The URL can be used to link to this page

Home My Public Portal About6227 SULTANA AVE_Electrical__ APPLICATION FOR ECTRICAL PERMIT Architect or Engineer Lic.No. FOR APPLICANT TO FILL IN (PRINT OR TYPE) p II CITY 07 �a Address New Residential Bldgs. &Pools Each No. Fee LY 1 &2-Family,Sq.Ft. $ — $ FOR APPLICANT TO FIL I (P INT OR TYPE) City Tel.No. Multi-Family,Sq.Ft-3 — Building Address I Applicant Tel.No. Residential Swimming Pools Address Outlets: Re, Light_Sw._ OwnerArl WT City Zip First 20 Total No. Additional Mail Addresil Legal Description Lot No. City Tel.No. Block Tract Lighting Fixtures First 20 �O Total No. Additional Contractor Size of Lot No. of Bldgs. Now on Lot Address � 61 VQ Use of Buildings Fixed Appliances Not Over 1 HP Range_Heater D.W. City r _ Tel.No-969, 177Oven—Dryer W.M. State Lic. No. Lie.Class r -1 Top_FAU W.H. Hood_Fan Other LICENSED CONTRACTOR'S DECLARATION Disp.—Room Air Cond. I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Power Apparatus&Large Appliances �-J Size&Type HP,KW,KVA,or KVAR License Clasp ICN License Numb 6-7 Up to 1 Incl. Date ! Contractor g{ D - to CJ Over 1 to 10 Incl CL OWNER-BUILDER DECLARATION Over 10 to 50 Incl. I hereby affirm that I am exempt from the Contractor's License Law for the following reason(Sec.7031.5,Business and Professions Code): Over 50 to 100 Incl. � ❑ Over 100 0= I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code). $@NIC@S 0-200 Am .Un er00 V r V ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and LLI a Professions Code). 201 - 1000 Amp.Under 600 V a- Over 1000 Amp.or Over 600 V 2E ❑ I am exempt under Sec. , B. & P. C. for this reason Temp.Power Pole&Appurtenances Date Owner Sign with One Branch Circuit WORKERS' COMPENSATION DECLARATION Additional Sign Branch Circuits I hereby affirm that I have a certificate of consent to self-insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof(Sec. 3800, Lob. C.). Misc.Conduits&Conductors Policy No. C2 dnQ o � Company 11— 15 �& LX n ILTF Other(See Compl.Fee Sched.) ❑ Certified copy is hereby furnished. ❑ Certified py isfiled with the city building inspection department. Date �T Applicant . sx r CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE PERMIT FEE (Sub-Total) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to PLAN CHECKING FEE become subject to the Workers' Compensation Laws of California. PERMIT ISSUING FEE $ Date Applicant TOTAL FEE 1§ ITIUsi NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' Compensation provisions Q ° of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. PLAN CHECK VALIDATION o 0 0 3 62$ 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 (Sec. 3097, Civ. Q. CK. CASH M O23 1 -85 Lender's Nam' Lenders Address 9 f This permit will expire if work is not started within 120 days of issuance or if the work is abandoned or suspensed for 120 days. PERMIT VALIDATION �s 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city ordinances and state laws relating to building construction, and he authorize representatives of this city to enter upon the above-mentioned property for inspect' purpos SigtJT6'o`f Applicant or Agent Date CK. CASH M.O. /�+� WORKERS'COMPENSATION DECLARATION 76A663 10/81 ��LI�/11 I®I� 'I°®R ELECTRICAL P�RI� J'he4eby affirm that I h9ve a certificate of consent to self CE-8066 insdte, or.a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY 6r.d cettifled"copy thereof(Sec. 3800, Lob. C.) Policy Nn3J2t7Z_Ko npony FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS ❑ Certified copy is filed wi4themy b —]r4g4AA uild' inspec- 1 &2-Family, Sq. Ft. $ — S LOCALITYtion department. Multi-family Sq. Ft. — NEAREST041A AAA. Residential Swimming Pools CROSS ST. Date plica OWNER OR FIRM NAME �CERTIFICATE OF EXEMPERS' Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE ADDRESS First 20 p� (This section noed not be comploted if the work Involvod by Total No. Additional CITY p`,� Tel. v tho permit is for one hundred dollars($100)or loss.) PLAN HECK I certify that in the performance of the work for which this 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 with comply with such provisions or this permit shall be Top FAU —W.H. — deemed revoked. CITY Tel. No. LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other— Disp. _ Room Air Cond. LICENSE G l y n Class. I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER J' f f%V }: (commencing with Section 7000)of Division 3 of the Business DISTRICT N& r/ PROCESSED B a and Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances 11J UR 0 Size&Type HP, KW, KVA, or KVAR V License Number Lic. Class Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE VAILHOON Contractor Date Over 10 to 50 Incl. W ❑ BYFINO_ I am exempt under Sec. Over 50 to 100 Inc. BY fn Over 100 B.&P.C. for this reason z Date: Services, Swbd., MCC&Panelboards 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole&Appurtenances Q� HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 0 3 3 a 9 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 0 0 2 Professions Code): ❑ 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)_ ® ) 2550 7044, Business and Professions Code). o 25506 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for 1, 0 4—8 5 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 i✓ PERMIT ISSUING FEE Lender's Address t 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 hereby u thorize repr a tatives of this County to enter upon the a e-mentioned perry for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE r /�—Lf—&sq— Signat rmittee Date