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HomeMy Public PortalAbout5412 BALDWIN AVE_Electrical__ 76A663 CITE 6068 10/77 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER JOB ~ BUILDING AND SAFETY DIVISION ADDRESS FOR APPLICANT TO FILL IN LOCALITY New Residential Bldgs &Pools EACH NO FEE NEARECROSS ST ©� - 1 &2 Family Sq Ft $ 025 — $ OWNER T Multi family Sq Ft 02 — FIRM NAME Residential Swimming Pools 2500 MAIL _d 0 �C ADDRESS J Cl Outlets Rec Light_Sw50 0� CITY C_ Tel NoZ��-� 3 First 20 PLAN CHECK Total No Additional 30 APPLICANT ADDRESS Lighting Fixtures First 20 50 p CITY Tel No Additional 30 PERMIT Total No APPLICANT Fixed Appliances Not Over 1 HP ADDRESS Range_Heater_D W CITY Tel No Oven_Dryer—W M LICENSE OR Top —FAU —W H REG NUMBER Class Hood_Fan _Other- 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Disp _ Room Air Cond 2 50 THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDIN ANCES AND STATE LAWS REGULATING ELECTRICAL WIRING Power Apparatus&Large Appliances Size&Type HP KW KVA or KVAR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSE REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT A Up to 1 Ind 2 50 THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY CD Over 1 to 10 Incl 500 v Over 10 to SO In1 2 50 PERMITTEE l/SIGNATURE C) Over 50 to 100 Inc 2500 Over 100 4000 DISTRICT NO /� PROCE ED BY N Services 0 200 Amp Under 600 V 1250 INSPECTOR 5 201 1000 Amp Under 600 V 2500 APPROVALS DATE SIGNATURE Over 1000 Amp or Over 600 V 5000 TEMP POWER POLE Temp Power Pole&Appurtenarces 1000 UNDERSLAB WORK Sign with One Branch Circuit 1000 ROUGH CONDUIT Additional Sign Branch Circuits 200 WIRING ' Misc Conduits&Conductors 1000 FIXTURES Other(See Complete Fee Schedule) POWER AUTHORIZED, UTILITY CO NOTIFIED FINAL PERMIT FEE (Sub Total) OA NOTES PLAN CHECKING FEE (One Fourth Permit Fee) PERMIT ISSUING FEE $700 )7 o TOTAL FEE / 6( PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION CK M 0 CASH 28 9 ir'o_MAY 5 2 1) SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE WORKERS COMPENSATION DECLARATION 63 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE O6G ,Osure or CE 8 a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY or o certified copy thereof (Sec 3800 Lab C ) Pal r1%No Company FOR APPLICANT TO FILL IN JOB r ❑~Certified co s hereby furnished EACH NO FEE ADDRESS PY Y New Residential Bldgs & Pools ❑ Certified copy is filed with the county building inspec 1 & 2 Family Scl Ft $ — $ LOCALITY tion department Multi family Scl Ft NEAREST E RESST Date Applicant Residential Swimming Pools OWNER OR /LC ,y r I 'f��r=iJj°rs_ FIRM NAME / GL,//V�V (A G V lJ CERTIFICATE OF EXEMPTION FROM WORKERSOutMAIL lets Rec Light Sw (/ Or COMPENSATION INSURANCE C is section need completed if the work involved b First 20 ADDRESS (Thton d not b p Y Total No Additional CITY �i�i�G �_ Tel No the permit is for one hundred dollars ($100)or less ) I certifythat in the performance of the work for which this PLAN CHECK P � 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 ti L ADDRESS - Total No - - -Additional CITY Date Applicant Fixed Appliances Not Over 1 HP PERMIT r NOTICE TO APPLICANT If after making this Certificate of APPLICANT 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 r Hood Fan _Other— CITY Tel No LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp _ Room Air Cond REG NUMBER Class (commencing with Section 7000) of Division 3 of the Business DISTRICT NO P SSED BY and Professions Code and my license is in full force and effect Power Apparatus& Large Appliances 0 G Size & Type HP KW KVA or KVAR �— � O License Number Lic Class_' Up to 1 Incl FINAL 4fV Lo } 24 Over 1 to 10 Incl DATE VALIDATIO D 0 Contractor i ' l Dateg-1247 Over 10 to 50 Incl V ❑ FIN 1 am exempt under Sec Over 50 to 100 Inc BY B &P C for this reason Over 100 fL AL W H Services Swbd MCC& Panelboards Z at 0 200 Amp Under 600 V Signature 201 1000 Amp Under 600V ;2 7 6 a 0 A ❑ Exemption Over 1000 Amp or Over 600 V for Reg Maint Elect # 0 0 0 o e 'Z SINGLE FAMILY - Temp Power Pole &Appurtenances ° ° 2 5,5 0 HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit = I hereby affirm that I am exempt from the Contractor s License ° ° ° 2 5 5 0,56 Low for the following reason (Section 7031 5 Business and Additional Sign Branch Circuits 0 8. 1 7+8 71 Professions Code) ❑ 1 as owner of the property will do the work and the Misc Conduits &Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ 7044 Business 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 PERMIT FEE (Sub Total) (Sec 3097 Civ C ) )' PLAN CHECKING FEE Lender s Name PERMIT ISSUING FEE Lender s Address �� 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 above menti one propertX for inspec on purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Q I Signature of Permittee Date t