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Home My Public Portal About5104 BALDWIN AVE_Electrical__ 76A663 CES06 3 64 APPLICATION FOR ELECTRICAL PER T COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A LAMBIE COUNTY ENGINEER WILLIAM A JENSEN SUP T OF BUILDING LOCALITY Te 1 ,Clt NEAREST / FOR APPLICANT TO FILL IN CROSS ST RECEPT TOTAL NO EACH FEE Ar 1 OUTLETS FIRst 20 $20 $ OWNER LIGHT MAIL 1. SWITCH --3 oven 20 10 ADDRESS 5104 N. Baldwin TOTAL CITY Ample Clty TEL NO LIGHTING FIRST 20 20 FIXTURES ADD L 10 ELECTRICIAN ov R 20 RANGES CLO DRYERS WTR HTRB 100 ADDRESS E. Gamey Ave. GARB DIHP STA COOK CITY TEL NO DISHWASH AUTO WASH STATE 0502 SPACE HTRB BTA APP (+/y H P MAX) SO LICENSE NO ]. 461 MOTORS OVER NOT OVER 3& DISTRICT NOOUP NE P QCESSED BY O 1 100 ./ J 1 3 ISO INSPECTION RECORD a 3 B 200AJ o V 8 IS 250 18 SO 300 0 SO 100 500 ` � �� nW. SIGNSt NO TRANS - Z NO LAMPS SERVICE O 600V NOT OVER 200A 100 SERVICF O 600V OVER 200 A 200 U SERVICE OVER SOON Soo MISC PERMIT ISSUING FEE 2 00 r SUPPLEMENTARY PERMIT ISSUING FEE 1 00 TOTAL FEE 1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DApT.A��^' INSPECTOR B SIGMATMIRE AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING // WIRING 41/ 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT I THE LEGAL OWNER O E ABOVE DESCRIBED REBIDENTI OPE POWER SIGNATURE UTILITY CO NOTIFIED OF PERMITTE FINAL G LIDATION ARTHUR C VEIT y CK_ MO CASH SUPERVISING ELECTRICAL ENGINEER L,�Il,o0 0 5 1-0 YR29 2 D 3 80~ WORKERS COMPENSATION DECLARATION 63 CE 806G (2 80) APPLICATION FOR ELECTRICAL PERMIT CE 8 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 a certified copy thereof(Sec 3800 Lab C) FOR APPLICANT TO FILL IN JOB �� Policy No Company EACH NO FEE ADDRESS I New Residential Bldgs &Pools Certified copy is hereby furnished 1 &2 Family Sq Ft $ — $ LOCALIT'7 ' Lg Multi family Sq Ft NEAREST Certified copy is filed with the county building inspection CROSS ST L. department Residential Swimming Pools OWNER OR FIRM NAME q Date Applicant Outlets Rec3-Light Swa MAIL First 20 ' e 64 ADDRESS A r ov CERTIFICATE OF EXEMPTION FROM WORKERS Total No Additional CITY Tel No Z Z } COMPENSATION INSURANCE PLAN CHECK d (This section need not be completed If the work Involved L APPLICANT Oe U by the permit is for one hundred dollars ($100) or less) Lighting Fixtures First 20 ADDRESS Total No Additional cc I certify that in the performance of the work for which this ) CITY Tel No U permit is Issued I shall not em to an erson in an manner Fixed Appliances Not Over 1 HP P p Y Y Y _ PERMIT N �^ � G { ' a so as to beco a subject to the Workers La s Range_ Heater_D W APPLICANT . / /�L Oven _ Dryer_W M ADDRESS lz �$/ �� j �}Allo tcX7 _ Acant Top FAU _W H ppliCITY �(�� T.1 No 3 y Dat LHood Fan _Other NOAPPLICANT If after aking this Certificate of DRC isp _ Room Air ond_ LICENSE OR - may Exemption you should become subject to the Worker REG NUMBER54'deV Class Compensation provisions of the Labor Code you must fort Power Apparatus& Large Appliances DISTRICT NO PROC SSED BY with comply with such provisions or this permit shall be deemed revoked Size&Type HP KW KVA or KVAR � k Up to 1 Incl FINAL /! / �?� LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl DATE VALIDATION Over 10 to 50 Incl I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc FINAL 9 (commencing with Section 7000) of Division 3 of the Busi Over 100 BY ness and Professions Code and my license is in full force and effect Servic tom"' t9 , 0 20 Amp Under 600 V Licese Numbe Lie Class 201 1000 Amp Under 600 V Co"n�rt � G�Z�i Date Over 1000 Amp or Over 600 V HOME OWNER BUILDER DECLARATION Tem Power Pole& Appurtenances ppurtenances I hereby affirm that I am exempt from the Contractors Sign with One Branch Circuit 4 3 1 2A License Law for the following reason (Section 7031 5 Busi Additional Sign Branch Circuits y ness and Professions Code) # o o o a o2 Misc Conduits&Conductors , I as owner of the property will do the work and the � 0 0 2$ C�1 0 Other (See Complete Fee Schedule)— r structure is not intended or offered for sale (Section 7044 Business and Professions Code) o 0 o 2 a 9 0: 1 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency 060 9—82 for the performance of the work for which this permit isPERMIT FEE (Sub Total) ` issued (Sec 3097 Civ C) a�U _ Lender s Name PLAN CHECKING FEE (One Fourth Permit Fee) Lender s Address PERMIT ISSUING FEE (gid 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 aut ze re re Ives of this County toe er upon t�ea�gve pe y for inspectio�7;7 purpose SEE REVERSE FOR EXPLANATORY LANGUAGE 621 Signare of Permittee ate