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Home My Public Portal About5645 PERSIMMON AVE_Electrical__ 78A668_GEec& -b°.. :APPLICATION FOR EL CTRICAL PERMIT 'COUNTY OF LOS ANGELES DEPAKTMENT-OF COUNTY ENGINEER B UILDING + BUILDING AND SAFETY DIVISION ADDRESS44' rS/ h. v_ + JOHN A. LAMBIE, COUNTY ENGINEER WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN cRosa ST. _jVA IG RECEPT. TOTAL NO, EACH FEE OUTLETS FIRsr 20U+ $2O B IIIA OWNER. LIGHT `� MAIL + ADD'L ////�� .t0 ADDRESS SWITCH. OVER 20 /r7 LIGHTING TOTAL FIRST 20 JZ .20 CITYsox fjpszn /i TEL.NO. FIXTURES } / AOD'L .tp ELECTRICIAN OV R 20 RANGES CLO.DRYERS WTR.HTRB. 1.00 ADDRESS S GARB.DISP. BTA.COOK • _ CITY T TEL.NO. �"ic7y DISHWASH. AUTO.-WASH. SPACE HTRB. BTA.APP.I V$H.P.MAX.)91.00 .50 LICE MOTORS, OVER NOT OVER H.P DIST T G� ZONE P SSED BY O t t s 1.5o INSPECTION RECORD a S 82.00 V a t s115.00 2.50 _ O is so3.00 so 100 - d h SIGNS, NO.TRANS. Z NO.LAMPS SERVICE 0.600V-NOT OVER 200A /r 1.00 SERVICE O-SOOV-OVER 200 A. 2.00 SERVICE OVER 600V 5.00 MISC. kyr ee7m .. 9 d PERMIT ISSUING FEE V 2.00 SUPPLEMENTARY PERMIT ISSUING FEB1.00 TOTAL FEE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATIC THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL-COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERID AND/OR A^ LICENSED A8 REQUIRED BY LOS ANGELES COUNTY AN STATE OF FIXTURES CALIFORNIA OR THAT 1 AM THE LEGAL ClyfMOF THE A OVIC DESCRIBED RESIDENTS AL-P E POWER SIGNATURE ' UTILITY CO.NOTIFIED OF PERMITTEE FINAL VA IDATION ARTHUR C. VEI C MO , .CASH SUPERVISING ELECTRICAL ENGINEER 0 2 O.1 2 Q 14AY 2 52 D �. 0.9 ON V "W� L!1 ... Y s 7'159_r'E806117Q APPLICATION FOR ELECTRICAL ER.MIT COUNTY GF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING /'s/, yyl !l BUILQING AND SAFETY DIVISION ElyCOLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IIV CROSS ST. OUTLETS NO. EACH I FEE $ $ OWNERAmes 4t � RECEPT._ MAIL n FIRST 20 ADDRESS LIGHT TOTAL 25 Gs /. V'� OVER 20 CITY EL. NO-11-e12^� O SWITCH 10 PLAN CHEC LIGHTING TOTAL FIRST 20 ,25 APPLICANT FIXTURES .f0 OVER 20 ADDRESS APPLIANCES CITY TEL. N0, PERMIT RANGE DRYER_WTR. HTR. APPLICANT Ode) STA. COOK DISP. F.A.U. ADDRESS SPACE HTR. AIR GOND. CITY TEL. NO. CLOTHES WASH. DISHWASH. LICENSE NO. CLASS. FAN OTHER 1.00 1 HEREBY ACKNOWLEDGE THAT I 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 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 - 1 1.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO } 1 - 10 3.00 RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. �- 10 = 50 5.00 OF PERMRITTE , I, 50 - 100 10.00 DISTRICT NO. CLASS ZON S BY Q 100 - S00 15.00 '~V r SIGN, GAS=SIGN ONE CIRCUIT 5.00 NOTES: / h TUBE, OR ? MARQUEE ADDITIONAL CIRCUITS 1.00 SERVICENOTOVER 600VOLTS OR200AMP3.00 APPROVALS DATE INSPECTOR'S SIGNATURE S ERVI CE OVER 600 VOLTS OR 200 AM P 10.00 TEMP.POWER POLE TEMP SERVICE,POLE,&APPURTENANCES 5.00 UNDERSLAS WORK TEMP LIGHT OR RECEPT. SYSTEM 3.00 ROUGH CONDIUT WIRING FIXTURE% POWER AUTHORIZED PERMIT FEE (SUB TOTAL) UTILITY CO. NOTIFIED PLAN CHECK FEE FINAL v PERMIT ISSUING FEE 3.00 JOSEPH C. ROOHAN TOTAL FEE SUPERVISING ELECTRICAL ENGIN P, PLAN CHECK VALIDATION CK. M.6. cASH PERMIT VALIDATION CK'. M.O. CAS 1 4 j s;ti JUL 15 2 D 6.00- SEE .00cvSEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 76AG63=tESOC, 47D APPLICATION FOR ELECTRICAV PERMIT lul w- • , COUNTY OF LOS ANGELES � DEPARTMENT OF COUNTY ENGINEERj DING BUILDING AND-SAFETY DIVISIONESS ¢ �+�5 1 rNt1 e COLEMAN W. JENKINS SUPERINTENDENT OF BUILLITY r FOR APPLICANT TO FILL INREST S ST. OU LETS NO. EACH $ $ OWNER ` o9, RECEPT. MAIL fC LIGH T FIRST 20 .25 ADDRESS OVER 20 r CITY r t TEL. NO. 7-1 . SWITCH f0 PLAN CHECK LIGHTINGTA F10IRST 20 .25. APPLICANT FIXTURES OVER 20 ADDRESS APPLIA14CES CITY TEL. NO. PERMIT RANGE DRYER_WTR. HTR. APPLICANT STA. COOK DISP. F.A.U. ADDRESS SPACE HTR. AIR COND. CITY TEL. NO. CLOTHES WASH. DISHWASH. LICENSE NO. CLASS. FAN OTHER 1.00 1 HEREBY ACKNOWLEDGE THAT I 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. S1ZE & TYPE OVER TO I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/Op 0 — 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM TME LEGAL OW OF, AND INTEND TO >. I — 10 3.00 RESIDE IN, THE ABOVE DESCRIBED (DENTIA O SIGNATURE C V 10 - 50 5.00 S OF PERMITTEE I, 50 - 100 10.000 DISTRICT NO. CLASS P 0 Y 100 - 500 15.00 f ZO D� a SIGN, GASSIGN AND ONE CIRCUIT 5.00 NOTES: N Z TUBE, OR MARQUEE ADDITIONAL CIRCUITS IAO SERVI CENOTOVER 600 VOLTS OR 200 AMP 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE SERVI CEOVER 600 VOLTS OR 200 AMP 10.00 TEMP.POWER POLE TEMP SERVICE,POLE,&APPURTENANCES 5.00 TEMP LIGHT OR RECEPT. SYSTEM 3.00 1 UNDERSLAB WORK ROUGH CONDIUT WIRING FIXTURES PERMIT FEE (SUB TOTAL) POWER AUTHORIZED UTILITY CO. NOTIFIED PLAN CHECK FEE FINAL PERMIT ISSUING FEE 9.00 CrV JOSEPH C. ROOHA TOTAL FEE R SUPERVISING ELECTRICAL ENGIN PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH Ar'. 1 5 7 Oi;� JUL22 2 a 55.0' 0— n \ SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE ' 3AG63-CESOS 10-81 APPLICATION FOR EL CTRICAL ERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING A BUILDING AND SAFETY DIVISION ADDRESS. ,V JOHN A. LAMBIE. COUNTY ENGINEER i " WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN I CROSS ST. T E M NO. I EACH FEE OUTLETS-. (FIRST 20) $.20 $ OWNER V LIGHTS RECEPT. SW MAIL OUTLETS: (ADD'L UNITS) f0 ADDRESS LIGHTS RECEPT. SW I LIGHTING FIXTURES: (FIRST 20) ,20 CIYY TEL.NO. LIGHTING FIXTURES: (ADDITIONAL) .10 ELECTRICIAN RANGES CLO.DRYERS WTR.HTRB. 1.00 ADDRESS p GARB.DISP. STA.COOK CITY TEL.NO. DISHWASH. AUTO.-WASH. STATE SPACE HTRB. STA.APP.(+A H.P.MAX.) .50 LICENSE NO. MOTORS: OVER NOT OVER H.P.. DISTRICT G P TE O 1 1.00 I i5 1.50 j INSPECTION )RD, 2.00 D_ g - 15 2.50 I /� U A � 15 SO 5.00 I `T f O 50 100 5.00 ' G W. d SIGNS: NO.TRANS. "" h NO.LAMPS Z SERVICE 0-600V-Nor OVER 200A 1.00 SERVICE 0-600V+OVER 200 A. 2.00 SERVICE OVER 600V 5100 MISC. I PERMIT ISSUING FEE 2.00 { SUPPLEMENTAIlY PERMIT ISSUING FEE 1.00 ;{ TOTAL FEE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INBPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT �•� WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING •'I' 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR I -" LICENSED AS REQUIRED BY LOS ANGELES.COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT 1 AM THE,L� OW F E i DESCRIBED RESIDENTIAL P e AB VE POWER00 , SIGNATUREUTILITY CO.NOTI ED OF PERMITTEE I FINAL LIDATIO,N ARTHUR C. VEIT CK MO CpgH SUPERVISING ELECTRICAL ENGINEER - •r 1 2 D 3 .40 r. 1 I WORKERS°'COMPENSATION DECLARATION I CE-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT CE-806G n i I hereby affirm that I have a certificate of consent to self COUNTY OF LOS'ANGELES .T G BUILDING AND SAFETY insure,or a certificate of Workers'Compensation Insurance,or a certified copy th Sec.3800:,Lab:C,) ✓ •, •I FOR APPLICANT TO FILL INJpg Policy No. Company. EACH NO. FEE ADDRESS m I New Residential Bldgs.&Pools ('t� Certified copy is hereby furnished. 1 &2-Family.Sq. Ft. $ —' $ LOCALITY _ C1 ❑ Multi-family Sq. Ft. — NEAREST Certified copy is filed . its h the.county building inspection C ROSS ST i department. ` Residential Swimming.Pools- OWNER OR FIRM NAME maQ U) Rao Date Applicant Outlets: Rec.�Light • Sw.� d MAIL �e/, First 20 ADDRESS CERTIFICATE 6F EXEMPTION FROM WORKERS' Total No.hk Additional CITY y �, Tel No. �� } COMPENSATION INSURANCE t. 4. PLAN CHECK t APPLICANT Q (This section-need not be completed if the work involvedS by the permit is for one hundred dollars ($100) or lessU Lighting Fixtures First 20 . O) ADDRESS I Additional Total No. Q I certify that in the performance of the work for which thisCITY Tel No. Fixed Appliances Not Over 1 HP permit is issued, I shall not employ any person in any mannerPERMIT t so as to.become subject tothe orkers'Comp ation Laws. Range_Heater D.W. _ - APPLICANT C - Oven _ Dryer W.M._ AD'DRESS N Date •I -Ap . Top =FAU _W.H. plican - { Hood _Fan _Other_ CITY Tel No. NOTIC O APPLICANT: If, after making this'Cer cate.of D.isp. _Room Air.Cond._ LICENSE OR t emption, you should become subject to th orkers' REG.NUMB Class Compensation provisions of the Labor Code,you must.forth- Power Apparatus&Large Appliances DISTRICT NO. PROCE SED.BY with'comply with such provisions or this permit shall be Size&Type HP,KW,KVA,or KVAR deemed revoked. 1 15-; 0 Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE .LICENSED CONTRACTORS DECLARATION � Over 10 to 50 Incl. ' � � ..• (�,.�� VALIDATION I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL j 9 commencing with Section 7000 of Division 3.of the'Busi- BY � g ) Over 100 ness and Professions.Code,and my license is in full force and - effect. Services ' License Number Lic.Class 0-200 Amp.Under 600 V 201-1000 Amp.Under 600 V. Contractor Date Over 1000 Amp.or Over.1500 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 ness and Professions Code): Misc.Conduits&Conductors' I', as owner of the property, will do the work and the Other(See Complete Fee Schedule)— r 0 6 6 6 A structure is not intpi►ded or offered for sale (Sec(ion 7044,Business and Professions Code). # o o 0 0 0 2 CONSTRUCTION LENDING AGENCY I hereby affirin that there is a construction lending'agehcy 2 C o 1 6,60 for the performance of the work for which this permit is PERMIT FEE (Sub-Total) issuedSec.3097,Civ.C.). x Lenders Name PLAN CHECKING FEE (One-Fourth Permit Fee) ° ° ° 0 0:y Lender's.Address PERMIT ISSUING FEE D R 0 7—8 1 ' 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 and Stats laws regulating Electrical wiring, and here y authorize r sentattves of this County to enter upon t ove-meat' d propert f r inspectio rposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE . Signature of Perm' ee Date I I XdORKER%COMPENSATION DECLARATION 766AGOS DPW(.12.91,) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that) have ayeftificat%of consent to self Insure, or a certifiea"le'of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. Appy thereof.(Sec.3800 Lab.C.) . , Policy No. . Company FOR APPLICANT TO FILL.IN ADDRESS ❑ copy by New Residential Bldgs.&Pools NO. EACH FEE LOCALITY Certified co is here furnished. ❑ Certified copy is filed with the county building.inspection 1&2-Family,Sq.Ft. _ $ $ department. Multi-family Sq.Ft. NEAREST AX's ° Date Applicant Residential Swimming Pools ASSESSOR MAP OK, PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' � � OWNER OR COMPENSATION INSURANCE Outlets:Rec. Light Sw.First 20 /` f�O �q g (This section need not be completed If the work Involved by the MAIL permit is for one hundred dollars($100)'or less.) Total No. •� Additional ADDRESS /yam I certify that in'the performance of the work for which this permit CITY Tel.No. is issued, I shall not employ any person in any manner so as to 6PLAN CHECK V v become subject to the Workers'Compensation Laws Lighting Fixtures First 20 APPLICANT Ar/ Total No. Additional ADDRESS Date Applican ` RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTI O AP LICANT: If., after making t s C ficate of CITY Tel.No. Exemption,you should become subject to the Workers' mpensation .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 LICENSED CONTRACTORS DECLARATION Size&.Type HP,KW,KVA,or KVAR ADDRESS' 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 5o Incl. LICENSE OR Over 50 to 106 Incl. REG.NUMBER Cl... O Over 100 DISTRICT NO. P D Y License Number Lie.Class Services,Swbd.,MCC&.Panelboards { 0-399 AmUnder600 V Contractor Date: DATE Amp. . t V ❑ I am exempt under Sec. XFINAL 400-1000 Amp.Under 600 V VALIDATION UJ Over 1000 Amp.or Over 600 V FINAL d B.&P,C:forlhis reasonBY � BRANCH CIRCUIT FEES Date: 15A,or 20A,120V,Lighting or Recepl. _ 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ Al Or More Branch Circuits Exemption for Reg.Maim.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILYS= 2 Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION CT. Sign with One Branch Circuitf*'r�,i e I hereby affirm that I am exempt from the Contractor's License Law t er for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): 3307 65.25 �. I,as owner of the property,.will do the work and the structure Misc.Conduits&Conductors T 1 ITEMS Is not Intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) i' � and Professions Code). � TiL. s _ e 6525 ,11 CONSTRUCTION LENDING AGENCY _ i s'rr��s}}I�,Ettl'1(7 _ __ "'t I hereby affirm that there is a construction lending agency for the ) :iei.) performance of the work for which this permit is issued(Sec. 3097, PERMIT FEE (Sub-Total) " Civ.C.) Lender's Name PLAN rEQKING FEE 0000-0001 4/26/93PERMSSUING FEE r(ae �Tt� I.. ••'•A1 7*4 Lender's Address °�5 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 enter upon the above mentioned property f s boon purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OFPERMITTEE WORKER'S COMPENSATION DECLARATION 20-0D19IDPW(12-91) , I 76A663, APPLICATION R ELECTRICAL PERMIT. LLLIII I hereby affirm that 1 have a certificate of consent to self Insure,. or a certificate of worker's Compensation Insurance,or a certified COUNTY OF LOS ANGELES EPT.:DF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof.(Sec..3800 Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN. JOB / ADDRESS SL's rFeIrS 1 M WKGYM Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY ❑ Certified copy'Is filed with the county building Inspection 111&2-Family,,Sq.Ft. — $ $ NEAREsr department. Multi-family Sq.Ft. CROSS 8T. Date Applicant Residential Swimming Pools ASSESSOR MAP.BOOK )AGE- CERTIFICATE AGE CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec. Li ht 0 SW. /�V OWNER OR a 1 j COMPENSATION INSURANCE / FIRM NAME Q First 20 !o (This section need not be completed if the work Involved by the ADDRESS /I,, �11f� /V� permit is for one hundred dollars(5100)or less.) Total No. AdditionalL` 7' s Ml �' i I certify that in the performance of the work for which,this permit CITY •� Tel.No. is Issued, I shall not employ any person,in arty manner so as to PLAN CHECK become subject to the Workers'Compensation Lairs. Lighting Fixtures First 20 APPLICANT Total No. r; Additional ' ADDRESS Date Applicant.rte' RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT:.If, after making this. rtificate of CITY Tel.No. Exemption,you should become subject'to the Worker Compensation OTHER APPLIANCES NOT OVER 3 HP. roviisions of the Labor Code, ou.must forthwith com I with such PERMIT P Y P Y'. APPLICANT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances %+ 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 TQI.No. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR } _ Over 50 to 100 Ind. REG..NUMBER Class.. a Over 100 DISTRICT NO. Pv SED BY V License Number. Lie.Class • Se as, bd., &Panel ards ,,� FINAL Contractor Data O-3 n er 6 V DATE ❑ exempt under Sec. 400 1000 Amp..Under 600 V I am ` VALIDATION Over 1000 Amp.or Over 600 V FINAL IL UJI B.&P.C.'for this reasonBY BRANCH CIRCUIT FEES , Date: 15A,or 20A,1.20V,Lighting or Recept:. _ 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Exemption for Reg.Maim.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER.-BUILDER DECLARATION ch Circuit 3 B with One ran { 116. I hereby affirm that I am exempt from the Contractor's License Law Signw :13 ,: for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits T— Code): I ITURS; U 1,-as owner of the property,will do the work and the structure Misc.Conduits&Conductors IJ� � ,.25is not intended or offered.for sale.(Section 7044, Business Other(See Complete Fee Schedule) ' I {r .1, r,c i and Professions Code). , CE �"ts•�i t CONSTRUCTION LENDING AGENCY CHANGE xL ;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) cls.C,) 0000-0001 5134L/9i. PLANCHECKING FEE Lender's Name 5445 1 P� 4-'-44 PERMIT ISSUING FEE p�� L� der's Address I c9rdfy that I have read this application and under penalty of purjury state TOTAL FEE //4, -• that the above information Is:correct. •I agree to comply with all County ordinances and State laws regulating Electrical wiring,and hereby authorize i reprgsentatives of this County to enter upon the above-mentioned property ' for i petitionpur es. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE.OF PERM.IDATE • I ,)NORKEA COMPENSATION DECLARATION 20-0019 DPW(12.91) I hereby affirm theta have aa�r{HICAof consent to self Insure, 76A663 APPLICATION FOR ELECTRICAL PERMIT LLLII or s certifi6ate'of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. appy thereof.(Sec.9800.Lab.C.) ' policy No. Company FOR APPLICANT TO FILL IN ADDRESS ❑ .,6 •� Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY _ $ $ ❑ 1&2-Family,Sq.Ft. / Certified copy is filed with.the county building Inspection NEAREST -� Ord department. Multi-family Sq.Ft. CROSS Sr. -lot— Date Applicant. Residential Swimming Pools ASSESSOR O . MAP PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Light Sw. t OWNER OR COMPENSATION INSURANCE Outlets:Rec. ` 21 UO ww, te First 20 I MAIL (This section need not be completed if the work Involved by the Total No. Additional ADDRESS permit Is for one hundred dollars(81001•or less.) I certify that in the performance of the work for which this permit CITY Tel.No. is issued, I shall not employ any person In any mariner so as to PLAN CHECK become subject to the Workers'Compensation Laws Lighting Fixtures First 20 1 APPLICANT' / Total No. Additional ADDRESS Date Applican ` RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTIC OAP LICANT: If, after making t s C ficate of CITY Tel.No. Exemption,you should become subject to the Workers'Ilgifiripensation. OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with suchPERMIT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances 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 Dlvision'3 of the Business and CITY Tei.No. Professions Code,and'my license is in full force and effect. Over 10 to 50 Incl. } LICENSE OR'. Cl Over 50 to 100 Incl. REG.NUMBER ass. CL O Over 100 DISTRICT NO. IPODJY License Number Lid.ClassServices,Swbd.,MCC&PanelboardsQ Contractor Date 1 0-399 Amp.Under 600 V DATE ATE F1 I am exempt under Sec. 400-1000 Amp.Under 660 V `�G VALIDATION w Over 1000 Amp.or Over 600 V FINAL lL B.&P.C.for this reason BY CO. BRANCH CIRCUIT FEES Date: 15A,or 20A,.120V,Lighting or Recept. _ 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits El Exemption Or More Branch Circuits Exemption for Reg.Maint:Elect.. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&.Appurtenances' - _ _ 2 _ HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit (CCTe* for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits • "'"'. Code): 3307 95.25 ,_.. �. 1,as owner of the property,will do the work and the structure Misc.Conduits&Conductors s ITE11S is not intended or offered for sale(Section 7044, Business 'Other(See Complete Fee.Schedule) TOTAL 65.25 and Professions Code). CONSTRUCTION LENDING AGENCY ! CHECK 65.2 1 hereby affirm that.there is a construction lending agency for the CHANGE.... e[IsV performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE '(Sub-Total) ' Civ.C.) PLAN CHECKING FEE 0000-00131 4!26793 Lender's Name PERMIT ISSUING FEE q 4 1• "AM 7=54 Lender's Address I certify that I have read this application and under penalty of puriury state TOTAL IFEE (!� 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 enter upon the above mentioned property s coon purposes: SEE REVERSE FOR EXPLANATORY LANGUAGE IGNATURE OF PERMnTEE d WORKERS'COMPENSATION DECLARATION CE-806G '°'a' APPLICATION FOR ELECTRICAL PERMIT I hereby 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.3800,Lab.C.) Policy.No. Company FOR APPLICANT It FILL IN JOB ❑ Certified copy is herebyfurnished. EACH NO. FEE ADDRESS 56 t , New Residential Bldgs.&Pools pyo ❑ _ 70 Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. $ $ LOCALITY e_nwfe ; department. Multi-family Sq.Ft. — NEAREST11 CROSS sr. L.r cam• . A_ Date Applicant Residential Swimming Pools OWNER4Wr AW V Outlets:Rec CERTIFICATE OF EXEMPTION FROM WORKERS' Light—Sw. MAIL c— — COMPENSATION INSURANCE ADDRESS (This section need not be completed If the work Involved by the First 20 CITY ' Tel.No. permit Is for one hundred dollars($100)or less.) Total No. Additional mu 7Al2 I certify that in the:performance of the work for which this permit PLAN CHECK I a APPLICANT is issued, I shall not employ any p 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. Date Applicant Fixed Appliances Not.Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPUCANTA t&t 0-0 IV"7217 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. _ CITY Tei.No. ��7—�� LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ I fiereb�7 affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. uCEN Class (commencing with Section 7000.)of'Division 3 of the Business and REG.NUMBS Professions Code,and my license is in full force and effect. DISTRICT NPROed4y BY Power Apparatus&Large Appliances Size&TypeHP,KW,KVA,or KVAR TINQ License Number Lic.Class Up to 1 Incl. FINAL V Over 1'to 10 Incl. DATE ` �' Contractor___ Date 10 to 50 Incl. - VALIDATION O Over❑ . f FINAL I am exempt under Sec. Over'50 to 100 Inc. BY BAP.C.for this reason Over 100 0. Services,Swbd.,MCC&Panelboards ® - co 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 HOME OWNER.-BUILDER DECLARATION. Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law' Additional Sign Branch Circuits A CCT ns for the following reason(Section 7031.5,Business and Professions Code): Q,31,'? 1z.t Misc.Conduits&Conductors t I,as owner of the property,will do the work and the.structure' 1. ITEMS is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). ® i TAL :14 _so CONSTRUCTION LENDING AGENCY 'I CASH 14.80 I hereby affirm that there is a construction lending agency for the CHANGE n)�13 performance of the work for which'this permit W issued(Sec.3097, PERMIT FEE- (Sub-Total) Civ.C.). PLAN CHECKING FEE Lender's Name 0000-0001 7/30/90 PERMIT ISSUING FEE Lender's Address 2 110 1 AM 9 0 28 I certify that I have read this application and.state that the above TOTAL FEE .0 V information is correct.I agree to comply with all County ordinances and State We regulating Electrical wiring, and hereby authorize• representatives of this C09ft to enter upon the above-mentioned J prop r'i specti.o es. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatureof Perriftlee Date WORKER'S COMPENSATION DECLARATION 76A863 DPW(12-91) PPLICATION FOR ELECTRICAL PERMIT LJ 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 OT:L'O.S. GELES 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. lO q,6— ir Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY 1 1 &2❑ -Family,Sq.Ft. — $ $Certified copy is filed with the county building inspection _ NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant 1 Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec.�Light 3' Sw. --aOwNp Epp 1 w COMPENSATION INSURANCE First 20 � (This section need nof•be completed if the work involved by the ,,''// ADDRMAIL permit is for one hundred dollars($100)or less.) f Total No. �L� Additional ESS ® I certify that in the performance of the work for which this permit CITY a a Tel.No. LP1p7_? is issued, 1 shall not employ any person in.any manner so as to + PLAN CHECK become subject.to-the Workers'Compensation Laws. Lighting Fixtures First 20 PPL[CANT Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If; after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. i provisions of the Labor Code,you,must forthwith comply with'such APP CANT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances LICENSED CONTRACTORS.DECLARATION i Size&Type HP,KW,KVA,or.KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000)of Division 3 of the Business and CITY Tel.No. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. 'LICENSE }• ' 1 Over 50 t0 100 Incl. 'REG.NUMBER Clare' d I ' Over 100 .DISTRICT NO. PROCES. O License Number Lic.Class () Services,Swbd.,MCC&Panelboards J . Contractor❑ Date. I 0-399 Amp.Under 600 V DATE — 0 I am exempt under Sec. 400-1000 Amp.Under 600 V 2—- s VALIDATION Over 1000 Amp.or Over 600 V FINA4 W B.&P.C.for this reason BRANCH CIRCUIT FEES BY Date: 15A,or 20A,120V,Lighting or Recept. Z_ 1 To 10 Branch Circuits f Signature 11 To 40 Branch Circuits °- ❑ i 41 Or More Branch Circuits + �'(~'k a$. Exemption for Reg.Maint:Elect. 15A,20A,208V To 277V Lighting Sr.Circuits L'�) , SINGLE FAMILY Temp.Power Pole&Appurtenances —313{ Li-'C G HOME OWNER-BUILDER DECLARATION I .� I hereby-offirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit , i MS for the following reason.(Section 7031.5, Business and:Professions Additional.Sign Branch Circuits , Code): T0:ALaJ a 00 I,as owner of.the property,will do the work and the structure Misc.Conduits&Conductors CHECK ECK W.LIV is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) ► CHANGE I�i and Professions Code). . NSTRUCTION`LENDING AGENCY + 1 hereby affirm the there is a construction lending agency for the f"rl A performance of the rk for which this permit is Issued(Sec. 3097, PERMIT FEE (Sub-Total) 2 1/95 Civ.C.) i 392 4. 1 P r;.6 1,31 PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE �(/ Lender's Address A I certify that I have lead this appllc TOTAL FEE tion.and under penalty of puriury state Q {y0 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 Coun o 'nter'upon the above-mentioned property + for 1 ec on purp s. SEE REVERSE FOR EXPLANATORY LANGUAGE NATURE OF ERMITTEE DA '