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Home My Public Portal About9148 OLEMA ST_Electrical__ 76A663-CE806 10/72 APPLICATION F40R�ELEICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER FADDRE 1 ' BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN OUTLETS N0. EACH FEE7 FIRM NAME RECEPT. $ $ MAIL FIRST 20 25 ADDRESS LIGHT TOTAL CITY TEL. NO.2brl- SWITCH OVER 20 „10 PLAN CHECK LIGHTING TOTAL FIRST 20 .251 APPLICANT ^, FIXTOVER 20 .f0 ADDRESS URES � RESIDENTIAL APPLIANCES SIT TEL. NO. / PERMIT RANGE DRYER_WTR. HTR. APPLICANT STA. COOK DISP. F.A.U. ADDRESS SPACE HTR. AIR COND. CITY TEL. NO. LICCLOTHES WASH. DISHWASH. REG.NSNU BER CLASS. REG. FAN-OTHER '-OD O 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW.KVA. ELECTRICAL WIRING. SIZE & TYPE OVER TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR O - 1 1.00 NEEDA9 REOUIREO B 09 ANGELES COUNTY AND STATE O� y AL DRNI HAT 1 M HE GAL 0 OF T ABOVE y„ r C, I - 10 3.00 �{ d ks BE MIT1 ENTIAR PE v 10 - SO 5.00 SI T E ll AF SO - 100 10.00W DISTRICT NO. OCESSE BY 100 - SOO 15.00 Jj SIGN., GAS SIGN AND ONE CIRCUIT 8.00 APPROVALS G/ DATE INSPECTdrS SIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.001 TEMP. POWER POLE SERVICENOTOVER 600 VOLTS OR 200 AMP 3.00 4P UNDERSLAB WORK SERVICEOVER 600 VOLTS OR200AMP 10.00 ROUGH CONDUIT TEMPSE RVI CE,PO LE,&APPURTENANCES 8.00 WIRING TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED FINAL PERMIT FEE (SUB TOTAL) NOTES; PLAN CHECK FEE PERMIT ISSUING FEE 3.00 d TOTAL FEE PLAN CHECK VALIDATION CK. M.0. H PERMIT VALIDATION cK.' M.0. CASH e 3 ti HO SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 1 M i K R S'COPENSATION DECL'ARAZIO& 76A663 �► " �` �.�= CE 806G (7=80) .APPLICATION FOR ELECTRICAL PERMIT I hereby affirrh that I have a certificate of consent to self , COUNTY OF LOS ANGELES BUILDING AND SAFETY insure,o'r a certificate of Workers'Compensation Insurance,or 'a.cbrtified copy thereof(Sec.3800,Lab.,C.) Policy No. Company FOR APPLICANT TO FILL IN% JOB �r / y�''�, New Residential Bldgs.&Pools EACH NO. FEE ADDRESS �� (; 4l e--%V-- Certified copy is hereby furnished. 1 &!2-Fam(Iy,Sq. Ft. $ — $ LOCALITY 4 Certified copy is filed with the:count building Multi-family wi miFt. NEAREST {0 y g inspection CROSS ST _FI.GI,wt. department. Residential Swimming Pools OWNER OR r� �® Date Applicant 10* FIRM NAME I��s• Outlets:. Rec 7 Light Ste.. "A MAI L ,�,, First 20 • W ADDRESS A* CERTIFICATE OF EXEMPTION FROM WORKERS' Total No.A* Additional CITY 1,-, (� Tel No. �.5�6-3� COMPENSATION INSURANCE > PLAN CHECK APPLICANT 0 (This section need not be completed if the work involved. U Lighting Fixtures First 20 , by the permit is for one hundred dollars .($100) or less.) ; ADD'RESs Total No. Additional 00, O I certify that in the performance of the work for which this CITY Tel No permit is issued, I shall not employ any person in any manner Fixed Appliances Not Over 1 HP LJJ An 8 so as to become subject to the Workers'Compensation Laws. Range_Heater_D.W. PERMIT APPLICANT r 49-1,", � Oven _ Dryer_-W.M._ ADDRESS N Date CApplicant —+^-`j Topl _ FAU _W.H.• A Hood -*Fan _Other— CITY' Tel No. NOTICE TO APPLICANT: If, after making this Cdrtificate of Disp. >L Room Air Cond_�&_ LICENSE OR Exemption, you should become subject to the•Workers' REG.NUMBER Class Compensation provisions of the Labor Code, you must forth- 'Power.Apparatus&Large Appliances , D'ISTRI'CT NO. PROCESS BY with comply with such provisions or this permit shall be Size&Type HP,KW,KVA,or KVAR /1 deemed revoked. V Up to 1 Incl. FINAL Over 1.to 10 Incl'. DATE LICENSED CONTRACTORS DECsLARATION Over 10 to 50 Incl. I _Z_ VALI TION I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL 9 (commencing with Section 7000)of Division 3 of the Busi- Over 100 BY ness and Professions.Code, and my license is in full force and l effect. Services License Number Lic.Class 0-200 Amp.Under 600 V - 201-1000 Amp.Under 600 V Contrabtor . Date Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp.,Power Pole&Appurtenances , ;14522A I hereby affirm that I 'am exempt from the Contractor's Sign with One'Branch Circuit License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits # 0 0 0 0 0 2 ness and Professions Code): ; �j � Misc.Conduits&Conductors 10 0 4 Q O O IL]1', as owner of the property, will do the work and the Other(See Complete Fee Schedule)— structure is not intended or .offered for sale (Section - - 40,005 7044,Business and Professions Code). - ( fl,2 3"$b CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency i for. the performance of the work for which this permit is PERMIT FEE issued(Sec.3097,CWC.). (Sub.-Total) Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) r Lender's Address PERMIT ISSUING FEE 0 I certify that I have read this application and state that the TOTAL FEE �� above information is correct.3 agree to coritply.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. I SEE`REVERSE FOR EXPLANATORY LANGUAGE 4-46 mature of Permittee Date 1 'WORKERS'COMPENSATION DECLARATION 76�DPW 3/W APPLICATION FOR ELECTRICAL PERMIT O F y affirm that I have a certificate of consent to self CE.gp6C,.,c , orb certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (S®c. 3800, Lab. C.) i • Policy NcaCompany FOR APPLICANT TO FILL IN JOB / ❑Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS el-31-/If Certified co is filed with the count buildinginspec- 1 &2-Family, S Ft. $ — $ LOCALITY L �� Py y p y q tion department. Multi-family Sq. Ft. NEAREST CROSS ST. Date Applicant Residential Swimming Pools OWNER OR FIRM NAME I-g CERTIFICATE OF EXEMPTION FROM WORKERS' i. Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE First 20 ADDRESS 0 G (This section need not be completed if the work Involved by Total No. Additional CITY (p ,e (f_ Tel. N6.3 the permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this PLAN CHECK NT 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. Additional Total No.Z CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION ��7Z.C-C� 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 FA� W.H. — deemed revoked. Hood —6Pan Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATION Disp. _ Room Air Cond. — LICENSE OR Class. I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. P SSED BY d and Professions Code,and my license is in full force and effect. j� Size&Type HP, KW, KVA, or KVAR ��O � >� •� O License Number Lic. Class I Up to 1 Incl. FINAL U Over 1 to 10 Incl. DATE ( _Z VALIDATION Contractor Date ❑ Over 10 to 50 Incl. FINAL F- I am exempt under Sec. Over 50 to 100 Inc. BY p W Over 100 B.&P.C. for this reason 0_ Services, Swbd., MCC&Panelboards , Z Date: Z 0-200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V IDExemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits -_ Professions Code): •--_ E] I, as owner of the property, will do the work and the Misc. Conduits&Conductors -- structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ ' p :errs Business and Professions Code). 30 i �- 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 PERMIT FEE (Sub-Total) (' ' .'•'C '-i- (Sec. 3097, Civ. C.). ' PLAN CHECKING FEE Lender's Name - PERMIT ISSUING FEE Lender's Address -- I certify that I have read this application and state that the TOTAL FEE c7Z fQ 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 r rty for inspectio �e n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Si nature of Per ittee Date ®s