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HomeMy Public PortalAbout4930 BALDWIN AVE_Electrical__ (2) 76A663-CE806 10/72 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER JOB BUILDING AND SAFETY DIVISION ADDRESS 'T7 LOCALITY �PL C� NEAREST FOR APPLICANT TO FILL IN CROSS ST. /C OUTLETS NO. EACHI FEE OWNER OR C/ J� $ $ FIRM NAME CT F444= Cj� /! X S CS%L'e- RECEPT._ MAIL ADDRESS �P3f� 6.•���-.C.l7LUJ�a,✓ �'�' LIGHT TOTAL FIRST 20 .25 ``gyp CITY �/N/hL� Cj TEL. N0.T7-���3/� SWITCH OVER 20 .10 PLAN CHECK LIGHTING TOTAL FIRST 20 25 APPLICANT FIXTURES OVER 20 ip ADDRESS RESIDENTIAL APPLIANCES CITY TEL. NO. PERMIT { RANGE DRYERWTR. HTR._ APPLICANT 'r STA. COOK DISP. F.A.U. ADDRESS SPACE HTR, AIR COND. CITY r TEL. NO. CLOTHES WASH. DISHWASH. LICENSE OR CLASS. REG. NUMBER 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 & TYPE OVER TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 - 1 1.00 LICENSED AS RE0U IRTHAI BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAI I AM THE LEGAL OWNER OF THE ABOVE 1 - 1O 3.00 DES CRIPED RESIDENTIAL PROPERTY. , CD U PERMITEE > ///� r w 10 - 50 5.00 SIGNATUREl.'�'�' P K v� CD SO - 100 10.00 DISTRICT NO. PROCESSED BY W CL 100 - 500 15.00 SIGN, GAS =AND ONE CIRCUIT 5.00 APPROVALS (/ DATE INSPECTOR'S SIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE SERVI CENOTOVER 600 VOLTS OR 200 AMP 3.00 'oU UNDERSLAB WORK SERVI CEOVER 600 VOLTS OR 200 AMP 10.00 ROUGH CONDUIT r TEMP SERVICE,POLE, &APPURTENANCES 5.00 WIRING 4 60 TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED FINAL E457 PERMIT FEE (SUB TOTAL) NOTES: d PLAN CHECK FEE PERMIT ISSUING FEE 3.00 TOTAL FEE PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH � X41 6 8 7riFEE 13 2 0 6.G © ,kJa SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE WORKERS'COMPENSATION DECLARATION 76A663 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT O h e*eby`affirm that I have a certificate of consent to self CE 806G 'msu e, or a certificate of Workers' Compensation Insurance, COUNTY OVLOS ANGELES DEPT. OF PUBLIC WORKS or Z3 certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB 1 L'Certified co is hereby furnished. EACH NO. FEE ADDRESS / l✓i' PY Y New Residential Bldgs. & Pools r ri Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY Tion department. Multi-family Sq. Ft. NEAREST CROSS ST. �' W Residential Swimming Pools OWNER OR �vl Date Applicant FIRM NAME O e. +t CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec y Light S Sw. 3 MAIL COMPENSATION INSURANCE First 20 ADDRESS (This section need not be completed if the work involved by Total No. X,'1_ Additional CITY 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 to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 � ADDRESS Additional Date Applicant Total No.� CITY Tel. No. Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' Range— Heater—D.W. APPLICATION 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 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. PRO OESSED BY and Professions Code,and my license is in full force and effect. d U d Size &Type HP, KW, KVA, or KVAR -t�� O License Number Lic. Class Up to 1 Incl. FINAL U Contractor Date Over 1 to 10 Incl. DATE g— �—'�Z VALIDATION cc F] Over 10 to 50 Incl. FINAL / O I am exempt under Sec. Over 50 to 100 Inc. BY �/� U ree �M' W B.&P.C. for this reason Over 100 a U)Services, Swbd., MCC & Panelboards , Z Date: 0-200 Amp. Under 600 V — Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp. Power Pole 8 Appurtenances I herebyaffirm that I am exempt from the Contractor's License Sign with One Branch Circuit }• R n Branch Circuits P Additional Si Ft` °° Law for the following reason (Section 7031.5, Business and 9 propfes�' ns Code): s owner of theproperty, will do the work and the Misc. Conduits&Conductors _ •) structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)— Business Business and Professions Code). , 11;) I 28 @ 30 CONSTRUCTION LENDING AGENCY •tai:_,. s;.�,,.:.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 Lender's Address `.L I certify that I have read this application and state that the TOTAL FEE 3 " above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize repr sentatives of this County to enter upon the ab mention rope ty for inspection purposeQs, SEE REVERSE FOR EXPLANATORY LANGUAGE 2- 7- Signa a of Permitte Date ©s WQKKERS COMPENSATION DECLARATION CE 806G (2 80) ' APPLICATIONFOR, ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self COUNTY OF LOS�ANGELES '—'BtlttBtiVG AND SAFETY insure or a certificate of Workers Compensation Insurance or ` a certified copy thereof(Sec 3800 Lab C) 074,00W,t�/ + ' � � FOR APPLICANT TO FILL rJOB � �(Jn e ��4 Ivl�f I Policy No Company New Residential Bldgs &Pools ' EACH NO ADD SS EE , r ❑ Certified copy is hereby furnished 1 &2 Family Sq Ft $ — $ r LOCALIT ✓ J"r t Multi family Sq Ft — NEAREST Certified copy is filed with the county building inspection CROSS ST � 0 Urr_r_ AZ USA ldepartment Residential Swimming Pools OWNER OR Ir t _ A FIRM NAME (Date V Applicant `� Outlets ReOffLight2.2- Sw ���/ \ ' First 20 ADDRESS 10ERTIFICATE OF EXEMPTION FROM WORKERS Total No C.L� Additional CITY = Tel No } j COMPENSATION INSURANCE r \ r I ( PLAN CHECK l O / X71 r PP,LICANT (This section need not bei completed if the work involved Lighting Fixtures First 20 `50 ADDRESS ! U igg jby the permit is for one hundred dollars ($100) or less) i cc P Total No 20 Additional O 1 certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP F CITY Tel No U permit is issued I shall not employ any person in any manner r PERMIT Ul so as to become subject to the Workers Compensation Laws Range_ Heater_D W 0 APPLICANT d i I Oven Dryer L W M ADDRESS tWi C/) Z Dai �� Applicant Top F,AU Other_ CITY ' Kel No L��i�� Hood Fan / 44 NOTICE TO APPLICANT f after making this Ce t tcate of Disp I Room Air Cond_ ` i REG NSE OR y ��� —!© Exemption you should become subject to the orkers Class Compensation provisions of the Labor Code you must forth Power Apparatus& Large Appliances _ DISTRICT NO UED BY with comply with such provisions or this permit shall be Size&,Type HP KW KVA or KVAR deemed revoked ' � r Up to 1 Incl � FINAL l LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl l DATE E — Z 7 Tr VALI 1A0 Over 10 to 50 Incl I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc FINAL — fi 9 (commencing with Section 7000) of Division 3 of the Busi Over 100\ of r ness and Professions Code and my license is in full force and effect Services �61✓3 33� is 1� 0 200 Amp Under 600 V License Numbe Lic Class I � `t � + i 201 1000 Amp Under 600 V � Contractor 'Date Over 1000 Amp or Over 600 V HOME OWNER BUILDER DECLARATION Temp Power Pole& Appurtenances f Sign with One Branch Circuit 1 ,'I hereby affirm that I amt exempt from the Contractors Additional Sign Branch Circuits License Law for the following reason (Section 7031 5 Busi ness anclTrofessions Code Misc Conduits&Conductors 0 3 9A A i 0 I as owner of the property will do the work and the Other (See Complete Fee Schedule)— ) # o t• o o • 2 structure is not intended or offered for sale (Section J i 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY 2 ° - 77, 1 O _ Ilhereby affirm that there is a construction lending agency Q r for the performance of the work for which this permit isIpERMIT FEE (Sub Total) Q O A °i° 0 7 7 1 0-J issued (Sec 3097 Civ C) + Lender s Name PLAN CHECKING FEE (One Fourth Permit'Fee) 0203-8 1 ' i ­ , Lender s,Address PERMIT ISSUING FEE I certify that I have read this application and state that the TOTAL FEE above information is correct I agree to comply with all County < ordinances and iState—laws regulating.Electrical wiring and hereby authorize representatives of this County to enter upon I _ e;e bo, mentygned property for inspection purposes I/l/� SEE REVERSE FOR EXPLANATORY LANGUAGE gnature of Permittee ` Date � A WORKERS COMPENSATION DECLARATION, CE 6-06G to/81 APPLICATION FOR ELECTRICAL PERMIT { h5rebymffirm that I have a certificate of consent to self Insure y P1.a`certlatate of Workers Compensation Insurance or a certified ` COUNTY OF LOS ANGELES ' BUILDING AND SAFETY copy thereof(Sec 3800 Lab C) Y Policy No ' Company 5 FOR APPLICANT TO FILL IN JOB' , /tea I��/ y ❑` Certified copy Is herebyfurnished a ADDRESS -/ /,� dj ( �V I�( ✓� t , , New Residential Bldgs &Pools� PEACHNO ' +FEE � y," ' A ' — $ LOCALITY 7 Pik�) G a /@❑ Certified copy Is filed with the county building inspection 1 & 2 Family Sq Ftdepartment Multi family Sq Ft ` — . NEAREST+-+ CROSS STs. AiDtResidential Swimming Pools h v$' 'd' OWNER ORDate Applicant TL "N FIRM NAMECERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec Light ! Sw -� - ` aMAIL r ° 't i ti a , COMPENSATION INSURANCE )+s, r r + f ,.ADDRESS �d� arv. VF.i (This section need not be completed if the work involved by the { z First 20 a $ �j P " - t CITY �^ :c Tel No ^oil ' permit is"fonone hundred dollars ($100) or le"ss) ` Total No �_ + Additional a ` " t !e! 4 I certify that in the performancecof the-work for which this permit R s + i PLAN CHECK F �' APPLICANT r 1; ,is Issued I shall not employ tany¢person In any manner so as tos ? become subject to the Workers Compe tion Law 46 np , Lighting Fixtures k First 20 t T T y +ADDRESS 1 f Y r t cr ., Additional +`' �� r s d A Total No I d+ , s _ CITY,- Tel No t Date'-R.-If- Applicant * ( �+ r� r z r Fixed Appliances Not Over 1 HP e PERMIT NOTICE TO APPLICANT If Nafter kin this tate of I Y_ ++Exemption you should become"'subject to the Workers ompensation ' y Range_ Heater Q DW r_A , 'APPLICANT ' provisions of the Labor'Code you mustgforthwith'comply with such Oven - Dryer W M ADDRESS B ytt ° provisions or this permit shall be deemed revoked ; —Too FAU W H w °e LICENSED CONTRACTORS DECLARATION'] s ' 'p ° CITY` TelnNo � s Hood — Fan Other_ � r .- I hereby affirm that I am,hcensed under rprovisions of Chapter 9 t's, t Room Air Co' LICENSE OR 1 Class 8 (commencing with Section 7000) of Division 3 of the Business and, p — e REG NUMBER r S r Professions Code a`nd my license it in full force andteffect Power Apparatus& Large Appliances _ ' DISTRICT NO P D,BY t ( +�� 1, ' � Size & Type HP KW KVA or KVAR t� _,I 1 h a License Number r Llc Class -Up to 1 Incl c n a 3 FINAL + r - R s r ;t c ar , _ Over 1 to 10 Incl DATE, VALIDATION a rContractor F ' Date Over 10 to 50 Incl FINAL + K r 0 ,❑ I am exempt under Sec Q .g Over 50 to 100 IncBY { , 7 W B&PC for this Feason ) Over 100 ) „ Y x Date Services Swbd MCC& Panelboards t y r 0 200,Amp Under 600 V loop. �f Z a Signature r` ` r 201 1000 Amp Under 600 V x ❑ } i + Over 1000 Amp or Over 600 V Exemption for Reg Maint Elect a'r`c SINGLE FAMILY 4Temp Power Pole &{Appurtenances M HOME OWNER BUILDER DECLARATION - Sign with One.aBranch Circuit I hereby affirm thatxl am exempt from the Contractors License Law ' ' f for the following'reason (Section 7031 5 Business and Professions Additional Sign Branch Circuits F Code) c t+ I I ° @ r r < t ` s , Misc Conduits & Conductors 5 r 1r< t y + 10j, I'as owner of the property will do the work and the structure I is not intended or offered for sale (Section 7044:'Business } Other(See Complete Fee Schedule)T e ,r and Professions Code) 7 ti t^ t CONSTRUCTION LENDING AGENCY s i `r ,i 9 1 2 8 A I hereby affirm that there isfa construction lending agency for the `a performance of therwork for which this permit is,issued(Sec 3097 PERMIT FEE ryTf} (Sub Total) b i f i # o Io oy 0"2 Civ C) I + � a : f � I oe2i.0 " PLAN CHECKING FEE Ole 0n _ r' Lenders Name 'Q 3:0 � PERMIT ISSUING FEE f tc i xl'Q c # t1w r e. r Lenders Address r I certify that I have read this application and state that the above L TOTAL FEE g _ S a 61 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 + y s o prop y for Ins tion pur oses y q * k + " SEE REVERSE FOR EXPLANATORY LANGUAGE sirureo_f-121ermitty 4' Date Y y i f WORKERS COMPENSATION DECLARATION 76A663 1 fl CE 806G (2 80) APPLICATION FOR ELECTRICAL PERMIT '�IUII I hereby4affirm that-1 have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY - insure or a certificate of Workers Compensation Insurance or 'aTertified copy thereof(Sec 3800 Lab C) FOR APPLICANT TO FI Policy No Company EACH N NO FEE ADDRESS 7✓ New Residential Bldgs &Pools Certified copy is hereby furnished 1 &2 Family Scl Ft $ — $ LOCALITY ❑ Multi family Scl Ft — NEAREST Certified copy is filed with the county building inspection CROSS ST 1„/e/ Zvt department Residential Swimming Pools OWNER ORS FIRM NAME Date Applicant Outlets Rec_Light_Sw MAIL ' First 20 ADDRESS /1 S CERTIFICATE OF EXEMPTION FROM WORKERS Total No Additional CITY �� h �`�hv i Tel No COMPENSATION INSURANCE r i PLAN CHECK 0- (This (This section need not be completed if the work involved APPLICANT 0 by the permit is for one hundred dollars ($100) or less) Lighting Fixtures First 20 ADDRESS U Total No Additional lr I certify that in the performance of the work for which this CITY , Tel No permit is issued I shall not em Fixed Appliances Not Over 1 HP p employ y an y person m anytmanner � PERMIT (, `so as to become subject to the Workers Coensation Laws Range+ Heater_D W APPLICANT rn i W ° Oven Dryer_W M ADDRESS (— ���^ W ��' Date ////- 3- Applicant Top FAU _W H i u Z Hood — Fan '=Other_ CITY 15-C7itfir` Tel No NOTICE TO APPLICANT If of er making this tifica a of Disp Room Air Cond_ LICENSE OR / Exemption you should become `subject to the Workers 1 REG NUMBER­X Class Compensation provisions of the Labor Code you must forth Power Apparatus& Large Appliances DISTRICT NO PROCE SED,BY with comply with such provisions or this permit shall be Size&Type HP KW KVA or KVAR lJ deemed revoked o Up to 1 Incl FINAL LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl DATE / ( .- VALIDATION Over 10 to 50 Incl / t I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc FINAL 9 (commencing with Section 7000) of Division 3 of the Busi _ Over 100 BY ness and Professions Code and/my license is in full force and F��' effect ) Services / / 6yL 6 0 200 Amp Under 600 V License Number � Lic Class- 201 1000 Amp Under 600 V Contractor 47 1'i+h 9 0 Date //-Z3 ,�7" d ' Over 1000 Amp or Over 600 V HOME OWNER BUILDER DECLARATION / Al Temp Power Pole&Appurtenances I hereby affirm that I am exempt from the Contractors Sign with One Branch Circuit Additional Sign Branch Circuits License Law for the following reason (Section 7031 5 Busr 3 0 S 4 A ness and Professions Code) i Misc Conduits&Conductors # o o o o o 2 ❑ I as owner of the property will do the work and the Other (See Complete Fee Schedule)— structure is not intended or offered for sale (Section 2 o of 7 0 0 t 7044`Business and Professions Code) , i CONSTRUCTION LLNDING AGENCYo 0 0 ] 0 0 v I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is PERMIT FEE ` (Sub Total) 1 1 3-8 0 issued (Sec 3097 Civ C) 7 Lender s Name PLAN CHECKING FEE (One Fourth Permit Fee) Lender s Address PERMIT ISSUING FEE x I certify that I have read this application and state that the TOTAL FEE 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 thea mentio property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 13, Sr ture o ermittee Date i