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Home My Public Portal About5210 MUSCATEL AVE_Electrical__ WORKERS'COMPENSATION DECLARATION 76Aa3 10/81 �n ; hereby affirm that I have a certificate of consent to self °CE-806G APPLICATION ®R EL ®Q'0 TRICAL PERMIT insure, or a certificate of Workers'Compensation Insurance, 3 COUNTY OF LOS ANGELES , BUILDING AND SAFETY u or a certified copy thereof(Sec. 3800, Lab: C.) 7 Policy No.. Company FOR.APPLICANT TO FILL IN 'JOB ADDRESS Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ❑ I 1 8 2-Family, Ft. $ = $ FOCALITY ` Certified copy is filed with the county building Inspec- I Y. S9• _ NEA tion department. I Multi-family Sq. Ft. REST CROSS ST. �e Residential Swimming Pools ,Q A licant FIWNER OR PP (FIRM. Date NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec ;:MAIL COMPENSATION INSURANCE Light Sw._First 20 ADDRESS �I�ol9 iE (This section need not be completed if the work involved by Total No. Additional I.CITY Tel. No. the permit is for one hundred dollars($100)or less.) I ,PLAN CHECK I certify that,in the-performance of the wdrk 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 2 Total No. Additional CITY Tel. No. DatJ'_ pplicant � � ��f�.2( Fixed Appliances Not Over 1H.P PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT to - � 'e I[ 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 —W.H. — , Tel. No. .� . deemed revoked. Hood ._Fan _Other ,CITY LICENSED CONTRACTORS DECLARATION LICENSE OR- 1 hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG.NUMBER (commencing with Section 7000)of Division:3 of the Business DISTRICT NO. PRO D BY and Professions Code,and.my license is in full force and effect. Power Apparatus 8 Large Appliances. p Size 8 Type HP, KW, KVA, or KVAR' O 'License Number J _A� 3 Lic. Class •c /� 'FINAL S Up to 1 Incl, J Leg Over 1 to 10 Incl. DATE p � �� VALIDATION Contracto N`y�•C!rj j-rX«'Date T Over 10 to 50 Incl. FINAL' C•i � ❑ I am exempt under Sec. Over 50 to 100 Inc. 4BY ! _ • Lu B.BP.C. for this reason Over 10°°°0 nnn��-___'''��I111... CP" Serv' S, Am,�i�CG boards ti Date: �n^2O0 Amp Under Signature r 201 =1000 Amp. Under 600 V ® Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power:Pole 8 Appurtenances , HOME OWNER.-BUILDER DECLARATION Sign with.One Branch Circuit I I hereby affirm that am exempt from the Contractor's License Sign ith. Sign Branch Circuits Law for the following reason (Section 7031.51 Business and Professions Code): ❑ I, as owner of the property, will do the'work and the IMisc. Conduits 8 Conductors IL 7 4 e A structure is not intended or offered for said (Section Other(See Complete Fee Sched'ule)_ `. 7044, Business and Professions Code). t tt u o 0 0 0 2 CONSTRUCTION LENDING AGENCY i 1,0 o. C 1 hereby affirm that there is a construction.lending agency for ' i the performance of the work for which.this permit is issued SPERMIT FEE- (Sub-Total) i (Sec. 3097,Civ. C.). � j PLAN CHECKING FEE Q u 2 4_ o z Lender's Name 1 f PERMIT ISSUING FEE j ' Lender's Address 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 `4.herebthorize representative of this County to enter upon-m tinned pro ert' r inspection purposes. SEE REVERSE FOREXPLANATORY LANGUAGEof.Per i tee Date 1.I QKERS' PENSATION DECLARATION 76A663 10/81 ` ? CE-806G APPLICATION FOR ELECTRICAL PERMIT 1, „xeby firm hat I have COMa certificat@ of consept to self Insure, '6r q c$G'tific of Workers' Compensq)ion Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY c0p9rhesaofi'(Sec.3800,Lab.C.) Policy'fdo��Company �� FOR APPLICANT TO FILL IN JOB ❑ Certified coy is hereby furnished. EACH NO. FEE ADDRESS esJrg5,L 4 p Y New Residential Bldgs.&Pools /�I —Ft. $ LOCALITY `� � $ ! %/e �� ® -'kpertified copy is filed with the county building inspection 1 &2-Family,Sq. — department. Multi-family Sq.Ft. NEAREST 6� CROSS O Dater ,.Applican_T 4�® b Residential Swimming Pools OWNER R FIRM NAME e. aa;tzaex CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec_Light Sw.— MAIL (7(7Q-_-PCOMPENSATION INSURANCE .— ADDRESS 77 (This section need not be completed if the work involved by the First 20 permit is for one hundred dollars($100)or less.) Total No. Additional CITY W L� Tel.N WJ-12?3.Z I certify that in the performance of the Work for which this permit PLAN CHECK is issued, I shall not employ any person in any manner so as to APPLICANT r L� become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS T/ Total No. Additional CITY /� No Date Applicant � 4C 67Tel. ' NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT 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._ ADDRESS ,provisions or this permit shall be deemed revoked. Top _ FAU _ W.H. CITY Tel.No. r LICENSED CONTRACTORS DECLARATION Hood _ Fan Other_ , I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR ,�// pp Class. • Q (commencing with Section 7000)of Division 3 of the Business and REG.NUMBER ��Gl� d,O (/ ProfessionsCode,and my license is in full force and effect. power Apparatus&Large Appliances DISTRICT NO.. PROCES BY �/� Size&Type HP,KW,KVA,or KVAR C� Q License Number 4W �� Sc. a Lic:Class Up to 1 Incl. FINAL. /t v Contractore44 e S_ Over 1 to 10 Incl. jAL ATE O IDATION Jr F Over 10 to 50 Incl. NI am exempt under Sec. Over 50 to 100 I13 nc. Y W B.&P.C.for this reason Over 100 N Services,Swbd.,MCC&Panelboards Date: 0-200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V ❑ Over 1000 Amp.or Over 600 V 9 7 3 3 A Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION o o ' 5i Sign with One Branch Circuit � Z I 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 x Code): 9 ( o o o 2 5,0. Misc.Conduits&Conductors 5 J 1 —?8 ❑, 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 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 Lender's PERMIT ISSUING FEE I certify that hatIAddress have read this application and state that the above TOTAL FEE information is correct.I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize. representatives.of this County t enter upon the above-mentioned pro y r inspection purpo SEE REVERSE FOR EXPLANATORY LANGUAGE ignatu of.Permittee Date i DEPARTMENT OF -•, • ,NG�,� K, �•y:�e�,,� � •� • NY BUILDIN 0. ,�• °r�cAZToI�' R•. �, • • •-,• ;COU OF LOS ANGELES.-,.:.. �•� a+ •I�C.CRIC��""y��' �'�;. • DIiTRICT .. d OUI�•a P •P IPA wIRINalyln11rlien DERVIee t � i,• '. c� . .� RANGE HlATtR FIRST INN%PE.•�•�•�� O i0 OATt •+hr J • ' e/aN Y/LetLtANrouB � . •:- •a.�t G..y,�,, s'r �' . .• _• •�• �.�. `• APPLICANT FILL IN HE •o„ � AYILY. OIITI.INi:D•I'OKTIUN ONLY. •- .'�w •A '�'':' :' NAMEY •ii' tlrp .,-y; • dOB f ..+� VIC '"• �. �• ADDR Rle P •� •• •' •� •tefl�AL ' n J• i CITY •+' M NO. r on pq' NLAREBT s^:• .• - la1�._•� .. g LTA Tt .. -, CROCE Mr. ..5..k .p'.•' LIG/7rOR Ne.. GOUREG. Me. TY a•S:•7L! DESCRIPTION OF WORK NAI S'•• NUMBER OR OUTLETS ON CIRCUITS' ' +;1' • , •+'gr-Yc' �,;'.7r� L ADDRlBB ` `^ LOCATION BV ROOMS _ :. .r I a�LIO_NT OUTLdTL rW f PLuoS nsT. Com_ f • _ NO• O• �• =7''.=• �aRcurre l c�o I c 1 ' I F�H ":.::. 'W CORItECTI0N8. • LM No ROOMI'V �y. OTMINO ROOM "• ., ::°J•,•1'I•J •y'.n•-�/AAe BATH L :• ,• ', T. HALL'•• }ice MALL Ho. k: �a. v �; •4. :. FRONT 1p i ONT'OIDQrORCN , d. ,•�a• .LA ,,r J:.. +, KITCHEN , ' •a �., '•R� ftRV.'!'cN. ` , —,. r• ��j'Yr t ��•J,•.�]f'.• k'` M-� 7.{af {aS:ip..�� ..,:l�,:f�.51r:t:•L*r c'ip•.t'••�•�j c•:t CLOStT, • : _ _mow. i ,.� , L el. '��"B•�Yt�':•r�a'k. '.� .�•r+•t.�.•;o-�r: 1. 0 i��ti. ��. rdi.� ■01M. NO. a /+ 131 ": :rh7}�i• x A��5.�7 9r '✓i t: • ,• y'i•f CtOLR _ _- , a. '•1 i�`.•i:,v' �' ,*rt,r q,� iM g " Ft ,:. 12T � ., "" •• "" � I 8 � �•R.''�o• . �+•%7'C�`�:w'r'•9„•�' •1' g}'CKs ..,�.,j• .,�y• .� ,. ' •,v •r ',i. .tiVz�Lj1..7e•�'f�Y�a,.�^-•eef, i"�;�w.�':l':`S:7'bC.•4yd � X07 '45. 7 e a y '��r�•- '�^T74V•UI,"�.�I4'S+� .• gid.L`--,^�,. f. - - TOTAL, f:. �� `. i p�.:•..;;' �e3Gv-rn;4�A;;r�, i••�:t.:�'}ta"? n -.�.,' fib: • •• tS+::'a B�CY� NO.Or OUTLET! B Yf is, YAPPROVALS ;i+,r.,.. ,. ' ". •,. r' �-� ' NO. O►PIXTURRL L •C.r�. .,. •}�': �a' �. '.`••• •YiV: .' NO. OR MOTORi'.. li•P. +:) - f, OATlr• :1 ° .IrA .4r }.. s• t iix.� f • L`., .• �• 0 CONDUIT .:hr,a?.•'M1li y.dy,..•, •:'}: ' •,� NO: OP VIONS ...+:► �RANB.'� r )' 4. ��. +�..s' L9PJ•5 •'i Ir!. � :''' ,J •'a ',•tRINq cr4• { :5i 'y v _ ;f d, }'� r../•at r.- ..�i:L, •NO••Olr RANOLL OR NtATtRL:i"D" •5' , ..• :!• ,, Jw,,,�,.� '� 1• •••• NILClLLAVIMUS 4r?'•• an•5_•�• '7• L• ..d 's7� f .' Y" �M•.:+i R :' fc' PlgM�T:r y:: rOWtR`:. .rlC ••'•`i'd. ,+4: Iv o;.},sem.. -� tarsi -----t�++;�.�.�''.::.,,�y,�y�`•'• R.:•. :•. Vij 11YCQc.N /y�,l'$. •• A• R •.3t.: J's'S 4�W:J8t:•.�rrrs:'4".:F:'.•'�i`,} ;•'.t � ti mss,. s l i: V' w . ` .•JAY• •M!. n ,• •.'. _ � i••.,.w-.• +�'in7�19J' iF. .:infd.'{��':J.yGiraFiD!tR�4a:. •• ti rO. adlllll ..iMw�®r•••.�..-M1..L,•�i•M�wa-' '...�....G•T•'tt•�Ri. ..i..e !wweii'f 451.• � .._�m.0�1�... .W- 1 1, - o • E• f1M!»!O f001.. '.,. •� 1 •�'•..i:dJC��.•.::.,rq:.i'!!il •7•R.V+�r•••�y�'`.1 a.� r ao .. ° DSPARTbIENT.OF•,BUILDING':AND 9A Er^.lA„" �.A CAVI tYOR p , COUNTY OF IAS ANGELES � '��,�� ^'�:�►n'% 6 i °• let : . •' ,•_,; C ° F INST ��r�t .••� NATURR 0 ALLATIO:�T' oit No..4' W9aRN8• ° et•• tflAYlCt' :�=� �� RAN0t3 NeATBR •• I '. --1 M afiADY/pa Toy�(�:�rj . . •,r:r 'e�-gar-+ °" �fj� APPLICANT FILL td HEAVILY OUTLINED PORTI N ONLY •.:1:�:,:;...>,; '' • NANc ' .. am •1. ° AD dm �rTr wo. NawastT r:7'. •. ( ° COUNT/ R ._ .i 7t6T. DESCRIPTION OF womc ~ .�•• F' ~d ®1 NYMttR•R1rounxrmON CIRCYITf ° ' •ADOwM C LOCATIOff tr ROON• • LIOMT OYTL •ri. Y • f0. ''• •'"1'+,r.L u•.a*7'!L ffe -•'• !ia' t.1°itCUfT y AMGMA� CON -Me LfOAL`�tOftet•OR Q G D �an`t �. {IZY;• ' LOSS LIVING ROON DIYIN4 a00M 1 AN lYf! ` ASOVt ' L taA1.befNoe 6F."to pios•aet 4 CRI+'ET. RM. •}', +•'(t!�+, a TKO .3r effT MALJI, .. i .,j►CORRECTIONS • r` , I HALLLNo. ,r FR :( ►a' KtTCHe>� �► 9[RV rN +TI Oil • CLO•eT 0. •. (•p CLO•eTAh FT-77 7H +7 i ^��: ;',%•',..%ter:!;::•.:4�. . ,..,, �;: OR a7lJ7LeT•- / F:t 3 : :, N 'O/ tIRTURe r • 7-7. �' oATlf••'* _ NO. Or MOTORO �i NO. OP •ION• IRAN• f11INd •"- r''r'` r i NO. OP aANOel=1 '•'. '� �' ngs rer I. rmM »iy:•:' L' .�.r•.+Y:•-.3. :.(•.'��''� (�7,'r•.!% 3":(i�''.'•,i l:Y�.�'=r°i"7S;I�O+• .•.dL•.,��t '� Z 0 "�• �'�X '"''jl \id Fi�y',�•4•.1;' .Jd 'SL >x•:�•*'S,;f�'7�" '•a..��..t°. ung - ...._...-...• ..+.. T.' DEPARTMENT OF n , , o .�Xy'v.,�,'s.•1?��•�'�"'1�w�'.B~�•.•�1Y�y•.. �� :• •f UILDING A j •"�' ND SAFis`PS"' '.NLIIPPLICAT'ZON FOR P1!'�tMIT' ' UN'I'Y r �� or L®s ANGELES f.ELECrRIC' N,(TMM-6'krON DISTRI OROUl�.TTP PCR WIRING ►IRIVR[t 1--j aBRYtet ' r :' "^ ,/�• °�) /1 RANG[ NCAY[R I POIr[R PIRfT IN PECTION •PonRt I ED OA/TaVlttyt along M11P[I LAN[OI171 • x'� '�'� �' AaL)W1'JON S F NAM[ ADORlflf ADDRESS J . :.b...w.� �. +. RNA.... L60ALM � s•} i ti CIT1I TCL No r Y NE [my OTAT[ M " • •d ' Lle[NE[NR Poe. ---NTT f� ,• ••A.• NAM[ 7r �. [G Ne g ' • DESCRII'Trox OF WORK r MAIL n . • NUMBER OF OUTLETS C4 CIRCUITS ti, 'AHDREaS LOCATION a7 ROOMS �• . +:' - LIGHT UTLETS GW.1 PLUOa CfT1►' ; •,"''TML Ne. •• / ` CrRcurr e cOu s �I ,. a N ;i• ti:` ' ,'; ; "i:;t'CORRECTrON3. LIVING ROOM / I_j v ` DINING ROOM a • ,•9• °� RATH 7- ENT. HAt3. HALL No. FRONT PORCH • OUTSIDE '1 _ .�,�..L - r. •.'�1g%dp RITCHIMLI I IZ .. .,. • ` itRV. IY.N. 7 ' _ W- 0----J, Owr.No. Uemf. No. 1 CLOSET1-71 1i. :•. ,y •APPROVALS •• ' NO.b►OIITLETt i POw[R !' :. t �••• r ' ~� ` NO:OP►IIITUR[e ® UTILITY C0.440TIFICD ► •9. Nb. OF MOTORS H.P. S FINAL :: �• o �h NO:'OF atGNa TRANS. '; (AM THE L[OAL.OYYHER CW THE A00VR Lda ANORq• COUNTY ARGISTRATION-NUMBER. NO.OF RANGES OR HEATICRa a te— e• +.:.. ,.. }o. • :., .'- M10CELLANtl7UR 'r ;t. •-•d'•r'.:..ry'i%T r. of. •, �: , aLtC7MCG,M. fi�A 5PErtmir r[[ a Nam OlTa PROPTNtLEQLCNOVS ' Eap1!! •t .o:..�;h. 'Y,:•• rt•�» t `•f• � ..: ...' ::�.. .. A: �.:^+�• L:•, owwOl. .x• :cv�: 'p 'ti:r•s+r#cei;:SL":3e;:'; r1r�'.'-'F,i�.`.i: •.?+c -