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Home My Public Portal About6017 PRIMROSE AVE_Electrical__ APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS or a certificate of Workers' Compensation Insurance,or a certified 6017Ave. copy thereof(Sec.3800,Lab.C.) CITY ZIP yl LOCALIT Tem e City Policy No. Company SIZE OF LOT NO91780 ` .OF BLDGS.NOW ON LOT 4 U ❑ Certified copy is hereby furnished. r r none NEAREST CRO ST. ❑ Certified copy is filed with the county building inspection Tl BLOCK LOT NO. USE ZONE MAP O department. 1t1n 2 &V Date Applicant �0 ASSESSOR MAP BOOK PAGE PARCEL �•J \ 7 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. . COMPENSATION INSURANCE 727-7967 WITHIN 1000 FT.OF SCHOOL? YES NO This section need not be completed if the permit is for one hundred ADDRESS ( P DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) _/- ITY ZIPNew York 1 !/ 7 I certify that in the performance of the work for which this permit �1� !_/ raaz�-a� is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. .� / 909-396-1218 STATISTICAL CLASSIFC///��ION l APT CONDO Date d!t "f P Applicantf, A `/�J�' 1 ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate Of. A REQUIRED TOTAL SETBI�CK FR12M JE Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PRO�I�, q , Compensation provisions of the Labor Code, you must forthwith -Qri,Pr FRONT -•comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL 33LL LICENSED CONTRACTORS DECLARATION SIDE CITY LIC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP !I HL _ (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FJUES r • Two Two ® BK L PG 4&9 fZ HECl% Professions Code,and my license is in full force and effect. : K License Number Lic.Class DESCRIPTION OF WORK ❑ VALUATION �; �° (.I'lYi+i::;'; , Contractor Date Two story duplex, each wi ❑ $ 0 . a = �c three bedrooms, wood frama ❑ I am exempt under Sec. ❑ $ O Ido m-a I_111=;'F'ij i . ' ''',�'' C B.&P.C.for this reason �. stucco exterior, Conc. tiL ❑ / , . � LDMA P/C f =s'y Il Date: USE OF EXISTING BLDG. ❑ s AM 8 D JA ne \a Signature PLICANT(PRINT) TEL NO. LDMA Perm ' ❑ 1, as owner of the property, or my employees with wages asfu Wu 909 869-4527 z0 their sole compensation, will do the work and the structure isDRESS not intended or offered for sale (Section 7044, Business and FINAL D Professions Code.) ILL THE APPLICANT ORFUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL .R A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ; ❑ I, as Owner of the property, am exclusively contracting withMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 'licensed contractors to construct the project (Section 7044• es❑ NoCIHBusiness and Professions Code.) ILL THE I NDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDINGCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY OAST AIR QUALITY MANAGEMENT DISTRICT ISCAOMD)SEE PERMITTING CHECKLIST FOR L' UIDEUNES. ! _•i 'eR� :•:. I hereby affirm that there is a construction lending agency for YES El NO 11j�r 1� a the performance of the work for which this permit is issued(Sec. , W IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 3097,CIV.C.) CHECKLIST UND TAND M QUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. _ N TITLE 2, TER 20 SECTION .20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS !�f iii'•!—''!•fe i; Lender's Name N A MATERI REPO ING AN TAI G A PERMIT FROM THE SCAQMD. 0 Lender's Address N.A. i.i'i' L €.1.M=r_•: 0 G I certify that I have read this application and state under penalty 6 of perjury that the above information is correct.I agree to comply P.C.FEE n. /3 PERMIT FEE N with all county ordinances and State laws relating to building m construction, and hereby authorize representatives of this County ISSUANCE FEEco t t0 enter upon the above-mentioned property for inspect•'' purpos 4G//v• CID 1� H5 115 11 4 l INVESTIGATION FEE TOTAL FEE/ 3 8 .7-s r- ` sq�awre m Hoar m n H=am oma . SEE REVERSE FOR EXPLANATORY LANGUAGE ON N 20-0019 I hera0eaffirm ORh ER'Vi ha eMa cerSt f elate oEconse tlOo self insure, 76A663 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT or a•certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV.. cifpythereof(Sec.3840 Lab.C.) f Policy No. Company FOR APPLICANT TO FILL IN JOB. �j ��/ ADDRESS I rrL /eX} Certified copy is hereby furnished. New Residential Bldgs.&.Pools NO. EACH FEE LOCALITY $•Ft S il Famy, q. . � — $ 'Certified copy is filed with the county building inspection 1&2- _ NEAREST 67 department. Multi=family Sq.Ft. CROSS ST. DateApplicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. OWNER OR 00, ' COMPENSATION INSURANCE ' FIRM NAME . First 20 MAIL (This section need not be completed if the work Involved by the Total No. Additional ADDRESS permit Is for one hundred dollars($100)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 APPLICANT t t 'Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP: NOTICE TO AP CANT: :If, after making thi Certificate of CITY Tel.No. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of,the Labor Code, you must forthwith comply with such PERMIT ( i provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT , LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that 1 am licensed under provisions of Chapter 9 Over 3 to 10 Incl. CITY Tel.No. (commencing with Section 7000)of-Division 3 of.the Business and _ 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 CI b ' O Over 100 DISTRICT NO. P SSED BY V License Number Lic.Class tC JC2 y�y Services,Swbd.,MCC&Panelboards 0.399 Amp.Under 600 V FINAL" 0 Contractor �.._� 'date 'DATE for-� - I- 0 I am exempt under Sec. 400-1000 Amp.Under 600 V FINAL VALIDATION d Over 1000 Amp.or Over 600 V B.&P.C:for this reasonBRANCH CIRCUIT FEES BY co Z Date: 15A,or 20A,120V,Lighting or Recept. — 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 2M Lighting Br.Circuits i 'SINGLE FAMILY Temp.Power Pole&Appurtenances r.-.4 E HOME OWNER-BUILDER DECLARATION A'A'I a a I herebyaffirm that I.am exempt from the Contractor's License Law Sign with One Branch Circuit r/s for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code):. Misc.Conduits&Conductors 4 ITEMS ❑ I,as owner of the property,will do the work and the structure is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) ® I j~jT�A 190=' 65 and Professions Code). r>` ,1 • :17 .� O�Io6 . • CONSTRUCTION LENDING AGENCYI.i() I hereby affirm that'there is a construction lending agency for the CHANGE ° performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) �! Civ.C.) � � PLAN CHECKING FEEf�L- (111y i_ '' Lender's:Name IBM-, B,7 j � I uti PERMIT ISSUING FEE 2L a ;,�_I, Lender's Address TOTAL FEE I certify that I have read this application and under penalty of purjury state /�p• 6' 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 to enter upon the above-mentioned property for inspZp: as. SEE REVERSE FOR EXPLANATORY LANGUAGE 1 ^\ ,r NS`GNATURE OFPERMITTEE