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HomeMy Public PortalAbout9551 BROADWAY_Electrical__ 76A663-LE306 9-64 APPLICATION FOR ELECTR CAL PERMIT YY COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER //////�1 COLEMAN W. JENKINS, SUPT. OF BUILDING LOCALITY 0J• NEAREST FOR APPLICANT TO FILL IN CROSS ST. �I a EG EPNO. EACH FEE r„L�2TOTAL OUTLETS FIRST 20�g�I S 2O 6 ��] OWNER L LIGHT GAS• MAIL !J 1 VER 10 ADDRESS L SWITC H.21�/ _.L�L� OVER LO VV TOTAL CITY i TEL. NO. LIGHTING I (FIRST 20 � .20 oll FIXTURES ) ADO'L 10 j ELECTRICIAN O RANGES CLO.DRYERS WTR.MTfl9. 1.00 ADDRESS U/`I GARB.DIEP. 2f STA.COOK 'L� ` 160 �j CITY TEL. NOG O DISHWASH. O AUTO.-WASH. STATE SPACE HTR9 STA.APP.I1h H.P %'.) Q .50 LICENSE NO. -2�? MOTORS: OVER NOT OVER H.P. DISTRI T NO. ONE O 100 , 1 — 3 1.50 INSPECTION RECORD 3 B 2.00 ( m f P < ESSED Y O 8 1s 2.50 15 50 3.00 YV P C �' o so loo 5.00 ('N. ee SIGNS: NO.TRANSN NO.LAMPS qa A"� � y'yyP /n / Z SERVICE 0-60OV.NoT OVER 200A 1.00 1-7 ^1 py14— SERVICE 0.60OV-OVER 200 A. 2.00 — - /I __����,/-„,5 p� A SERVICE OVER 600V 5.00 / u./Y�5 MISC. PERMIT ISSUING FEE 2.00 �` SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE 6 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS GATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING UA/5• Mi�JAr„ '�Al �' //Yl'JGI.J HEREBY .CERTIFY T PROPE Y REGISTERED ANO/OR ' T • , LIC ENSEO PS REOVIR BY LO L 5 COUNTY AND SYPYE OF FIXTURES CALIFORNIA OR TMP 1 T L OW OF, ND INTEND TO RE510E IN, TXE <B BE E51 E L PPOP PTY. POWER pI SIGNATURE UTILITY CO.NOTIFIED )w. OF PERMITTE FINAL -9 e( I] LO,Y (0)0” j 1 —VALIDATION ION JOSEPH C. ROOHAN CK MO CASH SUPERVISING ELECTRICAL ENGINEER Lr;i,o 4 7 9 5 ;: IG 19 2 0 12 2.8 0' c y / 76A663-CE806 B.62 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING -('� 7&00 G �Q� BUILDING AND SAFETY DIVISION ADDRESS J JOHN A. LAMBIE. COUNTY ENGINEER WILLIAM A. JENSEN, SUPT OF BUILDING _ LOCALITY / NEAREST FOR APPLICANT TO FILL IN CROSS ST. E NO. EACH FEE - RECEPT. TOTAL FIRST 20 1$2O $ OWNER / G/. J OUTLETS LIGHT 10 MAIL ADOADDRESS 2 SWITCH. OVER 20 LIGHTING TOTAL FIRST 20 .20 CITY // y E TEL. NO. FIXTURES } 6o O�°R 20 U1p D ELECTRICIAN �(/ RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS /' GARB.OISP. STA.COOK CITY .GE TEL. NO. OISHWASH. AUTO.-WASH. STATE SPACE HIRE. STA.APP.(l/.H.P.MAX.) .50 LICENSE NO. 23Q MOTORS: OVER NOTOVER P. DISTRICT N GIR Z E PR C BY O 1 1.00 3 1 3 1s0 INSPECTION RECORD 3 8 2.00 8 15 12.50 15 50 3.00 50 100 5.00 O SIGNS: NO.TRANS� NO.LAMPS O H SERVICE O-SOON-NOT OVER 200A 1.00 IUi.I SERVICE 0.600V.OvER 200 A. 2.00 1 N SERVICE OVER 600V 5.00 ? MISC. PERMIT ISSUING FEE 2.00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE ICelf OO . I 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 WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTEREO AND/OR / LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT I THE LEGAL OWNER OF THE ABOVE / DESCRIBED'RESIDENT PERTY. POWER SIGNATURE � ��i � UTILITY CO.NOTIFIED �/ �.! I I1 Ann ♦w OF PERMITTEE-1 ��W �V•••� 1 FINAL 1(DATION ARTHUR C. VETT ' SUPERVISING ELECTRICAL ENGINEER' CK 9MO CASH Lid 0 8 6 3 3 JAN 7 2 D 2 0.0 0- v WORKERS' COMPENSATION.DECLARATION •Y000w oPw vee APPLICATION ®R 2n ��.r�rrsl�+ An rw�n.•pAIT 0 hereby''-affirm that have a certificate of consent to self CE_I - ELECTRICAL R( 'k A L P+ RM insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lab. C. Policy No. Company FOR APPLICANT TO FILL IN TOB C ❑Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS ✓ l �{Certified copy is filed with the county building in - - 1 & 2-Family, Sq. Ft. _ $ _ $� OCAUT 1 tion department. Multi-family Sq. Ft. - NEAREST ( CROSS Dey— j S— �ErAppliW rm _ Residential Swimming Pools - ' acOWNER SOR CERTIFICATE OF EXEMP RO / -FIRM NAME .WOR S'. Outlets: Rec—LightSw._ MwIL � �a COMPENSATION-I SUR C ADDRESS "I First 20Ij (This section need not be uncompleted a work involved,by Total No. Additional CITY r {� Tel the permit is for one hundred dollars ($100) or Iasi.) PLAN CHECK 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'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional CITY Tel. No. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range— Heater—D.W. — APPLICATION 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. Hood —'Fan —'Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATION Disp. — Room Air Cond. _ LICENSE OR rJ Class. BER (commencing with Section 7000)of Division 3 of the Business Power Apparatus.& Large Appliances DISTRICT NO. PRO SSED BY and Professions Code,and my license is in full force and effect. d Size 8 Type HP, KW, KVA, or KVAR ( © Q License Number-?!t)/ ��� Lic. Class Up to 1'Incl. L) A�y, FINALcc Contractr(Le-- - 7Y'/UB Gte � y Over I to 10 Ind. DAT ^7�g VALIDATION 0. ❑ / Over 10 to 50 Incl. FIN !.� v , am exempt under Sec. Over 50 to 100 Inc. U Over 11X1 I� B.&P.C. for this reason D- Services, Swbd., MCC& Ponelboards D Z D �, 0-200 Amp. Under 600 V _ Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exempti for Reg. /M(,_i n/t. Q SIMM F� Tem Power Pole &Appurtenances 6 7.,7 A HOME OWNER-BUILDER DECLARATION .p' Ci # • ° .is, s•2 ' I hereby affirm that I am exempt from the Contractor's License Sign With-One Branch Circuit Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits .I.• - 27.00 Professions Code): ° • • 2 7 O 0 Ell, as owner of the property, will do the work and the Misc. Conduits E Conductors A Other See Complete Fee Schedule— D 0 9' � 4'�8 8 structure a not intended or offered for sale(Section 7044, ( P ) .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 Q � Lender's Address - I certify that I have read this application and state that the TOTAL FEE v0 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-m htioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ig at FPp ee —� Date // j