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Home My Public Portal About9855 VAL ST_Electrical__ 76A663 CE•606R 9/76 APPLICATIO F R ELE. TRICAL PERMIT ` COUNTY OF LOS.ANGELES DEPARTMENT OF COUNTY ENGINEER JOB , L BUILDING AND SAFETY DIVISION ADDRESS FOR APPLICANTTO FILL IN LOCALITY 7�� New Residential Bidgs.&Pools EACH NO. FEE CROSS ST. 1&2-Family,Sq.Ft. $ .025 — $ OWNER OR Multi-family Sq.Ft. •02 — FIRM NAME �i Residential Swimming Pools MAIL ADDRESS G Outlets:Rec Light_Sw. CITY Tel.No. First 20 .50 PLAN CHECK Total No. Additional .30 APPLICANT ADDRESS Lighting Fixtures First 20 .50 CITY Tel.No. 01 Total No. Additional 30 APPLICANT ' Fixed Appliances Not Over 1 HP ADDRESS �� L Range_Heater_D.W._ CITY Tel.No. Oven—Dryer_W.M. LICENSE R Top —FAU —W.H. REG.NUMBER 49 _L Class.C/o Hood_Fan -Other 5b I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE 2 Disp. Room Air Cond. Z ' o- THAT THE ABOVE IS CORRECT AND/GREE TO COMPLY WITH ALL COUNTY ORDIN- ANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. Power Apparatus&Large Appliances Size&Type HP,KW,KVA,or KVAR 1 HEREBY CERTIFY AT AM PROPERLY REGIS /O LICE ED AS REQUIRED BY LOS A EL UNITY AND STATE CAL NI R T I AM Up to 1 Incl. Z� '�•�� THE LEGAL OWNER T BOVE DESCRIBED R ENTI ROP Y. Over 1 to 10 Incl. 5.00 Over 10 to 50 Incl. �Z�. � PERMITTEE. Over 50 to 100 Inc. Z- SIGNATURE ` Over 100 40 DISTRICT NO. PROCESS D BY O Services -5—" 4�� 9 0.200 Amp_Under 600 V 12.50 INSPECTOR'S W11 201-1.000 Amp.Under 600 V 25.00 APPROVALS DATE SIGNATURE Z Over 1000 Amp.or Over 600 V 50.00 TEMP.POWER POLE Temp.Power Pole&Appurtenances enances 10.00 UNDERSLAB WORK Sign with One Branch Circuit 10.00 ROUGH CONDUIT Additional Sign Branch Circuits 2.00 WIRING Misc.Conduits&Conductors /t' FIXTURES 39 4 Cj,F A Other(See Complete Fee Schedule) POWERAUTHORIZED i! 0 0 0 0 0 ? UTILITY CO.NOTIFIED ,_ „ FINAL �' .3'7Ta NOTES Q ° 0 0!:4- t'u PERMIT FEE (Sub-Total)- � � PLAN CHECKING FEE lone-Fourth Permit Feel • ao � PERMIT ISSUING FEE / $ e(r__ q TOTAL FEE p! �v PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH SEE BACK OF APPLIC@TION FOR COMPLETE SCHEDULE ®s I, W COMPENSATION DECLARATION 76-68 10/81 APPLICATION FOR ELECTRICAL PERMIT I hey affir : I ha�re a certificate`Yif consent to self insure, or a�R�rtificat , Workers'•Compensation Insurance, or aUrtified �4� COUNTY OF LOS ANGELES BUILDING AND SAFETY copy T*re ( c. 6 0,Lab.C.) PoliolVo. Company �� Np FOR APPLICANT TO FILL IN JOB �/ �" (�� ❑ Certified copy is hereby furnished. , EACH NO. FEE -DDREST ,�1' (f �/ � New Residential Bldgs.&Pools LOCALITY • ❑ Certified copy is filed with the co building inspe tion 1 &2-Family,Sq.Ft. $ _ $ NEAREST Lpartment. f/ 1 Multi-family Sq.Ft. CROSS ST.Dater Applicant v" Residential Swimming Pools OWNER OR y� J FIRM NAME Z CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL r,,J COMPENSATION INSURANCE Outlets:Rec—Light_ t 2 — ADDRESS�i/ X5 �/{�(Ig V (This section need not be completed if the work Involved by the First 20 CITY Tel.No. 114 ,permit is for one hundred dollars($100)or less.) Total No. Additional I certify that in the performance of the.work for which this permit PLAN CHECK 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'Compensation Range_ Heater D.W. provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M:_ ADDRESS provisions dr this permit shall be deemed revoked. Top - FAU W.H. •: - — _ . _ '• CITY Tel.No. LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ I hereby affirm that I am licensed under provisions of Chapter 9 Disp.. — Room Air Cond. LICENSE OR Class. (commencing with Section 7000)of Division 3 of the Business and REG.NUMBER Professions Code,and'my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO. SED BY &./ � � Size&Type HP,KW,KVA,or KVAR �1 O p License Num. er Lic.Class U to 1 Incl.. FINAL C� �a- C Over 1 to 10 Incl. DATE /�� VALIDATIdN 0 Contrac r Date J ' o I Over 10 to 50 Incl. FINAL ' ❑ I am exempt nder Sec. Over 50 to 100 Inc. BY I W B.&P.C,for this reason Over 100 / N Date Services,Swbd.,MCC&Panelboards ® / 3 0-200 Amp.Under 600 V Signature 201 1000 Amp.Under 600 V Over 1000 Amp:or Over 600 V Exemption for Reg.Maint.Elect. SINGLE FAMILY - Temp.Power Pole&Appurtenances 3307 25°50 HOME OWNER-BUILDER-DECLARATION Sign with One Branch Circuit 1 ITEMS I hereby affirm.that I am exempt from the•Contractor's Libense Law for the following reason(Section 7031:5,Business and Professions additional Sign Branch Circuits A� I�TFSL .50 Code): Conduits&Conductors CHECK 25.50•' ❑ I,as owner of the property,will do the work and the structure Misc.Other(See Complete Fee Schedule) _ ' is not intended or offered for sale (Section 7044, Business pop. `CHANE a011 and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction.lending agency for the �Vay -uLl�1 7� 0 performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub Total) Civ.C.). 5498 110924 PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the above TOTAL FEE information is correct.I agree to comply with all County ordinances and State 1974.9 regulating Electrical wiring, and hereby authorize representa iv of this County to enter upon the above-mentioned prop Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date Xym COMPENSATION DECLARATION 78-883 io/et APPLICATION FOR ELECTRICAL PERMIT I herthat I hereby affirm that have a certiiflcate of consent'to self inure, CE-806G or'�certificate of Workers' Compensation Insurance,,.or a''Fertified-' COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab.C.) i POligy No. Company I FOR APPLICANT TO FILL IN JOB [].SV //y� e ❑ Certified copy is hereby furnished. EACH NO. FEE ADDRESS a v�9 v New Residential Bldgs.&Pools. { ❑ 1 &-2-Famil S $ _ $ ? LOCALITY G Certified copy is filed with the county building inspection Y. q•Ft. NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets'Rao—Light Sw. . MAIL I _ — COMPENSATION INSURANCE � ADDRESS (This section need not be completed if the work involved b the First 20 p Y o. Add Total No. CITY Tel.No. permit is for one hundred dollars($100)or less.) PLAN CHECK I certify that in the performance of the work for which this permit I APPLICANT 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 V p n 1 NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should APPLICANT become subject to the Workers'Compensation Range— Heater D.W. — provisions of the Labor Code,you must forthwith comply with such Oven Dryer— W.M.—, ADDRESS Provisions or this permit shall.be deemed revoked. Top,, — FAU — W.H. — CITY' Tel.No.34 LICENSED CONTRACTORS DECLARATION ' Hood — Fan —'O#her— ' I hereby affirm that I arr licensed under provisions of Chapter 9IJCENSG OR Class (commencing with Section.7000)of Division 3 of the Business and Disp. — Room Air Cond. REG:NUMBER Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT-NO. ESSE Y Size&Type HP,KW,KVA,or KVAR V License Number Lic.Class i Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE VALIDATION Q Contractor Date Over 10 to 50 Incl. ❑ FINAL, (� I'am exempt under Sec. Over 50 to 100 Inc. BY UJ BAP.C.for this reason Over 100., U) Services,Swbd.,MCC&Panelboards Date: 0-200 Amp.Under 600 V Signature 201'- 1000 Amp.Under 600 V Ov& 1000 Amp.or Over 600 V ❑ Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole,&Appurtenances HOME OWNER-BUILDERMECLARATION Sign with One Branch Circuit � � g I hereby affirm.that I am exempt from the Contractor's License Law ACCT.11'r for the following.reason(Section 7031.5,Business and Professions Additional Sign Branch.Circuits �� Code): 33137 141.435 Misc,Conduits&Conductors 1 ITEMS ❑ I,as owner of.the property,will do the work and the structure Other See Complete Fee Schedule is not intended or offered for sale,(Section 7044, Business (; p ) and Professions Code). I ® TOTAL 14 IL m�� CONSTRUCTION LENDING AGENCY CHECK 141oD�r 1 hereby affirm that there is a construction lending agency for the lHANE a) � performance of the work for which this permit is issued(Sec.309.7, PERMIT.FEE (Sub Total) Civ.C.). PLAN CHECKING FEE Lender's Name CICIOD—DDD 1 3/ 9/90 PERMIT ISSUING FEE Ou Lender's Address 94356 1 AM 1011113 I certify that I have read this application and state that the above TOTAL FEE information is correct.I agree to.comply with all County ordinances and State laws regulating Electrical, wiring, and hereby authorize ;!gnat resent five of this unty to enter upon the above-mentioned 1 ' rtY or sec' n rposes: SEE REVERSE FOR EXPLANATORY LANGUAGE of Permittee• Date