HomeMy Public PortalAbout4831 BALDWIN AVE_Electrical__ (2) x6630 CE806B i,76/ APPLICATION FOR ELECTRICAL PERMIT
BUIL G AND SAFE DIVISION
FOR APPLICANT TO FILL IN
New Residential Bldgs &Pools EACH NO FEE ADDRESS 4831 N BALDWIN t-C—_
1 &2 Finaily Sq Ft
$ — $ LOCALITY T LE CITY
Multifamily Sq Ft — NEAREST
CROSS ST
Residential Swimming Pools OWNER OR
FIRM NAME GRIFFIN, EARL
Outlets Light Switch&Receptacle MAI L
ADDRESS SAME
First 20
Additional CITY TEMPLE CITY Tel No 448-4057
PLAN CHECK
Lighting Fixtures APPLICANT
First 20 ADDRESS
Additional
CITY Tel No
PER
IT
Fixed Appliances Not Over 1 HP APPLICANT
TRANE xcc
Range Heater DW ADDRESS 2034 N PECK RD
Oven Dryer W M
Top FAU 3c WH CITY SO EL MONTE Tel No 579-7982
Hood Fan LICENSE OR265094 Class C-10 OU
Disp A C 2 50 REG NUMBER
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION 0
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY V
Power Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING LiJ
Size&Type HP KW KVA or KVAR ELECTRICAL WIRING N
Up to 1 Incl Z
�'1 5 00 I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
l HP Over 1 to 10 Incl LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
Over 10 to 50 Incl DESCRIBED RESIDENTIAL PR RTY r V
Over 50 to 100 Incl PERMITEE
Over 100 SIGNATURE
fDRCT NO IiIIIfROC SED B
Services
Q
0 200 Amp Under 600 V o 6�/
201 1000 Amp Under 600 V APPROVALS DATE IN CTOR S
Over 1000 Amp or Over 600 V GNATURE
POWER POLE
Temp Power Pole&Appurtenances SLAB WORK
Sign with One Branch Circuit
Additional Sign Branch Circuits ROUGH CONDUIT
(Other) WIRING
FIXTURES
POWER AUTHORIZED
PERMIT FEE (Sub Total) 7 50 UTILITYCO NOTIFIED-[, ,�-
PLAN CHECKING FEE (One Fourth Permit Fee)
FINAL
PERMIT ISSUING FEE 7 30 `
NOTES
TOTAL FEE 14 50
—P-LAN-CH ECK VALID_ATIO 5"°`�CK p".��M10 O)NCASHI?6�Al PERMIT VALIDATION M O CASH
0,,,4&4 �t`(AR 2 3 -e 0 1 4 5
POLICY HOLDER 25;,o -Q, � ��� times
I f
76A663 CES06 10/74 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER 7FCDROSS
'
BUILDING AND SAFETY DIVISION RES J�
ALITY
REST
FOR APPLICANT TO FILL IN ST
OUTLETS NO EACH_F E OWNER OR
$ S FIRM NAME
RECEIPT_ MAIL
FIRST 20 25 AE
LIGHT TOTAL DDR . J
CITY
SWITCH OVER 20 10
PLAN CHECK
LIGHTING TOTAL FIRST 20 25 APPLICANT
FIXTURES
OVER 20 10 ADDRESS
RESIDENTIAL APPLIANCES CITY TEL NO )
PERMIT
RANGE DRYER_WTR HTR_ APPLICANT �Q
STA COOK DISP F A U ADDRESS
lam'`
SPACE HTR AIR COND CITY 0C TEL NO -�ys
CLOTHES WASH DISHWASH LICENSE OR D CLASS C )
REG NUMBER
FAN OTHER 100I
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS j REGULATING
IND HEATERS ETC HP KW KVA ELECTRICAL WIRING
SIZE & TYPE OVER TO
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 - I 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF }.
CALIFORNIA OR T Al I AM THE LEGAL OWNER OF THE ABOVE 13-
1 - 1O 300 DESCRI PED REST ENTIAL OPERT )} O
V
PERMITEE ' C
10 - 50 500 SIGNATURE h
F-
U
50 - 100 1000 W
DISTRICT NO ICES DIBY N
100 - 500 1 i 00 O c
SIGN GAS SIGN AND ONE CIRCUIT 500 APPROVALS DATE INSPECTOR S SIGNATURE
TUBE OR
MARQUEE ADDITIONAL CIRCUITS 100 TEMP POWER POLE j
i r
SERVI CENOTOVER 600 VOLTS OR 200 AMP 300 UNDERSLAS WORK
SERVI CEOVER 600 VOLTS OR 200 AMP 1000 ROUGH CONDUIT f
TEMP SERVICE POLE &APPURTENANCES 500 WIRING ,N+
1
TEMP LIGHT OR RECEPT SYSTEM 300 FIXTURES f F
i
POWER AUTHORIZED I
UTILITY CO NOTIFIED '
r
FINAL
PERMIT FEE (SUB TOTAL) NOTES
PLAN CHECK FEE
PERMIT ISSUING FEE 300
TOTAL FEE
PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION cK M 0 CASH
9 1 7 1 4 2 90'(j A-"3
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE V ��
I!
s_••_, -- ;WORKERS'COMPENSATION DECLARATION 76-663 10/81 APPLICATION FOR ELECTRICAL PERMIT �ry
I hereby affirm that I have a certificate of consent to self insure, CE-806G
or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec. 3800,Lab. C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB
❑ Certified copy is hereby furnished. EACH NO. FEE ADDRESS Jul 1
New Residential Bldgs.& Pools
❑ 1 & 2-Family, Sq.Ft. $ _ $ LOCALITY
Certified copy is filed with the county building inspection
department. Multi-family Sq.Ft. NEAREST e _
Residential Swimming Pools. CROSS ST. I!
Date Applicant OWNER OR
-FIRM NAME Flu 14
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec Light Sw.
COMPENSATION INSURANCE ADDRESS
(This section need not be completed if the work involved by the First 20'
permit is for one hundred dollars($100)or less.) Total No. Additional, CITY Tel.No. 4AA 4
iPLAN CHECK
I certify that in the performance of the work for which this permit APPLICANT
is issued, I shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
-
Date Applicant G Additional
"7_11-Cd
1`� 6 — Total No. CITY Tel.No.
NOTICE TO APPLICANT: If, after making this Certificat? Fixed Appliances Not Over 4 HP of PERMIT
Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APPLICANT
provisions of the Labor Code, you must forthwith comply with such Oven Dryer _ W.M._ ADDRESS JA ev
provisions or this permit shall be deemed revoked. Top FAU W.H.
CITY Tel.No.
LICENSED CONTRACTORS DECLARATION Hood Fan Other_
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. LICENSE OR Class.
(commencing with Section 7000) of Division 3 of the Business and REG.NUMBER
Professions Code,and my license is in full force and effect. DISTRICT NO. POC SED BY
Power Apparatus& Large Appliances
Size& Type HP,KW,KVA,or KVAR
License Number Lic.Class Up to 1 Incl. FINAL
Over 1 to 10 Incl. DATE, �•r � VALIDATION
Contractor Date Over 10 to 50 Incl. UUU 0
❑ FIN C.1
I am exempt under Sec. Over 50 to 100 Inc. g
B.&P.C.for this reason
Over 100 !!
Services,Swbd.,MCC& Panelboards
Date: 0-200 Amp.Under 600 V
Signature 201 - 1000 Amp.Under 600 V
❑ Over 1000 Amp.or Over 600 V
Exemption for Reg.Maint.Elect. 9 Q 12 6 A
SINGLE FAMILY Temp.Power Pole & Appurtenances # 0.0 0 0 0 2
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 2.550
I hereby affirm that I am exempt from the Contractor's License Law o 0
for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits 2 5 Q=
Code): ° °10 c5
I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors 0 71 ;1 m 8 8
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) ,
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 issued(Sec.3097, PERMIT FEE (Sub-Total)
Civ.C.).
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE
Lender's Address 7-61
v
I certifythat I have read this application and state that the above TOTAL FEE
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 inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date