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Home My Public Portal About9108 RANCHO REAL RD_Electrical_1972-12-20 76.0663-CE80611-71 APPLICATION FOR ELECTRICAL PERMIT LI COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS t + LOCALITY ale NEAREST FOR APPLICANT TO FILL IN CROSS ST. OUTLETS NO. EACH FEE OWNER RECEPT._ $ $ MAIL 0 /_ LIGHT TOTAL FIRST 20 25 ADDRESS Gt Ifa C� OVER 20 CITY jyj - + EL. NO. - SWITCH .10 PLAN CHECK LIGHTINGTOTAL FIRST 20 •Zg APPLICANT FIXTURES OVER 20 .10 ADDRESS RESID NTIAL APPLIANCES CITY TEL. NO. �� PERMIT ` RANGE DRYER Y WTR. HTR. APPLICANT 2CIle- STA. ( YI STA. COOK DISP. F.A.U. ADDRESS, L 7Q e� SPACE HTR. AIR COND. Cl TY_7;�,W Dle TEL. NO. CLOTHES WASH. DISHWASH. LICENSE.NO CLASS. FANOTHER 1.00 (jQ AND STATEY THAT THE EABOVE H8 AT CORRECT TEAD HIS AGREE TOLCOMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. SIZE & TYPE OVER TO 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR O - 1 . 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF } CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO IL 1 - 1O 9.00 RESIDE IN, THE ABOVE DESCRI ESIDENT L PROPERTY. V SIGNATURE a, 10 - 50 5.00 OF PERMITTEEy c . O 50 - 100 10.00 r DISTRICT NO, CLASS ZONE P OCESSED BY 100 - 500 15.00 OW. �,j z SIGN, GASSIGN AND ONE CIRCUIT 5.00NOTES• / 3 TUBE, OR OK, JL— MARQUEE ADDITIONAL CIRCUITS 1.00 f SERVICENOTOVER 600 VOLTS OR 200 AMP 3.00. ,300 APPROVALS DATE INSPECTOR'S SIGNATURE SERVICE OVER 600 VOLTS OR 200 AMP 10.00 TEMP.POWER POLE TEMP SERVICE,POLE,&APPURTENANCES 5.00 UNDERSLAB WORK TEMP LIGHT OR RECEPT. SYSTEM 3.00 ROUGH CONDI UT WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (SUB TOTAL) UTILITY CO. NOTIFIED PLAN CHECK FEE FINAL PERMIT ISSUING FEE 1 3.00 51,0 TOTAL FEE (f( PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. C ski H .v 00- Q SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE ON N 76A663 : wfWORjrm hatl haveMa certificate elate oEconsentlOto self insure, CE-8086 '°'B' APPLICATION FOR ELECTRICAL PERMIT 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 TO FILL IN JOB ❑ Certified copy is hereby furnished. EACH NO. FEE ADDRESS of l0 T �� Q+c o a New Residential Bldgs.&Pools ❑ Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. $ LOCALITY_ $ NEAREST department. Multi-family Sq.Ft. CROSS ST. (_rj It Applicant Residential Swimming Pools OWNER OR I{ FIRM NAME - � CERTIFICATE OF EXEMPTION FROM.WORKERS' Outlets:Rec—Light—Sw.— MAIL ' r COMPENSATION INSURANCE First 20 ADDRESS 9SK 3 i=ds'•",3 c� ?(This section need not be completed if the work involved by the Total No. Additional CITY �` Q(0 0 ks Tel.NrJr (� y; permit Is for one hundred dollars($100)or less.) ` CHECK I certify that in the performance of the work for which this permit APPLICANT C IANT is issued, I shall not employ any person in any fkner so as to ifbecome subject to the Workers'Compen tion La . /J Lighting Fixtures First 20 ADDRESS /!_ ?.5_ q X7///�Jrla Total No. Additional CITY T o. Date Applicant Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of PERMIT Exemption,you should become subject to the Workers'Compensation Range_ HeaterD.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 I am licensed under provisions of Chapter.9Disp. — Room Air Cond. LICENSE OR Class. (commencing with Section 7000)of Division 3 of the Business and REG.NUMBER 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 License Number Lim Class Up to 1 Incl. FINAL Over 1 to 10 Incl. Contractor � Date ,1_66P_9 VALIDATION � Over 10 to 50 Incl. FINAL/ V ❑ I am exempt under Sec. Over 50 to 100 Inc. BY W BAP.C.for this reason Over 100 N Services,Swbd.,MCC&Panelboards a Date: 0-200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V Over 1000 Amp.or Over 600 V E] Exemption for Reg.Maint.Elect. -21 2 Q 1 A SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION # o 0 0 0 0 2 Sign with One Branch Circuit 1 hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits ° ° L Jr J for the following reason(Section 7031.5,Business and Professions Code): o " 2 5, y 5 �( r 1. – ils�l I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors G 8 8 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 Zj PERMIT ISSUING FEE _ Lender's Address S 1certify that I have read this application and state that the above TOTAL FEE 4 information is correct.I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize jrepre ntatives of this un to enter upon the above-mentioned y for insp purpo as. SEE REVERSE FOR EXPLANATORY LANGUAGE ,//- Z*- I Signature of Permittee Date WORjtE�S'COMPENSATION DECLARATION CE-eosG '°'81 APPLICATION FOR ELECTRICAL PERMIT firm that,I have a certificate of consent to self insure, or a'certifitate-of Workers' Compensation Insurance, or certified COUNTY OF LOS ANGELES BUILDING AND SAFETY dopy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB 1 ADDRESS ❑ .Certified copy is hereby furnished. New Residential Bldgs,&Pools EACH NO. FEE ❑ Certified copy is'filed with the county building inspection 1.&247anlily,Sq.Ft. $ — :$ LOCALITY department: Multi-family Sq.Ft. NEAREST Residential Swimming'Pools CROSS ST Date Applicant OWNER OR FIRM NAME CERTIFICATE.OF EXEMPTION FROM WORKERS' Outlets:Rea—Light_Sw.— MAIL COMPENSATION INSURANCE ADDRESS (This section need not be completed If the work Involved by the First 20 Total No. Additional CI7,, Tel.No. permit..is for one hundred dollars($100)or less.), - - I certify that 'in the performance of the work for which this permit PLAN CHECK APPLICANT 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 Additional Total No. CITY Tei.No. Date r / �A licant Fixed Appliances Not Over 1.HP PERMIT NOTI TO APPLICANT- If; after • king is Certificate of , 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 T . •!4O. !f.2-4 LICENSED.CONTRACTORS DECLARATION, Hood — Fan Other_ - I hereby affirm that I am licensed. under provisions of Chapter 9LICENSE OR :.(commencing with Section 7000)of.Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER rS�d? 3 Class. �d Professions Code,.and my license is in full force and effect. DISTRICT NO.. PROCESSED BY Power Apparatus&Large Appliances /� J�LO 7/ � 8 Size&Type HP,KW,.KVA,or KVAR ��V Q License Numbe�r1 3 Ll..Class e Up to 1 Incl. FINAL r Over 1 to 10 Incl. DATE — (� V (DATION 0 'Contractor, Date --Over 10 to 50 Incl.. FINAL 0 ❑ I am exempt under Sec. Over 50 to 100 Inc. gY W 0 P.0:for this reason Over 1:00 N Services,Swbd.,MCC&Panelboards 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'S.ign Branch Circuits for the following reason(Section 7031.5,Business and Professions Code): ' Mism-Conduits&Conductors ❑ I,as owner of the property,will do the work.and the structure Other(See•Complete Fee Schedule) _ is,not intended or offered for sale (Section 7044, Business , and'Professions Code)`. i CONSTRUCTION LENDING AGENCY A(.4T°v I'hereby affirm that there is a construction lending agency for the. I' performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub Total) l� Y� 336137 Civ.C.). PLAN CHECKING FEE Lender's Name • •PERMIT ISSUING'FEE � �b 6 ! Uff ill.. I :Lrj a 93 Lender's Address p ' CHECK 110.9s 1 certify that I have read this application and state that the above TOTAL.FEE D 7 information is correct.I-agree to comply with all County ordinances CHANGE °Illi 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 CIL1�{—gal[ i/ru Signature of 130mitwe Date '