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HomeMy Public PortalAbout10637 BOGUE ST_Electrical__ L o t, /' /► �p 7'A663 DBS-5A APPLICATION FOR ELECTRIC PERMIT" _ 1 DBS-SA 11.58 DIVISION OF BUILDING AND SAFETY Department of County Engineer BUILDING o637$Ogue St. County of Los Angeles ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY TP�-r p (1,1f- FOR APPLICANT TO FILL 1N NEAREST E1 Monte 'PERMIT FEES cRoss sr. NUMBER OWNER Miller Prlee 15 LIGHT OUTLETS MAIL RECEPTACLES ADDRESS rr WALL SWITCHES FEE CITY TEL. NO. 51 TOTAL OUTLETS C@ 5¢ 00 ELECTRICIAN Southland�Electric- Co.. ELEC. RANGES 25 ADDREss403 E Broadway San Gabriel ELEC. HEATERS 25 CITY TEL. N&t-7-C 19 KW EA STATE 155718 FIXTURES 5 LICENSE NO. MOTORS DISTRICT NO. I GR P I ZONES I READY FOR INSPECTION NUMBER HORSEPOWER FEE - I NEW MVD. HP OVER INC. EACH INSPECTION RECORD 3 Y2 a LESS $ .25 - Y2 '2 ,.50 2 5 1.00 5 15 1.50 I5 50 2.50 50 200 5.00 misc. NO. SIGNS NO.TRANS. NO. SIGNS NO. LAMPS FOR EACH PERMIT: WIRING $1.00 FIXTURES $1.00 Up ` SUPPLEMENTARY " .50 APPROVALS TOTAL" FEE JAPPLICATION DATE INSPECTOR'S SIGNATURE 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THISAND STATE THAT THE ABOVE IS CORRECT AND AGRECONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS WIRINGELECTRICAL WIRING.I HEREBY CERTIFY THAT I AM PROPERLY REGISTFIXTURESLICENSED AS REQUIRED BY,LOS ANGELES COUNTY AFCALIFORNIA OR THATI THE LEGAL OWNER,OE POWER DESCRIBED RESIDENTIA OPERTY. / UTILITY CO.NOTIFIED SIGNATURE OF PERMITTEE FINAL JOHN A.LAMBIE COUNT ENGINEER VALIDATION ARTHUR C.VEIT.CHIEF ELECT. INSPECTOR CK MO CASH 11P2-8.7 �'�. F1rnr29 2 6.3Q m m WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self Insure, 76A663 or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec 3800 La$' C.) Policy NO Company FOR APPLICANT TO FILL IN JOB h �+ ADDRESS �,7 (�/ ❑• Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE _ _ ., •• _ $ $ LOCALITY G t9 tL Certified copy Is filed•with the county building Inspection 1 &2-Family,Sq.Ft NEAREST department,. Multi-family Sq.Ft. CROSS ST Date A Residential Swimming Pools ASSESSOR ) ` Pphcant _ MAP BOOK , O PAGE PARCEL lf`, CERTIFICAT.E,OF EXEMPTION FROM WORKERS' OWNER OR Outlets Rec. Llghi SW.• FIP,M NAME COMPENSATION INSURANCE V First 20 MAIL (This-section need not be completed if the work involved by the Total No. Additional ADDRESSZ- permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITY Tel No Is issued, I shall not employ any person In any manner so'as to PLAN CHECK become subject to,the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO ARPLICANT. If,; after making this Certificate of CITY Tel No. Exemption,you should become subject to the Workers Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked Power Apparatus-&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR / ADDRESS I hereby affirm that I'am licensed'under provisions of Chapter 9 Over 3 to 10 Incl J (commencing with Section 7000) of Division 3 of the Business and CITY Tel No Professions Code,and my license is in full force and effect Over 10 to 50 Incl. LICENSE OR Class Over 50 to 100 Incl. - REG NUMBER d License Number Lic Class Over 100 DISTRICT NO PROCES O V "' Services.Swbd. CC&Panelboards 6• Contractor Date 6 0 dimp.Under 600 V OSI EIDATE NAL O ❑ 4 "' - 400-1000 Amp Under 600 V _ VALIDATION V I am exempt under Sec, Over 1000 Amp or Over 600 V - FINAL LIJ B&P-C for this reason BRANCH CIRCUIT FEES By U) Date: 15A,or 20A, 120V,Lighting or Recept. Z Signature — — 1 To 10 Branch Circuits 11 To 40 Branch Circuits El 41 Or More Branch Circuits Exemption for Reg Malnt Elect 15A,20A,208V To 277V Lighting Br Circuits SINGLE FAMILY Temp Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION tat;rt„ °� I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit =•- ° for the following reason (Section 7031 5, Business and Professions Additional Sign Branch Circuits Code): T•:U i FE -1 r0 I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors 1 EI" is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) P-;T:t!•_ 81 and Professions Code) - • ;.�-Ifs.`,• y.°;�{4 CONSTRUCTION LENDING-AGENCY ( �3 I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ C.) PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE �O that the 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. Z SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF PERMITTEE �/� //- DATE_ �� ! WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) 76A663 APPLICATION FOR ELECTRICAL PERMIT - I hereby affirm that I have a certificate of consent to self Insure, or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof,(Sec. 3800 L Sb. C) r I17 Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS Certified copy is hereby.furnished. New Residential Bldgs &Pools NO EACH FEE LOCALITY ❑ 1 &2-Family, — $ $ Certified copy is filed with the county building inspection Sq Ft _ NEAREST department Multi-family Sq Ft. CROSS ST Residential Swimming Pools ASSESSOR �j/ p //yy� Date' Applicant - MAP BOOK Oto PAGE�0/ PARCELO"✓U CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets.Rec Light Sw. \ OWNER OR COMPENSATION INSURANCE FIRM NAME First 20 Q / (This section need not be completed if the work involved by the Total No. AAdditionalnooRESs permit is for one hundred'dollars($100)or less.) / — I certify that'in the performance of the-work for which this permit CITY I N r is Issued, I shall not employ-any person In any manner so as t0 PLAN CHECK become subject to'the Workers'Compensation Laws Lighting Fixtures First 20 APPLICANT Total No Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO,APPLICANT. If, after making this Certificate of CITY Tel No. ' Exemption, you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. rovisions of the Labor Code, you must forthwith comply with such PERMIT p p y Power Apparatus&Large Appliances APPLICANT provisions or this permit shall be deemed revoked LICENSED CONTRACTORS DECLARATION Size"&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I,am`hcehsed under provisions'of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000) of Division,3 of the Business and CITY Tel No Professions Code, and my license is in full force and effect. Over 10 to 50 Incl LICENSEClass Over 50 t0 100 Incl. REG NUMBER - O Over DISTRICT NO P SSED BY U License Number Llc.Class Services,Swbd,MCC&Panelboards ��� Q Contractor Date 0-399 Amp Under 600 V DATE f O 400-1000 Amp.Under 600 V Z- VALIDATION U ❑ I'am exempt under Sec. W Ovec-1.090•,Amp or Over 600 V FINAL - � B&P C for-this reason - BRANCH CIRCUIT•FEES BY Date. 15A,or 20A,120V, Lighting or Recept v Z 1 To 10 Branch Cucuds Signature 11 To 40 Branch Circwts El _ 41 Or More Branch Circuits _ Ezemptiori for Reg Maint Elect 15A,20A,208V To 277V Lighting Br Circuits SINGLE FAMILY Temp. Power Pole&Appurtenances ''"-' HOMEOWNER-BUILDER DECLARATION tj.`:t ° th C B with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law Sign for the following reason.(Section 7031 5, Business and Professions Additional Sign Branch Circuits Code) - - j rr i Is•. © I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors Is not Intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). CONSTRUCTION LENDING AGENCY ;•:-t- I hereby affirm that there is a construction lending agency for the ) ... performance of the work for which this permit is,lssued (Sec. 3097, PERMIT FEE (Sub-Total Civ. C.) /( `� PLAN CHECKING FEE Lender's Name :TAA _v U / n- PERMIT ISSUING FEE 'L - Lender's Address lok?7 /�'aue s^ / I certify that I have read this apphcat�ion Acl under penalty of purjury state TOTAL FEE that the 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 er upon the above-mentioned property for inspects rposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ' G A URE ERMITTEE DATE