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Home My Public Portal About9625 OLIVE ST_Electrical__ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of County EngineerL ECT I 1 DIVISION OF BUILDING & SAFETY WILLIAM J. FOX, County Engineer FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO. ELECTRICIAN A ADDRESS �,J�� "„mss Jr RECEIVED Saf READY FOR DAT ISSUED CITY f' // TEL.NO. „4�✓J6 � FIRST INSPECTION COUNTY LI CNSE NO. l EXPIRES BUILDING PERMIT FEES ADDRESS -e )) ((((/��//jj CY j NUMBER EACH FEE LOCALITY ,gQAf?J.%twC+ LIGHT OUTLETS NEAREST CROSS ST. / A/ RECEPTACLES y WALL SWITCHES OWNER .v //�1 w lI i�/• , TOTAL OUTLETS SO III MAIL ELEC. RANGES 85 ADDRESS _/L�-✓� ELEC. HEATERS 28 /r71{// _ f-{� / �/ TEL. NO. j FIXTURES CI--RES S 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. MOTORS I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER NEw MVD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. %2 a LESS 111 .25 SIGNATURE %2 2 .50 PERMITTE a 5 1.00 INSPECTION RECORD 5 14 1.50 q� 14 SD 2.50 Ra4jGR •.} GIP—dIT„ 5O 200 5.00 200 500 10.00 J 500 1000 15.00 Z OVER 1000 20.00 M.S. SET/FREQ. CHANGER-HP 0: WELDERS:AC-KVA O GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (75% OF ORIG.) MOVED MOTORS (75% OF ORIS.) M ISC. SIGNS NO. N O.TRANS. ” APPROVALS NO. NO.LAMPS FOR EACH PERMIT: DATE INSPECTORS NAME WIRING $1.00 CONDUIT / AA FIXTURES $1.00 WIRING Z i-175 �y"'T 'Z/7"., SUPPLEMENTARY .50 FIXTURES �7r POWER TOTAL FEEGJ UTILITY CO.NOTIFIED 4 . [r„/ FINAL 76A663 DBS#SA Z-S3 'GA668-CES06.10-86 APPLICATION FOR ELECTRIC PERMIT g BUILDING AND SAFETY DIVISION Dep ozlmant of County Engineer BUILDING COuatp of LOS AageleB ADDRESS JOHN A. LAMBIE.COUNTY ENGINEER �^ d CA98ATT D. GRIFFIN. SUPT OF BUILDING LOCALITY .v Ion- NEAREST FOR APPLICANT TO FILL IN CROs T y PERMIT FEES LIGHTS g RECEPTACLES SWITCHES 1 OWNER e.0 NUMBER ITEM EACH FEE MAIL ADDRESS TOTAL OUTLETS $ .10 $ ELEC. RANGES, .W,ATER HEATERS, CITY �: TEL.NO. CLOTHES DRYERS .50 ELECTRICIAN A . �.C�7Qg'•,g,ry�l ELEC. SPACE HEATERS, STAT'Y. 000K- ING UNITS, GARBAGE DISPOSERS, AUTO WASHERS, DISHWASHER .25 - LIGHTING FIXTURES .10 CITY 7 dal TEL. MOTORS STATE LICENSE NO. h PAS_ HORSEPOWER DISTRICT O. IGROUP ZO E READY FOR INSPECTION OVER ER INC. I/a a LESS .25 2 .sc INSPECTION RECORD 2 5 1.00 5 15 1.50 15 50 2.50 50 200 5.00 M18C. SIGNS I NO.TRANS , NO.LAMPS SERVICE 0-SOOV 1.00 SERVICE OVER GOOV 5.00 WIRING PERMIT 1.00 0 FIXTURE PERMIT 1.00 11,06 SUPPLEMENTARY PERMIT .50 q APP VAI+S TOTAL FEE q PECTOR's s TU I HEREBY ACKNOWLEDGE THAT I. HAVE READ THIS APPLICATION I AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED. AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AN THE LEGAL OWNER OF THE ABOVE POWER DESCRIBED RESIDENTIAL PROPERTY. d I SIGNATURE UTILITY CO.NOTIFIED OF PERMITTEE _ FINAL IOHN AMBE. 00oARTHUR RC.VEIT. OUNTYENGINEER TION SUPERVISINGELECT RICAL ENGINEER CpgH l- 3,..3 4 9V; IJG 2 0 2 2.80 BOUNTY of Lod ASdELM APPL=T= FOR PE MW Dof CouaiT Eagladdoc ]ELECTRIC�� DMBION SION OFF HIIII.DII�iG 8c S4FSTY WILLIAM L FOX. Goaly EinIseq FOR APPLI LIN DIIITRIOT NO. GROUP ZONE PERMIT NO. ELECTRICIAN LIVED ■Y READY FOR DAT! ISSUED ADDRESSrIIw INSPECTION /- .I NSPECTION CITY `, TEL MO. /V4 OVA /' _X3 COUNTY LID! M0. EXPIRES PEI= PM ADDRESS do y�j.iA NUMBER ICAUH R� LOCALITY �l LIONT OUTLET■ RE E r 1 J RECEPTACL M WALL SWITCHES , OVYMER 101 lG?.m TOTAL OUTLETS ■ea !ADDRESS eLeD. RwN■E■ an .t ELE0. HEATERS an CITY Ill�&titief til TEL. MO. MIXTURE■ ■ 1 HERE■Y ACENOWLSOS THAT 1 HAVE READ THIS 1EL APPLICATION AND STATE THAT THE ABOVE 10 CORRECT NUMBER Or LISHT CINCUITE AND ANNEX TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER Or RECEPTACLE CIRCu1Ts AND STATE LAW■ RERULATIM■ ELECTRICAL WININ■. MOTORS 1 OERTIrV THAT 1 POSSES THE ABOVE VALID L.O■ NuMueR NOR■EPOWER FEE AMEELE■ COUNTY LICEM■6 OR 1 AM THE LEGAL OWNER NM Mw. NP a11Eg INC. WAON Or THE RESIDENTIAL PROPERTY DE■CRISED ABOVE. f va S .0113 PERMITTRT �'�L i d 1.1301 � $ HEMRD s 1■ 1.sD 1s sO s.sD sD saa s.DD S00 SOO 10.00 J` BOD 1x00 16.OD Z Oven 1 am 60.00 Q M.S. mzT/rnra ONAN■en-HP WELDERse AO-RYA O ENERATOII■ - EW TRANSFORMERS - EVA TEMP. MOTORS or o11ioJ MOVED MOTORS 1T§ or unioJ MI NIONS N0. NO.TRANS. AP'PIMAW P D LA P ,. ran "ON PERMITI DATE 1 ■P R NA WIRING 0111.013 COMDUIT rlxrum ■ 011.00 WIRINS .00 FIXTURE■ POWER TOTAL FEE 01/ UTILITY CO.MCTlrlm FINAL *"fill Dw*" 4_611 JORKERs'COMPENSATION DECLARATION CE-8 6G loi87 APPLICATION FOR ELECTRICAL PERM:IT� I hereby„affirm tha6 I have a certificate of consentto self insure, ora certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES I BUILDING AND SAFETY cow@ f(S.ec.3800 Lab.C.) Policy NcS. V Company �� FOR APPLICANT TO FILL IN JOB ❑ Certified copy is hereby furnished. � New Residential Bldgs.&.Pools EACH NO. FEE ADDRESS $ _ LOCALITY ' Certified copy 18,filed with the,county building inspection 1 &2-family,Sq.Ft. $ �� 'f ��(/0- 7-7-9,o —Applicant' dep rttment. 4 Multi-family Sq.Ft. NEAREST DaCROSS ST. te %_ v Applicant / �a�� Residential Swimming Pools OWNER OR ,/ FIRM NAME, /C ♦c . CERTIFICATE OF EXEMPTION FROM WORKERS' I � � ! MAIL. Outlets:Rec Light t 2 — S' ®/ COMPENSATION INSURANCE 5' ADDRESS r �E (This section need not be completed if the work Involved by the First 20 7 permit is for one hundred dollars.($100)or less.) Tota!No.. Additional CITY /Q� e- �f Tel.No I certify thet'in.the performance of the work for which.this,permit PLAN CHECK is issued,, p y y Io 'an person inanY manner so as to shall not em APPL�CANT ' . become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional ' Total No. CITY Tel.No. Date. Applicant Fixed Appliances Not Over 1 HP' PERMIT NOTICE TO APPLICANT. If, after making this Certificate of APPLICANT ASR Exemption,you should become subject to-the Workers'Compensation Range_ Heater D.W. _ provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer W.M._ ADDRESS 429'p,7! Al X UO d l5 provisions or this permit shall be deemed revoked. Top ._ FAU W.H. _ LICENSED.CONTRACTORS DECLARATION CITY Hood Fan Other_ 7e* �e'f Tel.No.;W-31,0 ' ,_ I hereby affirm that I am licensed under provisions of Chapter•9 Disp. Room Air Cond. .3 d LICENSE OR dd��f S / Class. (commencing with Section 7000)of Division 3 of the.Business and REG.NUMBER ,[ d Professions Code;and•my license is:in full.force and effect. DISTRI O. P SEED BY Power Apparatus&Large Appliances }: �e (` 7Q Size&Type HP,KW,KVA,or KVAR j �Q1• License Number '7 J Liiccc.CllaasssU[C/a90 e3� Up to 1 Incl. FINAL �+ Contractor �vNNO� Date 7–r3�”�� Over 1 to 10 Incl. DATE !/ �� VALIDATION 0 Over 10,to 50 Inc!. FINAL ❑ I am exempt under Sec. Over 50 to 100 Inc. gy �rJJ� W B.&P:G,for this reason Over 100 ` 0. 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 Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole&Appurtenances HA�+�aOME OWNER-BUILDER DECLARATION Sign with Branch Circuit f75r4ToV I hereby affirm that I am exempt from the.Contractor's License Law Additional.Sign Branch Circuits for the following reason(Section 7031.5,Business and Professions i 3307 19,25 Code): Misc.Conduits&Conductors 1 ITEMS ❑ i as owner of the property,will do the work and the.structure Other See Complete Fee Schedule) _ o is not.intended or offered for,sale (Section 7044;Business i ( �T�TAl. � �.� 25 and Professions Code). i , CHECK 19025 CONSTRUCTION LENDING AGENCY �� .00I 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) 13 Q I Civ..C.).. PLAN CHECKING FEE M-0001 10/2¢/$9 Lender's Name PERMIT ISSUING FEE 6384 1 AHI1�53 Lender's Address ' I certify that 1 have read this application and state that the above i 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 ropty for inspection p es. SEE REVERSE FOR EXPLANATORY LANGUAGE ir—90 Permittee Date AiVii1,',, A.'- Jr-/re' WORKERS'COMPENSATION DECLARATION 7B-863, 10/81 APPLICATION ��iLl ® ELECTRICAL PERMIT GE-808G fl l� I hereby affirm that I have a certAcertificate of consent.to self.insure, " � IIJI or a certificate of Workers' Compensation•Insurande, or'a certified COUNTY OF LOS ANGELES' BUILDING AND SAFETY c re, (Sec,3800,Lab.C:,) POIdy o. ,q�if COntpeny. '0 FOR APPLICANT TO FILL IN JOB t.s� V ❑ Certified copy'is hereby furnished.' EACH NO. FEE ADDRESS 6 / New Residential Bldgs.&Pools Certified copy is filed'••with..the, county building .inspection 1 &2-Family,Sq.Ft: $ G department. Multi-family Sq,Ft LOCALITY NEAREST- ,Q CROSS ST C I Uce Applicants✓��n �/ /� ONd�' I Residential Swimming Pools OWNER OR n' FIRM NAME N�040 /Ne CERTIFICATE OF EXEMPTION FROM WORKERS' I MAIL Outlets:Rec.—Light_Sw..—• 9 COMPENSATION INSURANCE ADDRESS 6A S �U (This section need not be completed if the.work.involved.by the First 20 . permit Is:for one hundred dollars($900)or less.) Total No, _ Additional _ C Ef CITY Tel.No: f PLAN CHECK i I cerfify.that in the performance of the Work for which.this permit APPLICANT is issued„I shall not. employ any person in any manner so as to ' become.subject to the Workers'Compensation Laws. ILi ghting Fixtures First 2.0 ' ADDRESS Total No.. Addition. al CITY' Tel.IVO. Date Applicant _ . NOTICE• TO: APPLICANT. If, after making this Certificate.of 'Fixed Appliances Not Over'1 HP t� an Exemption;you,should.become subject to the Workers'Compensation Range_.Heater D.W. vNNo/Z l� 'L PERMIT APPLICANT provisions of the.Labor Code,you must.forthwith ccm..piy with such Oven . Dryer_ W.M..= ADDRESS ( cl provisions or this permit'shall be deemed revoked: Top FAU W.H. _ CITYTel.N. r LICENSED CONTRACTORS.DECLARATION Hood — Fan Other_ ••7 L �9 &r ?IS'7: I'hereby aff,irm.that I am licensed under provisions of Chapter 9 G. p ... Room Air Cond. — . C1. C GCENSE'OR (commencing With.Section 7000;)of.Division 3'of the Business and FtEG.,NUMBER' d Professions Code,and,my',I)oense is in full fdroe'and effect. DISTRICT NO. P ES$ED B +PowerApparatus.&.Large Appliances'+ Size&Type.HP;'KW,KVA,.cr KVAR' .License Number 7"DcS 7•�J ;Lic.ClasscrCdLr?•�X Up to 1 Incl. FINAL /� q. v Over-1 to 10 Incl. r DATE VALIDATION Contractor�Fr�A /✓e LO/I/.t/d/L' Date �—�'d L/ i , :. Over 10.to 50 Incl.: FINAL; ElI'am eOver.50.to 1..0...0.Inc. exempt under Sec. 1 1 BY d Over'100 B.&P.C.for this`:reason !� Services,Swbd.;MCC&Panelboards Date: 0-200 Amp.Under'800 V Sighatdre. 201 - 1000 Amp.Under 600 V Over 1000 Amp.or.Over 6.00•V ❑, Exemption for Reg.Maint.Elect.. F SINGLE FAMILY ;temp..Power Pole 82 Appurtenances HOME OWNER-BUILDER DECLARATION. Sign with One Branch Circuit' ACCT A 1 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 Circ4its, ! 3307 , Code): • Nlisc:Conduits.&Conductors 1` ITEMS. " Eliias.owner of the property,will do the work and the structure �� (]�I[ is not,'infended,.or offered.for-sale ,(Section 7044; Business Other.(See Complete Fee Schedule) _ t. and.Professions Code). CHEM CONSTRU.CTION LENDING AGENCY -00 I hereby affirm that there is.a construction lending agency for the performance of thg work.for Which this permit-is issued(.Sec.3097, PERMITTEE (Sub Total) Civ,.C.). (: 'PLAN CHECKING FEE 0000-0001 4/30/90 Lender's Name. 2 11397 1' AM 9n02 PERMIT:ISSUING FEE ��/ Lend'er's Address 1 certify that I have read this application and state that the above TOTAL FEE information is correct.I agree fo comply With all County ordinances -and.State laws regulating Electrical wiring, and hereby authorize ��, representatives of this.County'to enter upon the above-mentioned i pro rtyfofoJr iinnsppe�ction+pu S. / SEE.REVERSE FOR EXPLANATORY"LANGUAGE I , !`�.�G%�+�tr� 1 � f��Gam' ', • Signature of Permittee Date + 0,biJ.*ln,w .41;? _rN r - 4� reb �r��r'�WORKERS'COMPENSATION DECLARATION 76A663 10/61 gppLICATION FOR ELECTRICAL PERMIT CE-BOBG.y (firm that I have a certificate of consent to self insure,certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab.C.) ,r Policy No. Company FOR APPLICANT TO FILL IN JOB (>o?� 1 S 13, EACH NO. FEE ADDRESS U� ' Certified copy is hereby furnished. New Residential Bldgs.&Pools - ❑ _ $ / Certified copy is filed with the county building inspection 1 &.2-Family,Sq.Ft. $ LOCALITY V department. Multi-family Sq.Ft. NEARESTCROSS ST. Date Applicant Residential Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' � IL Outlets:Rec Light Sw.— COMPENSATION INSURANCE ;,� � . ADDRESS (This section need not be completed if the work involved by the First 20 permit is for one hundred dollars($100)or less.) Total No. Additional CITY, Tel.No. PLAN CHECK I certify that in the performance of the work.for which this permit APPLICANT is issued, i shall.not employ any person in any manner so as to become-subject to Pe Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS �� yP Total No. Additional CITY Tel.No. Date Applicant NOTICE' APP.LICANT: If,. er Ing th' Certificate. .of Fixed Appliances Not Over 1 HP PERMIT y� n T- Exemption,you should become object -:the 1111 ars'Compensation Range_ Heater D.W. _ APPUCANT p 19f1 AI AD �?A16 PIP L 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. LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other:_ CITY Lp1 y Tel:No. I 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 Class. Professions Code,.and,my'license is in full force and effect. DISTRICT NO. PRO�SSD ' Power Apparatus&Large Appliances ,/I O Size&Type HP,KW;KVA,or KVAR _�i • v License Number Lic.Class Up to 1 Incl. FINAL•//. � 0 Over 1 to 10 Incl. DATE �� Contractor Date VALIDATION 0 0 Over 10 to 50 Incl. FINAL 0. 1 am.exempt under Sec: Over 50 to 100 Inc. BY W B.&P.C.for this,reason Over 100 N f 'Services,Swbd.,MCC&Panelboards Z Date: 0-200 Amp.Under 600.•V em Signature 209 - 1000 Amp.Under 600 V F] Over 1000 Amp.or Over 600 V - Exerrlption for Reg.Maint.Elect. SINGLE FAMILY' Temp.Power Pole:&Appurtenances NOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit Thereby affirm that I am exempt-from the Contractor's License Law Additional Sign Branch Circuits "' @ for the following reason(Section 7031.5,Business and Professions Code): � �s IOCI 1,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) , o andProfessions Wa 2 1.Code). �� 210CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a cpnstruction lending agency for the performance of the work for which this permit Is issued(Sec.3097, PERMIT FEE ZSub=Total) e Civ.C4. PLAN CHECKING FEE ' exp Lender's Name 8 PERMIT ISSUING FEE J 3484 {I IO Sa69 Lender's Address 1 certify that I have read this application and slate that the above. TOTAL FEE I2N?/� 610 information is correct.Pagree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above-76P oned property for inspection purpose SEE REVERSE FOR EXPLANATORY LANGUAGE _ igna a.of Perm' a Date �! 4 t, nrORKEItS`COMPENSATION DECLARATION CE-806 10/81 APPLICATION. FOR .ELECTRICAL PERMIT r.. I herb%:o'F•firm t9at 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 ora certified copy thereof(Sec..3800,.Lab. Ci) Policy No. Company FOR APPLICANT TO FILL.IN JOB Certified copy is herebyfurnished. New Residential Bldgs. &Pooh . FEE EACH NOADDRESS i , ❑ ((�' $ _ g LOCALITY Certified copy is filed with the county building inspec7 1 &2-Family, Sq. Ft. NEAREST tion department. Multi-family Sq. Ft. -- CROSS ST. /�,fs (� Residential Swimming Pools 'C ` OWNER OR r` ` �1 d• Date Applicant FIRM NAME �-D /7 NOW�`�� CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL Outlets: Rec_LLight�Sw. COMPENSATION'INSURANCE ADDRESS First 20 �d 3z6 (This section need not be red'doled if the work involved by Total Na. Additional. CITY w @ �t Tel. No. ' the permit.is for one hundred'dollars(;100)or less.) I certify that in the performance of the work for which this PLAN CHEC PPUCANT permit is issued, I shall not employ any person in any manner- - so as to becom subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS dQ� pA} Q�C��P Total No. ✓�{ Additional �s O CITY Tel. No. Data ''if, a t , �Kr1'!w ® Fixed Appliances Not Over 1 HP PERMIT NOTIC TO APPLICANT: If, after making this Certificate of APPLICANT Exemption, you. should become subject to the Workers' Range_ Heater—D.W. Compensation provisions of fhe 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 Tel. ko. LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other—' Disp. _ Room Air Cond. LICENSE OR Class. I hereby affirm,that I am licensed under provisions of Chapter 9 REG.NUMBER (commencingwith Section 7000 .of Division 3 of the Business ) �. Power Apparatus&Large Appliances DISTRICT NO. PRO BY and Professions Code,and my license is in full force and effect. CCCJJJ Size&Type HP, KW, KVA, or KVAR' License Number Lic. Class Up to 1 Incl. FINAL L,/� Over) to 10 Incl. DATE // CCSS//��'' JDAT116N �j— Contractor Date Over 10 to 50 Incl. FINAL / W ❑ I am exempt under Sec, Over 50 to 100 Inc. BY B.&P.C. for this reason Over 1.00 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 Ci►cuit ;14.8 7.9 A I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Additional.Sign Branch Circuits # 0 0 0 0 02 ' Professions Code): I,.as owner of the property, will do the work anal the Misc. Conduits 8 Conductors I 0 o 23.25 structure is not intended or offered for sale (Section Other(Sod-Complete Fee Schedul.e)_ _ 7044, Business and Professions Code). , o o 0 2 3 2 5 5 CONSTRUCTION LENDING AGENCY 02 4_$6 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.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address C 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 bnd State. laws regulating.Electrical wiring, and / hereby authorize representatives.of this County to enter upon the above-mentioned pr for inspection urpo v s. SEE REVERSE FOR EXPLANATORY LANGUAGE - stR � �6 . Si Lure o ermittee Date I h� �,V!/ORKERS'COMPENSATION DECLARATION M0019 APPLICATION FOR ELECTRICAL PERMIT Q ereby affirm that,I.have a icertif cote of consent to.self, CE a insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof(Sec. 3600, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOBp/ �^ r-1Certified copy is•hereby furnished.' New Residential Bldgs. &Pools EACH NO. FEE ADDRESS LV 0? ale LOCALITY /� hL �� ❑Certified copy is filed with the county building inspec, 1 &2-Family,.Sq. Ft. $ .y, Q tion department. Multi-family Sq. Ft. NEAREST CROSS ST./ € / tJ Date Applicant Residential Swimming Pools r OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' `3 MlY �ti N� /�1 T� ' Outlets: Rec Light Sw._ AIL COMPENSATION'INSURANCE ADDRESS (This section need not be completed if the work involved by Total NoFirst Mnal O CITY Tel. No. S�G the permit is for one hundred dollars(S100)or less.) . PLAN CHECK 1 certify that in the performance of the work for which this APPLICANT 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 Date Applicant ..Total No. 3 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' Range— Heater—D.W. — APPLICATIONy 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. No. LICENSED CONTRACTORS DECLARATION LICENSE OR Disp. — Room Air Cond. — Class: I hereby affirm that I.am licensed under provisions of Chapter 9 REG.NUMBER (commencing with Section 7000)of Division 3.of the Business Power Apparatus&Large Appliances DISTRICT NO. PROC SED BY >_ and Professions Code,and my license is in full force and effect. Size&Type Ii P, KW, KVA, or KVAR a O License Number Uc. Class U Up to 1 Incl.. FINAL Contractor Date Over 1 to 10 Incl. DATE S 7i�o L VALIDATION Over 10 to 50 Incl. FINAL ❑•, I am exempt under.Sec. Over 50 to 100'Inc. BY U LU B.$P.C. for this reason ! Over 100' IL Services, Swbd..,MCC&Panelboards , to Date., Z 7 0-200 Amp.-Under 600 V Signature I 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp, or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY HOME OWNER-BUILDER DECLARATION .Temp. Power Pole$Appurtenances 1 herebyaffirm that I am exem t from.the Contractor's License Sign with One Branch Circuit , P Additional Sign Branch Circuits Law for the following reason (Section 7031•.5, Business and 9 _ „ r~~ 'Professions Code): t•�s.� y�j Misc. Conduits&Conductors &I, as owner.of the property, will,do the work and the i 1""Ell Other See Complete Fee Schedule structure is not:intended or offered for sale(Section 7044, ( P. )— Business and Professions Code). , I I';Vit,{ ��;�'c;; L:� CONSTRUCTION LENDING AGENCY :i-,r•: 'I hereby affirm that there is a construction lending agency for the performance of the.work for which this,permit is issued PERMIT FEE P P (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE - Lender's Address :7,c•.-r I certify that I have read this application and state that}he I TOTAL FEE ,, t 1: above information is correct. I agree to comply with all County i ordinances and State laws regulating Electrical wiring, and hereby authorize representa'v sof this County to enter upon the above-mentioned pro r inspection p arpos, ! SEE REVERSE FOR EXPLANATORY LANGUAGE 3162 Si ature ermittee Date ®a • WORKERS'COMPENSATION DECLARATION -20-w19 DPW 3/87 f;Nereby affirm that I have a certificate of consent to self '7-80W APPLICATION FOR ELECTRICAL PERMIT insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof(Sec. 3800, Lab. C.) Policy No. I Company + FOR APPLICANT TO FILL IN JOB /� Q .E Certified copy,is hereby furnished. New Residential Bldgs. &Pools EACH NO., FEE ADDRESS L v/ar Certified co is filed with the count. building inspec-. 1 &2-Family, S Ft.— tion t. $ — $ LOCALITY ' PY t Y 9 ' P Y. q• ._ NEAREST tion department. Multi-family Sq. Ft. CROSS ST.Te%Y & ej VZ Date Applicant Residential Swimming Pools OWNER OR n AI CERTIFICATE OF EXEMPTION FROM WORKERS' � FIRM MAIL NAME /T0 me- CERTIFICATE I �A/p lT COMPENSATION INSURANCE Outlets: Rec Light Sw._First 20 ADDRESS (This section need not:be completed if the work involved by Total No.- Additional' CITY iA , L �l Tel. No. "the permit is for one hundred dollars($100)or less.), PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit is Issued, I shall not employ any person In any manner so as to become blect to the Workers'Compensation Law Lighting Fixtures First 20 ADDRESS Additional _ _11 Ae �,,,. Total No. CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT 'NOTICE fO 4PLICANT: If, a r m mg thl ertificate of APPLICATION Exemption, you should beome subject the Workers' Range— Heater—D.W. — Compensation provisions of the Labor Code, you must forth- Oven _ Dryer —W.M.— is ADDRESS with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. Hood — Fan —Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR Disp. — Room Air Cond. — class. I hereby affirm that I'am licensed under provisions of Chapter 9 REG.NUMBER (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances �, DISTRICT NO. --. PROCESSE Y d W4 Professions Code,and my license is in full force and effect. Size&Type HP, KW, KVA, or KVARJ' U License Number Lic. Class Up to 1 Incl. FINAL Over 1 to 10 Incl. I; DATE �� VALID N Contractor Date Over 10 to 50 Incl. FIN U I am exempt under Sec. Over 50 to 100 Inc. B LU B.&P.C. for this reason Over 100 ' a Services, Swbd., MCC&Panelboards �9 9 4 9 A `n Date: Z '0-'200 Amp. Under 600 V # 0 0 2 Signature 201 -:1000.Amp. Under 600 V o;o 0 DOver 1000 Amp, or Over 600 V ) 0 - 2(125 Exemption for Reg.'Maint. Elect. SINGLE FAMILYs HOME OWNER-BUILDER DECLARATION Temp, Power Pole&Appurtenances o'0 0 2 L 5 Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License SigQ (�.2 1 ,8 8 Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits I' Professions ia. Misc. Conduits&Conductors I' F� 1, as owner of the property, will do the work and the structure is not intended or offered for sale(Section 7044, Other(See Complete Fee Schedule)_ Business and Professions Code). CONSTRUCTION LENDING AGENCY ! i I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued PERMIT FEE (Subtotal) (Sec. 3097, Civ:C.). PLAN CHECKING FEE .Lender's Name PERMIT ISSUING FEE Lender's Address T I certify that I have read this application. and state that the O 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 f the above-mentionedpropertyO inspection pur oses SEE REVERSE FOR EXPLANATORY LANGUAGE G a� ®' .od'SigrATure of mittee Date 1lVt�RKERS'COMPENSATION.DECLARATION 70•°°19DPW 3is7 /k��+,A�'I®fie �®� �`��I RICAL PERMIT ,0'f•.hea 'affirm'that I'have a certificate of consent to self 76A663 .10 APPLICATION�fil tl`� insure, o&i certificate of^Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof°(Sec. 3800, Lab. C.) ` 1 Policy No. Company FOR APPLICANT TO FILL IN JOB, Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS V I Certified co is filed with the count building y, Sq. Ft. $ = $ LOCALITY copy ' y g inspec- i 1 &2-Family, tion department. Multi-family Sq. Ft. NEAREST Date Applicant 1 . Residential Swimming Pools _ CROSSNIEST. C V FIRM NAME y CERTIFICATE OF EXEMPTION FROM WORKERS' ► Outlets: Rec Light Sw._ AMAIL DDRESS 6a v COMPENSATION INSURANCE First.20le. tm (This section need not be completed if.the work involved by Total No. Additional CITY C Tel No. aJJ-324 the permit is for one hundred dollars,($100)or less.) PLAN CHECK `,I certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ any erson in any manner N so as to become subject to the Worker C ensation La s. Lighting Fixtures First 20 ADDRESS Additional Date 7 Total No. CITY Tel. No.: Applicant Fixed Appliances Not Over 1 HP PERMIT NOTIC TO-APPLICANT: If, after making thi Certificate of • APPLICATION Exemption, you should become subject thf 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. Hood — Fari —Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATION LIC,ENSE OR I.hereby affirm that I am licensed.under provisions of Chapter 9 Disp. — Room Air.Gond. -� REG. NUMBER Class. (commencing with.Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PROCESSE a and Professions Code,:and my license is in full force and effect. �} Size&Type HP, KW, KVA, or KVAR t V U License Number Lic. Class Up to 1 Incl. FI�AL Over 1 to 10 Incl. D. TE �j� V LIDATION 0 Contractor Date i, Over 10.to 50 Incl. F NAL U ❑ 1:am,exempt under Sec. n Over 50 to 100 Inc. B B.&P.C. for this reason Over 100 LU Services, Swbd., MCC&Panelboards ® �:Q 2 9 A Z Date: 0-200 Amp. Under 600 V Signature 201. - 1'000 Amp. Under 600 V # 0 0 0 0 0 2 Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole&Appurtenances ( o,o-1 4.00 HOME OWNER-BUILDER DECLARATION' I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit o 0 0 A p,0 0 53 Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): ,0 7.2 5,—8 8 PVT I, as owner of the property, will do the work and the Misc. Conduits&Conductors structure is not intended or offered for sale(Section 7044,1 Other(See Complete Fee Schedule)_ 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,' PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSl11NG FEE Lender's Address 1, I certify that I have read this application and state that the TOTAL FEE i above information is correct. I agree to comply with all County ordinanc s and State laws regulating Electrical wiring, and hereby ntio;nreperty for inspection purposes.ufhorize representatives of this County to enter upon thea e-me SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Dat ®a t ,