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Home My Public Portal About5015 BALDWIN AVE_Electrical__ 6A663 CE806 5 62 APPLICATION FOR ELECTRICPERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS aldwin JOHN A LAMBIE COUNTY ENGINEER C/+ r WILLIAM A JENSEN SUP T OF BUILDING LOCALITY Temple l NEAREST T L Rosa FOR APPLICANT TO FILL IN CROSS ST RECEPT 2 TOTAL NO EACH FEE l OUTLETS FIRST 2020 $20 $ 4. )o OWNER LIGHT ZO ADD ADDRESS SWITCH OVER 20 f0 3.10 TOTAL CITY TEL NO LIGHTING F1RST20 20 FIXTURES =IADD L OVFR 20 10 ELECTRICIANConlee & Son Electr RANGES CLO DRYERS WTR HTRS 100 ADDRESS �1 N. , GARB DISP STA COOK San Gab r 1ejEL No CITY ®o — DISHWASH AUTO WASHl nn 4 STATE (�! �I (� SPACE HTRS STA APP (/p H P MAX2 2 50 2 O LICENSE NO _ 137567 C-10 s kSERVICE ER NOT OVER H P DIST CT G P Z N E PMODit P 1 100 1 3 ISO INSP CTION RECORD 8 200 15 250 d O 50 300 U ce 100 500 O H O TRANS U O LAMPS Ij a In 0V NOT OVER 2001 1 100 Z 0V OVER 200 A 200 R 600V 500 MISC PERMIT ISSUING FEE 200 2.0 0 SUPPLEMENTA13Y PERMIT ISSUING FEE 100 TOTAL FEE $ l5 0 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR SSIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT / i J WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING WIRING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR t-1, / �� U LICENSED AS REQUIRED BY LOB ANGELES COUNTY AND STATE OF FIXTURES `(/CALIFORNIA OR THAT 1 AM HE GAL NER OF THE ABOVEDESCRIBED RESIDENTIAL ROP RTY POWERA,}AJa p�SIGNATURE I �� UTILITY CO NOTIFIED 1`4//6 A OF PERMITTEE /d /y FINAL /B �V LIDATION ARTHUR C VETT � CK MO CASH SUPERVISING ELECTRICAL ENGINEER LA[� 7 728% DEC 3 2 D 1520- WORKER S COMPENSATION DECLARATION 20 DPW(12 91) APPLICATION FOR ELECTRICAL PERMIT 76A663 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) ''tt n `R7a N� Cy NO COm parry v /�� FOR APPLICANT TO FILL IN JOBUl ADDRESS 7C•�'S b.f l i l//VS /J/'t{� Certified copy is hereby furnished i New Residential Bldgs &Pools NOEACH FEE LOCALITY $ $ ' 1� ❑ Certified copy is filed with the county wilding i ectron 1 &2 Family Sq Ft _ NEAREST depart enI Multifamily Sq Ft CROSS Date Applicant Residential Swimming Pools ASSESSOR PAGE PARCEL CERTIFICATE OF EXE TI FROM WO S Outlets Rec _Light Sw Flats NAME 8 COMPENSATION INSURANCE First 20 MAIL (This section need not be completed if the work involved by the Total No Additional ADDRESS r (y V&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 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 ► I Y►./W! !L—r' provisions or this permit shall be deemed revoked Power Apparatus&Large Appliances APPLICANT Q PH/W LICENSED CONTRACTORS DECLARATION Size&Type HP KW KVA or KVAR / ADDRESS *11'6,/ ng'/•- N 2 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 &M Lf er� Tel Noge-4-7 4 Professions Code and my license is in full force and effect Over 10 to 50 Incl U / } LICENSE OR lClass Over 50 to 100 Incl REG NUMBER 3 C O 2 e� 0 Over 100 DISTRICT NO P SED BY License Number Lic Class U /�f Q Services Swbd MCC&Panelboards ��O �/�i cr Contractor, �'% /�� Date 0 399 Amp Under 600 V FINAL DATE O ❑ I am exempt under Sec 400 1000 Amp Under 600V ��/ W Over 1000 Am or Over 600 V t VALIDATION P FINAL a B&P C for this reason BRANCH CIRCUIT FEES BY Date 15A or 20A 120V Lighting or Recept Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits El 41 Or More Branch Circuits Exemption for Reg Maint Elect 15A 20A 208V To 277V Lighting Br Circuits 2 SINGLE FAMILY Temp Power Pole&Appurtenances AttTdg HOME OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contrac or s License Law Sign with One Branch Circuit 3303 4tO 70 for the following reason (Section 7031 5 Business and Professions Additional Sign Branch Circuits V Code) 1 ITEMS ,mak El as owner of the property will do the work and the structure Misc Conduits&Conductors TOTAL rm TAL 4670 is not intended or offered for sale (Section 7044 Bu-iness Other(See Complete Fee Schedule) rL1� t/ 46.70 1 �n and Professions Code) , ifECK o V CONSTRUCTION LENDING AGENCY CHANGE ut_`IJ 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) Q Civ C) 0000-0001 3/11/95 PLAN CHECKING FEE Cyt t 1 Lender s Name jL`t't 1 Fdot 11 6-31 PERMIT ISSUING FEE p� d 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 State I ws regulating Electrical wiring and hereby authorize represent ves of t Courty to enter upon the above mentioned property for in tion pur oses SEE REVERSE FOR EXPLANATORY LANGUAGE ,XtS - IGNATURE OF PERMI EE DATE fi,. that I COMPENSATION DECLARATION CE-663 10/81 APPLICATION FOR ELECTRICAL PERMIT 1 t4rAr)y dffirm that I have a certificate of consent to self insure, CE-806G or a certificate of Workers' Compensation Insura or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY thereof (Sec.3800,Lrt POIIC O. J Ompany �," `'-"x FOR APPLICANT TO FILL IN JOB s' ma�yy""♦ Certified copy is hereby furnished. EACH NO. FEE ADDRESS S Zoera New Residential Bldgs. & Pools Certified copy is filed with the county building in c n 1 & 2-Family, Sq.Ft. $ — $ LOCALITY –^ ��L� • department. Multi-family Sq. Ft. — NEAREST CROSS ST. ie►�� (�,� a Applicant �� w/� Residential Swimming Pools OWNER OR FIRM NAME (J� CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec Light _ Sw. MAIL COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work involved by the First 20 permit is for one hundred dollars ($100) or less.) Total No. Additional CITYr4-Tel.No. certify that in the performance of the work for which permit PLAN CHECK ' 1 APPLICANT is issued, I shall not employ any person in any ma er o as to become subject to the Workers' Compensati n Lighting Fixtures First 20 ADDRESS 0( Additional 3 Total No. CITY Tel. No. \ Date ApplicantFixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making th' Certificate f Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D W. APPLICANT provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M. _ ADDRESS,26"0 v provisions or this permit shall be deemed revoked. Top — FAU _ W.H. LICENSED CONTRACTORS DECLARATION Hood Fan Other_ CITY � � Tel. No I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE ORB (commencing with Section 7000) of Division 3 of the Business and REG.NUMBER SQ Class. d Professions Code,and my license is in full force and effect. DISTRICT NO PROCE BY Power Apparatus& Large Appliances �y nye Size & Type HP,KW,KVA,or KVAR �• O& a Up to 1 Incl. FINAL O License Number S�P'3/7 Lic. Cla� / T STV 1 9 Over 1 to 10 Incl. DATE Contractor�.V �'��G �� $Date Y VALIDATION 0 E] Over 10 to 50 Incl. FINAL ~ I am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C.for this reason Over 100 z Services, Swbd.,MCC & Panelboards 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 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 to 15Z) 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 with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above-mentioned pro erty f -peUturl)ose . SEE REVERSE FOR EXPLANATORY LANGUAGE Signa ure of Per i ee Date