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Home My Public Portal About9661 BROADWAY_Electrical__ V 16A663-CER06 5-62 APPLICATION -F�yq✓ Eb�TyICA�S RM, I W COUNTY OF LOS ANGELES .DEPARTMENT OF COUNTY ENGINEERBUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN ACROSS ST. RECEPT. TOTAL NO. EACH FEE LIGHT OUTLETS FIRST 20 $ 20 $ OWNER SWITCH. / MAIL ADD'L ADDRESS �� / OVER0 10 2 LIGHTING TOTAL FIRST 20 ,20 - CITV T FIXTURES }_Z4 ADO'L 1O - ELECT IAN VER 20 RANGES CLO.DRYERS WTR,HTRS. 1.00 ADDRES6 GARB.DISP.' STA.COCK CITY 1 TEL. NO DISHWASH. AUTO.-WASH. , STATE CEY� SPACE HTgS.d-_/STA.APP.(y H.P.MAX.) .50 LINSE NO. MOTORS: OVER NOT OVER H.P. DIST CT(JPO. GROUP ZONEP ESSED Y 0 1 1.00 (/ 8 ZLI / / 1 — 3. 1.50 1 INSPECTIIO1-N,, RECORD /A 3 — B 2.00 1 Chd ,JJo6C4,A. 1.7.fA i!'u ./ . 8 15 2.50 L" - G } d 15 50 3.00 0 50 100 5.00 O NO.TRANS. SIGNS: NO. LAMPS W �l a SERVICE 0.600V.NoT.OVER 200A 1.00 �ffV Z SERVICE 0-60OV-OVER 200 A. 2.00 SERVICE OVER 600V 5.00 MISC. PERMIT ISSUING FEE 2.00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE $ /v 1 HEREBY ACKNOWLEDGE.THAT I 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 1 AM PROPERLY REGISTERED ANO/OR CE LINSED AS.REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES (/ CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PRO RTY. POWER SIGNATURE UTILITY CO.NOTIFIED �, ! Flt OFPERMITTEE FINAL G �OS �..A VALIDATION ARTH R C. VEIT CK MO MO CASH SUPERVISING ELECTRICAL ENGINEER l f.,o 1 5 1 4n, FE$ 2 8 2 D 1 4.50 7 76A663-CE806 3-69 APPLICATION FOR ELECTRICAL E I� C � COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUIL1NG BUILDING AND SAFETY DIVISION AO D IDESS JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. NO. EACH FEE R ECEIPT.� 5 $ OWNER ` MAIL TIGHT TOTAL FIRST 20 ,2p 31(.a.0 ADDRESS C SWITCH OVER 20 ,10 CITYPLAN TEL.NO. LIGHTING TOTAL FIRST 20 ,20 7\ APPLICANT FIXTURES OVER 20 ,10 V ADDRESS RANGE_DRYER WTR. HTR. CITY TEL.NO. STA. COOK DISK. F.A.U. CONTRACTOR SPACE HTR._AIR GOND. ADDRESS 107 ael::& 4Z9 1 CLOTHES WASH. OISHWASH._ CITY' TE L.NO. r' / FAN OTHER 1.00 LICENSE NO. CLASS. MOTOR5,TRANSFORMERS RATING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION IND. HEATERS, ETC. HP. KW. KVA. AND STATE THAT THEABOVE IS CORRECT AND AGREE 70 COMPLY SIZE & TYPE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING /� ELECTRICAL WIRING. 0 - 1 1'00 / `^� 1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICE NSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATEOF 1 - 10 3.00 CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO d BESIDE IN, THE ABOVE DESCRIBED AEC, NTIAI PR RTY. O 10 — 50 5.00 V SIGNATURE 50 — 100 1000 OF PERMITTEE O 100 — 500 15.00 o1srRlcT No. GR z !9S.. BY IV SIGN,GAS SIGN AND ONE CIRCUIT 3.00 S, p / N TUBE, OR Z MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES' 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 INSPECTORS SIGNATURE TEMP. POWER POLE UNOERSLAB WORK ROUGH CONDUIT WIRING PERMIT FEE (SUB TOTAL) FIXTURES PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED' 2,K/ PERMIT ISSUING FEE 2.00 �'J Q UTILITY CO.NOTIFIED SUPPLEMENTARY PER ISSUING FEE 1.00 G FINAL TOTAL FEE 0�''I 1 1 JOSEPH C. ROOHAN SUPERVISING ELECT ENGINEER PLAN. CHECK VALIDATION CN. M.O. CASH - PERMIT VALIDATION CK. M.O. 'CASH I4 46098 AR22 2 D 1 0.0 0 SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE ✓(/A%� .� /// WORKERS'COMPENSATION DECLARATION i CE-806G;'s"sea ''bra, APPLICATION-FOR ELECTRICAL PERMIT „,I hpCebv;•affirm that'( have a certificate of consent to self nsure' - � - or &-certificate of'Workers' Compensation.Insurance or a certified - COUNTY OF LOS ANGELES` - '_BUILDING AND SAFETY copy the ( ec. 3 C.) } .. Policy N mpapy FOR APPLICANT.TO FILL IN - JOB - -(0401 �� Cerh6ed copy,is hereby�fu�nished 1New;Residential.Bldgs.&Pools :EACH ENOFE - ADDRESS Glerti ietl copy is filed with't ;'county buildin in echo '1 & 2-Family,Sq. FL $ LOCALITY NEAREST � Multi fam+ly Sq.Ft.YYYResidential Swimming Pools OWNE OpplicanOWNEROR61 FIRM NAME ERTIFICATE'OFfXEMPTION'FROMWORKERS' MAIL Outlets.ReeLight Swam Oki,JCOMPENSATION INSURANCE •2 `d ADDRESS(This seclionneed-not be completetl if the work mvolvedby the First 20. ;permit is.tor one hundred dollars ($100)or less.) - Total No. Addihon�al - CITY,, TeL No. I certifythat in the performance of the:work foi which,lhis permit PLAN'CHECK - APPLICANT^ is issued,, shall.not employ any person in any,manso as to ✓ . 'become sublecbtmanner so Workers'Comperr iori Laws. ?. Lighting Fixtures First 20 ADDRESS'• Additional. - Total No.' CIT,V^ Tel.Na^•, Date - - Applicant' - ' Fixed Appliances Not`Over 1 HP, . ° - PERMIT NOTICE.-TO APPLICANT:,If, after making this:Certificate 'ofNf Exemption,.you should become subject to the Workers'Compensation Range_ Heater_ D.NP =� APPLICANT'. provisions., ab of the Lor Code, you must complyrwith such; - Oven Dryer _.:W.M.— • ADDRESS provisions:or,this permit shall be deemed revoked. > Top _ FAU W.H. LICENSED CONTRACTORS DECLARATION _ Hood — Fan Other " 'CIT ,Tel No' hereby affirm thatI am licensed under provisions of Chapter & + ' LICENSE OR (commencing vaith Section 7000)of Division 3b the'Busirie'ss'and • Disp. Room Air Cond. -Class - REG.NUMBER Professions Code,and my license Is in full force and Effect DISTRICT NO. PR SSED BY ' Power Apparatus& Large Appliances ' f� �' Size& Type HP,KW,KVA,or KVAR �/r Q License N tier o Lic Class � .up to 1 I��j�' FINAL" ` - v Over 1 ofo 1 nc DATE I0 � . VALIDATION -0 .Contracro " 1 Data,' Over 10 to,50'1n11. U Li ` - FINAL. am exempt under Sec. Over.50'to 100 Inc. BY.. OW. B&P.C.for this reason - Over'100 wd.;MCC& Panelb cards D 2Services'S Date: 0 200 Amp Under 600 V AN T, 4 -'•Z Signature - ^201 1000 Amp:Under 600 V - - - Over 1000 Amp or Over 600 V :3303 46.70 �. Exemption for.Reg.Maint-Elect. SINGLE FAMILY. Temp Power Pole'& Appurtenances 1 �L ITE HOME OWNER-BUILDER DECLARATION' Sign with One Branch'Cimun - TOTAL T6Te 7® I hereby raffirm that I'am exempt from the Contractors License Law-.,' + for the following reason(Section 7031.5, Business and Professions-• Additional Sign Branch.Cimuits' - _ + .; _ _ MC,K.. __, „ ,46.70, Codl DiANqE .00 , Misc. Coni Conductors' as owner ot.tha property,will do the'work and the structure's ,:is not,intended or offeredfor sale,(Section-7044, Business Other(See Complete Fee Schedule)and Professions Code). 0000-0001•. 27 1776 . . CONSTRUCTION LENDING AGENCY I hereby affirm that there is-a construction'lendingagency forahe _ _. 46E3, -1 6. 1.1 performance of the-work for which this permit is issued(Sec.3097, PERMIT-FEE' - •-- (Sub Total) - ,Civ.C.). . - PLAWCHECKING FEE Lender's Name " - ~- '" •`• - 'r. PERMIT ISSUING FEE Q Lender's Address I certify thatl have read this application antl state that the above TOTAL FEE - information is correct. I agree'.to comply with all County ordinances. and State laws regulating Electrical wiring, and hereby authorize _• • • - ` x repres ntatives of this County to enter upon the• ove- ntioned prop foci s ect as -- r .SEE�REVERSE,FOR.EXPLANATORY LANGUAGE ISIgnature of P itte Date, - -