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Home My Public Portal About4836 BALDWIN AVE_Electrical__ (2) 76A663-CE806 10,74 APPLICATION OR EL TRICAL PERMIT COUNTY OF LOS ANGELES C DEPARTMENT OF COUNTY, ENGINEER aooREss BUILDING AND SAFETY DIVISION LOCALITY NEAREST 17- FOR APPLICANT TO FILL IN CROSS ST. - OUTLETS NO. EACH FEE OWNER OR + $ $ FIRM NAME RECEPT._ MAIL LIGHT TOTAL FIRST 20 25 ADDRESS L ' 14f�iy CITY I f, o TEL. NO. SWITCH OVER 20 10 PLAN CHECK LIGHTING TOTAL FIRST 20 .25 APPLICANT ADDRESS FIXTURES OVER 20 { 10 RESIDENTIAL APPLIANCES CITY TEL. NO. PERMIT RANGE DRYERWTR. HTR. APPLICANT ^�(t/ STA. COOK DISP. F.A.U. ADDRESS�Q PjgX/ es' Ue B SPACE HTR. AIR COND. CITY T TEL. NO. r ' CLOTHES WASH. DISHWASH. LICENSE OR REG. NUMBER ® CLASS. Q FAN OTHER 1.00 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. SIZE IN TYPE OVER TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR O - 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAI I AM THE LEGAL OWNER THE ABOVE �- 1 - l O 3.00 DESCRIBED RESIDENT L PR E Y. 6O7 PERMITEE 10 - 50 5.00SIGNATURE 50 - 100 10.00 W DISTRICT NO. P CES D BY N 100 - 500 15.00 Q, -. r TUBE,GOR AS SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE INSPECTOR'S SIGNATURE MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE 1 SERVI CENOT OVER 600 VOLTS OR 200 AMP 3.00UNDERSLAB WORK SERVI CE OVER 600 VOLTS OR 200 AMP 10.00 ROUGH CONDUIT TEMPSERVICE,POLE, &APPURTENANCES 5.00 WIRING TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED FINAL t PERMIT FEE (SUB TOTAL) NOTES: PLAN CHECK FEE PERMIT ISSUING FEE 3.00 TOTAL FEE 91 Q \ PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 3 2 4 5 19 2 SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE u""'4r a? WORKERS' COMPENSATION DECLARATION 66 ;76A9DPW 3ie7 APPLICATION FOR ELECTRICAL PERMIT O i hereby affirm that I have a certificate of consent to self Ce 8006G insure, or a cerNicate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. - Company FOR APPLICANT TO FILL IN JOB Certified copy is Yereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRES Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ _ $ LOCALITY �U tion department. Multi-family Sq. Ft. NEAREST S, Residential Swimming Pools OWNECROSS SOR�/10� ®�/7t—'c� � r,/� Date Applicant jj FIRM NAME(2$1 Ve! 6_S /U "I7 )kK_Sd CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Recf_�Lightql` Sw. DDRESSYJLCi COMPENSATION INSURANCE ��JJ � First 20 7! G_ - (This section need not be completed if the work involved by Total No.�¢L� Additional CIT �n Tel. No 0 W the permit is for one hundred dollars ($100)or less.) PLAN CHE 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 to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional Total No. CITY Tel. No. DateApplicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION 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. — deemed revoked. Hood — Fan —Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR Disp. .— Room Air Cond. — Class. I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY d and Professions Code,and my license is in full force and effect. Size 8 Type HP, KW, KVA, or KVAR �f�� ". Lp�,G�,� O License Number Lic. Class Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE Z _ VALIDATION 0 Contractor Date Over 10 to 50 Incl. U ❑ FINAL I am exempt under Sec. Over 50 to 100 Inc. BY UJ B.&P.C. for this reason Over 100 a_ Services, Swbd., MCC& Ponelboards , Z Z 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. SINGLE FAMILY Temp. Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits - - Professions Code): Ell, as owner of the property, will do the work and the Misc. Conduits&Conductors "t structure is not intended or offered for sale Section 7044, Other (See Complete Fee Schedule)_ Business and Professions Code). :.ai CONSTRUCTION LENDING AGENCY i "'` I 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) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE M ` Lender's Address h �/ I certify that I have read this application and state that the I TOTAL FEE v� 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-mentione prop ty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE I es g ature o 'PerrAittee Defte