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Home My Public Portal About5565 RYLAND AVE_Electrical__ ` WORKERS'CGSjDECLARATION B10/8 !,:here •pffirm that•I hbve 0 1$11ficate of consent to self cr 1 APPLICATION ®®LIC! TION 'FOR EL9,CTICA6 PERMIT insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof(Sec. 3800, Lab. C.) ` I Policy No. Company ' FOR APPLICANT TO FILL IN JOB .S.S� (� �/d ADDRESS Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE , Certified copy is filed with the county building inspec- 1 &'2-Family, S q. Ft. $ — LOCALITY — $ LC. T tion department. Multi-family Sq. Ft. NEAREST Residential Swimming Pools CROSS ST. 'y C'i OWNER Date Applicant FIRM NAME r CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL Outlets: Rec Light Sw._ ADDRESS S COMPENSATION INSURANCE r't C.. This section need not be completed if the work involved b I First 20 ( p y the permit is for one hundred dollars(8100)or less.) Notal No. Additional CITY Tel. No.gig—y/ss— 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. Li hting Fixtures First 20 ADDRESS ^�. (Total No. Additional Date ,�L, A licantl�� J da -A,��' I I AA CITY el. No. NOTICE TO APPLICANT PIf, after making this Certificate of �� Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range_ Heater_D.W. _ 'APPLICANT '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. — deemed revoked. CITY Tel. IVo. LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_ 'LICENSE OR i I hereby affirm that I am licensed under provisions of Chapter 91 Disp. _ Room Air Cond. REG. NUMBER Class. (commencing with,Section 7000)of Division 3 of the Business 'DISTRICT,NO V PROCES Y and Professions Code,and my license is in full force and effect. Power Apparatus 8 Large Appliances r}/f 0 Size&Type HP, KW, KVA, or KVAR License Number Lic. Class I �= Up to 1 Incl. iFINAL Over 1 to 10 Incl. DATE Contractor Date G� VALID IOP( W ❑ Over 10 to 50 Incl. FINA I am exempt under Sec. I Over 50 to 100 Inc. BY 12 B.&P.C. for this reason i Over 100 Date: Services, Swbd., MCC&Panelboards `S 0 -200 Amp. Under 600 V Signature I 201 - 1000 Amp. Under.600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit c 3 7 9 4 A I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and # 0 0 0 o a 2 ' Professions Code): ) 0 -, 2550 Misc. Conduits&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)_ 2 5 5 . 7044, Business and Professions Code). o o 0 0 C6 CONSTRUCTION LENDING AGENCY 01.09-86 1 hereby affirm that there is a construction lending agency for I 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 � I certify that I have read this application and state that the f TOTAL FEE �S r above information is correct. I agree to comply with all County otdinances 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 /�, Signature of Permittee Date 76A663 DBS SA 3-60 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFET 3 COUNTY OF LOS ANGELES 'ELECTRIC i WILLIAM J. FOX, CHIEF ENGINEER FOR APPLIC/�IGT TO FILL IN DISTRICT NO. GROUP ZONE (PERMIT NO. ELECTRICIAN " f7- 13 RECEIVED BY READY FOR DATE IB ED ADDRESS 0 'v FIRST INSPECTION CITY TEL.NO. P 5 COUNTY LICENSE NO.,/ EXPIRES BUILDIN ADDRESS / PERMIT- FEES , NUMBER EACH FEE LOCALITY �J LIGHT OUTLETS NEAREST t, f�OJ CROSS BT. RECEPTACLES r WALL SWITCHES OWNER !!` TOTAL OUTLETS so B I•b MAIL ✓ V ELEC. RANGES S5 ADDRESS ELEC. HEATERS 25• 'CITY TEL NO. FIXTURES 5 !:?2r ) HEREBY ACKNOWLEDGE THAT 1 HAVE READ ,THIS ApPLICATION AND- STATE THA-F THE ABOVE 18 CORRECT NUMBER GF LIGHT CIRCUITS. S AND 'AGREE TD COMPLY WIT14 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 [-AM THE LEGAL OWNER NEW MVD. HP -OVER 'INC. EACH !3F THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. R LESS B .25 SIGNATURE OF I/z 2 .50 PERMITTEE 2 s 1.00 CINSPECTION RECORD 5 75 1.50 is 50 2.50 50 1 2130 5.o0 2013 Oda- 10.00 J 500 1 1000 15.00 Q Z OVER 1000 20.GG (�J M.G. SET/FRE13.•CHANGER-HP -WELDERS:AC-KVA O GENERATORS - KIN TRANSFORMERS - KVA TEMP. MOTORS (75% OR ORIG-) MOVE MOTORS (75% OF CRIB.) M ISC. SIGNS NO. NO.TRANS. No.. NO.LAMPS APPROVALS , FOR EACH PERMIT. DATE INEPECTORPB NAME WIRING 81.1313 / CONDUIT / 0 �' WIRING . it�{•' •. ' f 1.��7 FIXTURES $1.0v f SUPPLEMENTARY .50 FIXTURES POWER TOTAL -FEE ��} ��` UTILITY CO.NOTIFIED /- .%ol./ FINAL - ��