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HomeMy Public PortalAbout9090 OLIVE ST_Electrical__ WORKERS'COMPENSATION DECLARATION - 10/81 APPLICATION FOR ELECTRICAL PERMIT I herL�y affirm that I have a certificate of consent to self insure, CE-806G 0 or a eertificate'of Workers' 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 JOB i— Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ADDRESS ❑ 1 & 2-Family,Sq.Ft. $ _ $ LOCALITY Certified copy is filed with the county building inspection NEAREST !' / department. Multi-family Sq.Ft. CROSS ST. �CCSK r"i r-f•-c t3L l.'C Date Applicant Residential Swimming Pools OWNER OR r FIRM NAME S CERTIFICATEMAIL COMPENSATION INSURANCE PTION FROM WORKERS' Outlets:Rec Light�— t 2 ADDRESS 1 y 1 n ss Q-" This section need not be completed If the work Involved by the / First 20 n ( P (!' CITY Tel.No. �� permit is for one hundred dollars($100)or less.) Total No. Additional e y �I� �� 0� I certify that in the performance of the work for which this permit APPLICANT CHECK 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 .t�''I f Y .A Total No. CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of PERMIT Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APPu .i.� provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADD provisions or this permit shall be deemed revoked. Top — FAU _ W.H. _ CITY / TelNo LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ . . 1 hereby affirm that I am licensed under provisions of Chapter 9Disp. — Room Air Cond. LICENSE OR Class. (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. V PROCESSED Size&Type HP,KW,KVA,or KVAR v Q License Number C/0 t? ic.Class Up to 1 Incl. FINAL V �a y % S/-/7 Over 1 to 10 Incl. DATE _ VALID TION Q Contracto �f`"P°1e`i """���pppate Over 10 to 50 Incl. ❑ FINAL I am exempt under Sec. Over 50 to 100 Inc. EN BY LLLI L. BAP.C.for this reason Over 100 Z Services,Swbd.,MCC&Panelboards Date: 0-200 Amp.Under 600 V r 7 j b i A Signature 201 - 1000 Amp.Under 600 V ❑ Over 1000 Amp.or Over 600 V ° o 0 0 0 0 2 Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole&Appurtenances o . 26". 5 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit o 0 0 2 6�f 5 I hereby affirm that f am exempt from the Contractor's License Law h Ci B Additional Sign Branch Circuits for the following reason(Section 7031.5,Business and Professions a 6 0 u Code): El1, pMises Conduits&Conductors �7•CQ i, owner of the property,will do the work and the structure Other(See Complete Fee Schedule) is not intended or offered for sale (Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3087, PERMIT FEE (Sub-Total) Civ.C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE C. Q Lender's 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 wiring, and hereby authorize representatives of this County to enter upon the above-mentioned p e ty for inspection pu poses. SEE REVERSE FOR EXPLANATORY LANGUAGE gnature of Permittee Date IASSS-CE80610-60 APPLICATION FOR ELECTRICAL PERMIT 1 COUNTY OF LOS ANGELES DEPARMENT OF COUNTY ENGINEER BUILDING �� �1 �.B �� /o BUILDING AND SAFETY DIVISION ADDRESS CJ e+ JOHN A. LAMBIE, COUNTY ENGINEER 11 WILLIAM A JENSEN,SUPT OF BUILDING LOCALITY /e- NEAREST 1 /- NEAREST ' FOR APPLICANT TO FILL, IN CROSS ST. d v , PERMIT FEES OWNER r -oe I T E M NUMBER EACH$ FEE MAIL OUTLETS: $ ADDRESS LIGHTS RECEPT. SW: •i0 CITY TEL.NO. LIGHTING FIXTURES ,10 EC.RANGES CLO.DRYBRS J .� ELECTRICIAN OS Q-[©j 7 c 4 ec L tWATER HEATERS .80 / , VV ADDRESS /✓ 7Yee4l ELEC.SPACE HTRS. DISHWASHERS (y J 1 C[TY '� 4 t TEL NO. ' ,/ dQ o GARBAGE DISPOSERS AUTO.- STATE y WASHERS STA.COOKING UNITS ,25 LICENSE NO. MOTORS: OVER INC. H.P. DISTR O. GR UP ON I P SSED BY o— 1/2Zs 0 1/2— 2 .50 INSPECTION RECORD S— IS 1.50 U Is— SO 2.50 - �� /gyp Si.�G • F_.�r_ SO— 200 5,00 -'" SIGNS: NO TRANS. C'Y� y NO.LAMPS .Q ,,Q.�...�- /� SERVICE 0-600V 1.00 Q SERVICE OVER SOOV 5.00 MISC. WIRING PERMIT• 1.00 s FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT SO TOTAL FEE $ 3, 60 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS. APPLICATION APPROVALS DATE . INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH. ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES ' CALIFORNIA OR THAT I AM THE LEGAL OWN OF THE ABOVE DESCRIBED RESIDENT L PROPERTY. POWER . SIGNATURE UTILITY CO.NOTIFIED OF PERMITTE FINAL 0DATION ARTHUR C.VEIT CK MO CASH SUPERVISING ELECTRICAL ENGINEER U11,1 0 7 7 0 JuL 31 0 3.00