HomeMy Public PortalAbout9040 BROADWAY_Electrical__ J6A6�80816/J81
APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES BUILDING AND
nSAFETY
� /
ldgs.
FOR APPLICANT TO FILL IN JOB 9040 E. U1�1JAI Al
New Residential B &Pools EACH NO. FEE ADDRESS
1 &2"Family,Sq. Ft. 8 .025 — 8 LOCALITY
Multi family Sq. Ft. .02 — NEAREST -
Residential Swimming Pools 25.00 CROSS ST. .2.y al
OWNEROR
FIRM NAME
Outlets:Rec—Light—Sw._ MAIL
First 20 "50 ADDRESS S��' -
30 CITY Sk E Tel.No.2866691
Total No. _Additional -
PLAN CHECK
APPLICANT
Lighting Fixtures First 20 .50 ADDRESS
Addinci - .30 . , _
Total No. CITY Tel. No.
Fixed Appliances Not Over 1 HP - PERMIT -
Range_Heater_ D.W, _ APPLICANT TfW E HCC
Ove n_Dryer W.M._ - ADDRESS 2034 N. PEM - -
Top —FAU :X W.H._ CITY S. LL 1VI)i -Ti
Hood_Fan —Other— LICENSE OR
Disp.—Room Air Cond. 2'50 REG.NUMBER Class. r-1 0
I HEREBY ACKNOWLED E HAT I HAVE READ THIS APPLI A
Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO
Size 8 Type HP, KW, KVA,or KVAR - COMPLY WITH ALL COUNTY ORDINANCES AND-STATE LAWS
REGULATING ELECTRICAL WIRING.
Up to 1 Incl. 2.5D V
500 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
Over 1 to 10 Incl .
. LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
Over 10 to 50 Incl._ 12.50 CALIFORNIA OR THAT I AM THE L GAL OWNER OF Ti ABOVE Q
Over 50 to 100 Inc. 25.00 DESCRIBED RESIDENTIAL PROPERTY.
q G
Over 100 40.00 PERMIT EE
�ae S �J YI
IGNATURE G
N'
Services - DISTRICT NO:- P ES BY S
0" 200 Amp. Under 600 V 12.50 j 0 g
201.1000 Amp. Under 600 V 25.00 . _
Over 1000 Amp,or Over 600 V 50.00 ,D.
ryyp� cam.a
Temp. Power Pole&Appurtenances 10.00 �v J / 0 Q
Sign with One Branch Circuit 10.00 _
Additional Sign Branch Circuits 2'00 INSPECTION >
u
INFORMATION
o.00
Misc.Conduits&Conductors ON REVERSE s
Other(See Complete Fee Schedulel_ $IDE
Z
34738A _
6
#i0 O O O O 2
PERMIT FEE - Sub-Totali 2 * 92200
PLAN CHECKING FEE (One Fourth Permit Feel O r
_ '0 0 0 2 2 0 0 0
PERMIT ISSUING FEE -57.00 f g '
a 0604-79
TOTAL FEE - >
INSPECTION FINALED W
/ j /� 6
date: � ��/� By.
. .. . 1?�=�• S-�—p, �- .�- 3l a=j -fir i ��cy
V> S' COMPENSATION DECLARATION. . 70.4663 to/Bt APPLICATION FOR ELECTRICAL PERMIT
I hereby-affirmffi(mthat I'have a certificate of consent to self CF806G
insure or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof (Sec. 3800, Lob. C.) - ,
Pollcy No?30735 �og�3flc National _ FOR APPLICANT TO FILL IN JOB
� �J e,�/
EACH 'NO. FEE ADDRESS. 1 O Q/J,ysa'1i4�
Certified copy is hereby.furnished, InS.CO. /L.
New Residential Bldgs. & Pools -
' Certified copy is filed with the cou t buil g inspec- I & 2-Family, Sq. Ft. $ —, $ LOCALITY
tion department. Multi-family Sq. Ft. — NEAREST IF
Residential Swimming Pools OWNER CROSS$i.
T. -
Date Applicant - -
FIRM�NAME -
CERTIFICATE OF COMPENSATION
I FROM RKERS' Outlets: Rec�Light�Sw.� MAIL
COMPENSATION INSURA ADDRESS L'S1S'Lp LAK,"
First 20 y^
(This section need not be completed if the work irrvolved.by Total No. Additional CITY Tel. No. �Z{(S� ICY
the permit is for one hundred dollars ($100)or less.) PLAN CHECK 7A-7e-
permit
?� .
I certify that in the performance of the work for which this APPLICANT
permit is issued, I shall not employ any person in any manner
so as to become subject to the Workers'CompensationLaws. Lighting Fixtures First 20 ADDRESS
Z Additional t
Total No. CITY Tel. No.
Date Applicant Fixed Appliances NotaOver I HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of <' APPLICANT G. & S. ELECTRIC
Exemption, you should became subject to the Workers' Range— Heater_D.W.
Compensation provisions of the Labor Code, you must forth- Oven _ Dryer W.M. ADDRESS531 S . Atlantic Blvd.
with comply with such provisions or this permit shall be Top FAU _W.H. —
deemed revoked. CITY Monterey Park Tel. 3-
6317
LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_
LICENSE OR
CIOlass.
—
I hereby affirm that I am licensed under provisions of Chapter 9 � Disp. Room Air Cond. REG. NUMBER 248057 c }
(commencing with Section 7000) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. PED BY D.
and Professions Code,and my license is in full force and effect. a C)
Size 8 Type HP, KW, KVA, or KVAR' �d V
License Number` 248057 Lic. Class C10 Up to 1 Inc. FINAL O
Ca.&S .Electr is Over 1 to 10 Inc], DATE VALIDATION I-
Contractor Date Over 10 to 50 Ind.a FINAL W
I am exempt under Sec. Over 50 to 100 Inc. BY CL
B.&P.C. for this reasor Over 100 z
to
Services, Swbd., MCC 8 Ponelboards D
0 -200 Amp. Under 600.V -
Signoture� 201 - 1000 Amp. Under 600 V
❑ Over 1000 Amp. or Over 600 V
Exemption or Reg. Mt, ec t.
SINGLE FAMILY Temp. Power Pole 8 Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
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 -
Professions Code):
Misc. Conduits 8 Conductors
I, as owner of the property, will do the work and the Other (See.Complete Fee.Schedule)
structure is not intended or offered for sale (Section D
7044, Business and Professions Code). - 5 9 Q 5 A
CONSTRUCTION LENDING AGENCY # e e e • e '�
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) I e,e Q O O 0
(Sec 3097, Civ. C.).
PLAN CHECKING FEE s Y a 2 Q 0 0 5'
Lender's Name A
PERMIT ISSUING FEE ( O. ;,I �,i� 8<8.6
Lendei s Address '
I certify that I have read this application and state that the TOTAL FEE czos
061
above int malion is correct. agree to comply with all Caunry '
ordinanc and State law r quieting Electrical wiring, and -
hereby th 'ze represe a ves of this County ro enter upon
the abo e- ntioned pro ty for in tion purposes.
- SEE REVERSE FOR EXPLANATORY LANGUAGE '
ur of ittee Dote