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Home My Public Portal About5033 BALDWIN AVE_Electrical__ (3) r _ A663 CE806 5 62 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEUILDING AND SAFETY DIV SIONER BUILDING BADDRESS 07 rx,-BALDWIN JOHN A LAMBIE COUNTY ENGINEER WILLIAM A JENSEN SUP T OF BUILDING LOCALITY TEMPLE CITY FOR APPLICANT TO FILL IN CROSS RELA ROSA RECEPT TOTAL NO EACH FEE OUTLETS FIRST 20 0 $20 $ OWNER $A DW N LIGHT 12 00 MAIL _ 50ADD L ADDRESS v3 3 A/ 13 AL-DW i AJ SWITCH 1 OVER 20 30 ID 00 f _ TOTAL CITY fi L TEL NO VI- 3- 7/[J LIGHTING F1R5T20I 12 20 2 0 FIXTURES ] 2 I ADD L 10 ELECTRICIAN CONLEE & SON ELECTRIC OV R 20 RANGES CLO DRYERS WTR HTRS too ADDRESS G D GAM DISP 1 STA.COOK cIT90. SAN GABRIELTEL NcAT.0-200 DISI1wwsH AUTO wASHl STATE 7 L SPACE HTRS STA APP (v.HP MAK , 50 1 LICENSE NO 137567 C-10 MOTORS OVER NOT OVER HP DISTRICT NO I GROUP ZONE I PROCESSED BY 0 1 too GDtovlco 1 3 150 INSPECTION RECORD 3 8 200_ i / yQ l vl'e x I 8 15 250 a 15 50 300Iwo • l u 50 100 5 00Aeali�10 '� � �l A O SIGNS NO TRANS V �j g U NO LAMPS ,d'-+r.�„crar tioh W c Co D_ SERVICE O 600V NOT OVER 200A 1 100 1 O `n Z SERVICE O 600V OVER 200 A _ 200 SERVICE OVER 600V Soo MISC PERMIT ISSUING FEE 200 2 0 SUPPLEMENTARY PERMIT ISSUING FEE 100 TOTAL FEE $ 1 19 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR S SIGNATURE AND STATE THAT THE ABOVE fs CORRECT AND AGREE TO COMPLYCONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING WIRING 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND)OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURE8 CALIFORNIA OR THAT I TM LEGAL OWNER OF THE ABOVE DESCRIBED RE8IDENTi POWER qA ♦.A SIGNATURE UTILITY CO NOTIFIED ®� X s� �� ' OF PERMITTEE FINAL �tSS ( ALIDATION ARTHUR C VETT JC MO CASH SUPERVISING ELECTRICAL ENGINEER Li it,o 2 9 1 0.2 APR 4 2 D 1390- WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I�have a certificate of consent to self insure, 76A663 or'a certffidate of Worker's Compensation Insurance, or a certified COUNTY'OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy there (Sec.3/800 Lab. C.) �L t J , Policy No j:-� L '-) Company �aa"v `� FOR APPLICANT TO FILL IN JOB DDRESS ❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools NO, EACH FEE v — LOCALITY Certified copy is filed with the count building inspection 1&2-Family,Sq. Ft. $ $ NEARESTde department. Multi-family Sq Ft. CROSS ST. Date C` Applicant �/�� Y/ Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' �� OWNER OR Outlets:Rec. ht Sw,Li COMPENSATION INSURANCE g FIRM NAME First 20 AIL (This section need not be completed if the work involved by the Total No. Additional MAIL permit �j .�� permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITY — T��,4>G df7 Tel.N 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 Power Apparatus APPLICANT pparatus&Large Appliances provisions or this permit shall be deemed revoked. LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS�� 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 / Tel.'No.-TF j Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. } Over 50 to 100 Incl. REGNNUM BELICESE OR Z-zz Ciass�~�U c .ca J v s^1 ^j Over 100 DISTRICT NO. PROCESSED BY License Number Lic.Class _ ` 7 Services,Swbd.,MCC&Panelboards �� FINAL cr Contractor ale d lk: l� Date )� VY 0-399 Amp.Under 600 V DATE 0 ❑ 400-1000 Amp. Under 600 V / ~ I am exempt under Sec. a VALIDATION V Over 1000 Amp.or Over 600 V FINAL LU d B.&P.C.for this reason BRANCH CIRCUIT FEES 13Y ".."....."..` Cn Date: 15A,or 20A, 120V,Lighting or Recept. ;: Z 1 To 10 Branch Circuits f $ Signature 11 To 40 Branch Circuits (ft.• •i ata El Exemption i 41 Or More Branch Circuits 4 t � � At Exemption for Reg.Maint. Elect. 15A,20A,208V To 277V Lighting Br.Circuits ht SINGLE FAMILY Temp.Power Pole&Appurtenances _ ...... 1 1 EMS HOME OWNER-BUILDER DECLARATION Oit qh Ci B with One Branch Circuit f. ,� , I hereby affirm that I am exempt from the Contractor's License Law Sign wAL 47 . 40 for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits r Code): ��HEC_r K 47.40 ❑ I, as owner of the property,will do the work and the structure Misc.Conduits&ConductorsC CHANGE ,^ is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). CONSTRUCTION LENDING AGENCY 00LIs.`-y —DOOIL 3/24/93 I hereby affirm that there is a construction lending agency for the �f ; c res�ett 1 AMI j a t performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) O5 21850 f Civ. C.) �► /a�v�„' PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE 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 and State laws regulating Electrical wiring,and hereby authorize representatives of this County to enter upon the above-mentioned property for” tion purposes: SEE REVERSE FOR EXPLANATORY LANGUAGE --�=� o 3 - SIGNATURE OF PERMITTEE DATE fiWORKER'S COMPENSATION DECLARATION 9 DPW 9/89 APPLICATION FOR ELECTRICAL PERMIT 76A66 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 Lamb.. C.) PolicyN0401:060 •`--ompany ��, N� FOR APPLICANT TO FILL IN JOB ADDRESS � (� � PyN 'CI Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ❑ $ — $ LOCALITY ��„ ( ��T •� - Certified copy is filed with the count building in ection 1 &2-Family,Sq.Ft. department. Multi-family S Ft. — NEAREST P Y q CROSS ST. Date 7 App(licant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM W RS' L � OWNER OR dn OUIIeIS:RBC. Light SW. �Le COMPENSATION INSURANCE First 20 C� (This section need not be completed if the work involved by the yp! FIRM NAME MAIL permit is for one hundred dollars($100)or less.) Total No. Additional ADDRESS I certify that in the performance of the work for which this permit CITYt/0' p O Z I4_ Tel.No. (� is issued, I shall not employ any person in any manner so as to 6,3 become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 PLAN CHECK 1 P g APPLICANT Total No. Additional ADDRESS Date Applicant 15 OR 20A120V BRANCH CIRCUITS NO ,TO APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers'Compensation 1 TO 10 INCLUSIVE EACH provisions of the Labor Code, you must forthwith comply with such 11 TO 40 INCLUSIVE EACH PERMIT provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH APPLICANT r }, LICENSED CONTRACTORS DECLARATION ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH O C?(commencing with Section 7000) of Division 3 of the Business and CITY p,V et 14- Tel.No. U Professions Code,and my-license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR Power Apparatus&Large Appliances REG.NUMBER J Class.. O Size&Type HP,KW,KVA,Or KVAR DISTRICT NO. PROCESSED BY License Numbe� F. Lic.Class _ U Up to 3 Incl. W CL Contractor�74 , dv Date ` Over 3 to 10 Incl. DATE U) ❑ Over 10 to 50 Incl. Z I am exempt under Sec. Over 50 to 100 Incl. VALIDATION Over 100 FINAL B.&P.C.for this reason BY Services,Swbd.,MCC&Panelboards D 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 -- ❑ 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) ,:•.---_•• —Q -�= and Professions Code). , l f.' CONSTRUCTION LENDING AGENCY __.. 1,Jn. 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 S -•. ,.:-•G 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 all County ordinances and State laws regulating Electrical j g, and hereby authorize representatives of this ounty toe er upon the above-mentioned property fo pecti pur S. SEE REVERSE FOR EXPLANATORY LANGUAGE /Z Z_. SIG URE OF AP CANT OR AGENT DATE