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HomeMy Public PortalAbout6019 SULTANA AVE_Electrical__ wORKERS'COMPENSATIONDECLARATION CE-806 APPLICATION FOR ELECTRICAL PERMIT 3 hereby affirm that 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.) - BT2.063079 Zenith Nate Ins. CO FOR APPLICANT TO FILL IN JOB Policy No. Company New Residential Bldgs.&Pools EACH NO. FEE ADDRESS 6019 N. Sultana ❑ Certified copy is hereby furnished. /—r/ O 1 &2-Family,Sq.Ft. $ — $ LOCALITY T p p e City* © Certified copy is filed with the county building inspection Multi-family Sq. Ft. CROSS ST department. Residential Swimming Pools OWNER OR Date 7/29/80 Applicant R. Cob i ne FIRM NAME POU IO OU IOS Outlets: Rec.^Light Sw. MAIL a5 job First 20 ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional — CITY Tel No. 285-1583 COMPENSATION INSURANCEa PLAN CHECK (This section need not be completed if the work involved APPLICANT 4� by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS Additional Total No. I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. . permit is issued, I shall not employ any person in any manner UPERMIT so as to become subject to the Workers'Compensation Laws. Range_Heater D.W. _ APPLICANT Cob i ne Electric CO Inc. a Oven -_ Dryer_W.M._ ADDRESS In •1607C hestnu � Date Applicant Top _ FAU _W.H.� Hood _ Fan _Other_ CITY Alhambra`' Tel No. 282-0315 NOTICE TO APPLICANT: If, after making this Certificate of Disp. —Room Air Cond—X 2.50 1 21.511ILICENSE OR Exemption, you should become subject to the Workers' REG.NUMBER 229847 Class C1 Compensation provisions of the Labor Code,you must forth- Power Apparatus&Large Appliances DISTRICT NO. PRMCB with comply with such provisions or this permit shall be Size&Type HP,KW,KVA,or VAR deemed revoked. I< eg00 Up to 1 Incl. FINAL LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATE Over 10 to 50 Incl. VALI RATIO 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 ness and Professions.Code, and my license is in full force and effect. Services License Number—229847 Lic.Class- C 10 0-200 Amp.Under 600 V f C�•Gi�,/`C"y/�.. ��y?��' /`� 201-1000 Amp.Under 600 V Contractor R. Cob i ne Date 7/29/$0 Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit License Law for the following reason (Section 7031.5, .Busi- Additional Sign Branch Circuits ness and Professions Code): 14 87 A Misc.Conduits&Conductors I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)— o a o n a 7 structure is not intended or offered for sale (Section 7044,Business and Professions Code). 2 o 0 0 0.50 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency o o o j j.for the performance of the work for which this permit is " issued(Sec.3097,Civ.C.). PERMIT FEE (Sub-Total) 2� 0 I I' J 1 —fl eLender's Name PLAN CHECKING FEE' (One-Fourth Permit Fee) {I Lende'r's Address PERMIT ISSUING FEE 7. 0 I certify that I have read this application and state that the TOTAL FEE 9.150 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 7./29/80 Signatute of Permittee Date 76AG63C-CE8a6H la/76 APPLICATION FOR ELECTRICAL PERMIT . w BUILDING AND SAFETYDIVISION Sunset FOR APPLICANT TO FILL IN ' 7Residentlal Bldgs.&Pools EACH NO. FEE ADDRESS 601 o Sultana 0_41� Sq. Ft. $ — $ LOCALITY Tem le Citq.Ft. — NEAREST Residential Swimming Pools CROSS ST. .VQ. oLt� OWNEROR FIRM NAME Hotro O Outlets: Light,Switch&Receptacle MAIL First 20 ADDRESS as job Additibnal CITY Tel. NO. 285-1583 PLAN CHECK Lighting Fixtures APPLICANT First 20 ADDRESS Additional CITY Tel.No. PERMIT Fixed Appliances Not Over 1 HP APPLICANT Cobine Electric Co. , InC.e Range_ Heater_ D.W. _ ADDRESS 1607 Chestnut St. Oven Dryer _ W.M. Top FAU _ W.H. _ CITY p Tel.No.282-0111-9 Hood Fan LICENSE G NNf1MBE.R 229847 C10 Class. p Disp. A.C: CD 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE TWAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 0 Power Apparatus&Large Appliances WITH ALL COUNTY ORDINANCES ANO STATE' LAWS REGULATING Size&Type HP,KW,KVA,or KVAR ELECTRICAL WIRING. 82 Up to 1 Incl. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR Z Over 1 to 10 Incl. LICENSED AS REQUIRED BY LOS ANGELES'COUNTY AND STATE OF CALIFORNIA OR THAT I 'AM THE LEGAL OWNER OF THE ABOVE Over 10 to 50 Incl. DESCRIBED RESIDENTIAL.P OPERTY. Over 50 to 100 Inc[. PERM'ITEE //y Over 100 SIGNATURE D'ISTR'ICT NO. PR9qESSjBY Services 0-200 Amp. Under 600 V 4.50 1 4.51 . 019 201 -1000 Amp.Under 600 V APPROVALS D INSPECTOR'S Over 1000 Amp,or Over 600 V SIGNATURE TEMP.POWER POLE Temp.Power Pole&Appurtenances UNDERSLAB WORK Sign with One Branch Circuit Additional Sign.Branch Circuits ROUGH CONDUIT (Other) WIRING' FIXTURES POWER AUTHORIZED PERMIT FEE (Sub-Total) 4-5) UTILITY CO.NOTIFIED PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL PERMIT ISSUING FEE o TOTAL FEE 9/00 NOTES PLAN CHECK VALIDATION CK. M.O. CASH 1 9 9�Pn,RMLT:YALtBA.T)ON CK. M.O. CASH y.I� V �GL P? IF Q.T i v 0 0 6 :T7 76A669C-_CEa06B 1875 APPLICATIN FOR ELECTRICAL PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN JOB. New Residential Bldgs.&Pools EACH NO. FEE ADDRESS 11 1 &2 Finaily Sq. Ft. $ — $ LOCALI Multi-family Sq.Ft. — NEAREST CROSS ST. Residential Swimming Pools OWNER OR - C FIRM NAM Outlets: Light,Switch&Receptacle a ADDRESS .First 20 Additibnal C 1 T PLAN CHECK Lighting Fixtures APPLICANT First 20 oe O ADDRESS Additional CITY Tel.No PERMIT _ Fixed Appliances Not Over 1 HP APPLICANT Range_ Heater_ D.W. _ ADDRESS Oven _ Dryer _ W.M. _ Top _ FAU _ W.H. _ CITY el. No. Hood Fan LICENSE OR / y CD REG. NUMBER Class. Disp. A.C. 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION Q AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY V Power Apparatus'&Large Appliances WITH- ALL COUNTY ORDINANCES AND STATE LAWS REGULATING uJ Size&Type HP,KW,KVA,or KVAR ELECTRICAL WIRING, N Up to 1 1 ncl. Z 1 HEREBY PHATI FY AM PROPERLY REGISTERED AND/OR Over 1 to 101ncl. LICENSED AS OS ISLES COUNTY AND STATE OF CALIFORNIA OTHE GAL OWNER OF THE ABOVE Over lU tO 50 Inal. DESCRIBED.REERT . Over 50 to 100 Incl. PERMITEE Over 100 SIGNATURE Services DISTRICT NO. PRO SSE B j 0-200 Amp.,Under 600 V 201 -1000 Amp. Under 600 V APPROVALS DA INSPECTOR'S/ SIGNATURE! Over 1000 Amp.or Over 600 V ' TEMP.POWER POLE Temp. Power Pole&Appurtenances UNDERSLAB WORK F•�i.®�� �/ 'r- ! Sign with.One Branch Circuit Additional Sign Branch Circuits ROUGH CONDUIT (Other) WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (Sub-Total) UTILITY CO.NOTIFIED �+ PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL J PERMIT ISSUING FEE , NOTES TOTAL F.EE 33e ` PLAN CHECK VALIDATION K'. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 6 6 7""OCT 20 -2 n 1 3.3 0 6V8