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Home My Public Portal About8734 WENDON ST_Electrical__ WORKERS'COMPENSATION DECLARATION CES 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES 7— BUILDING AND SAFETY or.a certified copy thereof(Sec. 3800, Lob. C.) - cy No7 Company— Vh� FOR APPLICANT TO FILL C JOB ADDRESS Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE r_1Certified copy is filed with the county building inspec- I &2-Family, Sq. Ft. $ — $ LOCALITY tion department. a Multi-family Sq. Ft. — NEAREST Q7 T. —07121 Residential Swimming Pools CROSS O I DateApplicant OWNER OR ' FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL Outlets: Rec�Light Sw. , COMPENSATION INSURANCE First 20 ADDRESS 8? '3 \\/G- (This section need not be completed If the work involved by Total No.�_ Additional CITY �� +�� Tel. No. the permit Is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this PLAN CHECKr_►- D permit is issued, I shall not employ any person in any mannerAPPLICANT so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 3 ADDRESS QEE WOd` 'Total No. Additional Date Applicant CITY C Tel. NOTICE TO APPLICANT: If, 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 �� CO Compensation provisions of the Labor Code, you must forth- Oven _Dryer —W.M.— ADDRESS ��V E with comply with such provisions or this permit shall be Top — FAU —W.H. — �deemed revoked. Hood Fan _Other_ CITY Tel. No. LICENSED CONTRACTORS DECLARATION • — LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG.NUMBER Z04 e Class. (commencing with Section 7000)of Division 3 of the Business DISTRICT NO. PROCESS BY and Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliancesi YP 'U f/ Size&Type HP, KW, KVA, or KVAR• lJ License Number 8Z P.Lic. Class 16^ Up to 1 Incl. FINAL sy'I,�'� Over 1 to 10 Incl. DATE � � VALIDATION Contractor Date❑ Over 10 to 50 Incl. 4-9 FINAL I am exempt under Sec. Over 50 to 100 Inc. BY B.&P.C. for this reason Over 100 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 HOME OWNER-BUILDER DECLARATION Sign with One-Branch Circuit 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 Professions Code): _ rj 6.8 ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors u 0 0 0 0 structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ , , P 7044, Business and Professions Code). j o o 2 Q TE CONSTRUCTION LENDING AGENCY I hereby affirm that there.is a construction lending agency for ° ° ° G Q.ryi y c the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). OLO oZ u 7 1 '1—,?17- PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address • 1 certify that I have read this application and state that the TOTAL FEE a 0,7 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 thea ove-mentioned p open r inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Permittee Date" 78AY03-CE80$8-68 • .APPLICATION FOR ELECTRICA PERMIT `COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS $73 WEN D o.tJ JOHN A. LAMBIE, COUNTY ENGINEER n� COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. p ( Q �- vOAj NO. EACH $ FEE OWNER / /AND T �S RECEIPT. MAIL LIGHT L T L FIRST 2010 ,20 p ADDRESS / AE N 1>0 A.) SWITCH OVER 20 ,10 CITY AJ &ARR(E f TEL.N0. PLAN CHECK LIGHTING TOTAL FIRST 20 20op% APPLICANT tof FIXTURES }� OVER 20 ,10 ADDRESS RANGE_DRYER_WTR. HTR. CITY TEL.NO277--1.2 STA. COOK_DISP._F.A.U. CONTRACTOR SPACE HTR. AIR COND. ADDRESS CLOTHES WASH._DISHWASH. CITY TEL.N0. FAN_OTHER 1.00 LICENSE NO. CLASS. MOTORS,TRANSFORMERS RATING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION r IND. HEATERS, ETC. HP. KW. KVA. AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY SIZE & TYPE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. 0 - 1 1'00 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF 1 - 10 3.00 CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO f RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. 10 - 50 15.00 SIGNATURE 50 - 100 10A0 OF PERMITTEE 100 - 500 1'55.00 DIST�T SIGN GAS SIGN AND ONE CIRCUIT 3.00 TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES: L O PrC✓1 .Q C2L SERVICE NOT OVER 600 VOLTS OR 200 AMP X2.00 SERVICE OVER 600 VOLTS OR 200 AMP 5.00 TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE TEMP. POWER POLE UNDERSLAB WORK ROUGH CONDUIT WIRING PERMIT FEE (SUB TOTAL) FIXTURES POWER AUTHORIZED PLAN CHECK FEE (50% PERMIT FEE) PERMIT ISSUING FEE 2.00 4 CV UTILITY CO.NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL TOTAL FEE JOSEPH C. ROOHAN SUPERVISING ELECT L ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 4 12 ivy SAR17 2 D 5.60- SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE 78A 63;-CEBO8�-69 !, " APPLICATION FOR ELECTRICAL PERMI COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. JL NO. EACH FEE $ $ OWNER RECEIPT._ MAIL LIGHT TOTAL FIRST 20 .20 ADDRESS 1� CITY TEL.NO ty SWITCH OVER 20 .10 PLAN CHECK LIGHTING TOTAL FRST 20 ,20 APPLICANT FIXTURES I-rov"ER 20 ,10 ADDRESS RANGE_DRYER_WTR. HTR. CITY TEL.NO. STA. COOK_DISP._F.A.U. CONTRACTOR Iv SPACE HTR. AIR COND._)d ADDRESS CLOTHES WASH._DISHWASH. CITY TEL.N0. FAN_OTHER 1.00 LICENSE NO. CLASS. MOTORS,TRANSFORMERS RATING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION IND. HEATERS,ETC. HP. KW. KVA. AND STATE THAT THE ABOVE I5 CORRECT AND AGREE TO COMPLY SIZE & TYPE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. 0 - 1 1.00 1 HEREBY CERTIFY THAT AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF I - 10 3.00 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO 4 RESIDE IN, THE ABOVE DESCRIBED RESIDENT, L PROPERTY. C 10 — 50 5.00 L SIGNATURE De 50 — 100 10.00 OF PERMITTEE ZodgeC F- 100 - 500 15.00 DISTR�N/O"� GROUP ZON O E LL SIGN GAS ��IRCUITS CIRCUIT 3.00 V / -% v TUSZ, OR Z MARQUEE 1.00 NOTES: SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 zf SERVICE OVER 600 VOLTS OR 200 AMP 5.00 TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE TEMP. POWER POLE UNDERSLAB WORK ROUGH CONDUIT WIRING PERMIT FEE (SUB TOTAL) FIXTURES POWER AUTHORIZED PLAN CHECK FEE (50% PERMIT FEE) PER ISSUING FEE 2.00 UTILITY CO.NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1.00 �J' FINAL TOTAL FEE v V�j JOSEPH C. ROOHAN SUPERVISING ELECTRICAL ENGINEER LAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH .00-B ! nr_ 4 2 Gi G R HRR 31 z D 4.00- 'BACK ACK OF APPLICATION FOR COMPLETE FEE SCHEDULE