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HomeMy Public PortalAbout5561 SULTANA AVE_Electrical__ , A TRAGGS CKSCI ID SI APPLICATION FOR ELECTRIC PERMIT 1 BUUMING AND SAFETY DIVMON Dyyarim16II1 Of L'O®ty$pQ16y[ BUILDING of f.0/�6f ADDO JOHN A. LA IE.COUNTY ENGINEER CASSATTD GRIFFIN MUPTOPYIIILDING LOCALITY NEAREST FOR APPLICANT FWILL IN CROSS GT_ LIGHTS RSCV ACLEA FW $WIT ME I OWNER MEtR 1 T R M I "Cli IQQ MAIL ADDR888 TOTAL OUTLETS 0 10 S CLEC RARSIS RATER HEATERS CITY HL N CLOTHn DATHRS 60 RLEC SPACE NUTn5 STAT T COOK ELECTRICIAN 9 OF 06701-- INS GRITS SA■TATE OltroSnt. ADDRESS AlIqN AUTO WASHUS DIIHWAIHER 26 LIGHTING FIXTURES IO w CITY TEL ROTORS STATE LICHN NO HORSEPOWER H P OVER INC I IC O UR R a La6a 2e 40, 2 60 HOPEIMON RECORD 2 E 1 DO 6 16 ISO ID 60 250 r 60 200 6 00 �Z- ..J MISC _ n SIGNS NO TRANI NO LAM" SERVICE 0-600V I00 SERVICE OVER 600V E DO WIRING PERMIT 1 DO ` FIXTURE-PERMIT 100 SUPPLEMENTARY PERMIT 60 S APPROM TOTAL FEE DAT! AO INSPECTOR S SIGNATURE IH ACKNOWLEDGE THAT I HAVE BEAD THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING WIRING -l�S 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AN THE LEGAL WNRR OF THE BOYE POWER DESCRIBED RESIDENTIAL PRO R SIGNATURE UTILITY CO NOTIFIED OF PERMITTEE FINAL 0 Immilmillm JOHN A LAMBIE M'U ARTHUR C VEIT COUNTY ENGINEER R NG GUN SUPERVISING ELECTRICAL ENGINEER -MO 64 M JUL 25 ' , 2 600 IV 1 COUNTY OF LOB ANGELES r DEPABTMEW OF COUNTY ENGnNSEe APPLICATION FOR PERM DriMON OF BUELDDfG Is SAFETY ELECTRIC 1 WaLum COUNTY ENan� FOR APPUCAW TO FI IN DISTRICT NO GROUP ZONE PERMIT NO ELECTRICIAN S -Z lq-1 ADDRESSIBIV READY FOR DATE 188U ^� FIRST INSPECTION FOR CITY TEL NO COUNTY6 NO BUILDIN PERMT n= ADDRESS Of NUMBEER IGCH FEE LOCALITY LIGHT OUTLETS _ NEAREST RECEPTACLES 21. WALL SWITCHES OWNER TOTAL OUTLETS do AIL BLEC RANGES 25 AMDDRESS ELEC HEATERS IIS FIXTURES S CITY TEL, NO misc 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS NUMBER OF LIGHT CIRCUITS APPLICATION AND STATE THAT THE ABOVE 18 CORRECT U P AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING MOTORS I CERTIFY THAT I POSSESS THE ABOVE VALID LOG NuMWR H R FEE ANGELES COUNTY LICENSE OR 1 AM THE LEGAL OWNER NEw MVD HP ovmt I INC EACH OF THE RESIDENTIAL PROPERTY DIMCPTJID ABOVE •1111 II6 SIGNATURE OF _ V2a 60 PERM It E too INSP=ON BEGGED E tE 1 Eo IS SO II Eo ' SO 2O0 S Oo IIO0 am tO OoO J IDDo 1E oo - < OVER 2000 aO oo T Z O M G eirr/rRag CHANGER-HP WELDERS, AC-KVA 0 GENERATORS•KIN TRANSFORMERS-KVA / TEMP MOTORS 7E of oma / MOVED MOTORS 757E of oma ) misc SIGNS NO NO TRANS APPaOVALB O FOR MACH PXRMlTm DATE INSPXCTOR•S NAME WIRING 1 00 CONDOR FIXTURES 41 Go WIRING SUPPLEMENTARY So FIXTURES POWER TOTAL FEE tUTILITY CO NOTIFIED I FINAL 7"OO DOW M x-11 1 1 1 UNM mmm APPUCANT "1 ir INE[EAVILY OUTIJNM PORTION ONLY DESCRIPTION OF WORK - - NUMBER Op OUTLETS ON CIRCUITS wil-m- -WWMNW�M LOCATION BY ROOMS RM13MIM i �7n■■■■■■■■� . Gf- IMMIN l■■■■■■0 V.4m-mmmnmm MEMO E�i�R�MIN■©■■©■■■M n•■■■■■■■■■■■ MMMI■■■■■■■■■■■ MEN MEMI■■■■■■■■■■■ �■■■■■■■■■ ■ MEN MEMI■■■■■■■■■ ■ MMIM■■■■■■■■■ ■ MMMI■■■■■■■■■ ■ MMIM■■■■■■■■■■0 ° MEN�■■■■■■■■■■■ MEMN■■■■■■■■■■■ mmmm■■■■■■■■■N■ MEN MMMI■■■■■■■■■■■ FURRW l�Llni 1 - �® EMENUMMEMN 1(O irm that CI have SATION cafe of ��;DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT O it hereby affirm that I have o certificate of consent to self �80hG insure, or o cert,ficate of Workers Compensation Insurance • COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS aria certified copy thereof (Sec 3800 Lab C ) Policy No Company � IST FOR APPLICANT TO FILL IN JOB F-1 Certified copy is hereby furnished New Residential Bldgs 8 Pools ` EACH NO FEE ADDRESS "'IF ❑Certified copy is filed with the county building inspec 1 8 2 Family, Sq Ft CA $ — S LOCALITY tion department Multi-family Sci Ft — NEAREST IP ,,{�{p1 Residential$wimmin Pools CROSS ST L Dote Applicant n ,O M 0I? 0 OWNER I FIRM NAME IG CERTIFICATE OF EXEMPTION FROM WORKER$ Outlets Rec_Light_$w_ MAIL If COMPENSATION INSURANCE ADDRESS First 20 o (This section need not be completed If the work involved by r Total No Additional CITY Tel No the permit a for one hundred dollars ($100)or Ins ) CHECK PLAN I certify that in he performance of the work for which this PLAN AM 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 Additional Date Applicant Total No CITY Tel No NOTICE TO APPLICANT If after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT e— Heater—D W _ APPLICATION P4 Exemption you should become subject to the Workers Range Compensation provisions of the Labor Code, you must forth Oven — Dryer —W M — ADDRESS MRIV i with comply with such provisions or this permit shall be Top' — FAU —WH — deemed revoked Hood — Fan —Other— CITU T No\ - 1,'71 LICENSED CONTRACTORS DECLARATION Disp — Room Air Cond — LICENSE OR - Class I hereby affirm that I am licensed under provisions of Chapter 9 REG NUMBER - '(wmmencing with Section 7000)of Division 3 of the Rumness Power Apparatus& Large Appliances DISTRICT NO / PROCESSE Y >- and Professions Code and my license is in full force and effect0 (/ d \ Size 6 Type HP, KW K\ or KVAR o O License Number _t2=1 X i�-9 Lic Class r -i0 rO Up to 1 In FINAL ,,I� Over 1 to 10 Ind DATE VALI ION Q Contractor 1�r•14 LAA Date rV-,XJ- � Over 10 to 50 Incl - � FO .❑ I am exempt under Sec Over 50 to 100 Inc By - W B 8P C for this reason Over 100 d Z Dote Services,`Swbd, MCC & Ponelboards Z 0 200 Amp Under 600 V Signature 201 1000 Amp Under 600V Over 1000 Amp or Over 600 V F-1Exemptionfor Reg Mamt Elect ;2 09 a 7 A SINGLE FAMILY Tem Power Pole 8 A unerionces i HOME OWNER-BUILDER DECLARATION P � � • • •j• • 2 1 hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit •, Law for the following reason (Section 7031 5 Business and Additional Sign Branch Circuits ,1 ,1 5'a 8 3 Professions Code) • . 1 5 3 8 3 ❑ I as owner of the property, will do the work and the Misc Conduits&Conductors structure is not intended or offered for sale(Sector,7044 Other (See Complete Fee Schedule}_ , 1 (125;-B8 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) Zq3 3-3 (Sec 3097 C,v C ) PLAN CHECKING FEE Lender s Name , PERMIT ISSUING FEE ' Lender s Address p3 I certify that I have read this application and state that the TOTAL FEE S 3 lO 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 inspection purposes � �� SEE REVERSE FOR EXPLANATORY LANGUAGE R'1 -aura 1-ice 117- Signature F)-ignature of Perminee Date rte- ' CBS WORKERS'COMPENSATION DECIAR consent 71~1 ex APPLICATION 'FOR ELECTRICAL PERMIT O 0. 1 J hereby affirm certificate fthatica have a Sertifi mp of consent to self R exec Insure.or e certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS or a certified copy thereof (Sec 3800 Lob C ) L - Policy No _A K 1 Company-�TF2'T d eA)r FOR AMICANT TO FILL IN ADDRESS T O � DCertified copy is hereby furnished New Residential Bldgs &Pools EACH NO FEE ElCertified copy is filed with the county building inspec 18 2-Family Sri Ft $ — $ LOCALITY rl.l G t T non department Multi family Sq Ft n�PSO — NEAREST CROSS ST j&V Date 10 —.4 Apphcant(;J�y—Ouaa Residential Swimming Pools OWNER FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec_Light_Sw_ MAIL COMPENSATION INSURANCE - First 20 ADDRESS (This section need not be completed If the work involved by Total No Additional CITU Tel No the pennif Is for one hundred dollars ($I00)or Ins) PCAs I certify that in the performance of the work for which this PLAN CK *mit is issued, 1 shall not employ any person in any manner APPU titin fixtures First 20 ADDRESS so as to become subject to the Workers'Compensation Laws 9 g - Additional Total No CITY Tel No Date Applicant Fixed Appliances Not Over I HP PERMIT NOTICE TO APPLICANT If after making this Certificate of Exemption you should become subject to the Workers Range— Heater—D W APPLICATION— e 0- Compensation provisions of the Labor Code you must forth- Oven _ Dryer —W M _ ADDRESS Alilb :01P6 with comply with such provisions or this permit shall be Top — FAU —W H — deemed revoked Hood — Fan —Other— CITY Tel NZEN2,eL-791 LICENSED CONTRACTORS DECLARATION D, _ Room Air Cond LICENSE OR EG NUMBER Class G 10 (commenting with Section 7000)of Drvnwn 3 of the Business power Apparatus 8 Large Appliances DISTRICT NO PROCESSED B Y and Professions Code and my license is in full force and effect t1 /D Size 8 Type HP KW, KVA, or KVAR t O License Number Uc Class Up to 1 Incl FINAL O Contractor lNIPe/ Over Ito 10 Ind DATE&— U VALID N cc//,, Over 10 to 50 Incl FINA V I am exempt under Sec Over 50 to 100 Inc BY 0 q$8 A LU B AP C for this reason Over 100 d Dote Services Swbd , MCC 8 Ponelboards ► 01 e'e i e 2 to Z 0- 200 Amp Under 600V 'I •,1 0850 Signature .�c?') 201 - 1000 Amp Under 600 V ❑ Exemption (or Reg Maint Elect Over 1000 Amp or Over 600 V • - 1 0 8 5 05 SINGLE FAMILY Temp Power Pole 8 Appurtenances ( 02 5-t'8 8 HOME OWNER BUILDER DECLARATION Sign with One Branch C I hereby affirm that I am exempt from the Contractor s License Circuit Additional Sign Branch ircuitCircuits Law for the following reason (Section 7031 5, Business and g Professions Code) ❑ I as owner of the property, will do the work and the Misc Conduits 8 Conductors structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ , Business and Professions Code) CONSTRUCTION LENDING AGENCY I hereby affirm that there is a consnuction lending agency for the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec 3097, Civ C ) j PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE 0 Lender s Address rt AA I certify that I have read this application and state that the TOTAL FEE above information is correct I agree to comply with all County ordinances and State lows regulating Electrical wiring, and t _ hereby authorize representatives of this County to enter upon ' the above-mentioned proppeerty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE S" r( nD /C_ —71k Signature of Permitee Dote ms DEC • 'WORKERS CI hov;SATION cafe of corse• �1o�w3r 1 APPLICATION FOR ELECTRICAL PERMIT J hereby affirm that I have a cproficote of consent to self Insure,w a cernficcne of Workers'Compensation Insurance, • COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS or a certified copy thereof (Sec 38M, Lob C ) t P cy NoQ 9�Company �%Wp11f T FOR APPLICANT TO FILL IN ADDRESSJOB �, / Cernf ied copy is hereby furnished New Residential Bldgs 8 Pools EACH NO FEE Certified copy is filed with the county building inspec- 1 8 2-Family Sq Ft S — $ LOCALITY4,,fL15 . / C- non deportment Multi family Sq Ft 2 _qNEAREST CROSS O Dole 141 -hj Applicant oGo { 9- Restdental Swimming Pools OWNER / - FIRM NAME L H CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec—Ught_Sw_ MAIL COMPENSATION INSURANCE ADDRESS (This section need not be corrfpleted if the work Involved byFirst 20 CITU Tel No the permit Is For one hundred dollars($100)or less ) Total No Additional I certify CHECK ty that d the performance of the work for which this APPLICANT hermit is aI shall not employ any person any manner so w to become m e subject to the WorkerskWorkersLighting Compensation Laws Fixtures First 20 ADDRESS Additional Total No CITYI Tel No Date Applicant Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT If, offer making this Certificate ficate of PERMIT L Exemption you should-become subject to the Workers' Range— Heater—OW — Compensation provisions of the Labor Code you must forth- Oven — Dryer —W M — ADDRESS with comply with such provisions or this permit sholl be Top — FAU —WH — deemed revoked Hood — Fan —Other_ CITY Tel N d (� LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp _ Room Air Cond _ REG NUMBER Clas`/ (commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO _ PROCE Y > and Profession Code and my license is in full force and effect S31Sw Size 8 Type HP KW KVA or KVAR J L� U License Number Lic Class-G-f Up to 1 Incl FINAL Q 1p� 4JIA9k L$$ Da o _ >Lf Over 1 to 10 Ind DATE 3- VA ATION lContractor to / O Over 10 to 50 Incl FI F- I I om exempt under Sec Over 50 to 100 Inc BY U W B SP C for this reason Over 100 1 f 0 9 8 9 A d Services, Swbd , MCC 8 Ponelboords , Z Dotep 0 200 Amp Under 600 V le's's • •'• e s t Z • Signature -Jj-u CL 2e 201 - 1000 Amp Under 600 V ( - 26299 ❑ Exem pnon forRe g Moinf Elect Over 1000 Amp or Over 600 V • - 26Z 1 262 996 SINGLE FAMILY Temp Power Pole 8 Appurtenances HOME OWNER-BUILDER DECLARATION ( 025 $$ I hereby affirm that I am exempt from the Contractor s License S'gn with One Branch Circuit Law for the following reason (Section 7031 5 Business and Additional Sign Branch Circuits Professions Code) V ❑ I as owner of the property will do the work and the Misc Conduits 8 Conductors structure is not.ntencied or offered for sale(Section 7004,' Other (See Complete Fee Schedule)— ► 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) S (Sec 3D97, Civ C ) PLAN CHECKING FEE Lender s Name - ' PERMIT ISSUING FEE Lender s Address - I certify that I have read this application and state that the TOTAL FEE above information❑correct I agree to comply with all County ordmances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above mentioned property for inspection purposes p SEE REVERSE FOR EXPLANATORY LANGUAGE Eq/ �7�/ Signature of Permittee Date Os WORKERS COMPENSATION DECLARATION' 2a0019 ova 3/V O ,A hereby affirm that I have a certificote of consent to self � APPLICATION FOR ELECTRICAL PERMIT insure,or a certlficdte of Workers Compensation Insurance, COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS or a certified copy thereof (Sec 3800 Lob C ) Policy No P_g89A/ Company I D T FOR APPLICANT TO FILL IN JAO�B � 4�/' ut �� ❑Certified copy is h reby furnished New Residential Bldgs 8 Pools EACH NO FEE sS C .—s/ ❑Certified copy is filed with the county budding mspec- 18 2 Family Sq Ft f — f LOCALITY tion department Multi-family Sq Ft711 If.l�� — NEAREST CROSS Date I O— Id Applicant l�j 14UTA L.E& Residential Swimm t Pools - OWNERSO L FIRM NAME J�T CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec—Light_Sw— COMPENSATION INSURANCE First 20 ADDRESS (This section need not be completed R the work Involved by Total No Additional CITY Tel No the permit Is for one hundred dollars($100)or less ) PLAN I certify that in he performance of the work for which this AFRICAN CHECK permit is issued I shall not employ any person in any manner Li titin Fixtures First 20 ADDRESS t so as to become subject to the Workers Compensation Lows g 9 Additional ^ Total No CITY Tel No Date Applicant Fixed Appliances Not Over I HP PERMIT NOTICE TO APPLICANT If after making this Certificate of APPLICATION L Exemption you should become subject' to the Workers' Range— Heoter—DW _ Compensation provisions of the Labor Code, you must forth Oven — Dryer —W M — ADDRESS 4jr with comply with such provisions or this permit shall be —FAU —W H deemed revoked Hood — Fan —Other— CITY Al No LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp _ Room Air Cond REG NUMBER Class/j (commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO PROCESSED BY Y r and Professions Code and my license is in full force and effect /) 0 a- [ V L¢ T>ense Number � -r u' USize 8 Type HP, KW KVA or KVAR c Class G— f7 Up to 1 InclFINAL U Over I to 10 Incl DAT Q/ V IDATION Q Contractor (.0'14 "A Jc�Dote ' Over 10 to 50 Incl FINA _ l� C/ r0 sl�l I am exempt under Sec Over 50 to IOD Inc BY U • �� B BP C for this reason Over 100 W 20990A a Services Swbd MCC 8 Ponelboords y N J7 IIAA Date 0 200 Amp Under 600 V ► # s e's e -,2 • Signature t&tM 41;4 Q aEeU 201 - 1000 Amp Under 600 V it -26299 ❑ Exemption for Reg MoOver 1000 Amp or Over 600 V Moms Elect • • 262996 SINGLE FAMILY Temp Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ' ) a 2 5 8 8 1 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 Professions Code) ❑ I as owner of the property will do the work and the Misc Conduits 8 Conductor - structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ , 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 1 (Sub-Total) (Sec 3097 Civ C ) PLAN CHECKING FEE Lender s Name 4� 4�PERMIT ISSUING FEELender s AddressOTAL FEE I certify that I have read this application and state 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 properly for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 1DL Signature of Permit" Date ®s r ' •WORKERS' COMPENSATION .ATlOh1hereby APPLICATION FOR ELECTRICAL PERMIT O � hereby affirm that I have a certificate cate ofof consent to tell •�� insure or a certlf,cdte of Workers Compensation Insurance COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS or a certified copy thereof (Sec 3800 Lab C ) I _ Policy No L_i L?-k1Company :FA'QA4DAa FOR APPUCAM TO RLL M JOB � �v ❑Certified copy is hereby furnished New Residential Bldgs 8 Pools EACH NO FEE ❑Certified copy is filed with the county building inspec- 1 & 2-Fomily Sq Ft $ _ $ LOCALITY tion department Multi-family Sq Ft - NEAREST It CROSS ST Dote /a— Applicant 14011) HVA L4R& Residential Swimming Pools R_ OR FIRM NAME � CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec_Light_Sw_ MAIL COMPENSATION INSURANCE First ?0 ADDRESS (This section nod not be completed If the work Involved by A 20 Additional CIN Tel No ' the permit Is for"&'hundred dollars($100)or less ) Total No CITY I certify that in the perfw ornnce of the work for which this 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 Additional Dote Applicant Total No CIN Tel No Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT If, after making this Certificate of PERMIT Exemption you should become subject to the Workers Range— Heater—DW — APPLICATION Compensation provisions of the Labor Code you must forth- Oven — Dryer —W M _ ADDRESS 1740 vilith comply with such provisions or this permit shall be T _ FAU —W H — deemed revoked Hood — Fan —Other_ CITYMAIX*p Tel 0 G _ LICENSED CONTRACTORS DECLARATION Ditto — Room Air Cond — LICENSE OR SJ Class I hereby affirm that I am licensed under provisions of Chapter 9 ' (commencing with Section 7000)of Drvimon 3 of the Business Power Apparatus&`Large Appliances DISTRICT NO / PROCE D BY Y • and Professions Code,and my license is in full force and effect O(/ CL O Size & Type HP, KW, KVA, or KVAR —J L O License Number Lc Class Oil-- J Up to 1 Incl ' FINAL C..) Ovm I to 10 Incl DATE V •DATION Q Contraclor 1" )4LUA IZVZ note IO- -A-(I- Over 10 to SO Incl FINAL r0 1 I I am exempt under Sec Over 50 to 100 Inc BY V LU •�,• B&P C for this reason Over 100 11 Services Swbd MCC& Panelboards ► Z DO1° 2099, 1 A p 0-200 Am Under 600 V r• Signatur --B-/T 201 - 1000 Amp Under 600 V V • • • • • 2 ❑ Over 1000 Amp or Over 600 V Exemfor Reg ption Maint Eject ( • 1 8 7 9 9 SINGLE FAMILY Temp Power Pole & Appurtenances • • 1 87995 HOME OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor s License Sign with One Branch Circuit Low for the following reason (Section 7031 5 Business and Additional Sign Branch Circuits ( G25-88 Professions Code) ❑ I, as owner of the property will do the work and the Muc Conduits&Conductors structure is not intended or offered for sale(Section 70" Other (See Complete Fee Schedule)_ Business and Professions Code) CONSTRUCTION LENDING AGENCY , I hmeby 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 that I have read this application and state that the TOTAL FEE above information is correct I agree to comply with all County - - ordinances and State laws regulating Electrical wiring and - t hereby authorize representatives of this County to enter upon ' the above mentioned property for inspection purposes - SEE REVERSE FOR EXPLANATORY LANGUAGE CAM Signature of Permittee D Date • mr r _ R WORKERS'COMPENSATION coaq of const 3P°p10°°"'s/� APPLICATION FOR ELECTRICAL PERMIT / hereby effum that I have a cprnf¢at of consent to Self •�� Insure or a cernficdse of Workers Com*nsation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec 3800 Lab C ) P lacy No Q-1&T481 Company;fA, T FOR APPLICANT TO FILL IN !OB /( Certified copy a hereby furnished New Residential Bldgs 8 Pools EACH NOFEE AOORE55 (l ❑Certified copy is filed with the county building mspec 1 8 2 Family Sq Ft $ — $ LOCALITYr.AA CIT non department Multidamily Sq Ft ;jISa//1 — 115 NEAREST n detial Swimming Pools CROSS ST Date 19- tis' Applicant �Q:_I-fh]4 LEE Residential , EIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS MAIL • COMPENSATION INSURANCE Outlets Rec_Light_Sw_ ADDRESS (This section need not be completed If the work In"hred byr First 20 CIN Tel No the permit Is for one hundred dollars ($100)or less) Total No Additional ECK I certify that in he performance of the work for which this qAP LIPIKANT derma is issued I shall not employ any person in any manner h hhn Fixtures First 20 ADDRESS So,as to become subject to the Workers Compensation Lows 0 g Additionaly Total No CIN Tel No Dote Applicant S Fixed Appliances Not Over 1 HP PERMIT subject Workers NOTICE TO APPLICANT If after making this Certificate of Exemption, you should become subject to the Workers Range— Hooter—DW _ APPLICATION Compensation provisions of the Labor Code you must forth- Oven _ Dryer —W M — ADDRESS gneiijr V& 'fob ' with comply with such provisions or this permit shall be Top — FAU —W H — • deemed revoked Hood — Fon —Other_ CITY Tel No .3471-7111-71 LICENSED CONTRACTORS DECLARATION LICENSE OR 1, Dmp Room Air Cond I hereby affirm that I am licensed under provisions of Chapter 9 G NUMBER Class C- (commencing with Section 70DO)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO� PR7 BY d and Professions Code,and my hcense is in full force and effect o 1 --T Size B Type HP KW, KVA or KVAR f v U License Number _C141L69 Lic Class r•-'!y Up to 1 Incl FINAL Over 1 to 10 Incl DATE L7 Contractor bYM WWA La:L n,.re�.- �c�- Q j — VAl TION 0 ❑ Over 10 to 50 Incl FI L) I am exempt under Sec Over 50 to 100 Inc B W j B 8P C for this reason Over 100 Dote Services Swbd , MCC 8 Ponelboards polo,y 0 200 Amp Under 600 V r Signature X. 201 1000 Amp Under 600 V "❑ Exemption for Reg Maint Elect Over 1000 Amp or Over 600 V ;20992A SINGLE FAMILY r t Temp Power Pole 8 Appurtenances HOME OWNER-BUILDER DECLARATION Q • • • • • 2 1 hereby affirm that I am exempt from the Contractors License Sign with One Branch Circuit ( - 12635 Law for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits Professions Code) 1 • • 12G356 ❑ I as owner of the property, will do the work and the Mac Conduits 8 Conductors structure is not intended or offered for sale(Section 704A Other (See Complete Fee Schedule)_ I 0,25-88 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) 15-S _ (Sec 3097 Civ C ) PLAN CHECKING FEE Lender s Name PERMIT ISSUING FEE 10 _ Lender s Address TOTAL FEE •�6 .3 1 certify that I have read this application and state that the above information is correct I agree to comply with all County - ordinances and State lows regulating Electrical wiring, and hereby outhonze representatives of this County to enter upon ' the above mentioned property far inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE )rn W1D lO�tiC� ��pi ms Signature of Permittee Date