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Home My Public Portal About9157 WOOLLEY ST_Electrical__ WORKERS'COMPENSATIONDI(iLARATION 76-6'$3 CE-$06G (2-801 APPLICATION FOR ELECTRICAL PERMIT ' I hereby affirm that I have a Certificate of�catsent 1o.tielf COUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.) FOR APPLICANT TO FILL IN JOB �y _ Policy No. Company EACH NO. FEE ADDRESS I I �C 7 F-1Certified Residential Bldgs.&Pools _ �] Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY `L-e O .—r Multi-family Sq. Ft. — NEAREST Y Certified copy is filed with the county building inspection CROSS ST � ( 1 1 department. Residential Swimming Pools OWNER OR ��, ' e /� FIRM NAME 0- W�v Date Applicant Outlets: Rec.11Light-95,S.. 10 75 MAIL G �y First 20 ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' Total No.. Additional ,, CIT JL t R_(cG L TeI No. 71� _ COMPENSATION INSURANCE PLAN CHECK 41 APPLICANT O U (This section need not be completed if the work involved Lighting Fixtures First 20 7y ADDRESS by the permit is for one hundred dollars ($100) or less.) Additional I certifythat in the Total No. O performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. Il— permit is issued, I shall not employ any person in any manner PERMIT �( sq.as to become subject to the Workers'Compensation Laws. Range_ Heater_D.W. APPLICANT e� 1 /fie a �'}/1 --_�_ Oven _ Dryer_W.M. ADDRESS N II �/ ��'`�� Top _ FAU L W.H. DateJL--(I`.�►--=TPPlicant9 CITY Tel No. � Hood _ Fan AOL Other— ` NOTICE TO APPLICANT: If, after ma Ing his CertI is a of Disp. _ Room Air Cond,_ 3� LICENSE OR Exemption, you should become subj o the Work REG. NUMBER Class Compensation provisions of the Labor Code, you must forth- ower Apparatus& Large Appliances DISTRICT NO. PROC SED BY with comply with such provisions or this permit shall be deemed revoked. Size&Type HP,KW, KV or KVAR Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE --- iy� LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. (f VALIDATION dh I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FIN 9 (commencing with Section 7000)of Division 3 of the Busi- Over 100 B ness and Professions Code, and my license is in full force and �Z effect. Service ' 0-200 Amp Under 600 V License Number Lie.Class 201-1000 Amp. Under 600 V Contractor Date 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 Additional Sign Branch Circuits License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): Misc.Conduits&Conductors I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)— structure is not intended or offered for sale (Section 7044, 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 PERMIT FEE (Sub-Total) issued (Sec. 3097,Civ.C.), Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE (✓ I certify that I have read this application and state that the TOTAL FEE .07 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 th above-mention pr rty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signa re of Permi ee Date z r7 CIT u 76.0663-CE80610/72 APPLICATION_ MIT u COUNTY OF LOS ANGELES DEPARTMENT'OF COUNTY ENGINEER FADDRESS /S~ �' a/� 7� BUILDING AND SAFETY DIVISION. ^ �r TY eo O.r. .O T /� FOR APPLICANT TO FILL IN ST. XvvC A'i7_tJ OUTLETS N0. EACH FEE R ff„tip`61 S FIRM NAME AZ S4 r��/h`�� RECEP * $ $ MAIL e ADDRESS LIGHT TOTAL FIRST 20 25 �� A"VmlCITY /� 0. r��/E �j� TEL. ✓_ 3!X Z� SWITCH. Ab l OVER 20 .10 PLAN CHECK fi VVI TOTAL LIGHTING FIRST 20 .25 APPLICANT J OVER 20 ADDRESS FIXTURES .10 RESIDENTIAL APPLIANCES CITY, TEL. NO. PERMIT RANGE DRYER_WTR. HTR. APPLICANT S19;�hi� STA. COOK DISP. F.A:U. ADDRESS SPACE HTR, AIR COND. CITY TEL. NO. CLOTHES W ISHWASH. LICENSE OR 'LICENSE CLASS. r FAN OTHER1.00 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION 0 AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. SIZE & TYPE OVER TO, I 'HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 - 1 1.00 LICENSEDAS REOU IRED BY LOS ANGELES COUNTY AND STATE OF CA.LI FOR NIA OR THAI 1 AM THE LEGAL 0 HER OF THE ABOVE I - 10 3.00 DESCRIBED RE TIA PROP. - C3 PERMITEE v 10 — 50 5.00 SIGNATURE 50 — 100 10.00 C DISTRICT N0: PROCESSED BY W 10D — 500 15.00 ® r SIGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE INSPECTOR'S SIGNATURE v TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1:00 TEMP. POWER POLE SERVICE NOT OV ER 600 VOLTS OR 200 AMP 3.00 UNDERSLAB WORK SERVICEOVER600VOLTSOR200AMP 10.00 ROUGH CONDUIT TEMPSERVICE,POLE,&APPURTENANCES 5.00 WIRING Srl,L�� :�J��.t+trr7�+/ TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED FINAL PERMIT FEE (SUB TOTAL) NOTES: , PLAN CHECK FEE PERMIT ISSUING FEE 3.00 TOTAL FEE PLAN CHECK VALIDATION CK. M.O. CASH -PERMIT VALIDATION' CK. M.D. CASH 8''0 OtiFEB 22 'p 8.75 --98 SEE SACK OF APPLICATION FOR COMPLETE SCHEDULE B O-CE806 „ 7, APPLICATION FO'ELE RICA6 6&IT L1 COUNTY OF LOS ANGELES -'DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. OUTLETS NO. EACH I FEE - MAIL OWNER RECEPT._ $ Is ADDRESS & LIGHT TOT FIRST 20 25 OVER 20 CITY /fP�� TEL. NO.p�Cp — �a SWITCH f0 PLAN CHECK LIGHTING TOTALFIRST 20 25 APPLICANT T 20 OVER FIXTURES � .10 ADDRESS RESIDENTIAL APPLIANCES CITY TEL. NO. PERMIT RANGE DRYER_WTR. HTR. APPLICANT STA. COOK DISP. F.A.U. ADDRESS SPACE HTR. AIR COND. CITY TEL. NO. CLOTHES WASH— DISHWASH. LICENSE NO. CLASS. FAN OTHER 1.00 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. SIZE & TYPE OVER TO I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR 0 - 1 1.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF O. } CALIFORNIA OR THA. THE LEGAL OWNER OF AND INTEND TO 1 - ,O 9.00 RESIDE IN, THE ABOV DES I,IBED SIDE IAL PROPERTY. V SIGNATURE P 10 - 50 5.00 OF PERMITTEE O 50 - 100 10.00 Il- DISTRICT NO. CLASS ZONE QC ED BY u 100 - 500 15.00 y SIGN, GAS SIGN AND ONE CIRCUIT 5.00 NOTES: 'g' '� ? TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 SERVI CENOT OVER 600 VOLTS OR 200 AMP 3.00 l APPROVALS DATE INSPECTOR'S SIGNATURE SERVI CEOVER 600 VOLTS OR 200 AMP 10.00 TEMP.POWER POLE TEMP SERVICE,POLE,&APPURTENANCES 5.00 UNDERSLAB•WORK TEMP LIGHT OR RECEPT. SYSTEM 3.00 ROUGH CONDIUT WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (SUB TOTAL) UTILITY CO. NOTIFIED PLAN CHECK FEE PERMIT ISSUING FEE 3AFINAL-� �® - TOTAL FES 2� PLAN CHECK VALIDATION CK. M.0. CASH PERMIT VALIDAT N CK M.O. CASH - 7•$• 14.-JUL 3 2 D 3.2 SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE -'