HomeMy Public PortalAbout9216 OLIVE ST_Electrical__ D55 5--A5-45APMCATION FOR IPERR1
VECMTMNTOY ]MUMBQNG MD SAL
COUNTY ®IF LOS MGMES ELECTRIC
IMM. J. FOX CHIEF ENGINEE=R
a NAME DIS`TRIC�NO. GROUP ZONE PERIIAIT NO.
0 ADDRESS !'�� / e
1' Y RECEIVED BY READY FOR DATE.ISSUED
CITY C TEL.NO. FIRST INSPECTION
.1 COUNTY R C`l ,"" el?N CERT.NO. / EXPIRES
APPLYCANT FILL IN HEAVILY OUTLMD PORTION ONLY
JOB
IDESCREMON OF WORD ADDRESS /e
NUMBER OF OUTLETS ON CIRCUITS LOCALITY Ali
LOCATION BY ROOMS
NEAREST
LIGHT OUTLETS 1SW. PLUGS FIILT CROSS ST. l1/
CIRCUIT A B C D E F G H E NAMEA/k,"i 1'J}
Z MAIL!
3 ADDRESS fl/.-.�phml .. �i
° CITY 7r ��i kA `i II TEL.NO.4/Y/-_y ` (`
1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANG COUNTY CERTIFICATE OF QUALIFICATION..
ELECTRICIAN.
I OA$'THIO LECIAL OWNER OF THE PROPERTY DESCRIBED
AB
q OWNER.
' COBREMONS
J
Q
Z_
R
R
D
TOTAL
,NO. OF OUTLETS $ APPROVALS
1 NO. OF FIXTURES $ DATE INSPECTOR'S NAME
s
NO. OF MOTORS H.P. $ CONDUIT
NO. OF SIGNS TRANS. $ WIRING f ! V R I-,-$
NO. OF RANGES OR HEATERS FIXTURES
M.ISCELLANEOUS $ POWER
PERMIT FEE $ '�f ti UTILITY CO.NOTIFIED
TOTAL FEE �� `-�� FINAL
DS S-A12-43 25M
DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PEIiM1T
COUNTY OF LOS ANGELES ELECTRIC
j WM. J. FOX CHIEF ENGINEER
NAME DISTRICT NO. GROUP ZONE, PERMIT NO.
U ADDRESS n/►� / - ��"
ry y 1
,I BY
CITY J f /FIO. � V� FIRST INSPECTION DATE ISSUED
COUNTY
CERT.NO. EXPIRES
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLYJOB
DESCRIPTION OF WORK ADDRESS
NUMBER OR OUTLETS ON CIRCUITSf/1fl•4J1� �
LOCALITY
LOCATION BY ROOMS
NEAREST
LIGHT OUTLETS SW. PLUGS Fl , CROSS T. / �?•M s \- t'I
CIRCUIT A 113 C 10 1 E Fr. H m NAME q G�►.,ivyt.piL:I %;.L-9''•!
J 3 MAIL
AD RES3 I I Q ���-�� i /�.J� ��r�(J�
3 O CITY . �ie 11.4-,;? L al-!tl LTEL.NO./11.0 .-!a!&
1 AM THE LEGAL 'POSSESSOR OF THE ABOVE LOS
ANGELES COUNT?V CERTIFICATE/OF QUALIFICATION..
t•
6L6CTRIGAN.
ABO IK �j 913 MM PROPERM DESCRIBED r
OWNER.
CORRECTIONS
J
Q
_Z
m
E
O
TOTAL S `�
NO. OF OUTLETS f APPROVALS
NO. OF FIXTURES S DATE INSPECTOR'S NAME
NO. OF MOTORS H.P. S CONDUIT
NO. OF SIGNS TRANS. I WIRING
NO. OF RANGES OR HEATERS S FIXTURES
MISCELLANEOUS / S POWER
PERMIT FEE /.1 S { F. UTILITY CO.NOTIFIED
TOTAL FEE �� FINAL 2
APPLICATION FOR ELECTRICAL PERMIT
WORKERS'COMPENSATION DECLARATION 76A663 10/81
L` t''heip affirm that I have a ce"cate-of 6onsent to self insure; CE-806G
or a certificate of Works
V' Compensation Insurance,or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY_
copy therdbf(Sec.3806,
Policy No. Company FOR APPLICANT TO FILL IN JOB
DDRESS f r
❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE.
$ _. $ LOCALITY o
Certified copy is filed with the county building inspection NEAREST&2-Family,Sq.Ft. _
departme Multi-family Sq.Ft. NEAREST
CROSS ST
Date Applicant14 Residential Swimming PooJI& OWNER OR
FIRM NAME'
CERTIIACATE OF EXEMPTIO ROM WORKERS' Outlets:Rec L Light—Sw. MAIL
COMPENSATION INSURANCE ADDRESS 01 Z
(This section need not be completed if the work Involved by the First 20
permit Is for one hundred dollars($100)of less.) Total No. Additional CITY Tel.No.
I certifythat'in the performance of the work for Which this permit PLAN CHECK
P P -APPLICANT
is issued, I shall not employ any person in any manner so as to
become.subject to the Workers'Compensation Laws. I Lighting Fixtures. First 20 S ADDRESS
Additional
Date Applicant
Total No. CITY Tel.No.
NOTICE TO' APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1-HP PERMIT'
Exemption,you should become subject to the Workers'Compensation, Range_ Heater_ D.W. APPLICANT
provisions of the Labor Code,you must forthwith comply with such Oven Dryer_ W.M. ADDRESS— a
0.
provisions.or this permit shall be.deemed revoked. Top FAU _ W.H. 1
CITYJ&_,&_ Tel:.N0.2"
LICENSED CONTRACTORS DECLARATION Hood _ Fan Other-
1 hereby affirm that I am licensed under provisions of..Chapter 9 LICENSE OR �
(commencing with Section 7000)of Division 3 of the Business and Disp. _ Room Air Cond. REG.NUMBER ''�f .�; 7 Class:
Professions Code,and my license is in full force and effect. DISTRICT NO, PROCESS , BY
Power Apparatus&Large Appliances �
� !' Size&Type HP,KW,KVA,or KVAR O SO(
!cerise Num r Z�r; 7(:/ LIC.Class _ Up to 1 Incl. FINAL "'
Over 1 to 10lncl. DATE. VA I ATION p
ntrecto S' Date Over 10 to 50 Incl. T— CF=A
I am Oempt under Sec. Over 50 to 100 Inc: FI W
BAP.C:for this reason Over 100 N
Services,Swbd.,MCC.&Panelboards Z
Date: 0-200 Amp.Under 600 V
•Signature 201 - 1000 Amp.Under 600 V
Over 1000 Amp.or Over 600 V 8 7 6 3 A
Exemption for Reg.Maint.Elect.
SINGLE FAMILY Temp.Power Pole&Appurtenances o 0 0 0 0 2
HOME OWNER-BUILDER DECLARATION. Sign with One Branch Circuit.
ereby affirm that I am exempt from the Contractor's License Law• I 0 6 1 9 0 0
r the following reason(Section 7031,5,Business and Professions Additional Sign Branch Circuits
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) _ 0 1: 1. 38 8
and Professions Code). ,
CONSTRUCTION LENDING.AGENCY
hereby affirm that there is a'construct'ion 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.
Lender's Name - .
• PERMIT ISSUING FEE Q
Lender's Address q 1
I certify that I have rea this application:and state that the above TOTAL FEE' r
information is corre gree to comply with all County ordinances
and State laws �I mg Electrical wiring, and hereby authorize.
representatives f County to enter upon the above-mentioned
Pro arty for' p. ' n.purposes. SEE REVERSE'FOR EXPLANATORY LANGUAGE'
Signature o rmittee �. J
'PJWORKERS'COMPENSATION DECLARATION 78-8061 10/81 APPLICATION FOR ELECTRICAL PERMIT
CE-806G
I�ierepK.affirm that I.,hava a_c�rtlficate•pf consent to self insure,
or!a certificate of Workers' Compensation Insurance, or a certified i COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec.3800,Lab.C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB
Certified copy is hereby furnished. ' New Residential Bldgs.8 Pools I EACH NO. FEE ADDRESS
S —
❑• Certified copy is filed with the county building inspection 1 &2-Family, q•Ft. $ $ LOCALITY— ,-
department. Multi-family Sq.Ft: NEAREST
Multi-family CROSS ST lll?
Date Applicant
Residential Swimming Pools OWNER OR
�� /
FIRM•NAME ' �
11
CERTIFICATE.OF EXEMPTION FROM WORKERS' MAIL
•COMPENSATION INSURANCE Outl ts:Rao—Light t 2 — LUSADDRESS' ' 1
(This•section.need not be completed if the work Involved by the J First 20
permit is for one hundred dollars($100)or less.) T tai No. Additional CITY �� Tei.No.a
I bertify'that in the APPLICANT
performance of the work for which this permit PLAN CHECK
is,issued; f shall not employ any person In any manner so as to - -•
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20' ADDRESS
Additional
Total No._L_ CITY" Tel.No.
�
Date ��–� Applicant Fixed Appliances Not Over 1 HP PERMIT !
NOTICE TO .APPLICANT: If; r making this Certificate of
Exemption,you should becomesubject to the Workers:Compensation .Range_ Heater_ D.W. _ APPLICANT
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 W.H. _, 1
1 CITY, 'Tel,No.
;. l ICENSED-CONTRACTORS DECLARATION ood _ Fa Otha TE �-
I hereby affirm that I am licensed under provisions of Chapter 9 p sp. d+�n _ � LICENSE OR
(commencing with Section 7000)of.Division 3 of the Business and � oom it ion . Class.
I REG.,NUMBER
Professions Code,and(ny license is in full force and effect. Power Apparatus&Large Appliances DISTRICT N.O. PROCESS(D BY
Size&Type HP,KW,KVA,or KVAR (� p
License Number Lic.ClassUp to I Incl. FINAL,
Over 1 to 10 Incl. DATE' (�
Contractor DateOver 10 to 50 Incl. FINAL 0 V IDATION 0
Elam exempt under Sec. ;i Over 50 to 100 Inc. BY 8
i BAP.C.for this;reason Over 100 N
Seiv ces,Swbd.,MCC&Panelboards Z
Date. 0-200 Amp.Under 600 V
Signature 2101 - 1000 Amp.Under 800 V '
•Over 1000 Amp.or Over 600 V
❑ Exemption for Reg.Maint.Elect. ;.9 3'7.'1 A
SINGLE FAMILY Temp.Power Pole.&Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One,Brandi Circuit # 0 0 0 0 0 2
1 hereby affirm that I am exempt from the•Contractor's License Law
for the following reason(Section 7031.5,Business and Professions. 1 Add i Tonal Sign Branch Circuits 0 1 625
Code):
Mi..
Conduits&Conductors o 0 01 62576
I,as owner of the property,will do the work and the structure j
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ 1
and Professions Code). i 011101.1 4.12 x 8 8
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.3097, PERUT FEE (Sub Total)
Civ.C.).
PLAN CHECKING FEE
Lender's Name D i
PER OIT ISSUING FEE
Lender's Address
I certify that I have read this application and state that the above TOTRL FEE ,a� I
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 purpo es. SEE REVERSE FOR EXPLANATORY LANGUAGE
Si a ure 61Permitted Date
WORKER'S COMPENSATION DECLARATION 2D.0019,DPW(12-91) AppLICATION FOR ELECTRICAL PERMIT
1 hereby affirm that (°'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:)
PoliLrNo. Company FOR APPLICANT TO FILL IN JOB of
ADDRESS
❑ 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 PAGE PAR
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec�Light sw: OWNER OR
ME
COMPENSATION INSURANCE First 20 D FIRM NAME
Jecia
(This section need not be completed if the work Involved by the ADDRESS
permit Is for one hundred dollars($100)or less.) Total No. Additional'
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 • ro PLAN CHECK /�
become subject to the.Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT 'A.
Total No. Additional
94 ADDRESS S
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. 04
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• Tel.No.
Professions Code,.and my license is in full force and effect. Over 10 to 50 Incl.
LICENSE OR Class. (l
Over 50 to 100 InCI. REG.NUMBER
Over 100 DISTRICT.NO. PROCESSED BY O
License Number Lic.Class. U
Services,Swbd.,MCC&Pa.n�elboards cc
Contractor Date
0-399 Ame1'600 V 6 DATE O
❑ 400-1000 Amp.Under 600 V VALIDATION qj ' W
I am exempt under Sec. Over,1000 Amp.or Over 600 V
FINAL. IL
B.&P.C.for this reason BRANCH CIRCUIT FEES BY co
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,208V To 277V Lighting Br.Circuits 2
SINGLE FAMILY Temp.Power Pole&Appurtenances
HOMEOWNER-BUILDER DECLARATION Sign with Orie Branch Circuit ACCT.
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason(Section 7031.5, Business and Professions Additibnal:Sign Branch Circuits 209.07
Code):
1W1,as owner of the property,will do the.work and the structure Misc.Conduits&Conductors 1 ITEMS
is.not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) TOTAL .209.07
and Professions Code). , CHECK
209-137
a
' 411GR.� .��9 s 137
CONSTRUCTION LENDING AGENCY CHANGE .0EI
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 -011 11/13/92
Lender's Name2
PERMIT ISSUING FEE 6472 1 Ali 81- 4
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 th" County to a er upon the above-mentioned property
if9r inspect i n ph s. SEE REVERSE FOR EXPLANATORY LANGUAGE
' a ATURE OF RMDTEE D E '