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HomeMy Public PortalAbout4935 RYLAND AVE_Electrical__ P''WORKERS'COMPENSATION DECLARATION I 76AM3 10.81 APPLICATION FOR ELECTRICAL PERMIT I �hpreby affirm that I have a certificate of consent to self CE-806G in Zre, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY II JI ,for 6 certified copy thereof(Sec. 3800, Lab. C.) Policy No. Company ! FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. I New Residential Bldgs. &Pools EACH NO. FEE ADDRESS L (U Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ — $ LOCALITY VIC— tion department. Multi-family Sq. Ft. NEAREST CROSS ST. 1Q Date Applicant Residential Swimming Pools OWNER OR 'FIRM(NAME CERTIFICATE OF EXEMPTION FROM WORKERS' � MAIL COMPENSATION INSURANCE I Outlets: Rec�_LI ght Sw. d 'ADDRESS L14 W (This section need not be completed if the work involved by A dt ti the permit is for one hundred dollars($100)or less.) I Total No. Additional 6 0 CITY Tel. No. So88 Q 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. _ AD— Additional It �d) 8S J, �,���� { CITY Tel. No. Date- Applicants, a NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP � PERMITExemption, you should become subject to the Workers' Range _ Heater_D.W. APPLICAN Compensation provisions of the Labor Code, .you must forth- Oven —Dryer W.M.— ADDRESS with comply with such provisions or this permit shall be Top — FAU ._W.H. — (04 deemed revoked. CITY Tel. No. LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other— LICENSE OR I hereby affirm that I am licensed under provisions of Chapter'9 D.isp. _ Room Air Cond. REG.NUMBER Class. (commencing with Section 7000)of Division 3 of the Business DISTRICT NO. PT D d- Appliances A Apparatus&Large pp and Professions Code,and my license is in full force and effe�t. Power App Size&Type HP, KW, KVA, or KVAR' License Number. Lic.Class Up to 1 Incl. FINAL i Over 1 to 10 Incl. DATE Z Contractor Date VALIDATION Over 10 to 50 Incl. ' FINAL W 0 I am exempt Under Sec. Over 50 to 100 Inc. BY O- B.&P.C. for this reason Over 100 ;� Z Date: Servi Swbd. MCC&Panelboards 0..-200 Am . Under 600-V Signature 201 - 1000 Amp. Under 600 V❑ ;2350. 1 A Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. # 0 0'0 0 0 2SINGLE FAMILY Temp. Power Pole 8 Appurtenances 'I HOME OWNER=BUILDER DECLARATION Sign with One Branch Circuit j ° ° 5 6 O O I hereby affirm that I am exempt from the Contractor's License i Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits •o o o 56000 Professions Code): I, as owner of the property, will do the work and the Misc. Conduits&Conductors Ij I 1,.1 9-85 structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ ► 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY j 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 `� Q® I certify that I have read this application and state that the TOTAL FEE 3 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 pproopper©ty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date 1 _I COUNTY OF LON ANSELEs APPL=T= FOS PRE= DN °mELECTRIC i DMSION OF H'OII.DIIQG & SAFETY WILLIAM J. FOX. Ceeft E■e1■.M FOR APPLICANT TO FILL IN D16TRICT NO. MRR/yO�UP ZONE PERMIT NO. ELECTRICIAN a ++✓3' IMMU ADDRESS �' Rm rlmMT 11 EMY OTION DA�TK IOIX CITY .t'. . . del- TEL.NO. 6,1.rkX ! r "- . O U LIO Na .+r lXPIReB NUILDINN PESHIIT FEES wDDRa f ' 1 NUMBER EH FEE ACLOCALITY 'L R LICHT CUTLLT■ NEA &W CROSS ST. Rl10ePrwoL.rM 4 1 ?(Z;kg WALL■WITCHM OWNERErA•- TOTAL OUTLET■ so a AIL CLEM RANNE■ MM ADDRESS !L!a HEATERS m CITY TEL. Na rIXTURlN s 1 HEI¢NY ACNMOWLEDM! THAT 1 HAVE READ THIS APPLICATION AND STAT! THAT THE MOVE 10 10pRSeoT NUMNER OF LIMHT OINOUITM AND ACME TO COMPLY WITH ALL COUNTY ORDINANOEM NUMBER Or RCUEPTACL! OIROUITM AND ■TATs LAW R ULATINS ELECTRICAL WININSL MOTORS 1 OaTIrV THAT 1 PDT THE ANOV! VAUD LOM Nuumn HORslPOWlR FEE ANMELE■ COUNTY LIUSH e. OR 1 AM THE LEMAL OWNER New MVa HP Dues SNR. EACs Or THE RESIDENTIAL PROPERTY DESCRIBED ABCVe. % a LEY a Ms MIN ATTR! Or 911 S .s0 M s I.m n ON MECORD s is I.sp IN sa M.NO -z so Mm 5.00 (/ MOO sop 1 am -/ , . ,�.!J Soo 10100 1N.010 Z DYER Icoo Sam "'' 'r ' MA. mirr/rwmj6 CHANNER-HP Afa d2a ` -dL' ^ d' WELOMMI AC-RVA O MENCRATORS - NW TRAN■FORMe - NV TEMPI. MOTORS or osis.) MOVED MOTORS l UP ORIN.I 1 BION■ Na NO.TRAN 6 APPEVMA NCL LAMM FOR lAON PlRMITI DA INBPlOTOS Mss CONDUIT WIRING Gum 1 rCITUSES 1.00 WIRINM p FIXTURE■ i pjjILITV TOTAL FEE 1 Oa NOTIFIED :Opp leNAL 1e a #BA 4-IM 7� o aA E-eo . AST W,TEM FOS PERwr DSpART�iT OFAND eAFBT! EL������ i . covNT�r OFF LOB ros ANGEM WILLIAM J. FOX. CHIEF ENSINEER FOR APPLICANT TO FILL IN DISTRICT J�10. CROUP ZONE PE IT NO. ELECTRICIAN '. - �� %�:�' �/ ✓ REOEIVED BY READY FOR DATE ISSUED ADDREY I s•z FIR■T INEPEOTION �/0 OITY TEV N z NMI 1 1 -47 oOUNTY LICK1116C NO. + t ■UILDINE 'm Y ' PE8�r ADDRESS C,se s NUMBER EACH RQ LOOAI.RY 1.10117 OUTLETS NEAREST REOEPTAOLES OROEBI ST. "� L• '� :P't' WALL■WITOHEE OWNER/! �'• . 1 • TOTAL OUTLETS Bo MAIL ELEO. RANEE■ BB ADDRESS ELEO. NEATER■ ME CITY TEL NO. FIXTUREE B 1 HERR■Y AOKNOWLMMZ THAT 1 HAVE READ THIS MIME. APPLIOATION AND STATE THAT THE ABOVE IS OORRCUT NUMBER OF LIGHT CIROUITE AND ARMS TO DOMPLY WITH ALL COUNTY OROINANOEB NUMBER OF REOEPTAOLE CIRCUITS AND STATE LAWS RESULATINE ELCOTRIOAL MOINE. MOTORS 1 CERTIFY THAT 1 POSSES! THE ABOVE VALID LOS NUNMH HORSEPOWER FEE ANEELCM OOUNTY LIOEN■E, OR 1 AM THE LESAL OWNER NEw Mw. HP—;;;N-7 Iwo. EMw OF THE RESIDENTIAL PROPERTY OCKORISEID ABOVE: i Lice .BB ■IENATURE OF PERMITTKIL S B 1.00 EffSPECTION SECOSn B in 1.80 111 SO 1.110 BO !DO 11.00 BOO BOO low BOO 1000 111.00 Z( OVER 1000 now � M.O. sirr/rum CHANEER-NP R WELDERBI AO-KVA D EENERATORS - KW RANSFOENE - KVA TEMP. MOTORS 711 or CRIB Mcfflw MOTORS or oSio MISE SION9 NO. NO.TRANL APPIMALS MEL No.&dmm FOR EACH PERMITS DA IN■PEOTOR7 NAM WIRINE a7.0O CONDUIT FIXTURES 7.00 WIRINE '• -• O FIXTURES POWER / TOTAL REED UTILITY DO.NOTIFIED ✓� / 'e �' FINAL COUNTY-41' ios ANGELES APPLICATION FOR PERMIT Department of County Engineer ,-;,,' DIVISION OF BUILDING & SAFETY , LEC'. C I WILLIAM J. FOX, County Englu r i FOR APPLICANT.TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO. - .�..,., _ ELECTRICIAN 7I,/1••-c �+^ �� _y RECEI ED B � READY FOR DATE ISSUE ADDRESS C h '7 11 .r�.v��/�qq.r�7 //',/�fy FIRST INSPECTION CITY /_ hrb! ° Y:% v STEL.NO./17A e� COUNTY LICENSE NO. � 7./' EXPIRES BUILDING11/� l J! •_ �/ l PERMIT FEES ADDRESS //moi �v(r/f//��+1�.� NUMBER EACH FEE LOCALITY d- .i/�2{7 fwd LIGHT OUTLETS NEAREST CROSS ST. RECEPTACLES- WALL SWITCHES OWNER TOTAL OUTLETS Sc $ _.AIL ELEC. RANGES 85 •:-5 . ADDRESS ELEC. HEATERS 2S S. CITY TEL-' NO. FIXTURES 5 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER.OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. MOTORS 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS . NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER New MVD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.' A s �eea $ .Zs SIGNATURE OF �/2 2 .513 PERMITTEE a s 1.930 INSPECTION (RECORD 5 1S 1.5D '15 5O 2.50 ,r+ �����- So Zoo 5.oa j)) ,►4AeF /i11 cls s . a Zoo Sao 10.00om ` ! , j �t-u. t;o �'rTe,I- •�, �strz�:ry f41�,p� n ,�_• Sao 1 000 15.00 � ^ Z OVER 1000 20.01 � M.G. SET/FRFQ. CFIANGER-HP �b � � �*d r!d�a I.•+�1�-_� ` a WELDERS:AC-KVA GENERATORS - KW TRANSFORMERB �- KVA _ TEMP. MOTORS (75% OF•ORIi0 MOVED MOTORS '(75% OF Oplo.) Misc. SIGNS NO. NO.TRANS. APPROVALS NO. NO.LAMPS FOR EACH PERMIT? DATE INSPE1CTOR' NAME° WIRING $1.00 t9v CONDUIT FIXTURES $1.00 WIRING ..t / r .SUPPLEMENTARY .50 FIXTURES / 6 pin! I^ POWER / TOTAL FEE III -UTILITY-- NDTIFIED �/'/ r FINAL - 1;y 7GA663 DBS#•6A 4-52 f 76ASS3 DBB SA 3-60 - - APPLICATION FOR PERMIT ' DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES r1 WILLIAM J. FOX, CHIEF ENGINEER ELECT'Aml I%C' FOR APPLICANT TO FILL IN DISTR17eG. GROUP ZONE PERMIT NO. [ADDRESS,/-�f�;//' LECTRICIAN ,e RECEIVED BY READY FOR DATE ISSUED ter ✓' �Cf A FIRST-INSPECTION _S7 CITY .✓.+ 37l� TEL /✓?NO. i Rim I COUNT-4COUNT-4 LICENSE NO. W EXPIRES BUILDING PERMIT F ES ADDRESS j FEE NUMBER EACH L13CALITY LIGHT OUTLETS NEAREST f s es CROSS ST. /fid RECEPTACLES �r WALL SWITCHES OWNER ./l,� .Y�S' TOTAL OUTLETS 5D S MAIL ELEC. RANGES 85 ADDRESS ELEC. HEATERS 25 CITY TEL. NO. FIXTURES 5 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS M19C. APPLICATION AND STATE THAT THE ABOVE 18 CORRECT NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. MOTORS 1 CERTIFY THAT i POSSESS THE ABOVE VALID LOS NUMBER HORSEPOWERANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER FEE NEW MVD. HP --OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. - t o I/2 A LE96 $ .25 SIGNATURE OF %2 2 .50 PERMITTE _ v 2 5 1.00 INSPECTION RECORD 5 15 1.50 15 50 2.50 50 200 5.00 200 500 10.00 -1 S00 1000 15.00 Z OVER 1000 20.00 Q M.G. BET/FREQ. CHANGER-HP WELDERS:AC-KVA O GENERATORS - KW TRANBFORMERB - KVA TEMP. MOTORS (75% OF OHIO-) MOVED MOTORS (75% OF DRIa.) MISC. SIGNS NO. NO.TRANS. • APPROVALS NO. NO.LAMPS FOR EACH PERMIT: DATEINSPECTORrB NAME WIRING $1.00 CONDUIT FIXTURES $1.00 WIRING I s;'1._ •7.c+�iy . v � SUPPLEMENTARY :50 FIXTURES POWER / ^' TOTAL FEE UTILITY 00.NOTIFIED� �A FINAL v -