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Home My Public Portal About9822 OLIVE ST_Electrical__ VAea.Ce80610_0;�� APPLICATION FOR ELECT RIC PERMIT 1 COUNTY OF LOSANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING 9822 Olive BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY Temple City Y• 77 FOR APPLICANT TO FILL IN NEAREST PERMT FEES CROSS ST. 1 TEM NUMBER I EACH FEE OWNER Johnson I, MAIL OUTLET14 HECzFT6 Bw. 4 14 S .i0 $ 1 40 ADDRESS LIGHTS LIGHTING FIXTURES 4 .10 40 CITY TEL.NO. ELEC.RANGES CLO.DRYERS ELECTRICIAN PTeWton Electric WATER HEATERS .50 ADDREss21 2 Daniels Ave ELrr_W.&Q =. DISHWASHERS 1 �5 CITY :^ est Covina -7 TEL.NO. Ed GARBAGE DISPOSERS AUTO.- STATE C 10 140901 WASHERS STA.COOKING UNITS .25 LICENSE NO. MOTORS: OVER INC H.P. DIST CT NO. I GROUP ZONEP OCESSE fan 0— Vs 1 •25 125 : -r6 ::I�- Vs— 2 .50 INSPECTION RECORD 2— 5 1.00 5— 15 1.50 15— 50 2.50 50-200 5.00 SIGNS: NO.TRANS. NO.LAMPS SERVICE 0-500V 1 1.50 1 SERVICE OVER 600V 5.00 MISC.. WIRING PERMIT 1.00 FIXTURE PERMIT 1.00 1 00 SUPPLEMENTARY PERMIT SO TOTAL FEE ls5 130 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT ELECTRICAL WIRING. WIRING 1 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 HE LEGAL OWNER OF THE ABOVE ' DESCRIBED RESIDENTIAL PR POWER ♦♦� ,� ��f SIGNATURE C , UTILITY CO.NOTIFIED OF PERMITTE FINAL I --- �p / ATION SUPERVISING ELECRI TCAL ENGINEER / -CKMO CASH .`�1 1 0 '7 " o 2 D 5.3a WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT I hereby atfirm'tJtat I have a certificate of consent to self insure, 76A863 or a certificate bf Worker's Compensation Insurance, or a certified COUNTY F LOS ANGELES T.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab.C.) � � �1.•�l Policy No. - Company FOR APPLICANT TO FILL IN g NO. EACH FEE ADDRESS Residential Bldgs.& Certified copy is hereby furnished. New RPools ❑ _ � $ $ LOCALITY , q Certified copy is filed with the county building inspection 1&2-Family,Sq.Ft. NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR NMP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. O ER OR O COMPENSATION INSURANCE RM NAME cy (This section need not be completed the work involved by the First 20 Total No. Additional ADDRESS�% � permit is for one hundred dollars($7000)or less.) I certify that in the performance of the work for which this permit CITY _� ei.No. 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 j Total No. Additional ADDRESS Date fv' 19 q 9�pplicant �h- NOTICE TO APPLICANT: If, after making this ertificate of RESIDENTIAL APPLIANCES NOT OVER 3 HP. CITY Tel.No. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. PERMIT provisions of the Labor Code, you must forthwith comply with such power Apparatus&Large Appliances APPLICANT provisions or this permit shall be deemed revoked. 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 Over 50 to 100 Incl. REG.NUMBER Class. IZ License Number Lic.Class Over 100 DISTRICT NO. Q� P O�G SSED BY Q ces,Swbbd.,MMCCCC&Panelbbooarrdds / ®a CG�'� � U Contractor Date '��r,3 S9�Amp.1800 V P / O FINAL DATE ,,� 400-1000 Amp.Under 600 V r �E ~ ❑ I am exempt under Sec. 7r'' .2VALIDATION V Over 1000 Amp.or Over 600 V FINAL SLI B.&P.C.for this reasonBY BRANCH CIRCUIT FEES �- Date: 15A,or 20 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 SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I 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 Circuits Code): 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) 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. 3097, PERMIT FEE (Sub-Total) Civ.C.) PLAN CHECKING FEE Lender's Name •/y'F��`�" PERMIT ISSUING FEE <� 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 represen atives of this County to enter upon the above-mentioned property for.hi pe ion purp 0, SEE REVERSE FOR EXPLANATORY LANGUAGE TUR OF PERM EE DATE IN WORKER S'COhIPENSATIONDECLARATION CE-800,G (2-800 it AP LICATION FOR ELECTRICAL PERMIT CE-BO Thereby affirm,that I have a certificate of consent to self COUNT OF LOS ANGELES �",C� BUIILDINC��INDSAFETY insure,or d'certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) FOR APPLICANT TO FILL IN JOB Policy No. Company EACH NO. FEE ADDRESS c New Residential Bldgs!&Pools C3 Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY CiTY Certified copy is filed with the count buildin Multi-family Sq.F`t. NEARESTLOF y g inspection CROSS ST d-Z department. Residential Swifnming Pools OWNER OR FIRM NAME Date Applicant Outlets: Reclkight-04.Sw. �L .ia ® MAIL V k," First 20 ADDRESS Rt CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Total No. #I Additional o t 610CITY Tel No. -� � > PLANK D- APPLIC O (This section need not be completed if the work involved Lighting Fixtures First 20 CC U by the permit is for one hundred dollars ($100) or less.) ADDRESS Additional Total No. Is CITY 1 No. Q 0 I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP permit is issued, I shall not employ any person in any manner PERMIT a so as to become subject to R orkers'Comp ens ion Laws. Range_Heater D.W._ APPLICANT UA � �.� Oven _ Dryer_W.M._ ADDRESS U) Date-Z /Applicant Top FAU _/W.H. _ Hood Fan Other_ CITY Tel No. NOTICE TO APPLICANT: If, after making this Certificate of Disp. _Room Air Cond._ SU LICENSE OR Exemption, you should become subject to the Workers' REG.NUMBER Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCES ED BY , with comply with such provisions or this permit shall be I %® deemed revoked. Size&Type HP,KW,KVA,or KVAR , Up to 1 Incl. 5l3 s C' i_-v� s'✓ FINAL LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATEVALIDATIONOver 10 to 50 Incl. I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL 9 (commencing with Section 7000)of Division 3 of the Busi- Over 100 BY ness and Professions Code, and my license is in full force and effect. Services License Number 0-200 Amp.Under 600 V Lic.Class 201.1000 Amp.Under 600 V Contractor 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 Hess an Professions Code)-. Misc.Conduits&Conductors I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)— structure 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 PERMIT FEE (Sub-Total) issued(Sec.3097,Civ.C.). Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE 1 certify that I have read this application and state that the TOTAL FEE (6; above information is correct.1 agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon th�.e3stive-mentione pro ty lo inspection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGESignature of Permi tee Date i