HomeMy Public PortalAbout5628 BALDWIN AVE_Electrical__ 768663-CE306 ,0,72 APPLICATION fOR ELEaRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER FADDRESS
BUILDING AND SAFETY DIVISIONZV
TY
7 T / R
FOR APPLICANT TO FILL IN ST. GdiL
OUTLETS NO.. EACH FEE OWNER OR
FIRM NAME 27
p,y/ "
RECEPT.,/W $ $ MAIL ,p
LIGHT�� TOTAL
FIRST 20 25
ADDRESS
OVER 20 :340 CITY TEL. NO.
SWITCH_ - .10 PLAN CHECK
LIGHTING TOTAL
FIRST 20 25 APPLICANT
�
OVER 20 ADDRESS
FIXTURES _ .10
RESIDENTIAL APPLIANCES CITY TEL. NO.
PERI T
RANGE DRYER WTR. HTR. APPLICANT
STA. COOK DISP. F.A.U. ADDRESS / � V
SPACE HTR. AIR COND. CITY ,"' TEL. NO -# . 3) •?�
CLOTHES WASH. DISHWASH. RI=G.NSE OR CLASS. l40
FAN OTHER 1.00 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING.
SIZE & TYPE OVER TO
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND:
/OR
0 — 1 1.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
1 — 10 3.00 OESCRIBED RESIDENTIAL. PR ERTY.
PERMITEE
10 — 50 5.00 SIGNATURE
O
50 — 100 10.00 DISTRICT NO. PROCE ED BY tJ
100 — 500 15.00 "fes
SIGN.., GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE INSP OR'S SIGNATURE
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE.
SERVICENOTOVER600VOLTS OR200AMP 3:00 - UNDERSLAB WORK
SERVI CEOVER 600 VOLTS OR 200 AMP 10.00 ROUGH CONDUIT
TEMPSERVICE,POLE, &APPURTENANCES 5.00 WIRING -7-Al
TEMP LIGHT OR RECEPT, SYSTEM 3.00 FIXTURES
POWER AUTHORIZED
UTILITY CO. NOTIFIED
FINAL ;`."Y-wry`, ,"J,tr r, r,,I ..
PERMIT FEE (SUB TOTAL) NOTES:
PLAN CHECK FEE
PERMIT ISSUING FEE 3.00 e7�f
TOTAL FEE 1-71 /70
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION " CK, M.O. CASH
1� L 19 2 D
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE '
76A653 DBS 5A 3-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY � � ��������
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR 1APPLICAPIT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
.5", 8r7
ELECTRICIAN
ADDRESS /jam �Q' j� (�U�� RECEIVEDFIRSTINSPECTION DY FOR DATE ISSUED
CITYrLY� �.�B �/ TEL.NO. G y r �7� r- 7 /�
COUNTY LICENSE NO A 4 LTi EXPIRES ✓ BUILDING a(
PERMIT FEES ADDRESS / CJ
FEE
NUMBER EACH LOCALITY ilil/le/KJ vl/�*�f
LIGHT OUTLETS /�`' NEAREST
RECEPTACLES 7 CROSS ST. _
WALL SWITCHES DWNER r
TOTAL OUTLETS so $ MAIL !
ELEC. RANGES 25 e� ADDRESS
ELEC. HEATERS 25 CITY TEL NO.
FIXTURES 5 _ 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE 18 CORRECT
NUMBER OF LIGHT CIRCUITS f 3 AND AGREE TO COMPLY WIT14 ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWERANGELES COUNTY LICENSE, OR IrAM THE LEGAL OWNER
FEE
NEW MvD. HP OVER IND. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
/
1/40 V/a A LESS 111 .25 +I / `
81GNERMIT EE J
V/a 2 .50 PERMITTEE
a s 1.011 iTNSPECTION RECORD
5 1s 1.50
15 so 2.511
50 200 5.00
200 Sao 10.00 J
6D0 loom 15.00 Z
OVER 1000 20.00 (!I
M.G. BET/FREQ. CHANGER-HP
WELDERS"AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF CRIS-)
MOVED_MOTORS (75% OF DR10.)
MISC.
SIGNS
No. NO.TRANS.
N0. N0.LAMPS APPROVALS
FOR EACH PERMIT" DATE INSPECTOR'S NAME
WIRING $1.00 1,06 CONDUIT
FIXTURES $1.00 / n WIRING
SUPPLEMENTARY .50 FIXTURES V !- %rl
POWER i
TOTAL FEE > UTILITY CO.NOTIFIED I
FINAL
• I I
95A553 D58 5A 7-51 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY ELECTRIC 1 {
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
DISTRICT NO. GROUP ZONE PERMIT NO.
FOR APPLICANT-j L N!J / 3G 3 ?c
ELECTRICIAN I 'T
�L� -° RECD BY READY FCR DATE ISSUED
ADDRESS
�...�— FIRST INSPECTION
^/+STEL 4/ �(NOyI/ �(a�
COUNTY LICENSE NO. XC EXPIRESY�� BUILDING P�,Q� J(/ �[� �f 7��`
PERMIT FEES ADOREeB (P fd5 v` 111 C/
FEE ov—
Ca
LOCALITY lsr-12, Lj. `�✓G✓ r�
NUMBER EACH
'LIGHT OUTLETS NEAREST
CROSS 9T.
RECEPTACLES ��++
WALL SWITCHES OWNER/C! 7 �f:�rf / "v-�i1� IJs'•G
TOTAL OUTLETS 5c $ MAIL
ELEC. RANGES 85 ADDRESS/ r �u -'•'vel-�}t C
ELEC. HEATERS 25 CITY /�-�J X" ll xTEL. N�'1J"C13I
FIXTURES 5 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWER ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
FEE OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
NEW MVD. HP OVER INC- EACH
Us i LESS .25 SIGNATURE OF = K ��&
Y2 2 .513 PERMITTEe c r
2 5 1.130 INSPECTION RECORD
5 15 1.50
15 50 2.SO /,��., y.
50 200 5.00 L �Q.I- cc +�/C�G G / O G4&T
200 Sao 10.00 710 �r d y TN /--v J—CJ d
Sao loco 15.00E E ` Z
OVER 1000 20.00 to
M.G. SET/FREQ. CHANGER-HP It
WELDERS:AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF ORIG-)
MOVED MOTORS (75% OF CRIG.)
MISC.
SIGNS
NO. NO.TRANS. APPROVALS
NO. NO.LAMPS
DATE INSPECTOR'S NAME
FOR EACH PERMIT.
WIRING $1.00 CONDUIT
FIXTURES $1.00 WIRING
SUPPLEMENTARY .50 FIXTURES
/ POWER
TOTAL FEE 5 / �.-UTILITY CO.NOTIFIED
( FINAL �Y3�S��iAa�T
v
WORKERS'COMPENSATION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self CE-806G `
insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES 7e-14 & 6 BUILDING AND SAFETY
or a c t' i thereof (Sec. 3800, Lab. C.)
� � Pacific National
Policy No. Company FOR APPLICANT TO FILL IN JOBg >��
Certified copy is hereby furnished. Ins. CO. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS 5-X, _24 fC! fsv�✓�/
® LOCALITY '
Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ — $
tion department. h J, Multi-family Sq. Ft. — NEARESTCROSS / l �/„ rU
Date Applicdnt” C 4� a�' Residential Swimming Pools OWNER OR y �(J
FIRM NAME _ - 7Jdp
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw—E y�
COMPENSATION INSURANCE L /, `U ADDRESS
First 20
(This section need not be completed if the work involved by Total No. Additional CITY mei U 7t Tel. No.
the permit is for one hundred dollars ($100) or less.) PLAN CHECK
I certify that in the performance of the work for which this APPLICANT
permit is issued, I shall not employ any personin 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 G. & S. ELECTRIC
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 531 S. Atlantic Blvd.
with comply with such provisions or this permit shall be Top FAU k W.H. —
Hood Fan _Other—
7� 283-6317
deemed revoked. CITY Monterey Park 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 24857 Class.C�-�
(commencing with Section 7000) of Division 3 of the Business DISTRICT N PR ESSED BY
and Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances `g`,
Size &Type HP, KW, KVA, or KVAR' d6 (f�j
License Number 2.48057 Lic. Class C10 Up to 1 Incl. FINAL
(' a<x S T ELECTLC Over 1 to 10 Incl. DATE A D QN
Contractor s- Over 10 to 50 Incl.
FINA o o ® ® o U
❑ I am exempt under Sec. Over 50 to 100 Inc. BY ® ® �j 4.,7 Am
B.&P.C. for this reason
Over 100 4
Date: Services, Swbd., MCC&Panelboards S a} UL ° ° ° 3 IL 7 5 cs
0 -200 Amp. Under600V 2-85
Signature (/— 201 - 1000 Amp. Under 600 V 0 5'
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 Additional Sign Branch Circuits
Law for the following reason (Section 7031.5, Business and
Professions Code):
ElI, 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 7
above information is correct. I agree to comply with all County
ordinances and State laws r ulating Electrical wiring, and
hereby aut 'riz present, i es of this County to enter upon
the above- a rLed prop y for ins ection purpo es. SEE REVERSE FOR EXPLANATORY LANGUAGE
An �J JS
?(81fignature of Per it a ate