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Home My Public Portal About9706 WOOLLEY ST_Electrical__ WORKER'S COMPENSATION DECLARATION 20.0019 DPW 9189 1 hereby affirm that I have a certificate of consent to self Insure, 7BM63 APPLICATION FOR ELECTRICAL PERMIT or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN ADDRESS Certified cop her fufnished. New Residential Bldgs.&Pools EACH NO. FEE LOCALITY ❑ 1 &2-Family,Sq.Ft. $ — $ LS Certified co I fll with the county building inspection _ NEAREST It department Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. F�MM NAME p q C COMPENSATION INSURANCE First 20 (This section need not be completed If the work Involved by the ADDRESS permit is for one hundred dollars($100)or lose.) Total No. Additional 0 O1� I certify that In the performance of the work for which this permit CITY Tel.No.r7 11 Is issued, I shall not employ any pe rso in any manner so as to PLAN CHECK become subject to the Workers'Comp en tion Laws Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date Z Applicant 15 OR 20A,120V BRANCH CIRCUITS NOTI E T APPLICANT: If, after m in this Ce tificate of CITY Tel.No. Exem ion,you should become subject to the orkers'Compensation 1 TO 10 INCLUSIVE EACH provisions of the Labor Code,you must forthwith comply with such 11 TO 40 INCLUSIVE EACH PERMITArrU�Nlja provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH ^ Ll�� LICENSED CONTRACTORS DECLARATION ADDRESS og q I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH o (commencing with Section 7000)of Division'3 of the Business and CITY Tel.No.Z� V Professions Code,and my license is In full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR /` l�f Power Apparatus&Large Appliances REG.NUMBER Class.C��0 License Number. C Lic.Class ^�a/ Size&Type HP,KW,KVA,or KVAR DISTRICT NO. PRO ED BY 0 Up to 3 Incl. 6,g ,_- W Contractorco ate -Over 3 to 10 Incl. FINAL n- ❑ Over 10 to 50 Incl. DATE VALIDATION Z I sm axe u der Sec. Over 50 to 100 Incl. AL B.&P.C.for this reason Over 100 gy Services,Swbd.,MCC&Panelbo . Date: 0-200 Amp.Under 600 1 �8 Signature 201-1000 Amp.Under 600 F1Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole&Appurtenancesr•�+ n HOME OWNER-BUILDER DECLARATION Av rT o 4 I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits 3307 94°51 Ceder 1 ITEMS ❑ 1,as owner of the property,will do the work and the structure Misc.Conduits&Conductors Is not intended or of red for sale(Section 7044, Business Other(See Complete Fee Schedule) , TOTAL ?4.5 l- and Professions od A0 �:�-IEtii 94.51 CON 10 ING AGENCY CHANGE .00 I hereby affirm that th s a o truction lending agency for the performance of the wo r wh h this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ.C.) PIAN CHECKING FEE 0000-00131 8/19/92 Lender's Name r�Q�� 1 �0 11 PERMIT ISSUING FEE p? 75 rider's Address certify th t I have read this application and state that the above TOTAL FEE formatio is correct. I agree to comply with all County ordinances rid State laws regulating Electrical wiring, and hereby authorize pros n fives of this Count to enter upon eabove-mentioned op or inspectio p s s. SEE REVERSE FOR EXPLANATORY LANGUAGE i NAT F PLI R T ISASSS•CESOS.7.56 APPLICATION FOR ELECTRIC PERMIT ], BU=ING AND SAFETY DMSION Department of County EngineerBUILDING '-7 County of Los Angeles ADDRESS ,- JOHN A.LAMBIE, COUNTY ENGINEER CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. A PE UM FEES NUMBER OWNER r LIGHT OUTLETS MAIL ADDRESS 4 RECEPTACLES WALL SWITCHES FEE CITY A f,TEL..NO. c. TOTAL OUTLETS @ 5¢ $ ELECTRICIAN } ELEC.RANGES 25 ADDRESS r� ,�7: ^��)ON ~i'•�''1` --- ELEC. HEATERS 25 CITY TEL.NO{;t KW EA STATE fl / FIXTURES g D LICENSE NO. U MOTORS DISTRICT NO. GROUP ZONE I READY FOR INSPECTION NUMBER yHORSEPOWER FEE NEW MVD. HP VVER INC. EACH Yz&LESS $ .25 INSPECTION-RECORD 14 2 .50 2 5 1.00 5 15 1.50 1550 2.50 50 200 5.00 MISC. ,l Pf p!R' NO.SIGNS NO.TRANS. NO.SIGNS NO.LAMPS FOR EACH PERMIT: WIRING PERMIT $1.00 FIXTURE PERMIT $1.00 SUPPLEMENTARY .50 APPROVALS TOTAL FEE DATE INSPECTORS SIGNATURE 1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CONDUIT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING. FIXTURES 1 HEREBY CERTIFY-THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF POWER CALIFORNIA OR THAT I ATHE L GAL OWNER OF THE AS VE DESCRIBED RESIDENTIAL P � ERTY .r��J UTILITY CO.NOTIFIED SIGNATURE 77�p OF PERMITTEE w• FINAL c. IOHN A.LAMBIE, i ARTHUR C.VEIT. ..OUNTY ENGINEER VALIDA SUPERVISING ELECTRICAL ENGINEER CK MO CASH I LAD04 s.3-.; JAN 15 2 22 5 In 7BAB58 DBS•SA 8.55 APPLICATION FOR ELECTRIC PERMIT 1 DIVISION OF BUILDING AND SAFETY Deportment of County Engineer County of LOS Angeles. BUILDING WM.J. FOX,COUNTY ENGINEER ADDRESS CASSATT D.GRIFFIN.SUPT OF BUILDING •� n LOCALITY st ✓�� FOR APPLICANT TO FILL IN NEAREST PERIVIIT FEES CROSS ST. NUMBER EACH FEE LIGHT OUTLETS OWNER RECEPTACLES MAIL ADDRESS WALL SWITCHES TOTAL OUTLETS 5¢ $ CITY TEL.NO. ELEC.RANGES 25 ELECTRICIAN l .7.6 ELEC.HEATERS 25 ADDRESS 1KW EA CITY G.l TEL.NO FIXTURES 5 -]Ld LICENSE NO. NUMBER OF LIGHT CIRCUITS - DISTRICT NO. I GROUP 17SiNF READY FOR INSPECTION e. NUMBER OF RECEPTACLE CIRCUITS �-j y MOTORS NUMBER HORSEPOWER FEE INSPECTION ECORD NEW MVD. HP OVER INC. EACH y2 Sc LESS $ .25 I If2 2 .50 2 5 1.00 5 15 1.50 4j 15 50 2.50 50' 200 5.00 r MISC. NO.SIGNS NO.TRANS. NO.SIGNS NO.LAMPS s FOR EACH PERMIT: WIRING $1.00 FIXTURES $1.00 "SUPPLEMENTARY 50 APPROVALS TOTAL FEE $ ® DATE INSPECTOR'S SIGNATURE_ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CONDUIT J Z"13 dT ! . A AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY �. WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING I� ELECTRICAL WIRING. �yy dLDESCRIBEDRESIDE1 EDBASCERTIFY REQU RED BY LOSAT I MANGELESLCOUNTYSTERED AND STATE/OR OF FIXTURES `L 'Sb �J��°• RNIA OR THA I AM E LEGAL 0 NER OF TH ABOVE POWER T PROP Y. UTILITY CO.NOTIFIED �URERMITTEE FINAL WILLIAM J.FOX.C LINTY ENGINEER VALIDATION A.C.VEIT.CHIEF ELECT.INSPECTOR 7 1 4 C'l� AUG 2 5 2 5.5 0 m :_A� "'