The URL can be used to link to this page

Home My Public Portal About9950 OLIVE ST_Electrical__ 1 75A659-GE8061/70 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS (�J JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY �~ COLEMAN W. JENKINS SUPERINTENDENT OF BUILDING NEAREST fj . FOR APPLICANT TO FILL IN CROSS ST. OUTLETS NO. EACH FEE. R5 OWNER ,1t. 7 RECEPT._ $ $ ADDRESS LIGHT TOTAL FIRST 20 20 —rye OVER 20 CITY ��,r,,-�•�*.. �" TEL. N0. SWITCH_ 10 PLAN CHECK FIRST 2020 APPLICANT LIGHTING' TOTAL } OVER 20 ADDRESS FIXTURES ! .10 APPLIANCES CITY TEL. N0. PERIT RANGE-M.DRER_WTR. HTR. APPILICANT '° �, {t dam+" '/7e^� � • STA. COOK DISP. F.A.U. ADDRESS 4, � jrM.JJ�'/..L•'/- ?,..- � SPACE HTR. AIR GOND. - CITY ,.$l5�1 F �!'i�tr/f� TEL:NO. CLOTHES WASH. DISHWASH. LICENSE NO. CLASS. 11 FAN OTHER 1.00 eo 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION: AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE' LAWS REGULATING IND. HEATERS, ETC. HP. KW.KVA. ELECTRICAL WIRING. > SIZE & TYPE OVER TO - 0. I HEREBY CERTIFY THAT I AM PROPERLY REGISTER.ED'AND/OR 0 - I 1.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF O CALIFORNIA OR THAT,11AM THE Ll;gkAL OWNER OF, AND INTEND.TO V .RESIDE IN, THE:. KBOVVE DESCPISE.D RES I$ENTIAL PROPERTY. IIJ I — 10 4.00 SIGNATUE 10 — 50 5.00 OF P$RMRTTEt= -'v?�tEPrl% t -- .' - $O - 100 10.00 DISYRICTNO. CLASS GROUP ZONEF.` ;P5dCESS f Q 100 — 500 1'5.00 / ,[. i, 9390 SIGN, GAS SIGN AND ONE CIRCUIT 3.00 NOTES: TUBE, OR Lu MARQUEE ADDITIONAL CIRCUITS 1.00 ~ SERVICE NOT OVER 600 VOLTS OR 200'AMP 2.00' APPROVALS DATE INSPECTOR'S SIGNATURE SERVICE OVER 600 VOLTS OR 200 AMP 5.00 TEMP.POWER POLE TEMP SERVICE,POLE,&APPURTENANCES 3.00 • UNDERSLAB WORK kPERMIT OR RECEPT. SYSTEM 3.00 ROUGH CONDI UT WIRING (SUB TOTAL) FIXTURES POWER AUTHORIZED FEE (50% PERMIT FEE) UTILITY CO. NOTIFIED UING FEE 2.00FINAL TARY PERMIT ISSUING FEE 1.00 JOSEPH C. ROOHAN TOTAL FEE SUPERVISING ELECTRICAL ENGINEER PLAN CHECK VALIDATION PERMIT VALIDATION lK„ M.O. CASH C 0. C S H p g� q r SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE WORKERS'COMPENSATION DECLARATION -CE 8o6G 10/81 APPLICATION FOR ELECTRICAL PERMIT k.heO�•affirm that I have a certificate of consent to self insure, or a ca?tificatf 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 �/� ❑ Certified copy is hereby furnished. EACH NO. FEE ADDRESS _J New Residential Bldgs.&Pot71s ❑ 1 &2-Family,S Ft. $ _ $ LOCALITY Certified copy is filed with the county building inspection y Q NEAREST department. Multi-family Sq.Ft. CROSS 3T Date Applicant Residential Swimming Pools FFIIRM NAME 7::*6YQiC. CERTIFICATE OF EXEMPTION FROM WORKERS' OutlLi1L MAIL r g COMPENSATION INSURANCE ets:Rec Light Sw. ADDRESS (This section need not be completed If the work Involved by the First 20 Total No. Additional CITY.----- Tel.No. permit Is for one hundred dollars($100)or less.) ,L ) I certify that in the performance of the work for which this permit PLAN CHECK an APPLICANT is issued, I shall not employ y person in any manner so as to I� become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 V ADDRESS ' � Total No., Additional CITY Tel.No. Date +J — Applicant Fixed Appliances Not Over 1 HP NOTI E TO APPLICANT: If, after making this Certi Icate of 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 provisions or this permit shall be deemed revoked. Top — FAU _ W.H. CITY Tel.No. LICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other_ I hereby affirm that 1 am licensed under provisions of Chapter 9Disp. — Room Air Cond. LICENSE OR (commencing with Section 7.000)of Division 3 of the Business and REG.NUMBER Class. Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO. 0 PROCESS D BY Size&•Type HP,KW,KVA,or KVAR S 0 8 License Number Lic.Class Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE Contractor Date. VA ATION O Over 10 tb 50 Incl. FINAL E] I am exempt under Sec. Over 50 to 100 Inc. :4BY W B.&P.C.for this reason Over 100 N Services,Swbd.,MCC&Paneiboards ® Z Date: 0-200 Amp.Under 600 V s Signature 201 - 1000 Amp.Under 600 V ❑ Over 1000 Amp.or Over 600 V 1 13,3A Exemption for Reg.Maint.Elect. )'! 0 0 0 0 0 2 SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit o o 5 5 U I hereby affirm that I am exempt from the Contractor's License Law x for the following reason(Section 7031.5,Business and Professions Additional Sign Branch 5 Circuits o 0 0 2 5 5 C code: 11, 1 5—8 8 110, _ 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 PERMIT ISSUING FEE l/ 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 lai re la'n Electrical wiring, and hereby authorize representatip s of C unty t enter upon the above-mentioned property f F mspe se . , SEE REVERSE FOR EXPLANATORY LANGUAGE Si $t of Pe mittee Date affirm that COMPENSATION DECLARATION CE 806G '°'s' APPLICATION FOR ELECTRICAL PERMIT Thereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.380.0,.Lab.C. Policy NO.WMC2 CQny s FOR APPLICANT TO FILL IN JOB 1Z Certified copy is herebyfurnished. EACH NO. FEE ADDRESS C New Residential Bldgs.&Pools $ _ $ LOCALITY F1 'Certified copy is filed wit the county building pection 1 &2-Family,Sq.Ft. department. Multi-family Sq.Ft I NEAREST G � I CROSS ST. Date Appli • Residential Swimming Pools OWNER OR r FIRM NAME CERTIFICATE.OF EXE PTI.O FROM WORKERS' 3 MAIL Outlets:RecA__Light Sw. COM.PENSA ON SURANCE XV ®� ADDRESS9 le a This section need not be co eted if the work involved b the ,First 20 ( y Total No. Additional CIT ,. Tel.No. permit is for one hundred dollars($100)or less.) I certifythat in the performance of the work for which this permit PLAN C C P P APPLICANT a" 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 a Additional Total No._ CITYTel.No. . Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT 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 provisions or this permit shall be deemed revoked. Top — FAU _ W.H.._ LICENSED CONTRACTORS DECLARATION Hood CITY Fan Other_ _ I.No. cclf �I 1 hereby affirm that I am licensed under provisions of Chapter 9LICEN OR Disp.. - Room Air Cond. REG.NUMBER Class. 1 (commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT'NO. PROCESSED BY Size&Type HP,KW„KVA,or KVAR Q License umber �8 Lic.Class- ,a —/ Up to 1 Incl. FINAL �+ Over 1 to 10 Incl. DATE VALIDATION � Contrac ate "' Over 10 to 50 Incl. FINAL ❑ I a .exempt under Sec. Over 50 to 100 Inc. BY /JA .l W P.C.for this reason Over 100 f �` Lv Services,Swbd.,MCC&Panelboards Date: 0-200 Amp.Under 600 V .001 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 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ACCT.0 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 1Yo Code): Misc.Conduits&Conductors I,as owner of the property,will do the work and the structure Other(See Complete Fee Schedule) _ 1 ITEM n is not intended or offered for sale (Section 7044, Business and Professions Code). ® TOTAL 1 o 75 CONSTRUCTION LENDING AGENCY CASH 19.75 1 hereby affirm that there is a construction lending agency for the WIN OD performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub Total) nOD Civ.C.). PLAN CHECKING FEE Lender's Name Q/ 4/89 PERMIT ISSUING FEE } Lender's Address 4191 1 M12311 I certify that I have read this application and state that the above TOTAL FEE 7 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 f�insrpecI p r SEEREVERSE FOR EXPLANATORY LANGUAGE Signatureee Date