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Home My Public Portal About4929 BALDWIN AVE_Electrical__ P - 7eAee3 cesoe 7 ee ' APPLICATION FOR ELECTRIC PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING / BUILDING AND SAFETY DIVISION ADDRESS , JOHN A LAMBIE COUNTY ENGINEER CASSATT D GRIFFIN SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN q NEAREST 00 PERMIT FEES CROSS s'1 I T E M NUMBERI EACH FEE OWNER OUTLE $ $ /111 MAIL / LIGHT RECEPT SW 10 f ADDRES LIGHTING FIXTURES 10 CITY TEL NO ELEC RANGES CLO DRYERS ELECTRICIAN W AT E R H EAT E R S 5o ADDRESS ELEC SPACE HTRS DISHWASHERS CITY L N GARBAGE DISPOSERS/ AUTO STATE WASHERS STA COOKING UNITS 25 LO LICENSE NO MOTORS OVER INC H P DIST RI T NO GR UPON j P CESS BY 0— 1/2 ( 25 1/2— 2 so INSPECPION RECORD 2— 5 1 Oo 5— 15 1 so 1s— so 250 50-200 500 SIGNS NO TRANS NO LAMPS SERVICE O 600V 100 SERVICE OVER 600V 500 MISC WIRING PERMIT 100 FIXTURE PERMIT 100 = SUPPLEMENTARY PERMIT So TOTAL FEE $ APPROVALS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION DATE INSPECTOR 5 SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING Icy ELECTRICAL WIRING WIRING 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED LOS ANGE ES CO NTY N STATE OF FIXTURES CALIFORNIA OR THAT 1 M THE LE L O ER HE ABOVE \� DESCRIBED RESIDENTIA R TY POWER SIGNATURE UTILITY CO NOTIFIED OF PERMITTEE FINA ^� �O .c<<--�"�� ATION ARTHUR C VEIT CK MO CASH SUPERVISING ELECTRICAL ENGINEER M2-855 fAll FB27 2 A 1065 M 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 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.) Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY Certified co is filed with the count building inspection 1 &2-Family,Sq.Ft. PY Y 9 P NEARESTT department. Multi-family Sq.Ft. CROSS ST. Residential Swimming Pools ASSESSOR Date Applicant MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER OR COMPENSATION INSURANCE Outlets:Rec._Light Sw. FIRM NAME (This section need not be completed if the work involved by the First 20 MAIL ADDRESS permit is for one hundred dollars($100)or less.) Total No. Additional 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 NOTICE TO APPLICANT: If, after making this Certificate of RESIDENTIAL APPLIANCES NOT OVER 3 HP. 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 provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT 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. a Professions Code, and my license is in full force and effect. Over 10 to 50 Incl 0 LICENSE Cl Over 50 t0 100 Incl. REG.NUMBER ass.ER V Over 100 DISTRICT NO. PROCESSED BY W License Number Lic.Class J Services,Swbd.,MCC&Panelboards LL Contractor Date 0-399 Amp. Under 600 V FINAL >_ DATE ❑ 400-1000 Amp. Under 600 V Q I am exempt under Sec. VALIDATION Over 1000 Amp.or Over 600 V FINAL Ir B.&P.C.for this reasonBRANCH CIRCUIT FEES BY d Date: 15A,or 20A, 120V,Lighting or Recept. 1 To 10 Branch Circuits U.1 Signature 11 To 40 Branch Circuits ~ ❑ 41 Or More Branch Circuits Exemption for Reg. Maint. Elect. 15A,20A,208V To 277V Lighting Br.Circuits 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 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 inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF PERMITTEE DATE WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-9i) APPLICATION FOR ELECTRICAL PERMIT 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.) Policy NO. , Company FOR APPLICANT TO FILL IN JOB ADDRESS ❑ f� Certified copy is hereby furnished. New Residential &Pools NO. EACH FEE ❑ dential Bldgs. _ $ $ LOCALITY Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec.,Light Sw. / OWNER OR FIRMNAME€ �'L Sf�fcac COMPENSATION INSURANCE / ev First 20 MAIL (This section need not be completed if the work involved by the Total No. _ Additional ADDRESS fj/p ve,' permit Is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITY? L� Gam!n Tel.No. O� is issued, I shall not employ any person in any manner as to PLAN CHECK become subject to the Workers'Compensation Laws. Lighting Fixtures - First 20 APPLICANT Total No. Additional ADDRESS S�a� �� -✓` Date 2' Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE APPLIC NT: If, after making i rtificate of CITY Tel.No. lrZ�� Exemption,you should become subject to the Wor rs'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT 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. Professions Code, and my license is in full force and effect. Over 10 to 50 Incl. CENSE OR Over 50 to 100 Incl. RIEG.NUMBER L/ Class. Lel a �/ Over 100 DISTRICT NO. PROCESS O License Number Lic.Class�o n Q /��p� �t / // Servic�4001 MCC&Panelboards � C 11 Contractor/it��r"r Coe n,Date � Amp.Under 600 V DATE _FINAL 0 - 000 Amp.Under 600 V S —1 3—(�j 0 ❑ I am exempt under Sec. !It VALIDATION w Over 1000 Amp.or Over 600 V FINAL a B.&P.C.for this reasonBY U) BRANCH CIRCUIT FEES �� Date: 15A, r 20�Aj 120V,Lighting or Recept. / Z Signature 1 To 10 Branch Circuits 11 To 40 Branch Circuits El Exemption Or More Branch Circuits 7 Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits AC/+r�^ `T SINGLE FAMILY AV•l i Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION io At', I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit 303 i ITEMS 117■80 for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits 1 1TEf S Code): Misc.Conduits&Conductors TOTAL 119 - 80 F1I,as owner of the property,will do the work and the structure CHECK i{� is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule)_— , CH 11 ■4 O and Professions Code). CHANGE .00 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the t� performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) ��/ 0000-OW1 5/ 2/96 Civ.C.) PLAN CHECKING FEE 5164 1 AM 8:20 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 o County to enter upon the above-mentioned property for inspecti seS. !/ 9 Q SEE REVERSE FOR EXPLANATORY LANGUAGE /�l L� Lo SIGNATUFtWMITTEE DATE WORKER'S COMPENSATION DECLARATION 76A663 6019 DPW(12-91) ' 76APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOSANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof'(Sec.3800 Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS R/ Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY El 1 &2 Family,Sq.Ft. — $ $ e - Certified copy is filed with the county building inspection NEAREST department. Multi-family Sq.Ft. — CROSS ST. Date Applicant Residential SwimmingPools ASSESSOR MAP PAGE 1PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' ,Q OWNER OR ME i Outlets:RBC. Light Sw. 6 FIRM NAME L COMPENSATION INSURANCE � � , Q Q �j� First 20 MAIL (This section need not be completed 0 the work involved by the Total No.SSL_ Additional ADDRESS 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 cl is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers'Cosation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after ma in 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 l�Qg Al 62 ' p p y Power Apparatus&Large Appliances APPLICANT r�� G provisions or this permit shall be deemed revoked. LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS f � 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.N �� Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR Lt 141 // } Over 50 to 100 Incl. REG.NUMBER T � 6 Class�� d y��,.1C� C�/� Over 100 DISTRICT NO. PROCESSED BY 0 License Number UU Lic.Class O 0 Services,Swb CC& anelb s Contractor/J� (a�[� Date r 3 Am�.' nder I DATE FINAL _ El 400-1000 Amp.Under 600 V CS VALIDATION V I am exempt under Sec. L!J Over 1000 Amp.or Over 600 V FINAL B.&P.C.for this reasond BRANCH CIRCUIT FEES BY Date: 15A, r 20A, 120V,Lighting or Recept. Z_ Signature 1 To 10 Branch Circuits 11 To 40 Branch Circuits El 41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION k i.•�•i °4 I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): El i T E* �t d &C it d Conus Conductors M 3 � I, as owner of the property,will do the work and the structure Misc. ,�, --.�• is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) v' a =° and Professions Code). ' r:;.-,r1, -•= 7,� ECK CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the CHANGE UL:1 .c performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) 15 Civ.C.) __ _ PLAN CHECKING FEE [}ISI j[i-09Ofi !`,:<';' Lender's Name PERMIT ISSUING FEE 1-1 11,963 • Lender's Address /O , I certify that I have read this application and under penalty of purjury state TOTAL FEE I hat the above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring,and hereby authorize representa s of this County to enter upon the above-mentioned property for insp on purp es. SEE REVERSE FOR EXPLANATORY LANGUAGE NATU F PER ITTEE I DATE