Loading...
HomeMy Public PortalAbout4948 BALDWIN AVE_Electrical__ 76A66JC CE966B 12/76 APPLIC TIO FOR ELEC RICAL PERMIT f BUILDING AND SAFETY DIVISION yy FOR APPLICANT TO FILL IN JOB ADDRESS d ✓� rResidential Bldgs &Pools EACH NO FEE Sq Ft $ — $ LOCALITY CIV e el T-V Multifamilyq Ft NEAREST VS imming Pools OWNER OR FIRM NAME 14 Outlets Light Switch& Receptacle MAI L First 20 ADDRESS f T Additional CITY 7e-w, 1 t a/ Tel No PLAN CHECK APPLICANT Lighting Fixtures First 20 ADDRESS Additional CITY Tel No PERMIT Fixed Appliances Not Over 1 HP APPLICANT Q Vj e Q( d C�r Range Heater_ D W &- 3 ` !p.K r c Oven Dryer W M ADDRESS Top FAU W H � e—CITY 'LK-eTel No h P^`/� Hood Fan LICENSE OR �7� y �/ REG NUMBER T 6 G_ Class � Disp A C cD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY O Power Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING Size&Type HP KW KVA or KVAR ELECTRICAL WIRING v w a Up t0 1 Incl HEREBY CERTIFY THAT I AM PROPERLY RE (STEREO AND/OR N Over 1 to 10 Incl LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE/� LEGAL R OF THE ABOVE GOver 10 to 50 Incl DESCRIBED RESID AL PRO PEFafV Over 50 to 100 Incl PERMITEE G/.L Over 100 SIGNATU DISTRICT NO OC S D BY Services O 0 200 Amp Under 600 V —� 201 1000 Amp Under 600 V APPROVALS ATE INSPECTOR S Over 1000 Amp or Over 600 V SIGNATURE TEMP POWER POLE Temp Power Pole&Appurtenances UNDERSLAB WORK Sign with One Branch Circuit ROUGH CONDUIT Additional Sign Branch Circuits (Other) WIRING FIXTURES ]POWER AUTHORIZED PERMIT FEE (Sub Tota l) UTILITYCO NOTIFIED ^� PLAN CHECKING FEE (One Fourth Permit Fee) FINAL '/2 PERMIT ISSUING FEE NOTES TOTAL FEE PLAN CHECK VALIDATION CK MO CASH PERMIT VALIDATION C/ K MO CASH 4 3 2'I{UG 2 5 2 1) 1 3 5 0 A"o WORKERS COMPENSATIONDECLARAT.?N CEB06G'T240) ' APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure or a certificate of Workers Compensation Insurance or i a certified copy thereof(Sec 3800 Lab C) JOB Policy No Company FOR APPLICANT TO EACH FILL IN NO FEE ADDRESS 419 6 �A/O�/� �N ei New Residential Bldgs &Pools Certified copy is hereby furnished 1 &2 Family Scl Ft $ — $ LOCALITY Lo e 7 S Multi family Scl Ft — NEAREST Certified copy is filed with the county building inspection CROSS T S department Residential Swimming Pools OWNER OR qq / F I R M N AMES ` Date Applicant Outlets Reia��Light� Sw / "/ J!'D © ADDRESS if 0 IdW AI "1vPi First 20 �/ CERTIFICATE OF EXEMPTION FROM WORKERS Total No Additional 30 CITY�� Tel No 7� 07/ } COMPENSATION INSURANCE PLAN CHECK �- (This section need not be completed if the work involvedLighting Fixtures First 20 () �f APPLICANT O by the permit is for one hundred dollars ($100) or less) ADDRESS Additional cr Total No �_ I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No permit is issued I shall not employ any person in ani manner PERMIT ,so as to become subject to th Workers Compe sat on Laws Range_ Heater D W APPLICANT W W CL Oven _ Dryer W M ADDRESS N Z Date V Applicant / /t/ Top _ FAU W H CITY Tel No Hood L Fan e�Other_ NOTICE TO APPLICANT If after making this ertificate of Disp Room Air Cond_ So LICENSE OR Exemption you should become subject to the Workers REG NUMBER Class Compensation provisions of the Labor Code you must forth Power Apparatus& Large Appliances DISTRICT NO PROCES D VY with comply with such provisions or this permit shall be Size&Type HP KW KVA or KVAR deemed revoked Up to 1 Incl FINAL LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl DATE /® a r—�� _ Over 10 to 50 Incl VALIDATION I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc FINAL 9 co mencm with Section 7000 of Division 3 of the Bust BY E ( m B ) Over 100 ness and Professions Code and my license is in full force and 1 effect Services License Number 0 200 Amp Under 600 V Lic Class t 201 1000 Amp Under 600 V Contractor Date Over 1000 Amp or Over 600 V HOME OWNER BUILDER DECLARATION Temp Power Pole&Appurtenances I hereby affirm that I am exempt from the Contractors Sign with One Branch Circuit License Law for the following reason (Section 7031 5 Bust Additional Sign Branch Circuits ness and Professions Code) Misc Conduits&Conductors ;2402 8 A I as owner of the property will do the work and the Other (See Complete Fee Schedule)— structure is not intended or offered for sale (Section #io 0 o o 0 2 7044 Business and Professions Code) i CONSTRUCTION LENDING AGENCY 2 - 4270 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is PERMIT FEE (Sub Total) o 0 0 4 2 7 0 mo: issued(Sec 3097 C C) // 3 Lender s Name Awn n n�er�e s� PLAN CHECKING FEE (One Fourth Permit Fee) 021 0-81 Lender s Address �A� �A7/�.Q/So Z-4A-V/I 414--VA bl-4 PERMIT ISSUING FEE I certify that I have read this application and state that the TOTAL FEE d above information is correct I agree to comply with all County ordinances and State laws regulating Electrical wiring and hereby authorize represen atives of this County to enter upon the above'menti&ed pro rty for inspection purposes / � / SEE REVERSE FOR EXPLANATORY LANGUAGE ��C & i 02L1'q Signature of Permitte 'Datfi WORKERS'COMPENSATION DECLARATION DPW3/87APPLICATION FOR ELECTRICAL PERMIT O I 'hereby affirm that I have a certificate of consent to self CE 806G insure, or a ctartificate of Workers' Compensation.Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certifi copy t ereof`ry-S{pe�c. 3800, b. ) Policy No 0 'C dmpany FOR APPLICANT TO FILL IN JOB 4414/- ❑Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY ' tion epartment. { Multi-family Sq. Ft. NEARESTCROSS ST. Residential Swimming Pools OWNER OR Date Appica FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Recl—Light � Sw� MAIL COMPENSATION INSURANCE First 20 D ADDRESS (This section need hot be completed if the work involved by Total No/--3-- Additional CITY Tel. Nd� _ the permit is for one hundred dollars ($100)or less.) PLAN CHECK 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. Na. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLIIT 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. — �p deemed revoked. Hood — Fan —Other_ CITY Tel ylJ�—. LICENSED CONTRACTORS DECLARATION LICENSE OR Disp. — Room Air Cond. — REG. NUMBER 0 Class. I hereby affirm that I am licensed under provisions of Chapter 9 �' (commencing with Section 7000)of Division 3 of the Business Power Apparatus & Large Appliances DISTRICT NO. i PR SED BY d and Professions Co e, and my license is in full force and effect. Size &Type HP, KW, KVA, or KVAR =:>,®f License Number 6 Lic. Class l� Up to 1 Incl. FINAL U ��A LA 1:!::i '�� Over 1 to 10 Incl. DATE VALIDATION 0 Contractor 6 e Over l0�to 50 Incl. F- ❑ FINAL U I am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C. for this reason Over 100 d Services,Swbd., MCC& Ponelboards NZ Date: -0-200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ' �Zq ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION ' I herebyaffirm that I am exempt from the Contractor's License Sign with One Branch Circuit n -. n Branch Circuits p Additional Si Law for the following reason (Section 7031.5, Business and g Professions Code): ___, oaf# El1, as owner of the property, will do the work and the Misc. Conduits & Conductors a t' i structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)— Business and Professions Code): CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for ii the performance of the wofk for which this permit is issued PERMIT FEE (Sub-Total) : }`f11( � '`-= (Sec. 3097, Civ. C.). / PLAN CHECKING FEE Lender's Name ��u / ` I._i ficlI 1i'cl I PERMIT ISSUING FEE r./{ Lender's Address -� t - -• z kJI i I 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 laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the abo -mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE r Signal e'of Permittee Date ©: