HomeMy Public PortalAbout6046 AGNES AVE_Electrical__ 1
t�
r �
1
76A663 CV BZ761 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY /
FOR APPLICANT TO FILL IN JOB
New Residential Bldgs &Pools EACH NO FEE ADDRESS
1 &2 Family Sq Ft $ 025 — $ LOCALITY
Multi family Sq Ft 02 — NEAREST +
0 CROSS ST
Residential Swimming Pools 25 0OWNEROR �y �'LI 1
FIRM NAME ►`6
Outlets Rec Light Sw MAIL
First 20 50 ADDRESS 0
Total No Additional 30 CITY j L. T Tel No
J PLAN CHECK
APPLICANT
Lighting Fixtures First 20 50 ADDRESS
Additional 30
Total No CITY Tel No
Fixed Appliances Not Over 1 HP PERMIT r
APPLICANT
Range_Heater_D W ADDRESS
Oven—Dryer_W M— a C
Top _FAU WH CITYf� J,2,,74-ce4X,1 Tel No 3p2
Hood_Fan —Other LICENSE OR 2 w& G 70
Disp —Room Air Cond _ 2 50 2 S REG NUMBER 31.5 // �o Class
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA
Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO
Size&Type HP KW KVA or KVAR COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
9:2 50 REGULATING ELECTRICAL WIRING
t4 Up to 1 Incl 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR O
3 Over 1 to 10 Incl 5 00 LICENSED AS REQUIRED BY LOS ANGELES'COUNTY AND STATE OF
Over 10 to 50 In 12 50 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
25 00 DESCRIBE 1 Y
Over 50 to 100 Inc PERMITE r
Over 100 40 00
SIGNAT �
N
Services DISTRICT NO �/ PR ESS BY
0 200 Amp Under 600 V 12 50 0 J ✓dye f
201 1000 Amp Under 600,V 25 00_ 0
Over 1000 Amp or Over 600 V 5000 Z
10 00 Com( Pyl� �"n a
Temp Power Pole&Appurtenances r
� G �
Sign with One Branch Circuit 1000 J
Additional Sign Branch Circuits 200 INSPECTION >
Misc Conduits&Conductors 1000 INFORMATIONON REVERSE x
Other(See Complete Fee Schedule) SIDE V " 9 4 2 6 6 A
J # o o o o o 2
d
12 - 2700
PERMIT FEE (Sub Total) D o 0 0 27006
Z
PLAN CHECKING FEE One Fourth Permit Feel O
C 0509-79
PERMIT ISSUING FEE $7 00 vQ
J
� Q
TOTAL FEE , D() >
INSPECTION FINALED etc
I.
date 7'4 —bv By �,� a. p:
WORKERS COMPENSATION DECLARATION CE76A6�3806 10ie1 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self CE 8066
insure or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof (Sec 3800 Lab C )
Policy No Company FOR APPLICANT TO FILL IN JOB
ADDRESS
Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE
❑ 1 8 2 Family S Ft $ — Adylo A) A6A�) f
$ LOCALITY �`
Certified copy is filed with the county building inspec Y q
tion department - Multi family Sq Ft — NEAREST
CROSS ST (IAA(64��,
Residential Swimming Pools
Date Applicant OWNER OR —y�,
FIRM NAME L_y W/ t'cllf
191 CERTIFICATE OF EXEMPTION FROM WORKERS 7.� � MAIL �—
Outlets Rec Light Sw DDRESS (-
COMPENSATION INSURANCE First 20 6
(This section need not be completed if the work involved by Total No.� Additional ITN O( C Tel No
the permit is for one hundred dollars ($100)or less ) PLAN CHECK
I certify that in the performance of the work for which this APPLICANT
permit is issued I shall not employ any person in any manner
so as t�ze d to the Workers mpens n Laws Lighting Fixtures First 20 ADDRESS
Additional
Total No
CITY Tel No
Date pplic Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT If after ma ing this Certificate of APPLICANT
Exemption you should become subject to the Workers Range_ Heater D W
Compensation provisions of the Labor Code you must forth Oven _Dryer —W M — ADDRESS
with comply with such provisions or this permit shall be Top — FAU W H — t
deemed revoked CITY Tel No
LICENSED CONTRACTORS DECLARATION Hood — Fan Other
LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp — Room Air Cond REG NUMBER Class
(commencing with Section 7000) of Division 3 of the Business Power Apparatus & Large Appliances DISTRICT NO PROSED BY >_
and Professions Code and my license is in full force and effect IL
Size &Type HP KW KVA or KVAR O
License Number Lic Class Up to 1 Incl FINAL V
Over 1 to 10 Incl DATE VALIDATION 0
Contractor Date Over 10 to 50 Incl FINAL V
❑ I am exempt under Sec Over 50 to 100 Inc BY W
IL
T
B 8P C for this reason Over 100 WZ
Date Services Swbd MCC & Panelboards
0 200 Amp Under 600 V
Signature 201 1000 Amp Under 600V
❑ Over 1000 Amp or Over 600 V
Exemption for Reg Maint Elect
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) 2089 9 A
1 as owner of the property will do the work and the Misc Conduits & Conductors f o 0 0 0 0
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ # I 2
7044 Business and Professions Code) 1 2 0 0 3&75
CONSTRUCTION LENDING AGENCY 0 -1- 387 Jr 5I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued PERMIT FEE (Sub Total) 0502-84
(Sec 3097 Civ C )
PLAN CHECKING FEE
Lender s Name
PERMIT ISSUING FEE
Lender s Address
I certify that I have read this application and state that the TOTAL FEE f �C
above information is correct I agree to comply with all County _
ordinances and State laws regul ting Electrical wiring and
hereby outhoriz resentati of t s County to enter upon
the ab endo a prop or pection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
Sign ure of Permittee T� v
/ l