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HomeMy Public PortalAbout6240-6242 ROSEMEAD BLVD_Electrical__ 76p663-CE608 10/72 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER JOe BUILDING AND SAFETY DIVISION ADDRESSO D, LOCALITY�pLE NEAREST FOR APPLICANT TO FILL IN CROSS ST. ON�pF/�I OUTLETS N0. EACP. F.EE OWNER OR J J'� $ $ FIRM NAME.LD.f (/ Z#SFOR&r vawo RECEPT._ MAIL /j/oI / RD vEN�E FIRST 20 x�(/ LIGHT TOTAL 2S ADDRESS OVER 20 CITY _jr B ,LL TEL. SWITCH_ 10 PLAN CHECK FIRST 20 .25 APPLICANT LIGHTING TOTAL OVER 20 ADDRESS FIXTURES •10 RESIDENTIAL APPLIANCES CITY TEL. NO. PERMIT .S LL B rR1N� RANGE DRYER_WTR. HTR. i APPLICANT STA. COOK DISP. F.A.U. ADDRESS /6-p SU SPACE HTR. AIR COND. CITY LOS / ��� TEL. NO,pZd� ° ,357` CLOTHES WASH. DISHWASH. REG. NUMBER 14IS961 CLASS. �0 FAN OTHER 1.00 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 .TAT.E LAWS REGULATING IND. HEATERS, ETC. HP. KW.KVA. ELECTRIC G. SIZE & TYPE OVER TO EREBY CE TIFY THAT 1 AM PROPE Y REGISTERED AND/OR 0 - 1 100 L ENSED AS R OU BY LOS ANGE COUNTY AND TATE OF CALI I AM THE L L OWNER OF TH ABOVE 1 - 1O 3.00 DEG III R RE P OP I C� PERMIT E 10 - 50 5.00 SIGNAT RE CD CL.O 50 - 100 10.00 DISTRICT NO. PROCES ED BY 93-W C4 100 - 500 15.00 2c SIGN, GAS ][SIGN ONE CIRCUIT 5.00 APPROVALS DATE INSPEG SSIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.001 TEMP. POWER POLE SERVI CENOTOVER 600 VOLTS OR 200 AMP 3.00 a UNDERSLAB WORK SERVICEOVER 600 VOLTS OR 200 AMP 10.00 ROUGH CONDUIT TEMP SERVICE,POLE,IN APPURTENANCES 5.00 WIRING _46 -7 t + TEMP LIGHT OR RECEPT. SYSTEM 3.00 :3 Qo FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED FINAL + .7i/ PERMIT FEE (SUB TOTAL) 3 NOTES: PLAN CHECK FEE PERMIT ISSUING FEE 3.00 300 TOTAL FEE 6,0 PLAN CHECK VALIDATION CK. M.O. CASH EFIAIT VALIDATION cK.' M.O. CASH 5 L 5iLZ`JUN 1 0 6.0 0 ®ss SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE r °"°°°°°°°°' APPLICATI N OR EL CTRIC PERMIT 1' COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING A{I /,� BUILDING AND SAFETY DIVISION ADDRESS J ° SA –S A. LAMBIE. COUNTY ENGINEER WILLIAM A.JENSEN.SUPT OF BUILDING LOCALITY 4 FOR APPLICANT TO FILL 1N NEAREST • PERMIT FEES cRoss ST. OWNER 3 bj r ITEM NUMBER I EACH FEB MAIL OUTLETS: E $ ADDRESS _ + LIGHTS RECEPT. SW. .10 LIGHTING FIXTURES .10 CITY TEL.NO. r ELEC.RANGES CLO.DRYERS ELECT - WATER HEATERS .80 ADDRESS Appprr q�pp ELEC.SPACE HTRS. DISHWASHERS CITY EdV4ERML.&L MONTE GARBAGE DISPOSERS AUTO.- STATE WASHERS STA.COOKING UNITS .25 LICENSE NO. MOTORS: OVER INC. H.P. DISTRICT NO. GROUP ZONE I P SED BY 0— 1/a .28 1/2— 2 '50 INSPECTION RECORD 2— 8 1.00 5— t8 1.80 Is— SO 2.50 p / / t��� $0-20. 8.00 I- I- 6f h /7- It I17Yi�`RfiLTA' SIGNS: NO.TRANS. 7. . NO.LAMPS �Y.S' /7F •� C1.SE I/l/1 /� SERVICE 0-60 OV 1.00 SERVICE OVER.600V 5.00 MISC. ` WIRING PERMIT 1.00 ® oCj s ,(rA 1 — FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT 50 P[!nn If M f1Al .S TOTAL FEE S &0 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY q WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT A, /1,•,�jrjt,/f ELECTRICAL WIRING. (/� 6'/ b4;}C�.• 1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR WIRING LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT 1 AMTHE LE OWNER OF THE ABOVE DESCRIBED. RESIDEN AL PROPERTY. POWER SIGNATURE r UTILITY CO.NOTIFIED OF PERM ITTE / y+u /b FINAL /MXN�F ATION ARTHUR C.VETT, ' CK O CASH SUPERVISING ELECTRICAL ENGINEER 2.00 7?p� 76A669 CE 6061t 16/77 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES / �p DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN LOCALITY f 6 PGE C" I New Residential Bldgs.&Pools $EACH NO. $ FEE CROSS ST. OEM 1 &2-Family,Sq.Ft, OWNER OR // //�� Multi-family Sq.Ft. •02 — FIRM NAME �ft� L6 A...�Q. Residential Swimming Pools 25.00 MAIL ADDRESS Outlets:Rec Light—Sw. CITY M\c,, OpW�� el.No. ZgsCjSD First 20 50 PLAN CHECK Total No. Additional .30 APPLICANT ADDRESS Lighting Fixtures First 20 .50 CITY Tel.No. MIIT Total.No. Additional 30 APPLICANT �S�I�: C—GCGTf2(C Fixed Appliances Not Over 1 HP ADDRESS C76TJ~ L_'rZ —T-U AJ4,S C)JIE� Range—Heater_D.W.— CITY070' `�MF�CTel.No. Z�7-_�Ci�r' q Oven_Dryer_W.M. LICENSE OR Top —FAU —W.H. REG:NUMBER Class. Hood—Fan _Other— I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Disp. — Room Air Cond. 2.50 THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDIN- ANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. Power Apparatus&Large Appliances Size&Type HP,KW,KVA,or KVAR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OWTHAT I AM Y° Up to l Incl. 2.50 THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. CD Over 1 to 10 Incl. 5.00 c7 12.50 PERMITTEE C Over 10 to 50 Incl. SIGNATURE Over 50 to 100 Inc. 25.00 v Over 100 40.00 DISTRICT NO. / O OCES ED BY ti Services V z° 0.-200 Amp.Under 600 V 12.50 IN OR'S 20.1.1000 Amp.Under 600 V 25.00 APPROVALS DATE r$ NATURE Over 1000 Amp.or Over 600 V 50.00 TEMP.POWER POLE Temp.Power Pole&Appurtenances 10.00 IFIXTURES, NDERSLAB WORK Sign with One Branch Circuit 10.00 OUGH CONDUIT Additional Sign Branch Circuits 2'00 IRING Misc.Conduits&Conductors 10.00 JA Other[See Complete Fee Schedule) OWERAUTHORIZED TILITYCO.NOTIFIED.INAL PERMIT FEE (Sub-Total) ' NOTES PLAN CHECKING FEE (One-Fourth Permit Feel PERMIT ISSUING FEE $7.00 `] CO —PLAN CF�ECK'r/fiL1DAN PERMIT VALIDATION CK. M.O. CASH. 2. 6 1 r'-JUN 29 2POLICY HOLDER:__� SEMUCYASUMSPECOR.COMPLETE SCHEDULE ^r ` i6A663 CE-80616/78) APPLICATI FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN, JOB //�� New Residential Bldgs.&Pools EACH NO. FEE ADDRESS ld��. ©fj 8/ 1 &2-Family,Sq.Ft. $ .025 — $ LOCALITY • 6 a` Multi-family Sq.Ft. .02 — NEAREST Residential Swimming Pools 25.00 CROSS ST. OWNER OR -,p� . FIRM NAME lae Outlets:Rec Light Sw. MAIL First 20 .50 .ADDRESS Total No. Additional .30 CITY Ly Tel.No. a PNCH K A LIC T Lighting Fixtures First 20 •50 ADD SS Additional .30 Total No. ^�, Tel.No. Fixed Appliances Not Over 1 HP APPLICANT f'rp[[ �G ( <' Range_Heater_D.W.— Oven_Dryer—W.M. ADDRESS /7,7-5 /(r/ A d e_ Top _FAU —W.H._ CITY A-ZG/41)( Tel.No.4g7ti 75 -b Hood_Fan —Other LICENSE OR e-0 Disp._Room Air Cond. 2.50 REG.NUMBER. 737—TOY Class. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA- Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO Size&Type HP,KW,KVA,or KVAR COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS Yp REGULATING ELECTRICAL WIRING. 2.50 Up to 1 Incl. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR Over 1 to 10 Incl. 5.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF Over 10 to 50 Incl. 12.50 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE Over 50 to 100 Inc. 25.00 DESCRIBED RESIDE IAL PROPER Y. 40.00 PERMIT EE Over 100 SIGNATUREoil Services DISTRICT NO.- CES ED BY 0-200 Amp.Under 600 V. 12.50 201-1000 Amp.Under 600 V 25.00 U CJ Over 1000 Amp.or Over 600 V 50.00 Z O ,Temp.Power Pole&Appurtenances 10.00 Sign with One Branch Circuit 10.00 3 Additional Sign Branch Circuits 2'00 INSPECTIONbc > u INFORMATION Misc.Conduits&Conductors 10.00 ON REVERSE s Other(See Complete Fee Schedule) SIDE u Z -95245A ;; aa0aa2 PERMIT FEE (Sub-Total) 2 0 0 l a 0 0 PLAN CHECKING FEE (One-Fourth Permit Feel O i= 0 0 0 1 a Q a u PERMIT ISSUING FEE $7.00 c TOTAL FEE ; 0629-79 INSPECTION FINALED W date:. By/4 O ®s I6A669 CE+80816/78) APPLICATI FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY NEW FOR APPLICANT TO FILL IN. JOB New Residential Bldgs.&Pools EACH NO. FEE ADDRESS 1 &2•Family,Sq.Ft.T_ $ .025, — $ LOCALITY Multi-family Sq.Ft. .02 — NEAREST CROSS ST. Residential Sw.immingPools. 25.00 OWNER OR ,D�. 7 FIRM NAME C Outlets:Rec Light Sw. MAIL First 20 •50 ADDRESS Total No. Additional •30 CITY �p ,Lp Tel,No. �Q�� P NCH 'K A LIC T Lighting Fixtures First 20 ,50 ADD SS Additional .30 Total No. Tel.No. Fixed Appliances Not Over 1 HP ePERMIT Range_Heater_D.W._ APPLICANT Oven—Dryer_W.M.— ADDRESS Z7- Top _FAU —W.H._ CITY �.Z.G��( Tel.No.�fg7g 7f� Hood_Fan —Other LICENSE OR Disp._Room Air Cond. 2.50 REG:NUMBER Z rJ Class. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA- Power Apparatus&Large Appliances TION AND.STATE THAT THE ABOVE IS CORRECT AND AGREE TO Size&Type HP,KW,KVA,or KVAR COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS Yp REGUOTI.NG ELECTRICAL WIRING: 2.50 Up to 1 Incl. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 Over 1to 10 Incl. 5.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF W Over 10 to 50 Incl. 12.50 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE O ' Over 50 to 100 Inc. 25.00 DESCRIBED RESIDE IAL PROPE!Y. Over 100 40.00 PERMITEE SIGNATURE. Services DISTRICT NO. CES ED BY Z 0-200 Amp.Under 600 V 12.50 00 201-1000 Amp. Under 600 V 25.00 6. , 0 0 Over 1000 Amp.or Over 600 V 50.00 Z O Temp.Power Pole&Appurtenances 10.00 Sign with One Branch Circuit 10;00 c 'Additional Sign Branch Circuits 2.00 INSPECTION > INFORMATION u Misc.Conduits&Conductors 10.00 ON REVERSE i Other.(See Complete Fee Schedule) SIDE u Z a. —052Q5A 0 0 0 0 0 2 PERMIT FEE (Sub-Total) 2 0 o 1 Q 0 0 PLAN CHECKING FEE (One-Fourth Permit Fee) O 0 0 0 1 Q Q 0 5 PERMIT ISSUING FEE $7.00 c TOTAL FEE no � 0629-79 INSPECTION FINALED o�c 6 date: ����12�y By ®s WORKER S'COMPENSATION DECLARATION CE-806G (2.80) APPLICATION FOR ELECTRICAL. PERMIT ­ I ' CE-806G • I hereby affirm that I have a certificate of consent to self ; insure,or a certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES �''VBUILDING AND SAFETY a e�r9tified copy thereof(Sec.3800 ab.C.) 1 cy o.` ` `�y Company (°y', FOR APPLICANT TO FILL IN JOB New Residential Bldgs.&Pools EACH NO. FEE ADDRESS 42 ❑ Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ '— $ LOCALITY Multi-family Sq. Ft. NEAREST Certified co .y is filed with t co y building inspection CROSS ST depar men Residential Swimming Pools, OWNER OR �f FIRM NAME Date V' Applicant Outlets: Rec._Light Sw. MAIL First 20 ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' I Total No. Additional CITY Tel N COMPENSATION INSURANCE PLAN CH CK }a (This section need not be completed if the work involved I APPLICANT 0 by the permit is for one hundred dollars ($100) or less.) -Lighting,Fixtures First 20 ADDRESS ' 0 Total No. Additional Cc I certify that in'the performance of the work for which this CITY Tel No. O permit-is issued, I shall not employ an person in an manner Fixed Appliances'Not Over 1 HP FU- P P Y' Y P Y PERMIT so as to become subject to the Workers'Compehsation Laws. Range_Heater D.W. _ APPLICANT � __aa -- /4irC�"t Iia' W ZZ 140 Oven _ Dryer_W.M._ ADDRES U6 Top FAU _W.H.._ ,rI J Date Applicant CITY o.el Nm Hood _ Fan —Other NOTICE TO APPLICANT: If, after making this Certificate of Disp. _Room Air Cond— LICEN EOR Qn Exemption, you should become subject to the Workers' REG.NUMBER 7Oy&ClassCe­1 6. Compensation provisions of the Labor Code, you must forth- Power Apparatus&Large Appliances DISTRICT NO. P ES D' BY with comply with such provisions or this, permit shall be deemed revoked. Size&Type HP,KW,KVA,or KVAR Up to 1 Incl. O FINAL Over 1 to 10 Incl. DATE LICENSED CONTRACTORS DECLARATION .� � VALIDATION Over 10 to 50 Incl. I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL 9 (commencing with Section 7000)of Division 3 of the Busi- Over 100 ' BY r� ness and Professions.Code, and my license is in full force and effect. /� Services �/' License Numbers Lic.Class ` a 0 200 Amp.Under 600 V /0e (�fx 201-1000 Amp.Under 600Y ` ' �( 66 "" 0,1 0.0 A Contractor Date 0Z Over 1000 Amp.or Over 600 V # 0 0 0 0 0 HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances I hereby'affirm.that I am exempt from the Contractor's Sign with One Branch Circuit - 2 0 0 1 Q 0 0 License Law for the following reason (Section 7031.5, Bus'- Additional Sign Branch Circuits o •0 0 1 0 0 - ness and Professions Code): I, as owner of the property, will do the work and the Misc.'Conduits&Conductors 0'A 2'6—8 1 . 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 PERMIT FEE (Sub-Total) issued(Sec. 3097,Civ.C.). ' Lender's Name - PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE �Q - I certify that I have read this application and state that the TOTAL FEE D abov mf ation is correct.I agree to comply with all County dr an s nd State 1 ws regulating Electrical wiring, and he b t orize represe tatives .f this County to enter upon the entione ro arty for inspection u poses. ) i SEE-REVERSE FOR EXPLANATORY LANGUAGE Sig re of Per itte ate WORKER S'COMPENSATION DECLARATION 1 CE-806G (2-80) MPPLICATION FOR ELECTRICAL PERMIT ,. I hereby affirm'fhat I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate of Workers.'Compensation Insurance.,or a certified copy thereof(Sec.3800,Lab.C.) FOR APPLICANT TO FILL IN JOB ,r Policy No.' Company I EACH NO. FEE ADDRESSv ' New Residential Bldgs.&Pools Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY ❑ Multi-family Sq. Ft. NEAREST Ce rtified copy is filed.with the county building inspection CROSS ST department. Residential Swimming Pools OWNER OR FIRM NAME A01A Date Applicant Outlets: Rec._LightSw. ADDRESS �- First 20 CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY ����� Tel No.Z � COMPENSATION INSURANCE PLAN cHEC a (This section need not be completed, if the work involved APPLICANT O by the permit is-for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS V Total No. Additional W I certify that in the performance of the work for which this ; Fixed Appliances Not Over 1 HP CITY Tel No. O permit is issued, I shall'not employ any person in any manner1--PERMIT so as to become subject to the Workers' Compensation Laws. Range_Heater D.W._ APPLICANT L7C C L W a Oven _ Dryer_W.M. ADDRESS 1ZZ S ry L %4 Pei f.- U) Date Applicant Top _ FAU _W:H.._ Hood _ Fan —Other CITY ( /p, Tel No.( L(L NOTICE TO APPLICANT: If, after making this Certificate of Disp. _Room Air Cond.— LICENSE OR Exemption, you should become subject to the Workers' REG.NUMBER 3z'so to Class ��I Compensation provisions of the Labor Code, you must forth- Power Apparatus&Large Appliances DISTRICT NO. PROCESSED BY with comply with such provisions or this permit shall be Size&Type HP,KW,KVA,or KVAR Q deemed revoked. Up to 1 Incl. ' 57 FINAL LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl: DATE /' -VALIDATION Over 10 to 50 Incl. C� I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL n 9 (commencing with Section 7000)of Division 3 of the Busi- Over 100 BY Q/ ness and Professions.Code, and my license is in full force and effect. 22� Services License N6mbe?�'ZSOi7� Lic.Class _/0 0-200 Amp.Under 600 V YY,,�� 201-1000 Amp.Under 600 V Contracto44it1 F/.FLW%ate 2 Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION. Temp.Power Pole&Appurtenances ;`466- a q I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit Vc o'0 0 0 2 License,Law for the following reason (Section. 7031.5, Busi- Additional Sign Branch Circuits ness and Professions Code): 2 0'a ( 5 Misc.Conduits&Conductors I, as owner of the property, will do the work and the Other(See Complete Fee Sche le)— o 0 0 1 4,5G' structure is not intended or offered for sale (Section 7044,Business and Professions Code). 0629-82 2O2 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is PERMIT FEE (Sub-Total) issued(Sec.3097,Civ.C.). Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE - I certify that I have read this application and state that the TOTAL FEE above inform ion is correct.I agree to comply with all County or nces n State laws regulating Electrical wiring, and hereby t riz representatives of this County to nter pon the abo e- n 'oned property for inspection purpo ens. SEE'REVERSE FOR EXPLANATORY LANGUAGE U� ez Signature of Permi tee Oate WORKERS'COMPENSATION DECLARATION CE-806 10/81 A APPLICATION FOR ELECTRICAL RICAL PERMIT I hereby affirm that I have a certificate of consent to self ,CE-8066 P"f►®'" �s insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LAS ANGELESB ILDING A SAFETY or a certified copy thereof(Sec. 3800, Lab. C.) ' (�© Policy No. Company FOR APPLICANT TO FILL IN JOB a Certified copy is hereby furnished. New Residential Bldgs: $Pools EACH NO. ADDRESS semil ' FEE ❑ Certified copy is filed with the county building inspec- y, q. — LOCALITY 1 8 2-Family,t S Ft. $ — $tion department. Multi-family Sq. Ft. NEAREST Residential Swimming Pools CROSS 5T. Ti,,/ e Date Applicant j WNER OR FFIIRM NAME /C°14 �i�t�r"D CERTIFICATE OF EXEMPTION FROM WORKERS' 'MAIL COMPENSATION INSURANCE Outlets: Ree Light Sw._ ADDRESS !J X_ tThis section need not be completed if the work involved b First 20 he permit Is for one hundred dollars($100)or less.) 1 ( Total No. Additional CIT C " I. Naze4 72 I certify that in the performance of the work for which this + PLAN CHECK APPLICANT permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT Exemption, you should become subject to the Workers' Range_Heater_D.W. — Compensation provisions of the Labor Code, you must forth- Oven —Dryer —W.M.— ADDRESS ,? ;gey� with comply with such provisions or this permit shall be. Top — FAU —W.H. — deemed revoked. CIT ,e Tel. No. /j/ Hood _ Fan _Other_ LICENSED CONTRACTORS DECLARATION LICENSE OR 1 hereby affirm that I am licensed under provisions of Chapter 9 D.isp. _ Room Air Cond. REG,NUMBER S� d CI°ss�-� (commencing with Section 7000)of Division 3 of the BusinessDISTRICT NO. PROCESSED BY <. and Professions Code,and my license is in full force and effect. I Power Apparatus$Large Appliances • 0 j�► Size 8 Type HP, KW, KVA, or KVAR' ."L - O License Number r6&®� L'ic. Class, to 1 Incl. FINAL F y ' Over 1 to 10 Incl. DATE e= Q VALIDATION ®' Contractor Date Over 10 to 50 Incl. I" r_1 FINAL U I am exempt under Sec. J Over 50 to 1,00 Inc. BY ILIL B.$P.C. for this reason Over 100 Date: Services, Swbd., MCC$Panelboards 0 -200 Amp. Under 600 V � Signature 201'- 1000 Amp. Under 600 V• �I�, tij; ti ❑ 5 Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp.Power Pole$Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 'L I hereby affirm that I am exempt from the Contractor's License Additional Sign'Branch Circuits j Law for the following reason (Section 7031.5, Business and Professions Code): ` ,Ss�••, ❑ I, as owner of the property, will do the work and the Misc. Conduits$Conductors ' structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)- 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY + JR. klilul 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 thai I have read this application and state that the TOTAL FEE r J pbove information is correct. I agree to comply with all County ordinances and State la s regulating Electrical wiring, and hereb authorize rep a tatives of this County to enter upon t ov do d operty f inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee . Date. WORKERS'COMPENSATION DECLARATIONbl0/81 APPLICATION. FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self E-806-806 G insure, or acertificate 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 El Certified copy is hereby furnished.: New Residential Bldgs. &Pools EACH FNO, FEE ADDRESS 1 &2-Family, S. Ft. $. $ LOCALITY .❑ Certified copy is filed with the county building.inspec- Y• q•tion department. Multi-family Sq. Ft•' NEAREST Residential Swimming Pools CROSS ST. Date Applicant OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' •MAIL COMPENSATION INSURANCE Outlets: Rec Light Sw._ ADDRESS .� be lb First 20. (This section need not completed if.the work involved, Y Total No. Additional CITY -• �,�- Tel. No. the permit is for one hundred dollars($100)or less.) I certify,that in the performance of the work for which this A PPLALCHECK ICANT permit is issued,I shall not employ any person'iri any mariner so as to become subject to the War. ComWR sation Laws. Lighting Fixtures First 20 ADDRESS Additional �/ � Total No. CITY Tel. No. i Date 7r,"�_'&7 Applicant PERMIT NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP APPLICANT' Exemption, you should become subject to the Workers' Range_ Heater_D.W. APPLICANT' o-(/� or c4LW- Compensation'provisions of'the Labor Code, you must forth- Oven _Dryer, _W.M.— ' ADDRESS �i3s', Tom, ' with comply with such provisions or this permit shall be Top _'FAU —W.H. — deemed revoked. Hood _Fan _Other_ CITY' [Y Tel. No. .,��� LICENSED CONTRACTORS,DECLARATION; LICENSE OR I hereby affirm:that I am licensed under provisions.of Chapter 9 Disp.. Room Air Cond: REG.NUMBER ��6 -� Class.'^l O (commencing with Section 7000.)of Division 3 of the Business DISTRICT NO. PROCESSE BY and Professions Code,and m license is in full force and effect. ' Power Apparatus&Large Appliances � Y IL, f f® � ? 0-/ P . `/ b Size&Type HP, KW, KVA, or KVAR' I r, O License Number, Lic.Class at-,r- to'1. Incl. FINAL W '� e�� t„dQhgD Y 2i� '�/• Over 1 to 10 Incl. DATE � I VALIDATION 0 I Contractor.,. ate Over 10 to 50'Incl. j ,r ❑ —FINAL I am exempt'Under Sec. Over 50 to 100 Inc. i BY BAP.C. for this reason Over 100 I Services, Swbd.,MCC.&Ponelboards Date: �� y 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 for the following reason(Section 7031:5, Business and• Additional'Sign Branch Circuits ,• Professions Code): 1p T, z ❑ I, as owner of the property,will do the work and the Misc. Conduits&Conductors structure Is. not intended or offered for We (Section. Other(See Complete Fee Schedule)_ 6 0-7;--8�{ 7044; Business and Professions Code). CONSTRUCTION LENDING AGENCY , I hereby off irm 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.). { iPLAN CHECKING.FEE Lerider's•Name r, PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the TOTAL FEE above in is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring,. and S hereby authorize re sentatives of this County to enter upon i the do pro ert .or Inspection purposes. h 4 SEE.REVERSE FOR EXPLANATORY LANGUAGE ignature of Perm itte Date i WORKERS'COMPENSATION DECLARATION j;� l0/81 APPLICATION FOR ELECTRICAL PERMIT � e�etiyaffirm 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 ADDRESS Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ❑ 1 &2-Family, S Ft. $ —Is LOCALITY Certified copy is filed with the county building inspec- Y. q• tion department. Multi-family Sq. Ft. — NEAREST _ Residential Swimming Pools CROSS ST. OWNER OR Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE ADDRESS s secon need not bo com leted If the work Involved b First 20 �. (Thitip Y Total No. Additional CITY Tel. No. the permit is for one hundred dollars($100)or less.) PLA I certify that in the performance of the work for which this APPLICANTK 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 A Total No. Date ��J�` np �011 �� Additional CITY Tel. No. Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT Exemption, you should become subject to the Workers' Range— Heater—D.W. g Compensation provisions of the Labor Code, you must forth- Oven —Dryer —W.M.— ADDRESS s with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. Hood — Fan —Other— CITY Tel. IVo. 27 d LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REG. NUMBER �� ,aj ClassL°.�Q (commencing with Section 7000)of Division 3 of the Business DISTRICT NO. PROCES ED BY and Professions Code,and m license is in full force and effect. Power Apparatus 8 Large Appliances � y (��/� Size&Type HP, KW, KVA, or KVAR 15i O& License Number Lic.Classes Up to 1 Incl. FINAL d�A ��,� Over 1 to 10 Incl. DATE ,� VAL ATION Contractor ®0 Date Over 10 to 50 Incl. FIN AVn ❑ 1 am exempt under Sec. Over 50 to 100 Inc. BY B.&P.C. for this reason Over 100 Date: Services, Swbd., MCC&Panelboards 0 -200 Amp. Under 600 V , Signature 201 - 1000 Amp. Under 600 V c u ❑ Over 1000 Amp, or Over 600 V Exemption for Reg. Maint. Elect. � o o I SINGLE FAMILY Temp. Power Pole&Appurtenances o 0 0 , 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 () C Law for the following reason (Section 7031.5, Business and Professions Code): ❑ Misc. Conduits 8 Conductors I, as owner of the property, will do the work and the 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 ( U Lender's Address I certify that I have read this application and state that the TOTAL FEE `Q above information is correct. I agree to comply with all County I ordinances and State laws regulating Electrical wiring, and hereby authorize rep ntatives of this County to enter upon i th - endo d ape y for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGESignature of Permittee Date WORKERS'COMPENSATION DECLARATION ,l CE B83 10/81 i thereby erfirm that I have a certificate of consent to self insure, APPLICATION FOR ELECTRICAL PERMIT {� or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY LJ copy thereof(Sec.3800,Lab.C.) I Policy No. Company FOR APPLICANT TO FILL IN JOB ❑ Certified copy is hereby furnished. EACH NO. FEE ADDRESS New Residential Bldgs.A Pools ❑ 1 &2-Family,Sq.Ft. $ _ $ LOCALITY Certified copy is filed with the county'building building inspection _ department. I Multi-family Sq.Ft. CROSS ST. h Date Applicant Residential Swimming Pools OWNER OR r FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' ! MAIL COMPENSATION INSURANCE Outlets:Rec—Light—Sw:— ADDRESS (This section need not be completed If the work Involved by the First 20 permit is for one hundred dollars($100)or less.) Total No. Additional CITY Tel:N �— I certify that in the performance of the work for which this permit i PLAN CHECK APPLICANT is issued, I shall not employ any person in any m n r so as to become subject to the Workers'.Compe a Lighting Fixtures First 20 ADDRESS Additional Date Applica Total No. ; CITY ogq Tel.No. Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this ertificate of ! Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. _ APPLICANT A z , provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS /awe provisions or this permit shall be deemed revoked. i Top — FINU _ W.H. _ CITYr-1Q LICENSED CONTRACTORS DECLARATION I � Tei.No.If 41Ja Hood— Fan _ Other_ } I hereby affirm that I am licensed under provisions of Chapter Ig LICENSE OR (commencing with Section 7000)of Division 3 of the Business and Disp, — Room Air Cond. REG.NUMBER � vsk-q Class..�b �p Professions Codd,and my license is in full force and effect. Power Apparatus&Large Appliances j DISTRICT NO. �(" PROCESSE Y 11 Size&Type HP,KW,KVA,or KVAR �(V 5/ License Number Lic.Class Up to 1 Incl. FINAL O 0 Over 1 to 10 Incl. DATE VALIDATION Contractor Date I Over 10 to 50 Incl. O FI o �.. ❑ I am exempt under Sec. Over 50 to'100 Inc. fU r 100 i d B.&P.C.for this reason OVeN Services,Swbd.,MCC&Panelboards Z Date: 0-200 Amp.Under 600 V res 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 J a HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit i I hereby affirm that I am exempt from the Contractor's License Law # o 0 0 0 0 for the following reason(Section 7031.5,Business and Professions Additional Sign Branch.Circuits Code): I d o I a O 0 Misc.Conduits&Conductors- El I,as owner of the property,will do the work and the structure • . '0 0 0 x is not intended or offered.for sale.(Section 7044,Business Other a mplete F Schedule) _ P, Q•,� and Professions Code). 0323-88 CONSTRUCTION LENDING AGENCY i I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.309;, PERMIT FEE (Sub Total) , Civ.C.). 1 1 . PLAN CHECKING FEE Lender's Name i PERMIT ISSUING FEE , 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 laws regulating Electrical wiring, and hereby authorize representatives of this unty to enter upon the above-mentioneil p • -' p irpos s. O SEE REVERSE FOR EXPLANATORY LANGUAGE -91[grfaffire of Fdrmittee Date I