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HomeMy Public PortalAbout6019 AGNES AVE_Electrical__ / 76A663'CE-806(11 /78) APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN JOB ADDRESS J-G�.� �. •� L,' New Residential Bldgs.&Pools EACH NO. FEE C� tie 1 &2-Family,Sq. Ft. $ .025 — $ LOCALITY 7—e Multi-family Sq. Ft. .02' — NEAREST - 25.00 CROSS ST. �B Residential Swimming Pools OWNER OR �- C� ,U - Q MAIL First 20 j FIRM NAME ! , �)� Outlets:Rec � v Light Sw._L_ 50 13. ADDRESS ' % /. Total No. Additional 30 CITY' -aie k c ' Tel,No. "y�-- PLAN CHECK! APPLICANT Lighting Fixtures First 20 .50 L !222 ADDRESS Additional .30 .- .. Total No. CITY Tel. No. Fixed Appliances Not Over 1 HP - PERMIT - Range_Heater_D.W. APPLICANT Oven Dryer W.M. ADDRESS Top —FAU W.H._ CITY Tel. No. Hood Fan _Other LICENSE OR Disp. Room Air C 2'50 REG.NUMBER _ Class. IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPL'ICA Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE. LAWS Size&T pe HP, KW, KVA,or KVAR 2 50 �v REGULATING ELECTRICAL WIRING. Up to 1"Ind. 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR Over 1 to 10 Incl. 5.00 LICENSED AS REQUIRED BY LOS_ANGELES COUNTY AND STATE'OF Over 10 to 50 Incl. 12.50 CALIFORNIA OR THAT I AM THE LEGAL O _ _ OF THE ABOVE r4jl DESCRIBED RESIDEN L PROPE Y � C= Over 50 to 100 Inc. 25.00 80.00 PERMITEE /% Over 100 SIGNATURE U ,.r Q9J Services DISTRICT NO. PROC ES D BY 0-200 Amp.Under 600 V 25.00 /12.50C2 5-01 / 201-10.00 Amp. Under 600 V Over 1000 Amp.or Over 600 V 50.00 Z p Temp. Power Pole&Appurtenances 10.00 Q Sign with One Branch Circuit 10.00 Additional Sign Branch Circuits 2.00 INSPECTION > 97836A. INFORMATION U Misc.Conduits&Conductors 10.00 W0 0 0 0 0 2 ON REVERSE x Other(See Complete Fee Schedule) SIDEZ 2 0 0 6325 Q d 'a 0 a63,25' PERMIT FEE1 1, 1 9-79. (Sub-Total) Z PLAN CHECKING FEE (One-Fourth Permit Feel 2O "r PERMIT ISSUING FEE $7.00 G J TOTAL FEE �j 3 0e > INSPECTION FINALED W date: By ©s F 7'A663 DBS-SA 11-55 A® Y LIAT� \ DBS-SA � ®N FOR ELECTRIC PERMI DIVISION OF BUILDING AND SAFETY Deportment Of County Engineer BUILDINGS (+ County of LOS Angeles ADDRESS LAMBIE,COUNTY ENGINEER JCOAS ATT D. GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST ,q PERMIT FEES CROSS ST. NUMBER OWNER Gf. ; .d�l!/•r vti�Q. Cc-" LIGHT OUTLETS MAIL RECEPTACLES ADDRESS WALL SWITCHES FEE CITY TEL.NO. TOTAL OUTLETS @ 5Q $ ELECTRICIAN 4 . z ELEC. RANGES 25ADDRESS °>/)� t V}1 Q��a- cu'r, ELEC. HEATERS 25 KW EA CITY , l. . TEL. NO.Q. .4"f 19 STATE Q, `- FIXTURES 5 LICENSE NO. MOTORS DISTRICT NO. GROUP ZONE READY FOR INSPECTION NUMBER HORSEPOWER FEE i., C--- NEW MVD. HP OVER INC, EACH l �' 1/2&LESS $ .zs INSPECTION RECORD 1/2 2 .50 2 5 1.00 5 1 1.50 15 s0 2.50 50 1 200 5.00 misc. NO.SIGNS NO.TRANS. NO. SIGNS NO.IAMPS — FOR EACH PERMIT: WIRING $1.00 U" FIXTURES $1,00 SUPPLEMENTARY •50APPROVALS TOTAL FEE $ ® DATE INSPECTORS SIGNATURE I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT / -'� ; ?„ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING, WIRING g I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF f CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE POWER DESCRIBED RESIDENI]A PROPE Y. J ni SIGNATURE UTILITY CO.NOTIFIED OF PERMITTEE ' FINAL JOHN A.LAMBIE.COUNTY ENGINEER ATION ARTHUR C.VEIT.CHIEF ELECT. INSPECTOR C MO CASH LAC038591U-1 .JAN 3 2 1 .2 cJ ur WORKER'S COMPENSATION DECLARATION 9 DPW(12;�f, APPLICATION FOR ELECTRICAL PERMIT 76A66 I he;�eby affirm that I have a certificate of consent to self insure, 76A663 d' or a certificate of Worker's Compensation Insurance, or a certified COUf 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 JOB ADDRESS �t Certified copy is hereby furnished. idential Bldgs.&Pools NO. EACH FEE $ $ LOCALITY ❑ Certified copy is filed with the county building inspection i 2-Family,Sq.Ft. department. ti-famil S Ft. NEAREST p Y q CROSS ST. Date Applicant idential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' SN '�� OwNER OR tlets:Rec._Light COMPENSATION INSURANCE Ag IL NAME {�� �\ First 20 MAIL (This section need not be completed if the work involved by the ` �n � ® .permit is for one hundred dollars($100)or less.) Total No. Additional �! Q ADDRESS 6 0 K A �� I certify that in the performance of the work for which this per i CITY 10 is issued, I shall not employ any person in any manner so as ( PLAN CHECK ��11VV become subject to the Workers' Compensation Laws. Y Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date Applicant . NOTICE TO. APPLICANT: If, after making`this Certificate of RESIDENTIAL APPLIANCES NOT OVER 3 HP. •� � CITY 7e1.No. Exemption, you should become subject to the Workers' Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT provisions or this permit shah be deemed revoked. Power Apparatus&Large Appliances APPLICANT GZ� LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000) of Division 3 of the Business and CITY Tel.No. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. Over 50 to 100 Incl. LICENSE Class. REG.NUMBER Q. Over 100 DISTRICT NO. P O ESSED BY 0 License Number Lic.Class L Services,,,Sw d.,M C&&P elboard �'y> -20 Contractor Date �d¢Dcc /`Under6l 0� •1 /D TINA 0 DATE 400-1000 Amp.Under 600 V ~ ❑ I am exempt under Sec. Over 1000 Amp.or Over 600 V FINAL 1-�O~ VALIDATION W B.&P.C.for this reason BRANCH CIRCUIT FEES BY a- CD Date: 15A,or 20A, 120V,Lighting or Recept. 'lJ� Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits O El41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits i SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION 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 3'`t Code): ): t iLi i�; I,as owner of the property, will do the work and the structure Misc.Conduits&Conductors 370 = 35 is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) UAL and Professions Code). �- r"-�.E " - �i (o_ E �_s* CONSTRUCTION LENDING AGENCYf_� 3i�;fir"' ''• I hereby affirm that there is a construction lending agency for the _ performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) _ Civ. C.) t PLAN CHECKING FEE ")isj;tt(_ s{ 9?s8!_37r '`?w Lender's Name / ` 4.n7r C� PERMIT ISSUING FEE � �.'�� s l��I =.,-3_ Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE Q, that the 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 the above-mentioned property for i tion pur oses. / SEE REVERSE FOR EXPLANATORY LANGUAGE //A � Y SIGNATURE OF PERMITTEE DATE