HomeMy Public PortalAbout5421 BALDWIN AVE_Electrical__ (2) 16A663 CE806 10 61 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING j
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A LAMBIE COUNTY ENGINEER
WILLIAM A JENSEN SUP T OF BUILDING LOCALITY I
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
1 T E M NO I EACH FEE
OUTLETS (FIRST 20) "7�$2O $ OWNER
LIGHTS RECEPT SW 4 MAIL
OUTLETS(/ADD L UNITS) 10 ADDRESS
LIGHTS RECEPT SW
LIGHTING FIXTURES (FIRST 20) 1 20 ® CITY TEL NO
LIGHTING FIXTURES (ADDITIONAL) 10 ELECTRICIAN /i —r (�G -e.
RANGER CLO DRYERS WTR HTRS 100 ADDRESS r.a
GARB DISC STA COOK
CITY TEL NO Q S .
DISHWASH AUSTATE
SPACE HTR9 @TA APP CJs H P.1dA7L1 50
LICENSE NO d
MOTORS OVER NOT OVER H P DIST ICT7 JG!rP� P CESSED Y
O 1 100 , t
1 3 ISO a INSPECTION RECORD oh
3 a 200 buoy
l
8 15 250 V
15 50 300 0
50 100 500
a
SIGNS NO TRANS N
NO LAMPS Z
SERVICE O 600V NOT OVER 200A 100 j
SERVICE O 600V OVER 200 A 200
SERVICE OVER 600V Boo
MISC
PERMIT ISSUING FEE 200
SUPPLEMENTARY PERMIT ISSUING FEE 100
LNDTOTAL FEE
BY ACKNOWLEDGE THAT I HAVE READ THIS AP LICATI N APPROVALS DATE INSPECTOR S SIGNATURE
7-6
TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
LL COUNTY ORDINANCES AND STATE LAWS REGULATING
CAL WIRING WIRING
EBY CERTIFY THAT I AM PROPERLY REGISTERED AND/ORqD AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES 2NIA OR THA I AM THE LEGAL OWNER OF THE ABOVEED RESIDE. L PROPERTY POWER
URE UTILITY CO NOTIFIED
MITTE
FINAL
LIDATION ARTHUR C VETT r
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
6 0 .UPJ 7 2
COMPENSATION DECLARATION 10/81 APPLICATION FOR ELECTRICAL PERMIT
I h eryebya irm rm that I have a certificate of consent to self CE 806G
insure or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY
or ap ertified copy thereof (Sec 3800 Lab C )
Policy No Company FOR APPLICANT TO FILL IN JOB �7 r
Certified co is hereby furnished EACH NO FEE ADDRESS v lOW r
PY Y New Residential Bldgs & Pools �_.
Certified copy is filed with the county building inspec 1 & 2 Family Sq Ft $ — $ LOCALITY C
tion department Multi family Sq Ft — NEAREST
CROSS ST
Residential Swimming Pools } OWNER OR � �j fO' !
Dare Applicant \ t *� 1 `FIRM NAME 5,C C i /-
S/
CERTIFICATE OF EXEMPTIAwvE S Outlets Rec� ' Light�Sw t o MAIL IS141101E_
COMPENSATION INSURANCE ADDRESS
This section need not completed if the work involved b First 20 o �Z
( t bp Y Total No Additional CITY Tel No A
the permit is for one hundred dollars ($100)or less )
I certify that in the performance of the work for which this A PLICCAHNTK ,)A
permit is issued I shall not employ any person in any manner
so as to become subject to the Workers Compensation Laws Lighting Fixture��s�� First 20 ADDRESS
AdditionalTotal No � �r '
Date Applicant CITY F--�-�� Tel No?
NOTICE TO APPLICANT If after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT
Exemption you should become subject to the Workers Range_ Heater D W _ APPLICANT 1�r_l
Compensation provisions of the Labor Code you must forth Oven _ Dryer W M — ADDRESS S �,
with comply with such provisions or this permit shall be Top FAU X W H —
deemed revoked CITY Tel No
LICENSED CONTRACTORS DECLARATION Hood Fon _ Other_
LICENSE
Disp _ Room Air Cond ZlI',6 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 PROLE D p„
and Professions Code and my license is in full force and effect �j /, 0
`A Z-3 9f, Size &Type HP KW KVA or KVAR v i C/ 0
License Number � / Lic Class Up to 1 Incl FINAL cc
�� I,T�T Dare � ` Over 1 to 10 Incl DATl VALID TION
Contractor Over 10 to 50 Incl FINA / W
❑ I am exempt under Sec Over 50 to 100 Inc B p
B&P C for this reason Over 100 Z
Z
Date Services Swbd MCC & Ponelboards
0 200 Amp Under 600 V
Signature 201 1000 Amp Under 600V I
❑ Exemption for Reg MaOver 1000 Amp or Over 600 V
mt Elect �4 9 9 4 A
SINGLE FAMILY Temp Power Pole & Appurtenances
HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit # o 0 0 0 0 2
1 hereby affirm that I am exempt from the Contractor s License Additional Sign Branch Circuits ° ° 5 Q 5 0
Law for the following reason (Section 7031 5 Business and
Professions Code) ° ° ° 5 Q 5 0 5
❑ 1 as owner of the property will do the work and the Misc Conduits 8 Conductors
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ , Q 7 1 0—8 6
7044 Business 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 PERMIT FEE (Sub Total)
(Sec 3097 Civ C )
PLAN CHECKING FEE
Lender s Name
PERMIT ISSUING FEE U
Lender s Address
1 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 jaws regulating Electrical wiring and
hereby authorize representatives of this County to enter upon
the above mentioned pr erty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature 6f Permittee Date