HomeMy Public PortalAbout4836 BALDWIN AVE_Electrical__ 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