CHECKING FEE (One-Fourth Permit Fee) (i 25—E r er's Address PERMIT ISSUING FEE d iffy that I have read.this application and state that the TOTAL FEE e information is correct.I agree to comply with all County ances and St laws regulating Electrical wiring, and y thorim resentatives of this Count to enter upon ov -menY d grope pect,on poses. SEE'REVERSE FOR EXPLANATORY LANGUAGE nature of Permittee Date