HomeMy Public PortalAbout9936 BOGUE ST_Electrical__ 76A663-CE8061-68 APPLICATION FOR ELECTRI AL PERMIT
COUNTY OF LOS ANGELES 'fl
DEPARTMENT OF COUNTY ENGINEER C�
BUILDING AND SAFETY DIVISION C
JOHN A. LAMBIE. COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING17NEAREST
`
FOR APPLICANT TO FILL IN CROSS ST. ,{
NO. EACHI FEE
$ $ OWNER
� �✓ ci/w
RECEPT._1 MAIL
LIGHT' (,`TOTAL FIRST 20 .20 ADDRESS
SWITCH_/ OVER 20 .10 CITY TEL. NO.
PLAN CHECK
LIGHTING �TOTAL FIRST 20 .20 APPLICANT
UFIXTRES OVER 20 .10 ADDRESS
RANGE 1 DRYER—WTR.HTR._ CITY / TEL. N`O.C',, '�.� •
STA.COOK_DISP. F.A.U._ COINTRACTOR
SPACE HTR. AIR COND. /f f��7 A
ADDRESS /7` .(J
CLOTHES WASH._DISHWASH. CITY .r TEL. NO.
FANOTHER 1.00 E� LICENSE NQ. 3 7,6 Z_ CLASS. C�
MOTORS,TRANSFORMERS RATING /
IND. HEATERS, ETC. HP. KW. KVA. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
SIZE 8: TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING.
0 - 1 1.00
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
1 - 10 3.00 LICENSED AS REQU IREO BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO d
10 - 50 5.00 RESIDE IN, THE ABOVE OES CRIP,EDSIDEN L PROPERTY. O
SIGNATURE V
50 — 100 110.00 1 F PERMITTEE
100 — 500 15.00
DISTRIC N RO P ZONE P. CE SED.
TUBE, OR SSIGN,GAS IGN AND ONE CIRCUIT 3.00 d
MARQUEE ADDITIONAL CIRCUITS 1.00 ` h
NOTES: Z
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 �V
SERVICE OVER 600 VOLTS OR 200 AMP 5.00
TEMP SERVICE, POLE, & APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE
TEMP. POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
PERMIT FEE (SUB TOTAL) WIRING
FIXTURES
PLAN CHECK FEE (50% PERMIT FEE) �7 ]FINAL
POWER AUTHORIZED
PERMIT ISSUING FEE 2.00 L. UTILITY CO.NOTIFIED
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE JOSEPH C. ROOHAN
SUPERVISING ELECTRICAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. ASH
LALO 4 5 3 .9 MAY 7 2 D 5.00�.
3EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE /
WORKERS' COMPENSATION DECLARATION 10i81 APPLICATION FOR ELECTRICAL PERMIT
I hereby affir�n t,�at I have a certificate of consent to self CE-806G
ensures,or 6 certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certifiedQpcopy thereof (Sec. 3800, Lob. C.)* a
' Policy No!3l� eQ Company�� L r ewp FOR APPLICANT TO FILL IN JOB /
❑ C tified co is hereby furnished. EACH NO. FEE ADDRESS (� 7
PY Y New Residential Bldgs. & Pools
1 & 2-Family, S Ft. $ — $ LOCALITY l
Certified copy is filed with the county building inspec- Y- q� C
tion department. Multi-family Sq. Ft. — NEAREST
'NResidential Swimmin Pools
Date L 7 Applican /s.L( Q16��, � j• g OWNER OR
Y�f FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec> Light Sw.GMAIL
COMPENSATION INSURANCE ADDRESS 'q'17-3111�P LA
( eneednoif the work involved b
This section t be completed First 20
p Y Total No. Additional CIT C(� Tel. No. 7� =Z
the permit is for one hundred dollars ($100)or less.)
I certify that in the performance of the work for which this PLAN CHECK�O
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 20 ADDRESS LJ
Additional
Total No. CITY M_r Tel. No.' 7
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT 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. * -,CITY Tel. No.
LICENSED CONTRACTORS DECLARATION Hood � Fan Other— _
Disp. LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Room Air Cond. REG. NUMBER Class. s
(commencing with Sectionof Division 3 of the Business DISTRICT NQS ��/ PROCESSED BY
and Professions Code, and myy license is in full force and ffect. Power Apparatus & Large Appliances Ate) vx y
Size & Type HP, KW, KVA, or KVAR' 0.O
License Number Lic. Class Up to 1 Incl. FINAL V
i Q�� ,J Over 1 to 10 Incl. DATE �'/ — V LIDATION
Contractor —Date Over 10 to 50 Incl. FINAL
❑ I am exempt under Sec. Over 50 to 100 Inc. BY da
4A
B.&P.C. for this reason Over 100
Services, Swbd., MCC& Ponelboards
Date: 0 -200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600 V ;?81 23 A
❑ Over 1000 Amp. or Over 600 V
Exemption for Reg. Maint. Elect.
# ° ° ° a;o2
SINGLE FAMILY Temp. Power Pole & Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ° ° 4250
1 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 uo o 4 2 5 0 6)
Professions Code):
❑ 1, as owner of the property, will do the work and the Misc. Conduits& Conductors 0J5"87
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-mentio ed property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
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Signature o Permittee Date