HomeMy Public PortalAbout9071 OLIVE ST_Electrical__ 'e"663CE-eaeNFene. APPLICATIO FOR ELECTR_ ICAL PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPL.ICANTTO FILL IN JOB ��^^
EACH NO. FEE ADDRESS i%. d LI V 0.7
S`
New Residential Bldgs.&Pools 0 I
1 &2-Family,Sq.Ft. $ LOCALITY- 1 t1 PL C i TY CA
Multi-family Sq.Ft. — NEAREST
Residential Swimming Pools CROSS ST. e669FM dwo CfLI VE
OWNER OR n
"e
FIRM NAME M D, J 1"�;$
Outlets:Rec Light Sw. MAIL
First 20 .ADDRESSSI �-
Total No. Additional CITY / Tel.No.2 .
PLAN CHECK
APPLICANT
Lighting Fixtures First 20 ADDRESS
Total No. Additional
CITY Tel.No.
Fixed Appliances Not Over 1 HP PERMIT
Range_Heater_D.W..— APPLICANT
ADDRESS
Oven—Dryer_W.M.—
Top _FAU _W.H._ CITY el:No.
Hood_Fan _Other_ LICENSE O
Disp._Room Air Cond. REG.NUM§tV Class.
I.HEREBY—ACKNOWLEDGE THAT I HAVE READ THIS APPLICA-
Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO
Size&Type HP,KW,KVA,or KVAR COMPLY WITH ALL COUNTY ORDINANCES AND`.STATE LAWS
REGULATING ELECTRICAL WIRING. @,
Up to i Incl.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
Over'1 to 1.0 Incl. LICENSED AS REQUIRED BY LOS ANGELES COUNTY ANO STATE OF
Over 1.0 to:50 Incl. CALIFORNIA OR THAT I AM TH EGAL O R OF E ABOVE as
DESCRIB TIAL PRO PERT
Over 50 to.100 Inc.
Over 100 PERMIT
SIGNATU
Services DISTRICT NO. SED Y
0-200 Amp.Under 600 V ��
201.1000 Amp.Under 600 V `,/ G•�
Over 1000 Amp.or Over 600 V Z
O
Temp.Power Pole&Appurtenances.
Sign with One Branch Circuit
Additional Sign Branch Circuits INSPECTION >
INFORMATION
Misc.Conduits&Conductors ON REVERSE z
Other(See Complete Fee Schedule l SIDE u E 521.4A
5 # oo'oo- Z
L
2o'o19.50
•PERMIT FEE (Sub-Total)
0 0 0 =
PLAN CHECKING FEE (One-.Fourth Permit Feel O 1 9 ,5 0
0679
PERMIT ISSUING FEE o� 29—
j
TOTAL FEE >
INSPECTION FINALED / W
date: // BY ���Zf � '� Os
7//C- �
" �w,•i WORKERS'COMPENSATI.ON DECLA�RATION�' 76A663
CE-806G`(_2-80) APPLICATION FOR ELECTRICAL PERMIT
;�. I'
I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELE BUILDING AND SAFETY
insure,or a certificate of Workers'Compensation Insurance,or
a certified copy thereof(Sec.3800,Lab.C,)
FOR APPLICANT TO FILL IN JOB /� l
Policy No. Company ' EACH NO. FEE - ADDRESS D 7� (J�/J/u i6T
fResidential.Swimming
w Residential Bldgs.&Pools
Certified copy is hereby furnished. &2-Family,' Ft, $, — LOCALITY `�p j 1e
Oulti-family Sq. Ft. NEAREST
Certified copy is filed with the county building inspection Pools CROSS ST DSCM
department. OWNER OR
FIRM NAME ll7r��Ylr
Date Applicant Outlets: Rec.Light / Sw.11l�� ADDRESS ��7� �3/ids
First 20 �_
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. J0 40_ Additional �•� CITYe Tel No �� —0.4
PLAN
INSURANCE PLAN CHEC d
(This section need not be completed if the work involved C� �U PPLI.CANT p
by the permit is for one hundred 'dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS
Total No..
6 Additional
I certify that,in the-performance of the work for which this Fixed Appliances Nox Over 1 HP CITY _ Tel No. 0
permit is issued, I shall.not employ any person in any manner PERMIT
so as to become subject.to the Workers'Compensation Laws. Range_Heater'D.W. APPLICANT 0�07e r pW.
Oven _ Dryer W.M._ ADDRESS V7
Date_Applicant Top _ FAU —W.H.._ Z
Hood Fan 2A Other_ CITY Tel No.
NOTICE TO APPLICANT: If, after making this Certificate of Disp.. y Room Air Cond._ a LICENSE Oft
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 I S T R I CJ_.b1Q, PROCES It aBY
with comply with such provisions or this permit shall be _
deemed revoked. Size&Type HP,KW,KVA,or KVAR
Up to 1 Incl.
LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATEL UU�U T- VA'L:I17W, ON w '
Over 10 to 50 Incl.
I hereby affirm that I am licensed under provisions of Chapter Over 50 to-100 Inc. FINAL o 0 o o o 2
9 (commencing with Section 7000)of Division 3 of the Busi-. Over 100 BY m
ness and Professions.Coae,and my license is in full force and 2 o Q.3 1,8 0
effect. Services
0-200 Amp.Under 600 V. o, o c 3 1,8 0 U
License Number Lic.Class 209-1000 Amp.Under 600 V
1 '2--80 9,
0
Contractot Date Over 1000 Amp.or Over 600•V .
HOME OWNER-BUILDER DECLARATION Temp.Power Pole.&Appurtenances
I hereby affirm that I. am exempt from the Contractor's Sign with One'Branch Circuit
LIcense Law for.the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits
nese and Professions Code):
Misc.Conduits&Conductors
I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)—
T structure is not intended or offered for•sale .(Section
7044,Business and Professions Code). V D C L�•2 1 J A
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agencyo o c o o 2
for the performance of the work for which this permit is
PERMIT FEE (Sub-Total) -
issued(Sec.3097,Civ.C.). � 2 1.80
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) o o
i U
Lender's Address, PERMIT ISSUING FEE
9, 12-80
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:upgn
the ab ve-mentioned property for inspection purposes. SEE'REVERSE FOR EXPLANATORY'LANGUAGE
Signature of Peimitte Date