The URL can be used to link to this page

Home My Public Portal About10009-10011-10015 OLIVE ST_Electrical__ WORKERS'COMPENSATION DECLARATION 76AG63 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-8061.3 insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certif ed copy!hereof(Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB Pol Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS �Q^Q cs^ 4,1, ❑ Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ — $ LOCALITY y* 1p er tion department. Multi-family Sq. Ft. CRASS ST. ,Id1 Date Applicant REST Residential Swimming Pools OWNER OR J` FIRM NAME /G 6 CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec 1 MAIL _ COMPENSATION INSURANCE ADDRESLightSw. Sdd.o,r-�e s section neenote completed if the work Involved b First 20 (Thitineed b p 1/ Total No..___�__ Additional CITY o add'.. et. Tel. No. 7p3G�p s the permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this APPLICANTK permit is issued,I shall not employ any person in any manner l so as to become subject to the Workers'Compensation Laws. Lighting Fixtures Fust 20 ADDRESS Total No. Additional CITY Tel. No. DateAV W:!&VAPPlIcand Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making t ' Certificate of APPLICANT � p 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. CITY �t 01y Tel. No.y a LICENSED CONTRACTORS DECLARATION Hood — Fan —Other_ ,LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. REG. NUMBER /�,f s Class.dY(x (commencing with Section 7000)of Division S.of the Business Power Apparatus&Large Appliances DISTRICT NO. PROCESSED BY >• and Professions Code,and my license is in full force and effect. A, [/ Size 8 Type HP; KW, KVA, or KVAR'Up to 1 Incl: ! O License Number 7��'�s Lic. Class U FINAL Lill Over 1 to 10 Incl. DATE 09 VALIDATION 11— Contra 57� Date �y 3 AHe �3 Over 10 to 50 Incl. FINAL � � � � ❑ I am exempt under Sec. Over 50 to 100 Inc. BY tu B.&P.C. for this reason Over 100 Date: Services, AMCC 8"Panelboards ► � _ `r� 0 -2000 Amp. Under 600.V G� Signature it 201 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole&Appurtenances 7 A HOME OWNER:BUILDER DECLARATION Sign wifh One Branch.Circuit t, 0 0 0 01 o. I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and I o o 0 Professions Code): I ❑ : I, as owner of the.property, will do the work and the Misc. Conduits&Conductors 0,0 n � p,�62: structure is not intended or offered for sale (Section I Other(See Complete Fee Schedule)_ 7044, Business and Professions Code). 1 , () �+ I L?—8 3 CONSTRUCTION LENDING AGENCY j 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) (Sec. 3097, Civ. C.). 4 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 above.information is correct. I agree.to comply with all County i ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon I the above-mentioned property for inspection;purposes: SEE REVERSE FOR.EXPLANATORY LANGUAGE Signattire_of�pgFiSlttee Date WORKERS'COMPENSATION DECLARATION 10%81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-806G insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certifl+i�py g4ereof(Sec. 3800, Lab. C.) G Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS U U l✓ r®e. Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE 2-Family, — / _ r Certified copy is filed with the county building inspec- 1 � y' S q• Ft. $ $ LOCALITY'NEAREST tion department. Multi-family Sq. Ft. — `yl Residential Swimming Pools CROSS ST. Date Applicant j OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL COMPENSATION INSURANCE Outlets: RecLight Sw. -ADDRESS I' tThis seetion need not be completed if the work involved b First 20 ? he permit N for one hundred dollars'($100)or less.) 11 Total No. _ Additional CITY O 4av; Tel. No I certify that in the performance of the work for which this i APPPLALICANT 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 Additional s� 6� 1 �( Total No. CITY Tel. No. Dat J"""e Applicant �•� S 7`� �',/ NOTICE TO APPLICANT: If, after making this Certificate of Fixed%Appliances Not Over 1 HP PERMIT -/ Exemption, you should become subject to the Workers' Range_ Heater—D.W. _ APPLICANT /�j�1r✓ ��vyy��/�,,/ 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: IVo . C�a�a LICENSED CONTRACTORS DECLARATION LICENSE OR �/ I.hereby affirm that I am licensed under provisions of Chapter Disp. _ Room Air Cond. REG. NUMBER /l.� Class.G�c�y� (commencing with Section 7000)of Division 3.of the Business I DISTRICT NO. PRO SED'BY Power Apparatus&Large Appliances and Professions Code,and my license is in full force and effect. Size&Type HP, KW, KVA, or KVAR' //"/1 r ' U License.Number '7 `` Lic. Class � / Up to 1 Incl. FINAL �ir�br(/ J /5��/T Date +� �3 I Over 1 to 10 Inc[. DATE �. �e 0 Contractor FINAL VALIDATION Over 10 to 50 Incl. I am exempt under Sec. Over 50 to 100 Inc. BY e W IL Over 100 B.&P.C. for this reason Date: Services,Swbd.,MCC&Ponelboards 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 HOME OWNER=BUILDER.DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License t `.33 0 b 7 P Law for the following reason (Section 7039.5, Business and Additional Sign Branch Circuits Professions Code): , o 0 o 0 o 2 ElI, as,owner of the property, will do the work and'the Misc. Conduits&Conductors n 1 7'r- structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ 7044, Business and Professions Code). ► , �. •, F' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a'construction lending agency for e 6 2 2 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (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 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 pro ert i for i .pec tion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permits a Date ION WORKER'S I have a certificate of consent to 7SA6�DPW(12-91) 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(Seee.�p+]3]800 Lab. C.) ` POIICy N1J& ` `�'1.3- tiompany W/J s` FOR APPLICANT TO FILL IN JOB r� f ADDRESS 0OV? r IS"^ ❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY r ^ ,�. 1&2-Family,S Ft. — $ $ tel. C t 4 *artm is filed with the count uilding inspection y' q' NEAREST r '1 Multi-family Sq.Ft. CROSSST.DateApplicant Residential Swimming Pools ASSESSOR MAPBOOK PAGE PARCEL. TE OF EXEMPTION FR WORKERS' Outlets:Rec._Light Sw. OWNER OR , r COMPENSATION INSURANCE FIRM NAME l� First 20 (This section need not be completed if the work Involved by the Total No. Additional ADDRESS �. permit is for one hundred dollars($700)or less.) I certify that in the performance of the work for which this permit CITY /140ti"VO Tel.No.SS_� 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 �.Ik provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT l�J �� /✓ ��V�/ LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS Q3 y GJ, A0JM.1AA_ I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. 2 (commencing with Section 7000)of Division 3 of the Business and CITY ��Q Tel.No.9F6Lt Z•?.' Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE CIR Over 50 to 100 InCI. REG.NUMBER (V< <✓� CleseGi� d R +� P OC License Number `��' r Lic..Class Over 100 DISTRICT NO. ESSED BY O 0 An Services,Swbd.,MCC&Panelboards �9' O It Contractor Date � 0-399 Amp.Under 600 V DATE 0 ❑ 400-'1000 Amp.Under 600 V -(�—� I am axeunder Sec. VALIDATION V Over 1000 Amp.or Over 600 VFINAL d B.&P.C.for this reason BRANCH CIRCUIT FEES BY Date: :15A,or 20A,12OV,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,208V To 277V Lighting Br.Circuits • i SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances ACCT A I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit ^� for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits O 3307 82,{x 5 Code): , ❑ Misc.Conduits&Conductors i ITEMS I,as owner of the property,will do the work and the structure is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) TOTAL 82. 65 and Professions Code). 1 000. Er` 82. � CONSTRUCTION LENDING AGENCY CHANGE 65 1 hereby affirm that there is a construction lending agency for the e 00 performance of the work for which this permit is issued(Sec. 3097, PERMIT FEE (Sub-Total) Civ.C.) PLAN CHECKING FEE 0000-0001 1/21/93 Lender's Name PERMIT ISSUING FEE L 7746 1 AM104353 Lender's Address , I certify that I have read this application and under penalty of purjury 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 re entatives of this County to enter upon the above me tinned property r I paction purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 7; I. 31GNA E OF PERMITTEE DAT FWORKER'S COMPENSATION DECLARATION 20.0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, 76A663 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.) t PoliFOR APPLICANT TO FILL IN -6 ❑ Policy No. Company ADDRESS/D Certified copy Is hereby furnished. New Residential Bldgs.&Pools NO, EACH FEE LOCALITY ❑ 1&2-Family,Sq.Ft. _ $ $ Certified copy is filed with the county building inspection NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential.Swimming Pools ASSESSOR MAP BOOK PAGE4 PRCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light SW. OWNER OR COMPENSATION INSURANCE FIRM NAME First 20 MAIL (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.) 1 certify that in the performance of the work for which this permit CITY is issued, I shall not employ any person in any manner so as to PLAN CHECK became subject to the Workers'Compens ti n Laws. fighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date d pplicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making is Certific of CITY I.No3� �.j� Exemption,you should become subject to the W&Compensation OTHER APPLIANCES NOT OVER 3 HP. PERMIT 00, provisions of the Labor Code,you must forthwith comply with such 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 Tel.No. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR �'1 Over 50 to 100 Incl. REG.NUMBER 3 / J Class "'� O. G+� License Number42'✓ / Lic.Class Over 100 DISTRICT NO. O� WEBBED BY U Se�Igesbd9, anel oard Contractor ate 3 9 m . nder 00 ATE �\i ❑ 400-1000 Amp.Under 600 V UVJ 3 W I am exempt under Sec. Over 1000 Amp.or Over 600 V VALIDATION V FINAL d B.&P.C.for this reason BRANCH CIRCUIT FEES BY t 07 e: 15A,or 20A,120V,Lighting or Recept. s Z 1 To 10 Branch Circuits ACCT o a Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits 7_1 - t Exemption for Reg.Maim. Ct. 15A,20A,208V To 277V Lighting Br.Circuits ��+ C 61.65 SINGLE FAMILY Temp.Power Pole&Appurtenances 1 1TEML HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit T I hereby affirm that I am exempt from the Contractor's License Law TOTAL s AL 6 1.65 for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): 4ii�O.r o G•`.I ❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors f.:HANG is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) , and Professions Code). ty� CONSTRUCTION LENDING AGENCY `�L�j 612-2197 I hereby affirm that there is a construction lending agency for the 1],gU? 1 AM 8;17 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 ISSUING FEE Lender's Address penalty p 1 ry TOTAL FEE I certify that I have read this application and under enalt of urju state (!� 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 Countyto�ypon the above-mentioned property for inspection u s. /a SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE O RMrrTEE DATE WORKER'S COMPENSATION DECLARATION 9 DPW(12-81) APPLICATION FOR ELECTRICAL PERMIT 11 78A66 I hereby affirm that I have a certificate of consent to self Insure, 7GA863 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 No. Company FOR APPLICANT TO FILL IN JOB ADDRESS '� Q 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. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools MAP BOOK PAU P CEL go OWNCERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light FIRM N Sw. OR COMPENSATION INSURANCE FIRM NAME First 20 MAIL (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 rkers'Compensation Laws. L' filing Fixtures First 20 APPLICANT AnTotal No. Additional ADDRESS Date 6 Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT:. If, after aking Certi ate of CITY el.No. Exemption,you should become subject to the rors'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the.Labor Code,you must forth comply with such. power Apparatus&Large Appliances —APPLICANT provisions or this permit shall be deemed revoked. 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 Tel.No. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. } LICENSE OR a �f //��l�'77�' Over 50 to 100 Incl. .,REG.NUMBER (� f�Od License Number 7 ` / Lie.Claes SdL Over 100 'DISTRICT NO. PR ESSED BY Services,Swbd.,MCC&Panelboards . �p Contracto9Date 0-399 Amp.Under 600 V DATE r - 0 ❑ I am exempt under Sec. 400-1000 Amp.Under 600 V 4 ,� , VALIDATION III 0 Over 1000 Amp.or Over 600 V FINAL d B.&P.C.for this reasonBY BRANCH CIRCUIT FEES ate: a v 15A,or 20A,120V,Lighting or Recept. Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits El 41 Or More Branch Circuits t) Exemption for Reg.Main Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances I+�=JI HOME OWNER-BUILDER DECLARATION Branch Circuit B ith One ran ;: �` ?i 1 I hereby affirm that I am exempt from the Contractor's License Law Sign..w ,.r,.03 tF+3.re.�.r_ for the following reason (Section 7031.5, Business and Professions Additional.Sign Branch Circuits Code): 1 !TENS ❑ 1,as owner of the property,will do the work and the structure Misc.Conduits&Conductors TOTAL 43. 810 is not intended or.offered for sale(Section 7044, Business Other(See Complete Fee Schedule) jjff and Professions Code). `-�ECK 43.8100 CONSTRUCTION LENDING AGENCY CHANGE .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) Civ.C.) 0000-013101 4/10/93 PLAN CHECKING FEE Lender's Name 0200 1 ANi 1 IF) PERMIT ISSUING FEE Lender's Address. I certify that I have read this application and under penalty of purjury state TOTAL FEE that the above information Is correct. I agree to comply with ail County ordinances and State laws regulating Electrical wiring,and hereby authorize representatives of this County to enter upon the above-mentioned property for insp ct' n purposes. ' SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF P MITrEE ATE WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self Insure, or a.pertificate„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 No. Company FOR APPLICANT TO FILL IN JOB +D ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY E] Certifiedcopy is filed with the county building inspection 1 &2-Family,Sq.Ft. — $ $ NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGO P#ACEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. FIRM NAME COMPENSATION INSURANCE (This section need not be completed If the work Involved by the First 20 MAIL permit Is for one hundred dollars($100)or less.) Total No. Additional ADDRESS I certify that in the performance of the work for which this permit CITY ' Tel.No.S•Jw 5� is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers'Compe Sa ion Laws. Lighting Fixtures First 20 APPLICANT01 Total No. Additional ADDRES Dater Applican Annevwme±= RESIDENTIAL APPLIANCES NOT OVER 3 HP. , NOTICE TO APP (CANT: If, of this r ificate of CITY T.I.No Exemption,you should become subject.tvm Workers ompensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code,you mus41 comply with such P MIT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances IT LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR DADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. �o 00 (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. >_REG.NUMBER Over 50 to 100 Incl. LICENSE Class. fl License Number �� LIC.Class +/ �/ Over 100 DISTRICT NO. R EBBED BY V /�j Services,Swbd.,MCC&Panelboards Q Contractor Date /�` 1 0-399 Amp.Under 600 V LBY O 400-1000 Amp.Under 600 V VALIDATION I am exempt under Sec. WOver 1000 Amp.or Over 600 V (L B.&P.C.for this reason BRANCH CIRCUIT FEES Data. —A— 15A,or 20A,120V,Lighting or Recept. _ 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Exemption for Reg.Mal/Elect.. 15A,20A,208V To 277V Lighting Br.Circuits 7 SINGLE FAMILY Temp.Power Pole&Appurtenancesn r a HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ACC I o" 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 3303 f}3.81, Code): i ❑ Misc.Conduits&Conductors 1 IT EM` I,as owner of the property,will do the work and the structure a—� is not Intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) ® TOTAL 43 m 80 and Professions Code). ; 43.220 CONSTRUCTION LENDING AGENCY C I hereby affirm that there is a construction lending agency for the CHANGE • a�" performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ.C.) '1�f 6i I Lender's Name PLAN CHECKING FEE 0900_r, ' PERMIT ISSUING FEE O?� 0198 7 AN115114 Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE 3. 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 ins action purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF RMITiEE DATE • WORKER'S COMPENSATION DECLARATION 7883 DPW(12-97) APPLICATION FOR ELECTRICAL PERMIT LJ 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 No. Company FOR APPLICANT TO FILL IN ADD PoliRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE$Ft S il Famy, q. . LOCALITY — $ ❑ Certified copy is filed with the county building inspection t &2- _ NEAREST 40 department. Multi-family Sq.Ft. CROSS ST. km ?400`� Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK IYAGOP RCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. OWNFIRM NAME COMPENSATION INSURANCE First 20 MAIL (This section need not be completed If the work Involved by theTotal No. Additional ADDRESS Q", permit Is for one hundred dollars(8100)or less.) je I certify that in the performance of the work for which this permit CITY Tel.No. S is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers'Compen t' n Laws. Lighting Fixtures First 20 APPLICANT /v Total No. Additional ADDRESS 21-1 Date /y/A Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: if, after makin is Cer ate of CITY It 74 Exemption,you should become subject to the rkers'Col pensation 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 APPLICAN 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 Tel.No. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. d Over 50 to 100 Incl. LICENSE k REG.NUMBE 3� / �° Over 100 DISTRICT NO. PEI EBBED BY V License Number ro �7 Lic.Class v� �! Se /}es, wbd., CC Pan Ibo �, / �O �Gm O d•"— Date n er 6 DATE Contractor _ ❑ 400-1000 Amp.Under 600 V Tj VALIDATION V I am exempt under Sec. Over 1000 Amp.or Over 600 V LU FINAL LU B.&P.C.for this reason BRANCH CIRCUIT FEES BY Z Date, 15A,or 20A,120V,Lighting or Recept. — � 1 To 10 Branch Circuits Signatu 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits '] Exemption forC. Z.-Int. 2 Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances A(� �"81 HOME OWNER-BUILDER DECLARATION L 3i h Ci B O Sign with One Branch Circuit t: I hereby affirm that I am exempt from the Contractor's License Law Sz.r,-r� �a j a=�.r•J for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): 1 1 1 EMIS ❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors TOTAL 6-1 . 65 is not Intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). t CASH 61.65 CONSTRUCTION LENDING AGENCY CHANGE .011 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 r Lender's Name 0388 1 AI I v:17 0 PERMIT ISSUING FEE Lender's Address I certify that I have read this application and under penalty of purjury 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 inspectioZPERMITIXEE !/!�f_/�tDATE SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF WORKER'S COMPENSATION DECLARATION 76A6019 63 ) DPW(12-91APPLICATION FOR ELECTRICAL PERMIT LI I hereby affirm that I have a certificate of consent to self insure, or a;pertificate.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 No. Company FOR APPLICANT TO FILL IN JOB ADDRESS Certified co is hereby furnished. NO. EACH FEE . PY Y New Residential Bldgs.&Pools _ $ $ LOCALITY ❑ Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. NEAREST department. Multi-family Sq.Ft. _ CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. FIRM NOR COMPENSATION INSURANCE First 20 MAIL MAIL NAME (This section need not be completed if the work Involved by theTotal No. Additional ADDRESS permit Is for one hundred dollars($100)or less.) ty I certify that in the performance of the work for which this permit CITY Tel.No. S is issued, I shall not employ any pars n in any manner so as to PLAN CHECK become subject to the orkers'CompeAkition Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date V Applica RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, a Vh g this tificate of CITY al.No. Exemption,you should become subject tWorkers ompensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code,you muswith comply with such PERMIT P Y P y Power Apparatus&Large Appliances APPLICANT provisions or this permit shall be deemed revoked. 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 Tel.No. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR �/ Clesse�JO >_Over 50 t0 100 Incl. REG.NUMBER (Girl a License Number Over 100 DISTRICT NO. P SSED BY V 3�� Lic.Class 5.1 C/ ® Services,Swbd.,MCC&Panelboards Q � Contractor A�Date 0-399 Amp.Under 600 V FINAL O DATE F-1400-1000 Amp.Under 600 V I am exempt under Sec. —ISVALIDATION V Over 1000 Amp.or Over 600 V FINAL d B.&P.C.for this reason BRANCH CIRCUIT FEES BY ate: 15A,or 20A,120V,Lighting or Recept. Z Ile 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits• ❑ 41 Or More Branch Circuits Exemption for Reg. Int.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION .s I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit C91• o v for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits "3t,',5 43.30 Code): ❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors 1 ITEC! is not Intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) TOTAL 43.80 and Professions Code).ECK 4�a *lj CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the CHANGE ,00 performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ.C.) Lender's Name PLAN CHECKING FEE 0000-0001 6/10/93 PERMIT ISSUING FEE 13 i99 1 AN11o13T Lender's Addressp A I certify that I have read this application and under penalty of purjury state TOTAL FEE • 6 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 Inspesdon purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF PE ITTEE DATE .'