HomeMy Public PortalAbout5015 BALDWIN AVE_Electrical__ (2) 6A663 CE806 5 62 APPLICATION FOR ELECTRICPERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS aldwin
JOHN A LAMBIE COUNTY ENGINEER C/+
r WILLIAM A JENSEN SUP T OF BUILDING LOCALITY Temple l
NEAREST T L Rosa
FOR APPLICANT TO FILL IN CROSS ST
RECEPT 2 TOTAL NO EACH FEE
l OUTLETS FIRST 2020 $20 $ 4. )o OWNER
LIGHT
ZO
ADD ADDRESS
SWITCH OVER 20 f0 3.10
TOTAL CITY TEL NO
LIGHTING F1RST20 20
FIXTURES =IADD L
OVFR 20 10 ELECTRICIANConlee & Son Electr
RANGES CLO DRYERS WTR HTRS 100 ADDRESS �1 N. ,
GARB DISP STA COOK San Gab r 1ejEL No
CITY ®o —
DISHWASH AUTO WASHl nn 4 STATE (�! �I (�
SPACE HTRS STA APP (/p H P MAX2 2 50 2 O LICENSE NO _ 137567 C-10
s
kSERVICE
ER NOT OVER H P DIST CT G P Z N E PMODit
P
1 100
1 3 ISO INSP CTION RECORD
8 200
15 250 d
O
50 300 U
ce
100 500 O
H
O TRANS U
O LAMPS Ij
a
In
0V NOT OVER 2001 1 100 Z
0V OVER 200 A 200
R 600V 500
MISC
PERMIT ISSUING FEE 200 2.0
0
SUPPLEMENTA13Y PERMIT ISSUING FEE 100
TOTAL FEE $ l5 0
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR SSIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT / i J
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING WIRING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR t-1,
/ �� U
LICENSED AS REQUIRED BY LOB ANGELES COUNTY AND STATE OF FIXTURES `(/CALIFORNIA OR THAT 1 AM HE GAL NER OF THE ABOVEDESCRIBED RESIDENTIAL ROP RTY POWERA,}AJa p�SIGNATURE I �� UTILITY CO NOTIFIED 1`4//6 A
OF PERMITTEE /d /y
FINAL /B �V
LIDATION ARTHUR C VETT
�
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
LA[� 7 728% DEC 3 2 D 1520-
WORKER S COMPENSATION DECLARATION 20 DPW(12 91) APPLICATION FOR ELECTRICAL PERMIT
76A663
I hereby affirm that I have a certificate of consent to self Insure 76A663
or a certificate of Worker s Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
copy thereof(Sec 3800 Lab C) ''tt
n `R7a N�
Cy NO COm parry v /�� FOR APPLICANT TO FILL IN JOBUl ADDRESS 7C•�'S b.f l i l//VS
/J/'t{�
Certified copy is hereby furnished i New Residential Bldgs &Pools NOEACH FEE LOCALITY
$ $ ' 1�
❑ Certified copy is filed with the county wilding i ectron 1 &2 Family Sq Ft _ NEAREST
depart enI Multifamily Sq Ft CROSS
Date Applicant Residential Swimming Pools ASSESSOR
PAGE PARCEL
CERTIFICATE OF EXE TI FROM WO S Outlets Rec _Light Sw Flats NAME 8
COMPENSATION INSURANCE
First 20 MAIL
(This section need not be completed if the work involved by the Total No Additional ADDRESS r (y V&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 ► I Y►./W! !L—r'
provisions or this permit shall be deemed revoked Power Apparatus&Large Appliances APPLICANT Q PH/W
LICENSED CONTRACTORS DECLARATION Size&Type HP KW KVA or KVAR / ADDRESS *11'6,/ ng'/•- N 2
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl • / � �'
(commencing with Section 7000) of Division 3 of the Business and CITY &M Lf er� Tel Noge-4-7 4
Professions Code and my license is in full force and effect Over 10 to 50 Incl U / }
LICENSE OR lClass
Over 50 to 100 Incl REG NUMBER 3 C O
2 e� 0 Over 100 DISTRICT NO P SED BY
License Number Lic Class U
/�f Q Services Swbd MCC&Panelboards ��O �/�i cr
Contractor, �'% /��� Date 0 399 Amp Under 600 V FINAL DATE O
❑ I am exempt under Sec 400 1000 Amp Under 600V ��/ W
Over 1000 Am or Over 600 V t VALIDATION
P FINAL a
B&P C for this reason BRANCH CIRCUIT FEES BY
Date 15A or 20A 120V Lighting or Recept Z
1 To 10 Branch Circuits
Signature 11 To 40 Branch Circuits
El
41 Or More Branch Circuits
Exemption for Reg Maint Elect 15A 20A 208V To 277V Lighting Br Circuits 2
SINGLE FAMILY Temp Power Pole&Appurtenances AttTdg
HOME OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contrac or s License Law Sign with One Branch Circuit 3303 4tO 70
for the following reason (Section 7031 5 Business and Professions Additional Sign Branch Circuits V
Code) 1 ITEMS ,mak
El as owner of the property will do the work and the structure Misc Conduits&Conductors TOTAL rm
TAL 4670
is not intended or offered for sale (Section 7044 Bu-iness Other(See Complete Fee Schedule) rL1� t/ 46.70
1 �n
and Professions Code) , ifECK o V
CONSTRUCTION LENDING AGENCY CHANGE ut_`IJ
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) Q
Civ C) 0000-0001 3/11/95
PLAN CHECKING FEE Cyt t 1
Lender s Name jL`t't 1 Fdot 11 6-31
PERMIT ISSUING FEE p� d
Lender s Address
I certify that I have read this application and under penalty of purjury state TOTAL FEE
that the above information is correct I agree to comply with all County
ordinances State I ws regulating Electrical wiring and hereby authorize
represent ves of t Courty to enter upon the above mentioned property
for in tion pur oses SEE REVERSE FOR EXPLANATORY LANGUAGE
,XtS -
IGNATURE OF PERMI EE DATE
fi,. that I COMPENSATION DECLARATION CE-663 10/81 APPLICATION FOR ELECTRICAL PERMIT
1 t4rAr)y dffirm that I have a certificate of consent to self insure, CE-806G
or a certificate of Workers' Compensation Insura or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
thereof (Sec.3800,Lrt
POIIC O. J Ompany �," `'-"x FOR APPLICANT TO FILL IN JOB s' ma�yy""♦
Certified copy is hereby furnished. EACH NO. FEE ADDRESS S Zoera
New Residential Bldgs. & Pools
Certified copy is filed with the county building in c n
1 & 2-Family, Sq.Ft. $ — $ LOCALITY –^ ��L� •
department. Multi-family Sq. Ft. — NEAREST
CROSS ST. ie►�� �� �(�,�
a Applicant �� w/� Residential Swimming Pools OWNER OR
FIRM NAME (J�
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec Light _ Sw. MAIL
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 CITYr4-Tel.No.
certify that in the performance of the work for which permit PLAN CHECK ' 1
APPLICANT
is issued, I shall not employ any person in any ma er o as to
become subject to the Workers' Compensati n Lighting Fixtures First 20 ADDRESS
0( Additional
3 Total No. CITY Tel. No.
\ Date ApplicantFixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making th' Certificate f
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,26"0 v
provisions or this permit shall be deemed revoked. Top — FAU _ W.H.
LICENSED CONTRACTORS DECLARATION Hood Fan Other_ CITY � � Tel. No
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE ORB
(commencing with Section 7000) of Division 3 of the Business and REG.NUMBER SQ Class. d
Professions Code,and my license is in full force and effect. DISTRICT NO PROCE BY
Power Apparatus& Large Appliances
�y nye Size & Type HP,KW,KVA,or KVAR �• O& a
Up to 1 Incl. FINAL O
License Number S�P'3/7 Lic. Cla�
/ T STV 1 9 Over 1 to 10 Incl. DATE
Contractor�.V �'��G �� $Date Y VALIDATION 0
E] Over 10 to 50 Incl. FINAL ~
I am exempt under Sec. Over 50 to 100 Inc. BY W
B.&P.C.for this reason Over 100 z
Services, Swbd.,MCC & Panelboards 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 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 Circuits
Code):
❑ I,as owner of the property,will do the work and the structure Misc.Conduits& Conductors
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 to 15Z)
Lender's Address
I certify that 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
pro erty f -peUturl)ose .
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signa ure of Per i ee Date