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HomeMy Public PortalAbout6053 AGNES AVE_Electrical__ Leh,//e Cr`71 70663 CE 806 4 s8 APPLICATION FOR ELECTRICAL PERMIT I COUNTY OF LOS ANGELES DEQARTMENT OF COUNTY ENGINEER BUILDING / BUILDING AND SAFETY DIVISION ADDRESS 6®S3 4G1pL JOHN A LAMBIE COUNTY ENGINEER COLEMAN W JENKINS SUPERINTENDENT OF BUILDINGLOCALITY FOR APPLICANT TO FILL IN NEAREST /+_ CROSS ST �'}@J ggC_D/ NO EACH FEE $ S OWNER RECEPT� MAIL LIGHT TOTAL FIRST 20 tb 20 D� ADDRESS SWITCH OVER 204- PLAN 10 CITY TEL NO LIGHTING TOTAL FIRST 20 20 APPLICANT CHECK CANT FIXTURES OVER 20 10 ADDRESS RANGII"�DRYER L-WTR HTR' CITY TEL NO STA COOK_DISP/F A U _ CONTRACT-OR Q&J,r- Jej SPACE HTR AIR COND ADDRESS CLOTHES WASH !fn'-DISHWASH _ CITY TEL NO FAN L OTHER a 100 OULICENSE IJO CLASS MOTORS TRANSFORMERS RATING IND HEATERS ETC HP KW KVA I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING 0 — 1 1 00 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 1 — 10 3 00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT IAM THE LEGAL OWNER OF AND INTEND TO 10 — 50 5 00 RESIDE IN THE ABOVE DESCRIPED RESIDENTIAL PROPERTY SIGNATURE 50 - 100 10 00 OF PERMITTEE O U 100 - 500 15 00 DISTRICT NO GRQ P I PROCESSED JBY o SIGN TUBE A �",5IGN AND ONE CIRCUIT 3 00 1 U MARQUEE ADDITIONAL CIRCUITS 1 00 NOTES CL SERVICE NOT OVER 600 VOLTS OR 200 AMP 2 00 Z SERVICE OVER 600 VOLTS OR 200 AMP 5 00 TEMP SERVICE POLE _&_APPURTENANCES 3 00 APPROVALS DATE INSPECTOR S SIGNATURE c TEMP POWER POLE UNDERSLAB WORK ROUGH CONDUIT WIRING PERMIT FEE (SUB TOTAL) FIXTURES PLAN CHECK FEE (507 PERMIT FEE) POWER AUTHORIZED PERMIT ISSUING FEE 2 00 GV UTILITY CO NOTIFIED �j SUPPLEMENTARY PERMIT ISSUING FEE 1 00 FINAL TOTAL FEE p JOSE H C ROOHAN SUPERVISING ELECT AL ENGINEER PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION 0 M 0 CASH I 0SEE8 1 3 7 o jiAd 2 4 a 1 0 40— SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE 764,663 CE806 3 69 e� APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER n/ BUILDING AND SAFETY DIVISION ADDRESS ,9t 3 /V O JOHN A LAMBIE COUNTY ENGINEER COLEMAN W JENKINS SUPERINTENDENT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST 'DGe NO EACH FEE 69 vv $ $ OWNER RECEIPT MAIL LIGHT TOTAL FIRST 20 20 ADDRESS CITY TEL NO SWITCH OVER 20 10 PLAN CHECK LIGHTING TOTAL FIRST 20 20APPLICANT FIXTURES } OVER 20 10 ADDRESS RANGE_DRYER_WTR HTR CITY TEL NO STA COOK_DISP le!!._l_F A U CONTRACTOR SPACE HTR AIR COND ADDRESS CLOTHES ASH _DISHWASH CITY TEL NO FAN OTHER 1 00 © LICENSE NO CLASS MOTORS TRANSFORMERS RATING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 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 OO 1 HEREBY CERTIFY THAT AM PROPERLY REGISTERED AND/OR ICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATEOF } 1 - 10 3 OO CALIFORNIA OR THAT I AM THE LEGAL OWNER OF INTEND TO a RESIDE IN THE ABOVE DESCRIBED RESIDEN L ROP TY LL 10 - 50 500 /J L SIGNATURE 50 - 100 10.00 OF PERMITTEE c 100 - 500 1500 DISTRICT NOGROUP ZONE PROC SSED BY V LL SIGN GAS SIGN AND ONE CIRCUIT 3 00 ca/7 TUBE OR ? z MARQUEE ADDITIONAL CIRCUITS 1 00 NOTES ) P J SERVICE NOT OVER 600 VOLTS OR 200 AMP 2 00 SERVICE OVER 600 VOLTS OR 200 AMP 5 00 TEMP SERVICE POLE &APPURTENANCES 3 00 APPROVALS DATE INSPECTORS SIGNATURE TEMP POWER POLE UNDERSLAB WORK ROUGH CONDUIT WIRING PERMIT FEE (SUB TOTAL) FIXTURES POWER AUTHORIZED PLAN CHECK FEE (507 PERMIT FEE) PERMIT ISSUING FEE 2 00 UTILITY CO NOTIFIED �� b SUPPLEMENTARY PERMIT ISSUING FEE 1 00 FINAL TOTAL FEE 3 O� JOSEPH C ROOHAN SUPERVISING ELECTRICAL ENGINEER PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION CK M o CASH 04 3 7 2 4c'-'--' F317 2 D 3 00� SEE BACK OF APPI [CATION COR COMPLFTF FFF ^CHFOIILF ;66"1� 7¢A663 CE806 168 APPLICATION FOR ELECTRICAL PERMIT .i COUts1rY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER /_ BUILDING AND SAFETY DIVISION ADD ESS (oOS� JOHN A LAMBIE COUNTY ENGINEER COLEMAN W JENKINS, SUPERINTENDENT OF BUILDING LOCALITY e-v C.A NEAREST FOR APPLICANT TO FILL IN CROSS ST 614'k 6Lo NO EACHI FEE n $ S OWNER 6 1✓ 441,/6 RECEPT _1 MAIL LIGHT ,(`TOTAL FIRST 20 20 ADDRESS SWITCH_, OVER 20 10 CITY TEL NO PLAN CHECK LIGHTING �TOTAL FIRST 20 20 APPLICANT FIXTURES OVER 20 , 10 ADDRESS RANGE_DRYERWTR HTR _ CITY TEL NO STA COOK_DISP F A U CONTRAC rOR r SPACE HTR AIR COND ADDRESS CLOTHES WASH DISHWASH CITY TEL NO FAN—OTHER 1 00 LICENSE IJO CLASS f MOTORS TRANSFORMERS RATING IND HEATERS ETC HP KW KVA I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULAT,I NG ELECTRICAL WIRING 0 - 1 1 00 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 1 - 10 3 00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO a 10 - 50 5 00 RESIDE IN THE ABOVE OESCRIPED RESIDENTIAL PROPERTY O 50 - 100 10 00 SIGNATURE VOF PERMITTEE ad 100 - 500 15 00 DISTRICT NO I GRO IP JVZONE P O ESSED G0 TUBE OR SIGN AND ONE CIRCUIT 3 00 O LLJ a MARQUEE ADDITIONAL CIRCUITS 1 00 NOTESI + Z SERVICE NOT OVER 600 VOLTS OR 200 AMP =oar SERVICE OVER 600 VOLTS OR 200 AMP S 00 TEMP SERVICE POLE &APPURTENANCES 3 00 APPROVALS DATE INSPECTOR SSIGNATURE TEMP POWER POLE UNDERSLAB WORK ROUGH CONDUIT G WIRING PERMIT FEE (SUB TOTAL) y FIXTURES PLAN CHECK FEE (50% PERMIT FEE) q r � POWER AUTHORIZED PERMIT ISSUING FEE 2 00 2 Com!' UTILITY CO NOTIFIED ,,r SUPPLEMENTARY PERMIT ISSUING FEE 1 00 FINAL TOTAL FEE O JOSEPH C ROOHAN SUPERVISING ELECTRICAL ENGINEER PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION CK M o CASH 00 "EE \ Lt1Lo 6 7 5 9'�233 uL,l 9 4 D 400 - EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT 1 hereby affirm that I have a certificate of consent to self insure 76A663 or a certificate of Worker's Compensation Insurance, or a certifi d COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec. 3800 Lab.C.) Cy N0. r Company FOR APPLICANT TO FILL IN JOB ADDRESS ((�/�s'g� Ave- El g Certified co is hereby furnished. NO. EACH FEE PY Y New Residential Bldgs.&Pools COCALIT 1&2-Family,Sq.Ft. $ $ Certified copyis filed with the coun 4WOERS' ti n NEAREST department. Multi-family Sq. Ft. CROSS ST. Date Applicant Residential Swimming Pools. ASSESSOR 1 0'' tt,�,,//,, MAP BOOK PAGE PARCEL i ERTIFICATE OF EXEMPTION FROWNER OR ' \\ COMPENSATION INSURANCE Outlets:Rec. Light Sw. �� FIRM NAME (/� First 20 (This section need not be completed if the work involved by the . Additional MAIL MAIL ADDRESS Total NoW permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITY Tel.No. is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.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 shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or.KVAR ADDRESS 6 I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. �3 (commencing with Section 7000) of Division 3 of the Business and CITY T o. Professions Code, and my license is in full force and effect. Over 10 to.50 Incl. } LICENSE OR [_,;, j� Class. ry Over 50 t0 100 Incl. REG.NUMBER Y I a G/, ( �e � Over 100 DISTRICT NO. PR C ED BY Q License Number ! J *(-#� Lia Class /� . V Services,Swbd.,MCC&Panelboards s'lJ� Cc 0-399 Amp.Under 600 V FINAL V74 O Contrac '(zDate DATE ❑ I am a pt under Sec. 400-1000 Amp.Under 600 V �2 ~ VALIDATION U Over 1000 Amp.or Over 600 V FINAL ,, // W B.&P.C.for this reason BRANCH CIRCUIT FEES BY /� U) Date: 15A,or 20A, 120V,Lighting or Recept. Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits 41 Or More Branch Circuits Exemption for Reg.Maint. Elect. 15A,20A,208V To 277V Lighting Br.Circuits 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 Law for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuitsz(_,4_ =e Code): I, as owner of the property,will do the work and the structure Misc.Conduits&Conductors IS is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , L s TEM E I" and Professions Code). x TA sa 3 CONSTRUCTION LENDING AGENCY a--, I hereby affirm that there is a construction lending agency for the -H `K -' performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) 10 s.`_ia Civ. C.) PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Z °jsf Lender's Address e , I certify that(ha read this application and under penalty of purjury state TOTAL FEE .Z� .L--6 1:= _ EI'={'1•_ that the abov Inf rmation is correct. I agree to comply with all County ordinances a d ate laws regulating Electrical wiring,and hereby authorize r presenia of this County to me y�n the above-mentioned property fo pe ion purpo SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF PERMITTEE DATE