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HomeMy Public PortalAbout5540 BALDWIN AVE_Electrical__ }5;h'663-CE606 4-68 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING r LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. NO. EACH FEE - RECEPT._ $ $ OWNER MAIL LIGHT TOTAL FIRST 20 .20 ADDRESS - SWITCH_ OVER 20 .10 CITY TEL. NO. PLAN CHECK LIGHTING �TOTAL, FIRST 20 .20 APPLICANT FIXTURES OVER 20 .10 ADDRESS RANGE_DRYERJ—WTR.HTR.— CITY TEL. NO. STA.COOKDISP.—F.A.U.— CONTRACTOR SPACE HTR. AIR COND. ADDRESS CLOTHES WASH._DISHWASH._ CITY T. TEL. NO. FAN—OTHER 1.00 LICENSE IJO. ,% z/�j CLASS. MOTORS,TRANSFORMERS RATING IND. HEATERS, ETC. HP. KW. KVA. I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 0 — 1 1.00 ELECTRICAL WIRING. 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 1 — 10 3.00 ,LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO 10 — 50 5.00 RES DE IN, THE ABOVE D S,CRIPED RESIDENTIAL P PERTY. 50 — 100 10.00 SIGNATURE �� O OF PERMITTEE CJ 100 - soo 15.00 DISTRICTJXCO. GROUP Z NE PROCESSED BY o SIGN,GAS SIGN AND ONE CIRCUIT 3.00 f�// ~ TUBE, OR W MARQUEE ADDITIONAL CIRCUITS 1.00CL NOTES: N SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 0 SERVICE OVER 600 VOLTS OR 200 AMP 5.00 TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE TEMP. POWER POLE LPERMIT . � �, UNDERSLAB WORK ROUGH CONDUITWIRINGIT FEE (SUB TOTAL) FIXTURES CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED ISSUING FEE 2.00 Q(7UTILITYCO.NOTIFIED 9LEMENTARY PERMIT ISSUI NG FEE 1.0o FINAL L FEE {�� (�� JOSEPH C. ROOHAN SUPERVISING ELECTRICAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION � M.O. CASH 8 ` 4 ry Q2FGD cli V SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE 0,Z-, 3/3I/� 4 _ WORKERS'COMPENSATION DECLARATION 76A663 10/81 APPLICA4ION FOR ELECTRICAL PERMIT 4 I heby affirm that have a certificate of consent to self CE-806G _'i,�sure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified cop thereof X3800, Lab. C.) 'n Polic o. v - /C mp n7ye_ew- T' FOR APPLICANT TO FILL IN JOB . Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS _ d Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. — NEAREST e Residential Swimming Pools CROSS ST. OWNER OR f Date Applicant da FIRM NAME �tJ CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RecLight�Sw.� MAIL COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work involved by First 20 Total No. Additional CITY Tel. No. r the permit is for one hundred dollars ($100)or less.) PLAN CHECK I certify that in the performance of the work for which this PPLICANT 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 Total No.— Additional CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT 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 � 7T with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. CITY Tel. No. LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_ �� /v' f Disp. _ Room Air Cond. LICENSE OR / / Class. `� hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER l.• (I, (commencingwith Section 7000 of Division 3 of the Business ) Power Apparatus& Large Appliances DISTRICT NO. PR9_1 LE ED BB p' and Professions Code,and my license is in full force and effect. �/d(j �• Size &Type HP, KW, KVA, or KVAR License Number 'f 7 Lf Lic. Class FINAL � Up to 1 Incl /J_/ M Over 1 to 10 Incl. DATE�j7v Q' �i [e7 Cl1 JDATION 0 Contractor Date Over 10 to 50 Incl. FI / ❑ am exempt under Sec. Ld Over 50 to 100 Inc. B , aa B.&P.C. for this reason Over 100 /� �C� U) Date: Services, Swbd., MCC & Ponelboards 0 -200 Amp. Under 600V Poo. ;26662A Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V # °,•,e,° e 2 Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole &Appurtenances ° '1 - 39.25 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ° o © 3 Q 2 5 6 I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and Professions Code): O 31 2=8 7 ❑ I, 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 f 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-m oneclp p ty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o ermittee Date