HomeMy Public PortalAbout9525 BROADWAY_Electrical__ +.l APPLICATION FO
R ELECT ICAL PERMI {
)6 (yRTC�BCfi 5-62
r COUNTY OF LOS ANGELES
'` DEPA RTMENT OF COUNTY ENGINEER BUILDING lD
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER
WILLIAM A.JENSEN, SUPT of BUILDING LOCALITY
NEAREST 7
FOR APPLICANT TO FILL IN I CROSS ST. %, + .3- -(✓.0
/ TOTAL - NO. EACH FE
OUTLETS 4/ E / '
R EC EPT. FIRST 20 / $ 2O $ OWNER
1I` �s
LION %Q ` � " MAIL '
AOD'L �gj �� ) ADDRESS
SWITCH. OVEP 20 .10 /� s
-fes TOTAL ` CITY / TEL. NO.
LIGHTING �� FIRST .20 ti 6'
�7 /
FIXTURES C{ DADq 20 fp ELECTRI+C�IAN
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADORESS: "y / . mv
(`l/
.GARB:DISP. % STA.COOK CITYTEL
. NO
DISHWASH. AUTO-WASH.' _ STATE rJ r
+
LICENSE NO.
SPACE HTRS, STA.APP.
MOTORS: OVER NOT OVER H.P. DISTRICT NO. GIV P
UP I E PR 5 ED Y
O 1 1.00 _ `)
1. `3 LEO INSPECTION RECORD
3 B 2.00
_ e Is 2.50 a
is 50 3.00 O
50 top 5.00
O
SIGNS: NO,TRANS. U
NO.LAMPS IL
d
h
,i ERV ICE 0-600V-Nor OVER 200A. 1.00 - Z
SERVICE 0-60OV-OVER 200 A, 2.00
SERVICE DVER-600V 5.00
PERMIT ISSUING FEE 2.00
BUPPLEMENTASY PERMIT ISSUING FEE 1.00
TOTAL FEE $ � "
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE,IS CORRECT AND AGREE TO�COMPLY CONDUIT t
WIT. ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
1 HEREBY CERTIFY THAT�I. AM .PROPERLY REGISTERED ANO(OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES - d�' II �] /✓I•l 'R `
CALIFORNIA OR IT AT I AM THE ,LEGAL OWNER OF THE ABOVE
DESCRIBED
RE9IDTE TIAL PROPERTY. POWER
SIGNATURE + UTILITY CO.NOTIFIED -'!I, I -�Z �l1%1I'ILAKiL'y�+oCr
OF PERMITT /_!!!/// _ FINAL -SII-f Z /M�9•✓tM 6.f
///���VALIDATION ARTHUR C. VEIT V _
SUPERVISING ELECTRICAL ENGINEER
CK MO CASH
Uilo_�,2 8 3�- ACV21 2 D 1 2.80-
�: have SATIONDECLARATION CE-806 10/8I APPLICATION FOR ELECTRICAL PERMIT
�j: have a certificate of consent to self CE-8066
., or - $pCT of workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
certified copy thereof-(Sec. 3800, Lab. C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB r
'Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS
Certified copy is filed with the county building inspec- I & 24amily, Sq, FL $ — E LOCALITY �t
on department. e Multi-family Sq. Ft. — NEAREST /7
/ Residential Swimming Pools CROSS ST. C:' L.
Dat�Applicont - OWNER OR /� '
7�� `/ FIRM NAME ( /7 C. vr-1 .2
CERWICATE OF EXEMPTION FROM WORKERS' Outlets: Rectri Light y;,�Sw.& - MAIL
COMPENSATION INSURANCE ADDRESS p
(This section need not be completed if the work involved by Total No. First 20
the permit is for one hundred dollars ($100) or less.)
Additional CITY Tel. No.
I certify that in the performance of the work for which this PLAN CHECK
permit is issued, I shall not employ any person in any manner APPLICANT
so as la become subject to the Workers'Compensation Laws. Lighting Fixtures_ First 20 P5 ADDRESS
Additional
Total No.
CITY Tel. No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT /� �pp��
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT /� !/V/
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. — �� p
deemed revoked. .^ CITY sa (J Y7�e( el. IN
LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other— /✓l
Disp. Room Air Cond. LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER .Class.
(commencing with Section 70DD) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT N�QS•�- (� PROCESSE�BY
and Professions Code,and my license is in full force and effect. J' 1 L d
�y�'�1- Size 8 Type HP, KW, KVA, or KVAR O
License Number c1 J Lic Class Up to 1 Inc. FINAL
G ��G�wfAll�/ // Over 1 to 10 Incl. DATE �(/y/(/f 0
• Contractor I�tt't Date L_ 01
VALI TION
Over TO to 50 Ind. FINA 0
am exempt under Sec. Over 50 to 100 Inc. BY
B.&P.C. for this reason Over 100 ! CILy
Services, Swbd., MCC & Ponelboords � ?
Date: 0 - 200 Amp. Under 600 V (6024
Signature 201 - 1000 Amp. Under 600 V
❑ 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 :28029A
Law for the following reason (Section 7031.5, Business and
Professions Code):
❑ Misc. Conduits 8 Conductors' '# e • e e,e `L
I, as owner of the property, will do the work and the
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ D e',e 49.25
7044, Business and Professions Code). t(.
CONSTRUCTION LENDING AGENCY * - - 4q255
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) .O 9.3 Q.:8 7
(Sec 3097, Civ. C.).
PLAN CHECKING FEE _
Lender's Nome _
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 -
th ab ve-mentio operty for inspection purposes. '
SEE REVERSE FOR EXPLANATORY LANGUAGE
/l
14 6 74y, 3l1
Signature of Permmee Da