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Home My Public Portal About5436 BALDWIN AVE_Electrical__ 76A663-CE806 1-67 / APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING � � J BUILDING AND SAFETY DIVISION ADDRESS w JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS T. RECEPT, 1TOTAL NO. EACH FEE LIGHT l OUTLETS FIRST 20 $.20 $ OWNER /v)a !� J( MAIL O J • /G SWITCH ADD'L .10 ADDRESS OVER 20 TOTALCITY TEL.NO. a-f FIRST 20 . LIGHTING 1 FIXTURES 20 �® _ FIXTURES J( ADD'L .1O CONTRACTOR 11-14e:OVER 20 RANGES DRYERS'yWTR.HTRS. 1.0011 Q ADDRESS GARB.DISP. STA.COOK CITY TEL.NO. DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA. APPL. '.50 LICENSE NO.- MOTORS: OVER NOT OVER H.P. DIS CT,N GROUP ZONE PR SSED B, O 1 1.00 1/�J�/j 1 3 1,50 INSPECTION RECOR 3 8 :3 2.00 b0 8 15 2.50 15 50 3.00 a 50 100 5.00 0 SIGNS: NO.TRANS 0 NO.LAMPS 1- SERVICE O.600V•NoT OVER 200A 1.00 LLI IL SERVICE 0.60OV•OVER 200 A. 2.00 Z SERVICE OVER 600V S.00 - - OTHER (SEE COMPLETE FEE SCHEDULE) PERMIT ISSUING FEE 2.00 ap LCAFORNIA ENTARY PERMIT ISSUING FEE 1.00 APPROVALS DATE INSPECTOR'S SIGNATURE TOTAL FEE EBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION UNDERSLAB WORK ATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY' ROUGH CONDUIT LL COUNTY ORDINANCES AND STATE LAWS REGULATING ICAL WIRING. WIRING r/ EBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTUREBED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFRNIA OR THAT 1 AM TLEGAL OWNER OF,AND INTEND TO' POWERIN,THE ABOVE D C IBEnD�RESIDENTIA PR P TY.TURE b � �i UTILITY CO.NOTIFIEDRMITTEE FINAL j`9� -a/!�_ LIDATION JOSEPH C. RUGHAN w SUPERVISING ELECTRICAL ENGINEER K MO CASH L t o 9 9 7 1.a AUG 4 2 D 7.60- � 'V 76A663-CEt106 4-65 APPLICATION FOR E.LECTRIA L PERMlf;�� COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS i L._�6 '%A.1c JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN•W. JENKINS. SUPT. OF BUILDING LOCALITY FOR APPLICANT TO FILL IN CROSSS T. RECEPTACLE TOTAL NO EACH FEE 1 TFIRST 20 $.20 $ OWNERLIGHT 1_�� MAIL SWITCHADD'L 10 ADDRESS OVER 20 TOTAL FIRST 20 .20 CITY TEL. NO. LIGHTING FIXTURES FIXTURES ADD'L10CONTRACTOR 'Ltr'vL OVER 20 RANGES CLO.DRYERS WTR•HTRS. 1.00 ADDRESS GARB.DISP. STA.COOK '�— _, CITY TEL. NO. DISHWASH. AUTO,-WASH. STATE SPACE HTRS. STA.APP.0A H.P.MAX.) .50 LICENSE NO. MOTORS: OVER NOT OVER H.P. DISTRICT NOP Z E P O B O 1 1.00 �� r 1 3 1.50 INSPECTION RECORD 3 8 2.00 8 15 2.50 a 15 50 3.00 0 U 50 100 5.00 SIGNS: NO.TRANS. O NO.LAMPS F' W SERVICE 0.60OV-NOT OVER 200A 1.00 D_ SERVICE 0.60OV-OVER 200 A. 2.00 L SERVICE OVER 600V 5.00 OTHER (SEE COMPLETE FEE SCHEDULE) PERMIT ISSUING FEE 2.00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 �e TOTAL FEE $ 3 , 0 APPROVALS DATE INSPECTOR'S SIGNATURE IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION UNDERSLAB WORK AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I THELEGAL OWNER4OF, ND INTEND TOPOWER RESIDE IN,THE ABOV DE C�..ED RESIDENTIAPERTY. SIGNATUREiUTILITY CO:NOTIFIED ) /� OF PERMITTEE FINAL 'f �' E'�L� l _ � �%t'`t'-��^•�"Z�J ALIDATION JOSEPH C. ROOHAN CK MO CASH SUPERVISING ELECTRICAL ENGINEER Ao G 4 5 ",o D-EC 2.2 2 Q 3.2 0 f" 011 WORKERS'COMPENSATION DECLARATION CE 806G (2-80) 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 v a certified copy thereof(Sec. 3800,Lab.C.) FOR APPLICANT TO FILL IN JOB Policy No. Company ❑ New Residential Bldgs.&Pools EACH NO. FEE ADDRESS Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY OMulti-family Sq. Ft. — NEAREST Certified copy is filed with the county building inspection CROSS ST department. Residential Swimming Pools OWNER OR FIRM NAME f1 Date Applicant Outlets: Rec/JfLight�Sw. ` MAIL O First 20 ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY Tel No. J COMPENSATION INSURANCE PLAN CHECK LL (This section need not be completed if the work involved APPLICANT by the permit is for one hundred dollars Fixtures First 20 s ($100) or less.) Additional r ADDRESS K Total No. I certify that in the performance of the work for which this CITY Tel No. permit is issued, I shall not employ any person in any manner Fixed Appliances Not Over 1 HP PERMIT so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT Oven _ Dryer_W.M._ ADDRESS i� Date ` ��Applicant ,� �` .� Top _ FAU _W.H. Hood — Fan _Other_ CITY Tel No. NOTICE TO APPLICANT: If, after making this Certificate of Disp. —Room Air Cond.— 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. PROCESSED BY 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 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. Services License Number Lic.Class 0-200 Amp. Under 600 V 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 Contractor's Sign with One Branch Circuit License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits ness and Professions Code): Misc.Conduits&Conductors I, as owner of the property, will do the work and the Other (See Complet ee Schedule)— z structure is not intended or offered for sale (Section 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 PERMIT FEE (Sub-Total) issued (Sec. 3097,Civ.C.). Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE 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-mentioned property for inspection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE Signature f Permittee Date _l