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Home My Public Portal About5551 PERSIMMON AVE_Electrical__ 16ACE-8667C.Q;j, 78' APPLICATION F ELECTRICAL PERMIT' _ COUNTY OF LOS ANGELES BUILDING AND SAFETY -FOR APPLICANT TO FILL IN !:' JOB . New Residential Bldgs.&Pools EACH NO. FEE ADDRESS '1&2-Family,Sq.Ft. $ ..025 — $ LOCALITY C ,o Multi-family Sq.Ft. .02 — NEAREST Residential Swimming Pools 25.00CROSS ST.OWNER OR FIRM NAME' �?Ll��"f C7 Outlets:Rec—T—Lighf Sw. MAIL -First 20 .50 ZO b00 ADDRESS I Total No. Additional •}:•30 45T t CITY Tel.No...... v PLAN CHECK z APPLICANT Lighting Fixtures First 20 -.50 ' 7 ADDRESS , Additional .30 Total No. � CITY Tel.No. . Fixed Appliances Not'Over I.HP PERMIT ••7 - - ^ �� Range—Fieater—DAPPLICANT.W._ - ` Oven_Diyer_ -ADDRESS W.M.W.M— � f Top _•FAU —W.H._ CITY ' rel,No. • io-j 6 n� -(o Hood_Fan —Other LICENSE OR 7 ' Disp._Room Air Cond. 2.50 REG.NUMBER �j�. S.� Class. _ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI.CA + Power Apparatus&Large AppliancesTION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO Size&Type HP,KW,K.VA,or KVAR COMPLY WITH ALL COUNTY ORDINANCES-AND STATE "LAWS REGULATING ELECTRICAL WIRING. Up to 1 Incl: '' 2.50 1 HEREBY ERTI Y THAT'I AM P RL EGISTERED AND%OR U Over 1 to 10 Incl, 5.00 LICENSED AS RE I Y LOS A LES C TY AND STATE OF 29 Over.10 to 50 Incl. 12.50 CALIFORNIA OR, T I AM,THE L L ER QF TFIE.ABOVE ODESCRIBED RESIDE' L ROPERT Over 50 to 100 Inc. 25.00 Over 100 40.00. . PERMIT.EE._ SIGNATURE-_ y� Services DISTRICT NO. PROLES D BY - 0-200 Amp:Under 600.V 12.50 ' l `d. O 201-1000 Amp.,Under 600'V 25.00 �, U Over 1000 Amp.or Over 600 V 50;00 jq,a Z -10:00Temp.Power Pole&APPurtenances '✓ ///v r Q Sign with One Branch Circuit 10,.00 M Additional Sign Branch Circuits 2.00 INSPECTION .4 10:00 INFORMATION Misc.Conduits&Cbnductors ON REVERSE x Other(See Complete.Fee Schedule) SIDE u :'6 9 6 ti Z ` PEkMIT FEE •(Sub-Total) - p ° °•35UC PLAN CHECKING FEE. !One-Fourth Permit Fee) O ° ° ° U'� PERMIT ISSUING FEE $7.00 . o 1 Q o TOTAL FEE V D !A > INSPECTION FINALED W ' date: m� �� .'By04, d es WORKERS'COMPENSATION DECLARATION CE-8W 10,81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that 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 or a certified copy thereof(Sec. 3800,Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN , JOB' ! ADDRESS 6556 C-5(yyl 0 t ❑ Certified copy is hereby furnished. jNew Residential Bldgs..&Pools EACH NO. FEE I ❑ Certified copy is filed with the county building Inspec- 1 &2-Family, S q. Ft. $ — $ LOCALITY — 1Emp1E tion department. Multi-family Sq. Ft. 'NEAREST Residential Swimming Pdols CROSS ST. sjjl/ Ira: Date Applicant. OWNER OR FIRM NAME ♦� EL/A( CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RecLi ht � MAIL l, g �Sw. ,,//�� COMPENSATION INSURANCE 'ADDRESS - A- AQ First 20 L (This section need not be completed if the work involved by Total No. A Additional CITY �� 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 subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional \� CITY Tel No. ' xDate L�' �-L'8� Applicant� ��`� Fixed Appliances Not Over 1 HP PERMIT 'NOTICE TO APPLICANT: If, after making tis Certificate of APPLICANT //I/EQ°!/t16- Exemption, you should become subject to the Workers' Range— Heater_D.W. — Compensation provisions of the Labor Code, you must forth- Oven —Dryer —W.M.— ADDRESS 554/6 E, �� av with, comply with- such provisions or this permit shall be Top — FAU —W.H. deemed revoked. — CITY�j� �u! Tel. IVo. �� 7�ib Hood — Fan _Other— LICENSED CONTRACTORS DECLARATION ' 'LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REG.NUMBER �J�Y�J Classel)-O (commencing with Section 7000)of Division 3 of the:Business DISTRICT NO. PROCES BY and Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances. L f� ¢ /S�os IL Size&Type HP, KW, KVA, or KVAR' J �0 0 _ZZ, 0 .License Number Lic. Class 'tY FINAL � Up to 1 fncl. DATE d(,-� -� I9 /� �yj 1�,� Over 1.to 10 Incl. VALIDATION Contractor�// tt / Date Over 10 to 50 Incl. FINAL I am exempt under Sec. Over 50 to 100 Inc. BYJ UI B.&P.C. for this reason Over 100 / Services,Swbd., MCC&Panelboards ► �� J 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. �. SINGLEFAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign.with.One Branch Circuit 0 0 0 0 I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits r Law for the following reason (Section 7031.5, Business and u o Professions Code): ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ 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 issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the I TOTAL FEE' ��s 0 , 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 for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE H-1.1-83 Signature of Permittee Date WOrm that I have cerci DECLARATION CE-806'1 ,D,B, APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self SCE-806G insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a cgrtified copy thereof(Sec. 3800, Lab. C.) j /� 1 e Policy No. Company FOR APPLICANT TO FILLADNO. FEE ADJOB DRESS / ` rte/ rl'(ID Al , Certified copy is hereby furnished. New Residential Bldgs. &Pools ❑ 1 &2-Family, S Ft. $ — $ LOCALITY e I Certified copy is filed with the county building inspec- y' q' NEAR tion department. Multi-family Sq. Ft. ESTCROSS ST. LZ G Date Applicant Residential Swimming Pools OWNER OR ,� d FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' � -O— MAIL Outlets: Rec�Li ht Sw. l COMPENSATION INSURANCE g DDRESS tThis section need not be completed If the work Involved b - 6• First 20 he permit Is For one hundred dollars($100)or less.) Y Total No. Additional CITY LL e �` Tel. No. that in the performance of the work for which this PLAN CHECK I certify P 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 VV ADDRESS Total No. Additional Applicant CITY Tel. No. Date Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT 1 Exemption, you should become subject to the Workers' Range_ Heater—D.W. — Compensation provisions of the Labor Code, you must forth- Oven —Dryer —W.M.— ADDRESS 0 •� with comply with such provisions or this permit shall be Top _ FAU —W.H. VFW — deemed revoked. CITY • Tel. No. s• LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_ W Disp. _ Room Air Cond. LICENSE 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 DISTRICT NO. PROCESSED BY and Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances 06 Size&Type HP, KW, KVA, or KVAR S O License Number 13�0�- Lic. Class [3 Up U Up to 1 Incl. 09 pgal (r, �ejl��r-L.LL°�[�L' F–S Over 1 to 10 Incl. DATE �,t� .�r VALIDATION Contractor 15�T It Date Over 10 to 50 Incl. �+ FINAL ❑ I am exempt under Sec. Over 50 to 100 Inc. BY B.&P.C. for this reason Over 100 Services, Swbd., MCC&Ponelboards ?Q nm 0 -200 Amp. Under 600 V Signature �" 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V . Exem tion for Reg. aint. Elect. SINGLE FAMILY Temp. Power Pole&Appurtenances „ t HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits ' 1 Law for the following reason (Section 7031.5, Business and ` Professions Code): r ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ , 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 issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that they TOTAL FEE above information is correct. I agree to comply with all County ordinances and State jaws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE d ignature of Per F Date