HomeMy Public PortalAbout5915-5927 OAK AVE_Electrical__ WORKERS have
a ertdwA N DECLARATION CE76AG638061 ,o,a, APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that f have a certrficate of conaeri�to s�f Insure �BDBG
or a certificate of Mlg_r m Cofnpensabon Insurance or a certified w1 v COUNTY OF LOS ANGELES BUILDING AND SAFETY
eopq thereof(See 3800 Lab C) "fl
Policy No A pOtDMpany ( FOR APPLICANT TO FILL IN JOB
Certified copy is hereby furnished New Residential Bldgs &Pools EACH NO FEE ADDRESS
61149 Al
Eie? fled copy is filed with the county building Inspection 1 &2 Family Sq Ft $ — $ LOCALITY r
M dd t Multi family Sq Ft — NEAREST
CROSS ST
Date Applicant
Residential Swimming Poole OWNER o u
FIRM NAME r
CERTIFICATE OF EXEMPTION FROM WORKERSMAIL
COMPENSATION INSURANCE
Outlets Roe Light SW O ADDRESS Q
(This section need not be Completed If the work Involved by the Total No First
Addi20CITYCITY T NO J
permit is for one hundred dollars($100)or lose)
I certify that In the performance of the work for which this permit PLAN CHECK
m
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
Applicant Total No CITY Tel No
NOTICE TO APPLICAUT If after making this Certificate of Fixed Appliances Not Over 1 HP PEPUIIT
Exemption you should become subject to the Workers Compensation Range— Heater, D W
provisions of the Labor Code you must forthwith comply with such Oven _ Dryst_ W M M ADDRESS &/of AJ< !G* i
provisions or this permit shall be deemed revoked Top _ FAU WH
LICENSED CONTRACTORS DECLARATION Hood _ Fan Other_ CIN d Tel No
I hereby affirm that I am licensed under provisions of Chapter 97 Z O LICENSE OR
(commencing with Section 7000)of Division 3 of the Business and Dlsp — Room Air Corxf — — REG NUMBER C�8 rc7�
Professions Code and my license is in full force and effectDISTRICT NO PROC t+
Power Apparatus&Large Appliances
51`AA 3 C1` O Size&Type HP KW KVA or KVAR i
License Number J L.ic Class Up to 1 Incl FINAL
Contractort4w4LFIC Dffie �f _ Over 1 to 10 Ind DATE
l VALIDATION
❑ Over 10 to 50 Incl FINAL
I am exempt under Sec Over 50 to 100 Inc BY
B&PC for this reason Over 100
Services Swbd MCC&Panelboards N
Date 0 200 Amp Under 600 V
Signature 201 1000 Amp Under 600 V OA
Over 1000 Amp or Over 600 V
❑ Exemption for Reg Maim Elect
SINGLE FAMILY Temp Power Pole&Appurtenances 2
HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractors License Law Additional Sign Branch Circuits ACCT.!
for the following reason(Section 70315 Business and Professions
Code) 33[17 4$6.00
❑ I as owner of the property will do the work and the structure Misc Conduits&Conductors
Is not Intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule) _ 1 IT
and Professions Code) ► TOTAL 4846.00
CONSTRUCTION LENDING AGENCY 0ECK 406.00
1 hereby affirm that there is a constriction lending agency for the
performance of the work for which this permit Is Issued(Sec 3097 PERMIT FEE (Sub Total) c0a OD
CN C)
PLAN CHECKING FEE
Lender s Name PERMIT ISSUING FEE 3 0000-0001 $114/90
Lender s Address 2390 1 AM 8:lit
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 State laws regulating Electrical wrong and hereby authorize
representatives of this County to enter upon the above mentioned
pinspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
W,
E
�::)'p-13a-9a
Sig rim Date .�-
WORKERS COMPENSATION DECLARATION 7eAe83 10/81 APPLICATION FOR ELECTRICAL PERMIT {�
I hereby affirm that I have a certdlcate of consent to self insure CE 806G
or a cerbliWe of Workers Compensation Insurance or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
o9py thereof(Sec 3800 Lab C)
Policy No Company FOR APPLICANT TO FILL IN JOB
❑
Certified copy is hereby furnished -W141 9 a am
New Residential Bldgs &Pods EACH NO FEE ADDRESS
❑ Wj
Certified copy re filed With the county budding inspection 1 &2 Family Sq Ft $ _ $ LOCALITY L�L'
department Multi family Sq Ft NEAREST
CROSS ST
Date ApplIDant Residential Swimming Pools OWNER OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec Light_Sw MAIL r.
COMPENSATION INSURANCE ADDREss C—:
(This section need not be completed N the work Involved by the First 20
permit Is for one hundred dollars($100)or less) Total No Additional CITY _ Tel No Z
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 HP PERMIT
NOTICE TO APPLICANT If atter making this Certificate of
Exemption you should become subject to the Workers Compensation Range_ Heater DW
provisions of the Labor Code you must forthwith comply with such Oven _ Dryer_ W M ADDRES
provisions or this permit shall be deemed revoked Top — FAU _ WH _
CITY Tel No–"—ILICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other_
I hereby affirm that I am licensed under provisions of Chapter 9 Drsp — Room Air Cond LICENSE OR CWW
(commencing with Section 7000)of Division 3 of the Business and REG NUMBER
'555-1 sl
Professions Code and my license is in full force and effect Power Apparatus&Large Appliances DISTRICT ryQ_J ED BY
Size&Type HP KW KVA or KVAR 'o
License Number LID Class Up to 1 Incl FINAL
Over 1 to 10 Incl DATE VALIDATION p
Contractor Date Over 10 to 50 Incl FINAL
❑ 1 am exempt under Sec Over 50 to 100 Inc BY
� a
B&P C for this reason Over 100 H
Date Services Swbd MCC&Panelboards ► Z
0 200 Amp Under 600 V
Signature 201 1000 Amp Under 600 V
❑ Over 1000 Amp or Over 600 V
Exemption for Reg Maint Elect
SINGLE FAMILY Temp Power Pole&Appurtenances 2
HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit s
I hereby affirm that I am exempt from the Contractors License Law PaT.T
for the following reason(Section 70315 Business and Professions Additional Sign Branch Circuits
Code) 3307 33.�J
❑ I as owner of the property Will do the work and the structure Misc Conduits&Conductors property ITEMS
is not intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule) _ ►
and Professions Code) TOTS. 3 -OO
CONSTRUCTION LENDING AGENCY CHECK 33.00
1 hereby affirm that there is a construction lending agency for the .00
performance of the work for which this permit is issued(Sec 3097 PERMIT FEE (Sub Total)
CIV C)
PLAN CHECKING FEE
Lenders Name 1 7/26/90
PERMIT ISSUING FEE M62 1 AM 7-42.
Lenders 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 State laws regulating Electrical wrong and hereby authorize
representatives of this County to enter upon the above mentioned
erty for spection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
SiPermdtoe Date
WORKERS I COMPENSATION DECLARATION CE 806 tO/Bt APPLICATION FOR ELECTRICAL PERMIT {�
I hereby affirm that I have a certificate ct consent to self insure CE 8o8G L.1
or j cerldgAe of Workere 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 ADDRESS ' ✓(S
❑ Certified copy is hereby furnished New Residential Bldgs &Pools
EACH NO FEE
❑ Certified copy is filed with the county building inspection 1&2 Family Sq Ft $ _ $ LOCALITY
department Multi family Sq Ft CROSS ST �) V N •r*
Date Applicant Residential Swimming Pools OWNER OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS � Mal
COMPENSATION INSURANCE Outlets Roo Light Sw .� -- ADDRESS AA pr
(This section need not be completed M the work Involved by the First 20
permit Is for one hundred dollars($100)a leas) Total No CITY Tel No
Additional
GK
I certify that in the performerae of the work for which this permit PLAN CH T
is issulild I shall not employ any pereo manner so as to ��
become subject to the Workers Co (ro Laws Lighting Fixtures First 20 ADDRESS
Total No Additional CITY Tel No
WOE Apllie Fixed Appliances Not Over 1 HP PERMIT
NOTICE A PLICANT If a4-
making this Certo ct C
Exemption you should become subject to the Workers Compensation Range_ Heater,_ DW _ APPLICANT
provisions of the Labor Code you must forthwith comply with such Owen _ Dryer_ W M _ ADDRESS
provisions or this permit shall be deemed revoked Top _ FAU WH CITY y`+ ��C. t Tel No _Q7
LICENSED CONTRACTORS DECLARATION Hood _ Fan Other_ C'�
I hereby affirm that I am licensed under provisions of Chapter 9Disp ROOrrI Air�� LICENSE OR Clara to
(commencing with Section 1000)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 83ED BY
Sae&Type HP KW KVA or KVAR p
License Numbs Lie Class Up to 1 Incl FINAL Q
Over 1 to 10 Ind DATE —?jS-g VALIDATION
❑ Over 10 to 60 Ind FINAL
I am exempt under Sec Over 50 to 100 Inc BY
BAPC for this reason Over 100 CO)
Date Services Swbd MCC&Panelboards ► Z
0 200 Amp.Under 600 V
Signature 201 1000 Amp Under 600 V
❑
Exemption for Reg MaOver 1000 Amp or Over 800 V
Math Elect
SINGLE FAMILY Temp Power Pole&Appurtenances
HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor s License Law
for the following reason(Section 7p31 5 Business and Professions Additional Sign Branch Circuits TEM 41.30Code)
❑ i as owner of the property will do the work and the structure Miac Conduits&Conductors 3303 1 Z
4a not intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule) _ Poo.
'VIAL 41.30
and Professions Code) t
CONSTRUCTION LENDING AGENCY T1a'�
I hereby affirm that there is a construction lending agency for the M
performance of the work for which this permit is issued(Sec 3087 PERMFT FEE (Sub Total) 2,4
Cly C)
PLAN CHECKING FEE 1 8/ 9t"
Lenders Name PERMIT ISSUING FEE o't O IM 1 AN11325
Lender s Address
I certify that I have read the 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
repress tines of this County iter upon the above mentioned
Pel, q.r—pectron perp SSE REVERSE FOR EXPLANATORY LANGUAGE
P�niaturq of Permittee Da
VR S COMPENSATION DECLARATION 7776JUN DPW c12 e,, APPLICATION FOR ELECTRICAL PERMIT
I hereb)�affirmm thatthat 1 have a certificate of consent to self insure
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 38QO Lab C)
Policy No Company FOR APPLICANT TO RLL IN ADDRESS
❑ Certified copy Is hereby furnished New Residential Bldgs &Pools NO EACH FEE
Sq Ft — $ g LOCALITY
El Certified copy Is filed with the county bud1&2 Family
ding Inspection — NEAREST
department Multifamily Sq Ft CROSS ST 1 u n ias
Date Applicant Residential Swimming Pools ASSESSOR /�.�
MAP BOOK e 9 PAGE v t%/71 PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Re Light S.
OWNER AME ,Sus „g a nv
COMPENSATION INSURANCE
(This section need not be completed If the work Involved by the / First 200 v4 MAIL
permit Is for one hundred dollars ted if or lase) Total No Additional ADDRESS v�
I certify that in the performance of the work for which this permit CITY ( _ C Tel No
is issued I shall not employ any person in any manner as to PLAN CHECK
become subject to the Workers Compen tion Laws Lighting Fixtures First 20 APPLICANT
Total No Additional
ADDRESS
Date T Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP
NOTIC TO APPLICANT If aft r making this Certificate of CITY Tel No
Exemption you should become subject to the Workers Compensation OTHER APPLIANCES NOT OVER 3 HP
MIT
provisions of the Labor Code you must forthwith comply with such APPLICANT
provisions or this permit shall be deemed revoked Power Apparatus&Large Appliances
LICENSED CONTRACTORS DECLARATION Sme&Type HP KW KVA orUAR ADDRESS r
I hereby affirm that I am licensed under provisions of Chapter 9 Over 9 to 10 Incl
(commencing with Section 7000)of Division 3 of the Business and CITY Z--Gn Tel
Professions Code and my license is In full force and effect Over 10 to 50 Ind
LICENSE OR }
Over 50 to 100 Incl REG NUMBER CleasCL
L O L v Over 1 OD DISTRICT NO ED BY U
License Number / Lic Class
Sernces Swbd MCC&Panelboards �r Q
Contractor Date 0 399 Amp Under 600 V FINAL
' / V
❑ I am exempt under Sec 400 1000 Amp Under 800 V FINAL s Z$/Q$ d
Over 1000 Amp or Over 600 V VALIDATION
B&P C for this reason BRANCH CIRCUIT FEES BY �V t t Z
Date 15A or 20A 20V Lighting or Recept
Signature 1 To 10 Branch Circuits
9 11 To 40 Branch Circuits
❑ Exemption for Reg Maint Elect 15A,20A 209V To
41 Or Branch C�acwts
FAMILYSINGLE Temp Power Pole ch Circuit uit Appurtenances
HOME OWNER BUILDER DECLARATION Sign One BrancPLC T,
I hereby affirm that 1 am exempt from the Contractor s License Law with _ 70 99
for the following reason(Section 7031 5 Business and Professions Additional Sign Branch Circuits 3'30+3
Code) 1 ITEM
❑ I as owner of the property will do the work and the structure Mus Conduits&Conductors 1 I I�,pL �s,
Is not Intended or offered for sale(Section 7044 Business Other(See Complete Fee Schedule)
and Professions Code) , (HEC 70.95
CONSTRUCTION LENDING AGENCY (F"E .00
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) Q
Civ C) PLAN CHECKING FEE 0000-0001 5/ :/95
Lender s Name
PERMIT ISSUING FEE 0129 1 AM 2 't
Lender s Address TOTAL FEE 9
1 certify that I have read this application and under penalty of purjury state
that the above Information is correct I agree to comply with all County
ordinances and State laws regulating Electrical wiring and hereby authorms
repress ries of this Coun enter upon the above- nboned props
for ion purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
i-
R OF MI E DATE
PENSATION DECLTIN
I hereby affirmOR at II ha`vveMa certificate of coonsentOto self insure >eae�0°s's DPW c,2 9,, APPLICATION FOR ELECTRICAL PERMIT 11
or a certificate of Worker a Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
copy thereq((Sec 3800 Lab C)
Policy 1Cy No Company FOR APPLICANT TO PILL IN ADDRESS Cif �w
Certified copy is hereby furnished New Residential Bldgs &Pools NO EACH FEE LOCALITY , G —/ 17 er v
❑ Certified copy is filed with the county budding Inspection 1&2 Family Sq Ft $ $ NEAREST
department Multi family Sq Ft CROSS BT LJOK
Date Applicant Residential Swimming Pools ASSESSOR
MAP HOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Ree _Light Sw FlOWRM NAMENER OR "SAWr
COMPENSATION INSURANCE
First 20MAIL
(This section need not be completed If the work involved by the Total No Additional ADDRESS
permit Is forone hundred dollars($100)or less)
I certify that In the performance of the work for which this permit CITY Tel No
IB issued I shall not employ any person In any manner so as to PLAN CHECK
become subject to the Workers Compensation Laws Lighting Fixtures First 20 APPLICANT�j�, Total No Additional ADDRESS
Date � Applicant ��� 4562—&-, .516W RESIDENTIAL APPLIANCES NOT OVER 3 HP
NOTICE TO APPLICANT If after making this Certificate 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
bJ
provisions or this permit shall be deemed revoked Power Apparatus&Large Appliances
LICENSED CONTRACTORS DECLARATION Size&Type HP KW KVA or KVAR ADDRESSjo3
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl
(commencing with Section 7000)of Division 3 of the Business and CITYTel No
Professions Code and my license Is in full force and effect Over 10 to 50 Incl
LICENSE �1 /�� q�
/,-�i Over 50 t0 100 Incl REO NUMBER IL
(0
License Number 6�i 66.r U. Class cOver 100 DISTRICT NO P ESSED BY O W.
Services Swbd MCC&Panelboards v' (
Contractor/�t�i (� �✓ i� 0 399 Amp under 000 V ATE O
❑ 1 am exempt oder Secy' 400 1000 Amp Under SW V 5 Iss ~
VALIDATION
Over 1000 Amp or Over SOO V FINAL W
B&P C for this reason BRANCH CIRCUIT FEES eY p ca
Date 15A or 20A 12DV Lighting or R000pt Z
1 To 10 Branch Circuits
Signature 11 To 40 Branch Circuits
❑ Exemption for Reg Main Elect 15A 204,208V To 2747V�More Br Chranf its
SINGLE FAMILY Temp Power Pole&Appurtenances � �{eg
HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor a License Law v�
for the following reason(Section 7031 5 Business and Professions Additional Sign Branch Circuits
Code) 1 ITEMS
❑ I as owner of the property will do the work and the structure Mux: Conduits&Conductors
is not intended or offered for sale(Section 7044 Business Other(See Complete Fee Schedule) Ti ITSL 64 .50
and Professions Code) CWK 6*.5 i
CONSTRUCTION LENDING AGENCY CT7r11yE s
I hereby affirm that there is a construction lending agency for the 00
performance of the work for which this permit is Issued(Sec 3097 PERMIT FEE (Sub Total)
Civ C) PLAN CHECKING FEE "� 1 X24.,95
Lender s Name COW f FM 9 03
PERMIT ISSUING FEE
Lender s Address TOTAL FEE +
I Certify that I have read this application and under penalty of puqury state
that the above information Is correct I agree to comply with all County
ordinances and State laws regulating Electrical wrong and hereby authorize
representatives of this County to enter upon the above mentioned property
for Inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
oeoe
•
SIGNATURE OF PERYTM DATE
WORKER S COMPENSATION DECLARATION 200019 DPW(12 91) - APPLICATION FOR ELECTRICAL PERMIT 11
1 hereby affirm that I have a certificate of consent to self Insure 78A8�
ort certificate of Worker s Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV f
copy thereof(Sec 3800 Lab C)
` ❑Policy NOI ompany hfi s0� FOR APPLICANT TO FILL IN JOB�j ADDRESS
Certified copy Is hereby furnished New Residential Ridge &Poole NO EACH FEE LOCALITY
E] —C IS filed with the county building inspection &2 Family Sq Ft $ $
apectiOn Mufti family Sq Ft — NEARES
department CROSS T
\
Date A
— pplicant��-,2P• 4frf■ a w Residential Swimming Pools ASSESSOR
MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Roe _Light Sw Fl MENRAME E 1L M
COMPENSATION INSURANCE
(This section need not be completed If the work Involved by the First AppgE� G Y
permit Is for one hundred dollars($100)or less) Total No Additional J e
1 certify that in the performance of the work for which this permit CITY leha Tel No
is Issued I shall not employ any person In any manner so as to PLAN CHECK
become subject to the Workers Compensation Laws Lighting Fixtures First 20 APPLICANT
Total No Additional
ADDRESS
Date Applicant RESIDENTIAL APPLU►NCF.S NOT OVER 3 HP
NOTICE TO APPLICANT if after making this Certificate 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 1 �•
provisions or this permit shall be deemed revoked Power Apparatus&Large Appliances APPLICANT
LICENSED CONTRACTORS DECLARATION Sree&Type HP KW KVA or KVAR ADDRESS IS* h
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl CITY Tel No 3�e
(commencing with Section 7000)of Division 3 of the Business and O vrQn 0—
Professions Code and my license Is in full force and effect Over 10 to 50 Incl �
Over 50 t0 100 Incl LICENSE B O Cleta ... / a
REQ NUMBER
Over 100 DISTRICT NO P BY
License Number y 4 '(�Uc Class C-
c,, Services Swbd MCC&Panelboards ��`�
Contractor Sad ace. � o u Data Q
\ --�j� 0 399 Amp Under 800 V FINAL
❑ 400 1000 Amp Under 600 V "� ~
I am exempt under Sec VALIDATION Over 1000 Amp or Over 600 V eY
AL d
S&P C for this reason BRANCH CIRCUIT FEES
W
Date 15A or 20A 120V Lighting or Recept Z
1 To 10 Branch Circuits
Signature 11 To 40 Branch Circuits
41 Or More Branch Circuits
❑ Exemption for Reg Maint Elect 15A 20A 200V To 277V Lighting Br Cucuds 2
SINGLE FAMILY Temp Power Pole&Appurtenances /�,+�T
HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit 11\r\►t■*
I hereby affirm that I am exempt from the Contractors License Law
for the following reason(Section 7031 5 Business and Professions Additional Sign Branch Circuits 3M7 97.65
Code)
❑ I as owner of the property will do the work and the structure Mise: Conduits&Conductors 1 ITUS
is not intended or offered for sale(Section 7044 Business Other(See Complete Fee Schedule) '► OTAL 97.65
and Professions Code)
CF�(K 97.6%
CONSTRUCTION LENDING AGENCY �bfl
n�
I hereby affirm that there is a construction lending agency for the GE OD
performance of the work for which this permit is issued(Sec 3097 PERMIT FEE (Sub Total)
Civ C)
PLAN CHECKING FEE 1 4/30/93
Lender s Neme
PERMIT ISSUING FEE 9481 1 AN10:39
Lender a Address
I certify that 1 have read this application and under penalty of puqury state TOTAL FEE
that the 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 PERINITME DATE
WORKERS COMPENSATION catsDECLARATION
once %MAM3 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that 1 have a certificate of consent to self � O
insure or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS
jor a certified cop thereof(Sec 3800 Lab C)
'Policy No,ZAP 2& Company FOR APPLICANT TO FILL IN JOB
[:]Certified co is hereby furnished EACH NO FEE ADDRESS tr
PY Y New Residential Bldgs 8 Pools
Certified copy is filed with the county uil ng inspec 1 &2 Family Scl Ft $ — $ LOCALITY
T tion department Multifamily Sq Ft -- NEAREST
Residential Swimming Pools CROSS •
Dote Applicant OWNER O
FIRM NAME
CERTIFICATE OF EXEMPTION FRO KE Outlets Rec Light Sw_ MAIL
COMPENSATION INSURANCE First 20 ADDRESS
(This section need not be completed If the work Involved by Total NoAdditional 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 Lighting Fixtures First 20 ADDRESS
so as to become subject to the Workers Compensation laws g g
Additional
Date Applicant Total No CITY Tel No
NOTICE TO APPLICANT If after making this Certificateof Fixed Appliances Not Over 1 HP PERMIT
Exemption you should become subject to the Workers Range.— Heater—D W _ APPLICATION
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 —
deemed revoked Hood — Fan —Other— •
CITY �� el No
LICENSED CONTRACTORS DECLARATION LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp — Room Air Cond — REG NUMBER Class B
(commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NOPRO ED BY >-
and Professions Code and my license is in full force and effect J a0
Size 8 Type HP KW KVA or KVAR
License Number Lic Class Up to 1 Incl FINAL U
Z Over 1 to 10 Incl DATE VALIDATION cc
Contractor to / Over 10 to 50 In
r
E] FINAL F"
I am exempt under Sec Over 50 to 100 Inc BY W
B&P C for this reason Over 100 13.
Date Services Swbd MCC 6 Ponelboards ► _ Z
0 200 Amp Under 600 V
Signature 201 1000 Amp Under 600V
❑ Exemption for Reg Maint Elect Over 1000 Amp or Over 600 V �
SINGLE FAMILY Temp Power Pole Appurtenances 2
HOME OWNER BUILDER DECLARATIO11 N Sign with One Branch Circuit HIT v
1 hereby affirm that I am exempt from the Contractor s license
Law for the following reason (Section 7031.5 Business and Additional Sign Branch Circuits
J1.C+U
Professions Code) 2-07
❑ I as owner of the property will do the work and the Misc Conduits&Conductors 1 ITEMS
structure is not intended or offered for sale(Section 7044 Other(Sen Complete Fee Schedule)_ poolTUTAL F 1.DOBusiness and Professions Code)
CONSTRUCTION LENDING AGENCY LHEQ 131.00
I hereby affirm that there is a construction lending agency for CHANGE US
the performance of the work for which this permit is issued PERMIT FEE (Sub Total)
(Sec 3097 Civ C)
Lender s Name PLAN CHECKING FEE 0000-0001 9/ 2191
PERMIT ISSUING FEE 6767 1 AM 9. 11
Lender s Address TOTAL FEE Ba
I certify
Ahkrthisication and stare that theabove into comply with all County
ordinancing Electrical wiring and
hereby athis County to enter upon
the abovnspectign purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
SignatureDate ®s
WORKER S COMPENSATION DECLARATION 2aoo1e19 DPW(12 91) APPLICATION FOR ELECTRICAL PERMIT L1
1 hereby affirm that I have a certificate of consent to self Insure
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)
PolicyNO / fo Company sr�T� r�� FOR APPLICANT TO FILL IN JOB
ADDRESS
19- Certified copy Is hereby furnished New Residential Bldgs &Pools NO EACH FEE
LOCALITY
❑ Certified copy Is filed With the county building Inspection 1&2 Family Sq Ft NEAREST
department Mufti family Sq Ft — CRM ST
Data ApplicantQA Residential Swimming Pools ASSPBOOK PAGE PARCEL
CERTIFI TE OF EXEMPT14 FROM WORKERS Outlets Roc AE Light S. OWNER OR
COMPENSATION INSURANCEto FIRM NAME
his section need not be completed If the work Involved b the First 20 MAIL
permit is for one hundred dollars($100)or less) y Total No Additional ADDRESS &44g
Yt�
1 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 as to PLAN CHECK
become subject to the Workers Compensation Laws Lighting Fixtures First 20 APPLICANT
Total No Additional
ADDRESS
Date ` Apphcant RESIDENTIAL APPLIANCES NOT OVER 3 HP
NOTIC TO APPL ANT If after eking this Certificate of CITY Tel No
Exemption you should become subject tb,the Workers Compensation OTHER APPLIANCES NOT OVER 3 HP
provisions of the Labor Code you must forthwith comply with such PERMITQ �
provisions or this permit shall be deemed revoked Power Apparatus&Large Appliances
APPLICANT '54SH 4A1
LICENSED CONTRACTORS DECLARATION Size&Type HP KW KVA or KVAR ADDRESS W Oj!qc-
1 hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl
(commencing with Section 7000)of Division 3 of the Business and CITY p Tel No
Professions Code and my license Is In full force and effect Over 10 to 50 Incl }
LICENSE �� a
/♦ Over 50 to 100 Incl REG NUMBER
6 L BY U
License Number � Lic Class Over 100 DISTRICT NO PSSED�_ p'
��ww pp Services Swbd MCC&Panelboards 0 O
Contractc?a0� _Ma f�Date ��' � 0 399 Amp Under 800 V DDE F—
❑ I am exempt under Sec IF 400 1000 Amp Under 800 V �- 2 VALIDATION W
Over 1000 Amp or Over 600 V FINAL d
B&P C for this reasonBRANCH CIRCUIT FEES BY Z
Date 16A or 20A 120V Lighting or Recept
1 To 10 Branch Circuits
Signature 11 To 40 Branch Circuits
❑ Exemption for Reg Mamt Elect 15A Z IA 2WV To 21�Or More Branch roCI�Its iw�
SINGLE FAMILY Temp Power Pole&Appurtenances ACGT.&v
HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that 1 am exempt from the Contractor s License Law 73.20
for the following reason(Section 7031 5 Business and Professions Additional Sign Branch Circuits
Code) 1 ITM
❑ I as owner of the property will do the work and the structure Misc Conduits&Conductors TOTAL 73.21)
Is not intended or offered for sale(Section 7044 Business Other(See Complete Fee Schedule)
and Professions Code) ► MCK 73.20
CONSTRUCTION LENDING AGENCY GE .00
1 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) Q
CIV C)
PLAN CHECKING FEE 0000-0001 9/24/93
Lender a Name 1851 1 AM 9.12
PERMIT ISSUING FEE
Lenders Address ^
I certify that I have read this application and under penalty of purjury state TOTAL FEE d�
that the above Information Is correct I agree to comply with all County
grdinances and State laws regulating Electrical wiring and hereby authorize
representatives of this County to enter upon the above-mentioned property
for Inspecbon purpos SEE REVERSE FOR EXPLANATORY LANGUAGE
MGNATURrF PERMITr DATE
J
4 wol�ER S COMPENSATION DECLARATION 7�6a00aes's DPW(12 9„ APPLICATION FOR ELECTRICAL PERMIT
1 hereby affirm that 1 have a certificate of consent to self insure
,br a certificate of Worker s Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
copy thereof(See 3800 Lab C)
Policy NO&UL29"t.S Company ah&�Ift _ FOR APPLICANT TO FILL IN JOB
I. O
ElCertifiedcopy is hereby furnished New Residential Bidge &Pools NO EACH FEE LOCALITY
I&2 Family Sq Ft — Af_ AVS
$ $
Certified copy is filed with the county building inspection _ NEAREST
department LAV Multifamily Sq Ft CROSSST fuh—J"
Date Applicant �� Residential Swimming Pools MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Roe _Light Stn 4 FINE WOOF
COMPENSATION INSURANCE
First 20 MAIL11
(This section need not be completed If the work Involved by the Total No Additional ADDRESS
permit Is for one hundred dollars($100)or less)
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 as to PLAN CHECK
become subject to the Workers Compensation Laws Lighting Fixtures First 20 APPLICANT
Total No Additional
ADDRESS
Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP
NOTICE TO APPLICANT if after making this Certificate 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 Power Apparatus&Large Appliances
APPLICANT
LICENSED CONTRACTORS DECLARATION Size&Type HP KW KVA or KVAR ADDRESS
I hereby affirm that I am licensbd under provisions of Chapter 9 Over 3 to 10 Incl
(commencing with Section 7000)of Division 3 of the Business and CITY Tel No
Professions Code and my license is in full force and effect Over 10 to 50 Incl LICENSE OR �y d
Over 50 to 100 Incl REG NUMBER45 dr ass A
License NumberyV
�o�ar46 Lic Class Over 100 DISTRICT NO P OCESSED BY S
Services Swbd MCC&Panelboards bit
NAL 0
Contractor Data — — 0 398 Amp Under 800 V DATE
Y U
❑ I am exempt under Sec 400 1000 Amp Under 800 V '� VALIDATION W
Over 1000 Amp or Over 600 V FINAL CL
B&P C for this reasonBRANCH CIRCUIT FEES BY co
Date 15A or 20A 120V Lighting or Recept
1 To 10 Branch Circuits
Signature 11 To 40 Branch Circuits
❑ Warich Circuits
Exemption for Reg Maint Elect 15A 20A 208V To 2747VOLirgMhfing Or Qmft 2
SINGLE FAMILY Temp Power Pole&Appurtenances a
HOME OWNER BUILDER DECLARATION t MAT
I hereby affirm that I am exempt from the Contractors License Law Sign with One Branch Circuit ��n.., LZa�tr
for the following reason(Section 7031 5 Business and Professions Additional Sign Branch Circuits 33CC s
Code) 1 IT
❑ I as owner of the property will do the work and the structure Mise Conduits&Conductors
is not intended or offered for sale(Section 7044 Business Other(See Complete Fee Schedule) TOTAL 63.45
and Professions Code)
0ECK 63•4r;
CONSTRUCTION LENDING AGENCY nuAtt ■�(�
I hereby affirm that there is a construction lending agency for the CW
performance of the work for which this permit is issued(Sec 3097 PERMIT FEE (Sub Total)
Civ C)
PLAN CHECKING FEE 0000-0001 11/ 3/a3
Lender a Name PERMIT ISSUING FEE 2415 1 AM10:27
Lender s Address
1 certify that I have read this application and under penalty of puqury state TOTAL FEE
that the above information is correct I agree to comply with all County
ordinances and State laws regulating Electrical wrong and hereby authorize
representatives of this County to enter upon the above mentioned property
for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNATURE OF PERMnV Jr DATE
WORKERS COMPENSATION DECLARATION 20-0019 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT
a O
I hereby affirm that I have certificate of consent to self O
insure or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS
or a certified copy thereof(Sec 3800 Lab C
Poli o'll gAA6 CompanyEw FOR APPLICANT TO FILL IN JOB
ADDRESS C
Certified copy is hereby furnish New Residential Bldgs &Pools EACH NO FEE
Certified copy is filed with
theIFIV Inspec 1 &2 Family Sq Ft $ — $ LOCALITY
tion department Multifamily Sq Ft — NEAREST
t Residential Swimming Pools ROSS
OWNER T
DotM - a1 ApplicantOR
FIRM NAME
CERTIFICATE OF EXEMPTION FRO WO RS MAIL /c
Outlets Rec Light Sw_ ADDRESS V
COMPENSATION INSURA E First 20 d
(This section need not be completed If the work Involved by Total No 071 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 Lighting Fixtures First 20 ADDRESS
so as to become subject to the Workers Compensation Laws g g
Additional
Dote Applicant Total No CIN Tel No
Fixed Appliances Not Over 1 HPRMIT
NOTICE TO APPLICANT If after making this Certificate of APPLICATION 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 —
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 � 5J 7& Class
(commencing with Section 700D)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO ==.at.
dand Professions Code and my license is in full fore land effect /( Size&Type HP KW KVA or KVAR Q� O
License Number 7h5 Lic Class Up to 1 Incl FINAL U
Contractor UIN ` n.,+e .. G�� Over 1 to 10 Incl DATE s q 1 VALIDATION 0
❑ Over 10 to 50 Incl FINALU
I am exempt under Sec Over 50 to 100 Inc gY LLl
B&P C for IN eason Over 100 N
Date r Services Swbd MCC&Ponelboords , Z
_V 0 200 Amp Under 60D V —
Signature i, 201 1000 Amp Under 600 V
❑ Over 1000 Amp or Over 600 V
ExemptionJRRe t ElectGLE FAMILY Temp Power Pole&Appurtenances
HOME OWNER BUILDER DECLARATION
Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor s License
Law for the following reason (Section 7031 5 Business and Additional Sign Branch Circuits ri4�� v,�,
Professions Code) h[r
❑ I as owner of the property will do the work and the M�sc Conduits 8 Conductors i ,
structure is not intended or offered for sale(Section 7044 Other(See Complete Fee Schedule)_
Business and Professions Code) , TUTAL 115®70
CONSTRUCTION LENDING AGENCY iH&Y lei -411
Ihereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued PERMIT FEE (Sub Total) NANGE
(Sec 3097 Civ C)
PLAN CHECKING FEE
Lender me PERMIT ISSUING FEE
Lenders cess .,
I certify a I have read this application and state that the TOTAL FEE S + i AMID-77
above in tion is correct i a ree to comply with all County
ordinanc regulating Electrical wiring and
hereby au o ze re resentatrves of this County to enter upon
the above boned ro y for mspectio purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signatu tee to t ®s
WORKER S COMPENSATION DECLARATION 20-M197SAM DPW(12 97) APPLICATION FOR ELECTRICAL PERMIT
I her@by affirm that I have a certificate of consent to self insure 76ABB9
or a certificate of Worker a Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
copy thgreof(Sec 3800 Lab C)
Policy Ninny &Amf f-a&1* FOR APPLICANT TO FILL IN JOB
ADDRESS
❑ Certified copy is hereby furnished 9� New Residential Bldgs &Pools NO EACH FEE
_ S $ LOCALITYeA
Certified copy is filed with the county budding mapecbcn 1&2 Family Sq Ft
department Multifamily Sq Ft —
NEAREST
Date Applicant Residential Swimming Pools ASSESSOKR
MAP PAGE PARCEL
CERTIFICATE OF EXEMPTION FRO WORKERS Outlets Roo —Light Sw OWNER OR
COMPENSATION INSURANCE FIRM NAME
(This section need not be completed If the work Involved by the First 20 MAILTotal No Additional ADDRESS
permit Is for one hundred dollars(=100)or loss)
1 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 as to PLAN CHECK
become subject to the Workers Compensation Laws Lighting Fixtures First 20 APPLICANT
Total No Additional ADDRESS
Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP
NOTICE TO APPLICANT If after making this Certificate 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
provisions or this permit shall be deemed revoked Power Apparatus&Large Appliances
LICENSED CONTRACTORS DECLARATION SDw&Type HP KW KVA or KVAR ADDRESS 14-1
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl
(commencing with Section 7000)of Division 3 of the Business and Over 10 to 50 Incl CITY LICENSE OR . Tel No
Professions Code and my license is in full force and effect
Over 50 to 100 InCI REGI NUMBER VAL
Claes fi a
�,d r b a I,r Over 100 DISTRICT NO P D BY O
License Number 1 U�Lic Chas `d Q
Services Swbd MCC&Panelboards e� Q
Contractorl'� 0140W f. Data— �-L 2 0 399 Amp Under 800 V Dam 0
❑ I em exempt under Sec 400 1000 Amp Under 800 V
Over 10Amp or Over 800 V VALIDATION a
00
B&P C for this reason BRANCH CIRCUIT FEES &�'
Date 15A or 2DA 120V Lighting or Recept Z
1 To 10 Branch Circuits
Signature 11 To 40 Brandi Circuits 1
❑ Exemption for Reg Mamt Elect 15A 20A 208\/To 277V�Lighting
More Branch roCi�As
2
SINGLE FAMILY Temp Power Pole&Appurtenances �*
HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit ACCTA A
I hereby affirm that I am exempt from the Contractor s License Law
for the following reason (Section 7031 5 Business and Professions Additional Sign Branch Circuits 3307 61-65
Code) c❑ 1 ITEM
r
I as owner of the property will do the work and the structure Mies Conduits&Conductors t
is not intended or offered for sale(Section 7044 Business Other(See Complete Fee Schedule) , TOTAL 61,-p5
and Professions Code) CK 61.65
CONSTRUCTION LENDING AGENCY n�ul4r�r�
I hereby affirm that there is a construction lending agency for the C 00
performance of the work for which this permit is issued(Sec 3097 PERMIT FEE (Sub-Total)
Civ C)
PLAN CHECKING FEE 1 4/22/T
Lender a Name
PERMIT ISSUING FEE 9313 1 AM 9 01 49
Lender a Address TOTAL FEE
1 certify that I have read this application and under penalty of puqury state
that the above information is correct I agree to comply with all County
ordinancAs and State laws regulating Electrical wrong and hereby authorize
representatives of this County to enter upon the above-mentioned property
for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
(y —LZ-
SIGNATURE OF PERMnT DATE
RKER S
TION
I bereby affirm Otthat I havveeMa certificate cate of coonsentOnt to self Insure DPW(12 91) APPLICATION FOR ELECTRICAL PERMIT
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 L$b C)
Policy NA U Company 9%J D2% JaQ 40' FOR APPLICANT TO FILL IN ADDRESS w
10 Certified copy Is hereby furnished New Residential Bldgs &Pools NO EACH FEE
_ $ $ LOCALITY �
Certified copy isfiled with the county building inspection
1&2 Family Sq Ft NEAREST
department / Y Y Multi family Sq Ft CROSS ST
Date Applicant Residential Swimming Pools ASSESSOR
PP MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Ree -Light Sw OWNER OR
COMPENSATION INSURANCE First 20
FIRM ME
(This section need not be completed If the work Involved by the Total*)L Additional MAILADDRESS
permit Is for one hundred dollars($100)or less)
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 as to PLAN CHECK
become subject to the Workers Compensation Laws Lighting Fixtures First 20 APPLICANT
Total No Additional ADDRESS
Date Applicant RESIDENTIAL APPLIANCES NOT OVER 9 HP
NOTICE TO APPLICANT If after making this Certificate 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 Power Apparatus&Large Appliances APPLICANT
LICENSED CONTRACTORS DECLARATION Size&Type HP KW KVA or KVAR ADDRESS
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl
(commencing with Section 7000)of Division 3 of the Business and CITY OTel No
Professions Code and my license is in full force and effect Over 10 to 50 Incl
Over 50 to 100 Incl REG NUMBER 4, OT g Clap }
1 D� e,�.�1 Over 100 DISTRICT NO PROCESSED BY O
License Number. 4c Class (j
` V r SeanIt
Services Swbd MCC&Panelboarde
Contractor Data 0 399 Amp Under 800 V FINAL
Q
❑ I am exempt under Sec 400 100OAmp Under B00 V 143 VALIDATION V
Over 1000 Amp or Over 800 VFINAL W
B&P C for this reason BRANCH CIRCUIT FEES BY &i� N
Date 15A or 20A 120V Lighting or Recept Z
Signature i 1 To 10 Branch Circuits
11 To 40 Branch Circuits
❑
Exemption for Reg Malnt Elect 15A 20k 20VV To 277V Ligh�tire Sr�Ghrcuii sum
SINGLE FAMILY Temp Power Pole&Appurtenances 2
HOME OWNER BUILDER DECLARATIONSign with One Branch CircuitACCT•A
I hereby affirm that I am exempt from the Contractor s License Law
for the following reason(Section 7031 5 Business and Professions Additional Sign Branch Circuits .'3307 64.65
Code)
❑ I as owner of the property will do the work and the structure Misc Conduits&Conductors
is not intended or offered for sale(Section 7044 Business Other(See Complete Fee Schedule) , 3W7 —"•65
and Professions Code) 3� 61.65
CONSTRUCTION LENDING AGENCY .7�7
1 hereby affirm that there is a construction lending agency for the 1 ITEMS
performance of the work for which this permit Is issued(Sec 3097 PERMIT FEE (Sub Total) GWei TOTAL 6•a w 6p 5
CIV C) t V �u. e.
PLAN CHECKING FEE CHECK 61.69
Lender a Name
PERMIT ISSUING FEE of CHANGE .00
Lender s Address TOTAL FEE
I certify that I have read this application and under penalty of puqury state
that the above information is correct I agree to comply with all County Q�1 4/ �!7�a
3
ordinances and State laws regulating Electrical wiring and hereby authorize
representatives of this County to enter upon the above mentioned property %49 1 AM 9*-29
for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
4-
SIGNATURE OF PERVfM DATE
WORKER S COMPENSATION DECLARATION 2W19 DPW 9189 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirlfi that I have a certificate of consent to self Insure 78A�9
or a cer)Ificate of Worker a Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
copy thereof(Sec 3800 Lab C) " 4"OPAnN
1
Pal�Cy No Company 16190 �•+d• FON APPLICANT TO FILL IN JOADDRESS �y
1` A ♦
�lJl Certified copy is hereby furnished New Residential Bldgs &Pools EACH NO FEE 7�
❑ Certified G s�copy Is filed with the county building Inspection 1&2 Family Sq Ft $ — $ LOCALITY , � .91 /�Gt
department Mufti family Sq Ft — Cm aT �s -W"S •
Date `4 8A*9�App6cant Residential Swimming Pools ASSESSOR
MAP BOOK p PARCEL
CERTIFICATE OF EXEI I FROM WORKERS Outlets Rea $Light Sw OWN R OR �1� •�� �p
COMPENSATION INSURANCE 7QAff 46 FIRM
(This section need not be completed If the work Involved by the First MAIL
permit Is for one hundred dollars($100)or less) Total No Additional
ADDRESS 404 15,1 certify that In the performance of the work for which this permit CITYS&A tTd Nos W
Is Issued I shall not employ any person In any manner so as to PLAN CHECK
become subject to the Workers Compensation Laws Lighting Fixtures First 20 APPLICANT
Total No Additional ADDRESS
Data Applicant 1b OR 20A 120V BRANCH CIRCUITS
NOTICE TO APPLICANT If after making this Certificate of CITY Tel No
Exemption you should j)ecome subject to the Workers Compensation 1 TO 10 INCLUSIVE EACH
provisions of the Labor Code you must forthwith comply with such 11 TO 40 INCLUSIVE EACH PERMIT
provisions or this permit shall be deemed revoked 41 OR MORE BRANCH CIRCUITS EACH
LICENSED CONTRACTORS DECLARATION ADDRESS
I hereby affirm that I am licensed under provisions of Chapter 9 15 OR MA 208V TO 277V LIGHTING EACH a
(commencing with Section 7000)of Division 3 of the Business and CITY Tel No
Professions Code and my license is In full force and effect RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR Claes
I
!� Power Apparatus&Large Appliances REG NUMBER 13
L cense Number �g1� LK: Claws i Size&Type HP KW KVA or KVAR DISTRICT NO D By 13
Up to 3 Incl QLLI
Contractor w pfs CA Data Over 3 to 10 Incl DA W
❑ Over 10 to 50 Incl Z
I am exempt under Sac Over 50 to 100 Ind I—SI VALIDATION
B&P C for this reason A Over 100 By
Date 2 '��•9 Z Services swbd MCC&Panelboards
kzy"" —
0 200 Amp Under 800 V
Signature 201 1000 Amp Under 800 V
❑ Over 1000 Amp or Over 800 V
Exemption for Reg Malnt Elect 2
SINGLE FAMILY HOME OWNER BUILDER DECLARATION Temp Power Pole&Appurtenances ACCT AJL
I hereby affirm that I am exempt from the Contractors License Law Sign with One Branch Circuit �-* ,7
for the following reason(Section 7031 5 Business and Professions Additional Sign Branch Circuits TAA Is J
Code)
❑ 1 ITEMS
I as owner of the property will do the work and the structure Misc Conduits&Conductors
Is not Intended or offered for sale(Section 7044 Business Other(See Complete Fee Schedule) VITAL 38.35
and Professions Code) , CHECK
CONSTRUCTION LENDING AGENCY C GE 30
I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is Issued(Sac 3097 PERMIT FEE (Sub Total)
Civ C)
PLAN CHECKING FEE 0000-0001 7/ 1/92
Lender s Name x}214 1 Aid 8-0 10
PERMIT ISSUING FEE '
Lender s Address pp+
1 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 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 APPLICANT OR AGENT DATE
,YIfORKERS COMPENSATION DECLARATION 7E1A883 1081 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self insure CE BM
or a certificate of Workers Compensation Insurance or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sao 3800 Lab C)
Policy No�S( any � FOR APPLICANT TO FILL IN JOB
❑ Certified copy re hereby furnished New Residential Bldgs &Poole EACH NO FEE ADDRESS
Certified copy is filed with the county building inspection 1 &2 Family Sq Ft $ Is LOCALITY
department Multi family Sq Ft _ NEAREST
CR033 3T
Date ApplcaM Residential Swimming PoolsOWNER CR
FIRM NAME
CERTIFICATE OF EXEMPTION PROM WORKERS Outlets Roc Light�—Sw MAIL
COMPENSATION INSURANCE ADDRESS
(This section need not be completed It the work Involved by the First 20
Additional CITY Tel No
permit Is for aria hundred dollars(y100)Or loTotal No Add
ss) PLAN CHECK
I certify that in the performance of the work for which this permit AppUCANT
is issued I shall not employ any person in any manner so ds to
become subject to the Workers Compensation Laws Lighting Fixtures First 20 ADDRESS
Total No Additional CITY Tel No
Date Apples Fixed Appliances Not Over 1 HPn
NOTICE TO APPLICANT If aW making this Certificate of APRMCANi
Exemption PU
S s C►�
xemption you should become subject to the Workers Compensation Range— Heater D W
proVisions of the Labor Code,you must forthwith comply with such Oven — Dryer— W M — ADDRESS 6
proviWns or this permit shall be deemed revoked Top — FAU — WH —
L ICENSED CONTRACTORS DECLARATION Hood _ Fan — Other— CITY. 49 O
1 hereby affirm that I am licensed under provisions of Chapter 9 Disp — Room Air Cond LICENSE OR Close
(commencing with Section 7000)of Division 3 of the Business and REG NUMBER ?A L^
Professions Code and my license is in full force and effect Power Apparatus&Large Appliances DISTRICT NO C ED BY
��a,�, Srze&Type HP KW KVA or KVAR Q
License Number 2�7�"v Lac Class Up to 1 Ind FINAL 8
Over 1 to 10 Incl DATE Zq VALIDATIOContractor— N
/ Over 10 to 50 Incl FINAL
I am exempt under Sec Over$0 to 100 Inc BY
15
B&PC for this reason Over 100 N
Date Services Swbd MCC&Panellloards � Z
0 200 Amp Under 600 V
Signature 201 1000 Amp Under 600 V
❑ Exemption for Reg Mand Elect Over 1000 Amp or Over 600 V
SINGLE FAMILY Temp Plower Pole&Appurtenances +'
HOME OWNER BUILDER DECLARATION Sign with One Branch Circus I V0
i
I hereby affirm that i am exempt from the Contractor's License Law Additional Sign Branch Circuits ACCTsi
for the following reason(Section 70315 Business and Professions
Code) 307 3.00
Misc Conduits&Conductors 1 ITEMS
El as owner of the property will do the work and the structure Other(Sae Complete Fee Schedule) — ►
is not intended or Offered for sale (Section 7044 Business ,mf�, ��®O�
and Professions Code)
CONSTRUCTION LENDING AGENCY 'HEC( 33.0
I hereby affirm that there is a construction lording agency for the
Performance of the work for which this permit is issued(Sac 3097 PERMIT FEE (Sub Total) CHIVa .05
CIV C)
PIAN CHECKING FEE
Lenders Name 000G-=1 9/18/91
PERMIT ISSUING FEE ' 3
Lenders Address TOTAL FEE 9073 1 AM 8e 1:
I certify that 1 have read this pplication and state that the above
Information is correct agree comply with all County ordinances
and State laws rep ng EI I wrong and hereby authorize
representatives of enter upon the above mentioned
property for ins
_ / SEE REVERSE FOR EXPLANATORY LANGUAGE
��jig
Sgneti,re Perm�e �
WORKER I have
ate of consent to 2o.00t9DPW(,2 91) APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self Insure
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 Nok1w If-"�' Company &CLOW goatt:k
:1 FOR APPLICANT TO FILL IN JOB
Certified
d
❑ Certified copy Is hereby furnished `g7 New Residential Bldgs &Pooh NO s EACH $ FEE ADDRESS STLOCALITYT'
❑e Certified copy is filed with the county building Inspection 1&2 Family Sq Ft _ NEAREST
department Mufti family Sq R
CROSS 3T LAS 71kA1*=1
Date Applicant Y Ir Residential Swimming Pools ASSESSOR
01 MAP BOOK PAGE PARCEL
t CERT KATE OF EXEMPTION FROM WORKERSOutlets ReC —Light Sw O NER OR
COMPENSATION INSURANCE
(This section need not be completed If the work Involved by the First 20 MAIL
permit Is for one hundred dollars($700)or less)
Total No Additional ADDRESS
I certify that in the performance of the work for which this permit CITY Tel No
is Issued I shall not employ any person In any manner so as to PLAN CHECK
become subject to the Workeril Compensation Laws Lighting Fixtures First 20 APPLICANT
Total No Additional ADDRESS
Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP
NOTICE TO APPLICANT If after making this Certificate of CITY Tel No
Exemption you should become subject to the Workers Compensation OTHER APPLIANCES NOT OVER 3 HP
provisions of the Labor Code you must forthwith comply with suchPERMIT
provisions or this permit shall be deemed revoked Power Apparatus&Large Appliances APPLICANT P c•
LICENSED CONTRACTORS DECLARATION Size&Type HP KW KVA or KVAR ADDRESS
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl r
(commencing with Section 7000)of Division 3 of the Business and CITY Tel No 6
Professions Code and my license Is in full force and effect Over 10 to 50 Incl CE SE ORn }
p Over 50 t0 100 Incl REG N MB R 6 6 ` C� C d
License Number. � { Llc Class G"`f r Over 100 DISTRICT NO d P ESSED BY U
Services Swbd MCC&Panelboards �a Q
Contractor Date �fL S� 0 399 Amp Under 600 V DAA 0
❑ 1 a em under Sec 400 1000 Amp Under 800 V VALIDATION W
Over 1000 Amp or Over 600 V FINAL j1
B&P C for this reason BRANCH CIRCUIT FEES BY co
Z
Date 15A or 20A 120V Lighting or Recept
1 To 10 Branch Circuits
Signature 11 To 40 Branch Circuits
41❑ Exemption for Reg Mamt Elect 15A,20A 208V To 27NOr Mong BranchCircuits
3307 61.65
SINGLE FAMILY Temp Power Pole&Appurtenances 1 ITEMS
HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractors License Law TOTAL 1 �
for the following reason(Section 7031 5 Business and Professions Additional Sign Branch Circuits
Code) GE$f`I�i 61.65
❑ I as owner of the property will do the work and the structure Misc Conduits&Conductors �+t�wt,'rr
Is not intended or offered for sale(Section 7044 Business Other(See Complete Fee Schedule) NGE
, O ■00
and Professions Code)
CONSTRUCTION LENDING AGENCY 1 ¢� 5193'
I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued(Sec 3097 PERMITFEE (Sub-Total) 9047 1 9�
Civ C)
28
PLAN CHECKING FEE
Lender s Name �
PERMIT ISSUING FEE
Lender s Address
1 certify that I have read this application and under penalty,of puqury state TOTAL FEE
that the above information Is correct 1 agree to comply with all County
ordinances and State laws regulating Electrical wrong and hereby authorize
representatives of this County to enter upon the above-mentioned property
for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
i 4-X,-
y
SIGNATURE O P E DATE
WORKER S COMPENSATION Df consent
to MAW DPW 9,M APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self insure
or a certificate of Worker a 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 'b8 O40 CDmpany SATZ IRA" FOR APPLICANT TO FILL IN A�ooREss
Certified copy is hereby furnished New Residential Bldgs &Pools EACH NO FEE - LOCALITY
1&2 Family Sq Ft $ — $
C&WW copy is filed with the county building Inspection _ 11EAREST
department A• Multi family Sq Ft CROSS 9T
Date - • Applicant Residential Swimming Pools ASSESSOR
MAP ROOK PAGE PARCEL
CERTIFICATE OF IXEM N FROM WORKERS Outlets Rec_LigM Sw A FIRM NAME job• bM
COMPENSATION INSURANCE 1'f
(This section need not be completed If the work Involved by the First MAIL ♦
permit Is for one hundred dollars($100)or less) Total No d+ Additional ADDRESS a LArW WHd
1 certify that In the performance of the work for which this permit - CITY elNo4wl.14M
is issued I shall not employ any person In any manner so as toPLAN CHECK
become subject to the Workers Compensation Laws Lighting Fixtures Fust 207, APPLICANT
Total No wow Additional ADDRESS
Date Applicerht 16 OR 20A 120V BRANCH CIRCUITS
NOTICE TO APPLICANT If after making this Certificate of CITY Tel No
Exemption you should become subject to the Workers Compensation 1 TO 10 INCLUSIVE EACH
provisions of the Labor Code you must forthwith comply with such 11 TO 40 INCLUSIVE EACH APPLE M' C'j
provisions or this permit shall be deemed revoked 41 OR MORE BRANCH CIRCUITS EACH
LICENSED CONTRACTORS DECLARATION ADDRESS ��� CL
O
1 hereby affirm that I am licensed under provisions of Chapter 9 ICOR 20A 208V TO 277V IJGHTINS EACH
(commencing with Section 7000)of Division 3 of the Business and CITY ` � No 3" U
Professions Code and my license Is in full force and effect RESIDENTIAL APPLIANCES UP TO 3HPLICENSE OR �*� CW. I O
I b I Power Apparatus&Large Appliances RFA NUMBER
License Number LIC Class Size&Type HP KW KVA or KVAR DISTRICT NO 0-09 7r
LLBY V
Up to 3 Incl Vd
�' • • pi, Over 3 to 10 Ind FINAL C/3Contractor DateOver 10 to 50 Incl DATE 2
❑ I am exempt under Sec Over 50 to 100 Ind VALIDATION
113&P C for this reason Over 100 g y
Services Swbd MCC&Panelboards
Date 0 200 Amp Under 800 V
Signature201 1000 Amp Under 61XIV
❑ I Over 1000 Amp or Over 800 V
Exemption for Reg Mamt Elect
SINGLE FAMILY Tamp Power Polls&Appurtenances
HOME
HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit I_
I hereby affirm that I am exempt from the Contractor a License Law
MS
for the following reason(Section 7031 5 Business and Professions Additional Sign Branch Circuits �)IT � ®�!�
Code) ucTt� _
❑ i as owner of the property will do the work and the structure Mrec Conducts&Conductors r HECK Zr 1.c3
is not intended or offered for sale(Section 7044 Business Other(See Complete Fee Schedule) ►
and Professions Code)
CONSTRUCTION LENDING AGENCY E i IF
I hereby affirm that there Is a construction lending agency for the
Cirperformance
r ance of the work for which this permit Is issued(Sec 3097 PERMIT FEE (Sub TOtaQ C) ��� �I C; 1 CK —31
PLAN CHECKING FEE
Lender a Name
PERMIT ISSUING FEE C3
Lender a Address TOTAL FEE CC 1 r1
1 certify that I have read this application and state that the above p�
Information is correct I agree to comply with all County ordinances W Ua
and State laws regulating Electrical wiring and hereby authorize
representatives of this County to enter upon the above mentioned 3 1
propsrly fq( nspectlon purposes SEE REVERSE FOR EXPLANATORY LANGUAGE tO I. EI 0 Lj
YLA ?. 14.
81137URE OF APPLICANT OR AGENT DATE " l'.7 f✓1 P f
WORKERS COMPENSATION DECLARATION aes 10,91 APPLICATION FOR ELECTRICAL PERMIT
I hereby 1lifvrn that I have a certificate of consent to salt insure CE�so6G
'6r a certificate of Workers Compensation Insurance or a certified COUNTY OF LOS ANGELES BUILDING'AND SAFETY
copy thereof(Sec 3800 Lab C) t P.
Pd,y NO Ll&W4W5' Lmpgnysi
FOR APPLICANT TO FI L IN JOB 4% 644 SE►
TL
❑ Certified copy to hereby furnished Now Residential Bldgs &Pools WH NO FES
❑ Qertihed copy is fled with the county budding inspection 1 &2 Family Sq Ft $ = $ LOCALITY C
NEARST
department � • Multi family Sq Ft - CROSS ST
Date ioant Residential Swimming Pools OWNER OR
FIRM NAME Alls7 •
CERTIFICATE OF EXEMPTI FROM WORKERS Outlets Rec�Light...—SwionaMA a l COMPENSATION INSURANCE First 20 ADDRESS
(This section need not be completed If the work involved by the Total No Additional CITY 4 Tet No •
permit Is for one hundred dollars($100)or less)
I certify that in the performance of the work for which this permit PLAN CHECK
APPLICANT
ed
ss IssuI shall not employ arty person in any manner so as to
become subject to the Workers Compensation Laws lighting Fixtures First 20 ADDRESS
DateTotal No_T_ Additional CITY Tel No
���antFixed Appliances Not Over 1 HP PERMIT
NWCE TO APPLICANT If after making this Certificate of MPP
WM
Exemption you should become subject to the Workers Compensation Range_ Heater_ DW
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 _ WH
CITY Tet No
LICENSED CONTRACTORS DECLARATION Hood — Fan — Other_...
I herby affirm that t am licensed under provisions of Chapter S Dlsp Room Air Cond LICENSE OR Close
(commencing with Section 7000)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
' Size&Type HP KW KVA or KVAR o O "Q'
License Number s s*:6 L, '0688 Up to 1 incl FINAL V
DATE
Contractor A n/ • Over 1 to 10 Incl ,0
i. LIDATION
Over 10 to 50 Incl FINAL
❑ I am exempt under Sec Over 50 to 100 Inc By
BAPC for this reason Over 100
Date Services Swbd MCC&Panelboards ►
0 200 Amp Under 600 V
Signature #VNW—LA%!!= 20t 1000 Amp Under 600 V
❑ Over 1000 Amp or Over 600 V
Exemption I Reg Maint Elect
SINGLE FAMILY Temp Power Pole&Appurtenances ,7
HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit 2
1 hereby affirm that I am exempt from the Contractors License Law
for the following reason(Section 70315 Business and Professions Additional Sign Branch Circuits At CT.a
Code) 7 14.x!)
❑ 1 as owner of the property will do the work and the structure Misc Conducts&Conductors
20
is not intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule) _ 1 ITS
and Professions Code) , TOTAL 14®so
CONSTRUCTION LENDING AGENCY CHECK 14.W
I hereby affirm that there is a construction lending agency for the
performance
rformance of the work for which this permit is issued(Sec 3007 PERMIT FEE (Sub Total) .00
PLAN CHECKING FEE
Lenders Name PERMIT ISSUING FEE 3doe 9/ 9/91
Lenders Addresst 1 AM 9:ZU
1 certify that I have reed this application and state that the above TOTAL FEE
rnformabon is correct I agree to comply with all County ordinances
and State laws regulating Electrical wrong and hereby authorize
representatives of this County to enter upon the above mentioned
property for inripection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
9.9' —
Sig re of Fermittee I Date
COUNTY OF LOS ANGELES TEMPLE CITY 00508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 9902240021
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL 10 FEES PAID BUILDING ADDRESS
TR 6561 LT 344 5919 OAK AV
FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917802028
NEAREST CROSS STREET LAS TUNAS
8587 007-008 Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID J3 LOCALITY TEMPLE CITY
G1 OUTLETS-LGT,SW,RECP 1 00 OUT 1 95
TENANT TOTAL FEES 29 TO
ISSUEd ON PR ESSED BY PLAN BY EXPIRES ON
02/24/99 UT 24/00
OWNER TEL NO FINAL DATE COVE
OAK TREE SHOPPING CENTER Z`
60 CANINO REAL AV
ARCD 910064043
INSTALL PUSH BUTTON FOR X RAY MR=
APPLICANT TEC-WF-
EXPRESS ELECTRICAL SERVICE (818) 762 0645
11225 PEACH RD #101
NORTH HOLLYWOOD
CONTRACTOR TEL NOAPPROW" E INSPECTOR SIGNATURE
� PNGELES COV
EXPRESS ELECTRICAL SERVICE (818) 762 0845 �►� �T�
11225 PEACH GROVE APT 101 LIC NO TEMPORARY POWER POLE
N HOLLYWOOD, CA 41601 651752/C10 UNDERGROUND PUIT
ARCHITECT ar=!NEER TEL NO UFER GROUND
LIC NO 111111ROUGH CONDUIT
ROUGH WIRING
UnrWER LINE
�#UBLIC W PLASTIC Y/N METAL Y/N
Service That��t
REPORT ID DPR265 ROUTE TO BS0508