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Home My Public Portal About9341 OLIVE ST_Electrical__ 78A888-CE; 06 4.85n APPLICATION FOR ELECTRICAL PERMIT- COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER FNREAR BUILDING AND SAFETY DIVISION JOHN A. LAMBIE...COUNTY ENGINEER COLEMAN.W. JENKINS. SUPT. OF BUILDING FOR APPLICANT TO FILL IN RECEPTACL TOTAL NO. EACH FEE �I d OWNER LIGHT FIRST 20 !i 20 MAIL SWITCH ADD'L .10 ADDRESS OVER 2C TOTAL FIRST 20 .20 CITY TE;NO.—: LIGHTING FIXTURES FIXTURES ADD'L OVER 20 10 CONTR RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS GARB.DISP. BTA.COOK CITY TEL D18HWA8H. AUTO.-WASH. STA SPACE HTRS. BTA.APP.(I/=H.P.MAX.) .50 LICENSE NO. MOTORSt OVER NOT OVER H.P. DI§T`R,,IC NO. I GR UP Z/�E PROCESSED BY O 1 1.00 V /C� 1 s. 11.50 INSPECTION RECORD s a 2.00 8 is .2.50 1s so 3.00 so 100 5.00 1!C SIGNSI NO.TRANS. O NO.LAMPS SERVICE O-SOOV•NOT OVER 200A 1.00 00 A t>L . SERVICE O.SOOV•OVER 200 A. 2.00 Z_ SERVICE OVER SOOV 5.00 OTHER(SEE COMPLETE FEE SCHEDULE) _ PERMIT ISSUING FEE 2.00 ' SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE R APPROVALS DATE INSPECTOR'S SIGNATURE I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION UNDERSLAS WORK AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING _ ELECTRICAL WIRING. WIRING , 1 HEREBY CERTIFY THAT 1 AM PROPERLY.REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO POWER RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. SIGNATURE f r UTILITY CO.NOTIFIED i OF PERMITTEE FINAL DATION JOSEPH C. ROOHAN r CK MO CASH SUPERVISING ELECTRICAL ENGINEER LAUo 3 0 7 7- JUN27 2 D 4.00 H WORKER'S COMPENSATION DECLARATION 176A683 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 I COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab.C.) I ,� Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY — $ ElC. 1 &2-Family,Sq.Ft. $ ertified copy is filed with the county building inspection _ NEAREST department. Multi-family Sq.Ft. NEARS Sr. Date Applicant Residential Swimming Pools ASSESSOR v�GP � PAGE G� PARCEL el MAP BOOK ) O [.v` CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER OR COMPENSATION INSURANCE Outlets:Rec.—Light Sw. IRM NAME ��LS First 20 MAIL �l�.�Q� (This section need not be completed the work Involved by the Total No. Additional ADDRESS permit Is for one hundred dollars($1000)or less.) I certify that in the performance of the work for which this permitCTY i Tel.No, _ 3l 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 provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT 1�+2 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. >_Over 50 to 100 Incl. RIEGNNUMBER Class. IL Over 100 DISTRICT NO. PROCESSED BY 0 License Number Lic.Class 0 ,AANes,Swbd. MC &Paonelboards / �/• �dGJ IY Contractor Date w=say A p.Under 600 V FNA ❑ I am exempt under Sec. 400-1000 Amp.Under 600 V W Over 1000 Amp.or Over 600 V VALIDATION P FINAL d B.&P.C.for this reason BRANCH CIRCUIT FEES BY Z Date: 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.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits - J.. SINGLE FAMILY Temp.Power Pole&Appurtenances -. a HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit s for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): 3 r;ME- I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors --, Y9 is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) ® I�(4 '� _ ' -' and Professions Code). CHECK CONSTRUCTION LENDING AGENCY1_ • I^ a L1 I hereby affirm that there is a construction lending agency for the CHANGE performance of the work for which this permit is issued(Sec. 3097, PERMIT FEE (Sub-Total) Civ.C.) PLAN CHECKING FEE 000,0-00101 // 00,i— 101 13/25/97 4 Lender's Name PERMIT ISSUING FEE �(p Q a �= 1 Fs1�' �'"42 Lender's Address / 1 certify that I have read this application and under penalty of purjury state TOTAL FEE (p that the above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring,and hereby authorize representatives ofthis County t enter upon the above-mentioned property for' ti purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE IGNATURE OF PERMI D I WORKER'S COMPENSATION DECLARATION 76A663 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 I COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab.C.) .'MS:M XY`SCompanyl� & �h D• FOR APPLICANT TO FILL IN JOB ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE $ $ LOCALI ® Certified co is filed with the count building inspection 1&2-Family,Sq.Ft. PY Y 9 P NEAREST department. Multi-family Sq.Ft. CROSS ST. Date l?-- 1—9 3 Applicant�a�� A. Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Ree._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.) I certify that in the performance of the work for which this permit CITY Tel. 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 P y P y provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,DVVAR ADDRES I hereby affirm that I am licensed under provisions of Chapter 9 O� 04 Incl. f� (commencing with Section 7000)of Division 3 of the Business and Clel.No. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. } LICENSE OR Class a Over 50 to 100 Incl. REG.NUMBER �� G � �r� Over 100 DISTRICT NO. P SSED BY U License Number c � �_Lia Class G� �/ .� Services,Swbd.,MCC&Panelboards •,*.f � IZ Contractol�� 6fe{ 1 Data I'--2h Z2 0-399 Amp.Under 600 V DATE ❑ I am exempt under Sec. 400-1000 Amp.Under 600 V Over 1000 Amp.or Over 600 V FINAL VALIDATION W B.&P.C.for this reason BRANCH CIRCUIT FEES BY Date: A,15 , r q��j OV,Lighting or Recept. j YY Signature 1 To 10 Branch Circuits 11 To 40 Branch Circuits ❑ Al Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits y SINGLE FAMILY Temp.Power Pole&Appurtenancesj;.;ti a HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 33013! ,., , 1 I hereby affirm that I am exempt from the Contractor's License Law , .f�? for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits 330= Code): i ITEMS ❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors TOTAL � �� yy— is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). , HECK 1.65F CONSTRUCTION LENDING AGENCY ;!1 I hereby affirm that there is a construction lending agency for the CHANGE o_ performance of the work for which this permit is issued(Sec. 3097, PERMIT FEE (Sub-Total) Civ.C.) PLAN CHECKING FEE GGLIC-103 12/ Lj9=* Lender's Name PERMIT ISSUING FEE �� d 2920 1 Crii'`°T 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 --el-inspection purpos SEE REVERSE FOR EXPLANATORY LANGUAGE si l z-8--93 SIGNATURE OF PERMITTEE DATE