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Home My Public Portal About9669 BROADWAY_Electrical__ APPLICATION FOR ELECTRIC PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDIrvc p ,y BUILDING AND SAFETY DIVISION BUILD]ADDRESS :JOHN A. LAMBIE, COUNTY ENGINEER CASSATT D. GRIFFIN,5UP'T OF BULLDING LOCALITY FOR APPLICANT TO FILL• IN NEAREST PERMIT FEES ceoss sr. IT M NUMBER OWNER.EACH FEE MAIL 0:UTLE. $ $`Y�% ADDRESS LIGH REC .f0 LIGHTING FIXTURES to CITY TEL. I ELEC.RANGES CLO.DRYERS ELECTRICIAN LIT ez - WATER HEATERS .50 ADDRESS J[/ ELEC.SPACE HTRS. DISHWASHERS CITY / TEL. NO. Q�AfljA- DI6P05 AUTO,- STATE �--/ WASHERS STA.COOKING UNITS .25LICENSE NO. - MOTORS: OVER INC. H.P. DISiI@ICOT IGRTP I ZONE I PROC 0— I/E - .25 `''�7 i J:: _ vz— 2 .50 INSPECTION RECORD z— 5 1.00 5— 15 1.50 15— 50 2.50 50-200 5.00 SIGNS: NO.TRANS. NO.LAMPS SERVICE O-000V 1.00 SERVICE OVER 600V 5.00 MISC.. WIRING PERMIT 1.00 FIXTURE PERMIT 1.00 (� SUPPLEMENTARY PERMIT .50 TOTAL FEE $ I HEREBY.ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT'THE ABOVE IS CORRECT AND AGREE.TO COMPLY WITH L ALL COUNTY ORDINANCES AND STATE LAWS REGUATING CONDUIT O` /I41,1 ELECTRICAL WIRING. WIRING I HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED AND/OR 1,4r' .(. LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES / /4r' CALIFORNIA ORT I A THE LEGAL NER OF THE ASOYE DESCRIBED RESIDE T L PERTY. POWER ,o{�`�, SIGNATURE UTILITY CO.NOTIFIED 119-1f-bo (�✓NJ y'/ l.4 OF.PERMITT '�•�/;`,, FINAL Q lA"H 1) 7wazo of ®= CfDATION ARTHUR c.vEIT. C MO CASH SUPERVISING ELECTRICAL ENGINEER � f 5 0 5 6 0 P,UG 15 2 D._ 9.7 5 '6A663-CES06 5-62 APPLICATION FR ELLE pppyyICA / RMI } COUNTY OF LOS ANGELES I DEUILDING BPARTNT OF COUNTUILDING AND SAFETYYDIV SIONER ADDRESS li�a��/�_ . (v'vc � JOHN A. LAMBIE, COUNTY ENGINEER q . WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY h NEAREST FOR APPLICANT TO FILL IN CROSS ST. RECEPT. TOTAL NO. EACH FEE OUTLETS FIRST 20 $10 6 - OWNER _ `Un LIGHT �' �" MAIL AOD'L ADDRESS JN%r'VI/Uf SWITCH. OVER 20 .10 _ 1� r / LIGHTING TOTAL FIRST 201 .20 CITY G L TEL. NO. FIXTURES } ' ADO'L ELECTRICIAN OVER 20 .10 RANGES '^ CLO:.DRYERS .WTR.HTR9.: 1:00 ADDRESS aw10.JGIIIP' erw:`COOK CIT.'/ T O. JJI»Iww911: Aur'o^wAaN '` ` S - i TATE ID'ACE H11J9., ... SFA:APP (yA H.P MAX) '-.60 LICENSE NO. MOTORSz. OVER DISTRICT N. -GROUP ZONE P O SEq BY 1Ao o t s icso INSPECTION RECORD 2.00 , aIs 2.50 > n IS 50 3.00 I O V 50 100 15.00 1 D: SIGNS: NO.TRANS- O NO.LAMPS W n SERVICE 0-600K NOT OVER 200A 1.00 N Z SERVICE 0-600V OVER 200 A. 2:00 SERVICE OVER 600V 5.00 PERMIT ISSUING:FEE - SUPPi.EMENTAEY PERMIT ISSUING FIM.'-. 1.00 .. .'.TOTAL',FEE.. -1 XE!✓eBY ACITNOWL®GE TNATI HAYe REAO;'If1I9.APPuuTIDN - APPROVALS DATE INaPECTOR'9 SIGNATURE wxD,9TwTe'Txl1T'TXe wa°ve..n CORRECT AND.AGREE io COMPLY CONDUIT MTx ALL'COUmm CRDINAxCE9-AND STATE a Way REGD TING ECTRI etCAt V1TRDiG:. :.,i _ WIRING Mg LICENSED AS REQUIRED SY_LOs ANGELF3COUMY ANDDSTATEIOP FIXTURES. CALIFORNIA.OR THAT I.AM TME LEGAL OWNER OF THE AXIOMS D ISED RE9IOENTIA/L_P.RDPSRTY.. . - POWER y OF PERM17TE /v'G - UTILITY Co.NOTIFIED p /`� FINAL Z/z0 Y MTJA SU HUS C. VETT CK K� MID O CAB - SUPERVISING ELECTRICAL ENGINEER Lill 0 8 2 1 8 0 DEC 1 1 2 D 2.60- _. 76d663-CE80610-62 APPLI Ail EdE�RICAd PERMIT COUNTY OF LOS ANGELES ' DEPARTMENT OF COUNTY ENGINEER - FF M'NGBUILDING AND SAFETY DIVISION DDREssJOHN A. LAMBIE. COUNTY ENGINEER WILLIAM A.JENSEN, SUPT OF BUILDING CALITY NEAREST FOR APPLICANT TO FILL.IN CROSS$T. RECEPT. .,. TOTAL NO. "EAC. F�E ,OU'[LETS Flx 20 OWNER ER- LIGHT w/I MAILADD' ADDRESSsW1TCX.�. OVER LO TOTAL CITY . TEL. NO.LIGHTING ST20, - FIXTURES I( ovER 20 .10 ELECTRICIAN RANGES CLO.'DRYERS WTR.HTRS. 1.00 ADDRESS G ��A.!✓.^-T GARB.DISP. STA.COOK CITY _\.. TEL. NO. OIBHWAEH. AUTO.-WASH. '$TATE SPACE HTRS. STA.APP.P/a H.P.MAX.) ..So LICENSE NO. MOTORS: OVER NOT OVER H.P. DISTRICT}��}I0.: OIUP - Z NE PR/¢,JE D BY O 1 / 1.00 / tQ D U DV L — //V 1 3 1.50 �/ //�' INSPECTION RECORD 3 8 2.00 �l v/ti 8 15 2.50 0 15 . 50-' 3.00 A 50 100 5.00 - - O NO.TRANS. tttULLL SIGN$:, NO.LAMPS N Z SERVICE 0.60OV-NOT OVER 260A 1.00 SERVICE 0-60OV-OVER'200 A. 2.00 SERVICE OVER 600V 5.00 - MISC. li PERMIT ISSUING FEE. 2.00 Q 0 6 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 .. TOTAL FEE - $ 1 HEREBY ACKNOWLEDGE THAT 1HAVE READ THIS APPLICATION APPROVALS q' DATEI/ I NSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CO RRECI AND AGREE_ TO COMPLY .CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING _ p ELECTRICAL WIRING. WIRING p �• 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSEDAS REQUIRED BY LOS A 5 COUNTY AND STATE OF FIXTURES / CALIFORNIA OR THAT I AM THE LEG L OW OF THE ABOVE . a - DESCRIBED RESIDENTIA OPERIY. POWER OF NATUREf 'L % UTILITY CO.NOTIFIED ��/qq �.� �IpJAj FINAL �W9 - VALIDATION - ARTHURIC. VEIT"- (CK MO CASH SUPERVISING ELECTRICAL ENGINEER Lito 1961- OCT 29 2- 0 4.40- 76A663-CE606 9-66 APPLICATION FOR ELECTRICAL PERMl COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS Flu "1 JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY f NEAREST FOR APPLICANT TO FILL IN CROSS ST. I RECEPT. TOTAL NO. IEACH I FEE 11 OUTLETS FIRST 20 5.20IS O OWNER 7 r �lan LIGHT MAIL SWITCH ADD'L 1 10 ADDRESS , 7 OVER 20 l TOTAL LIGHTING LIFIRST 20I .20 ('� CITY TEL. NO. VX L FIXT RE6 FXTURES Jr ADD'L 1O CONTRACTOR OVER 20 _ RANGES DRYERS WTR.HIPS. 1.00 ADDRESS GARB.DISP. STA.COOK CITY TEL. NO. DISHWASH. AUTO. WASH. STATE SPACE HIPS. STA. APPL. ,50 LICENSE NO. MOTORSI OVER NOT OVER H.P. DISTRICT G_Rrj Z O E D O 1 1.00 P fi 1 3 1 11.50 INSPECTION RECORD 9 8 2.00 8 15 2.50 15 — 50 13.00 y 50 100 15.001 NO.TRANS6 SIGNS: NO.LAMPS O SERVICE 0.60OV.NOT OVER 200A 11.00 Ami a SERVICE 0.600V OVER 200 A. 2.001 h SERVICE OVER 600V 1 5.00 1 ? OTHER (SEE COMPLETE FEE SCHEDULE) .tf PERMIT ISSUING FEE 2.00 V SUPPLEMENTARY PERMIT ISSUING FEE 11.00 APPROVALS DATE INSPECTOR-Ill SIGNATURE TOTAL FEE 6 IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIO UNDERSLAB WORK ANO 5TATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING L ♦, �- ELECTRICAL WIRING. WIRING HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REOU FE. BY LOS ANGELES COUNTY AND STATE OF _ CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO V RESIDE IN.THE AROV SCfl18 O PESIDE,H1TIAL PROPERTY. POWER ` SIGNATURE y r UTILITY CO.NOTIFIED - `,l /g OF PERMITTEE ��V��/��V 111��I rr�lll1 umw FINAL VALIDATmO Ip SUPEJOSEPH C. ROOHAN SUPERVISING ELECTRICAL ENGINEER CK MCASH L& 8 45 3 1W 9 2 D 5.40- s • _ WORKER'S COMPENSATION DECLARATION 2UDD19DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT ll 6A663 Iheleby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB /1 �./^ ADDRESS V 4 Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE - — $ S LOCALITY LE Certified copy is filed with,the County building inspection 1&2-Family,Sq.Ft. department. Multi-family Sq.Ft. NEAREST. CA Residential Swimming Pools ASSESSOR Date Applicant MAP BOOK 12- CERTIFICATE OF EXEMPTION FROM WORKERS' / }�' PAGE PARCEL Outlets:Rea_Light SW. FFIIRM NAME Tamz op COMPENSATION INSURANCE ? AOOREBS`��GFirst 20 '4 (This section need not be completed if the work involved by the J MAIL ^f /. f permit Is for one hundred dollars($100)or less.) Total No. Additional I certify that in the performance of the work for which this permit CITY Tel.No. is issued, I shall not employ any person in any manner so as to p CK CRE become subject to the Workers' Compensation Laws. Lighting Fixtures –y First 20 'a U O PLPLAN AN CHE - .Total No. f Additional ADDRESS Date ApplicantRESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certificate of CITY Tet No. ' Exemption, you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of'the Labor Code, you must forthwith comply with such Power Apparatus 8 Large Appliances APPLICANT PERMIT provisions or this permit shall be deemed revoked. LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR - ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 101ncl. (commencing with Section 7000) of Division 3 of the Business and CITY Tel.No. Professions Code,and my license is in full force and effect Over 10 to 50 Incl. LICENSE 08 } Over 50 to 100 Incl. REG.NUM ER Class. _ d License Number LIe.Class Over 100 DISTRICT NO. �OO P ESSED BV Q Services,Swbd.,MCC&Panelboards Contractor Date 0-399 Amp.Under 600 V FIAA ❑ I am exempt under Sec. 400-1000 Amp.Under 600 V f 2 L VALIDATION UU Over 1000 Amp.or Over 600 V FINAL d B.BP.C.for this reason BRANCH CIRCUIT FEES BY Date: Z 15A,or 20A, 120V,Lighting or Recept. _ - 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits - - ❑ 41 Or More Branch Circuits ') Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits r SINGLE FAMILY ACCT, Temp.Power Pole 8 Appurtenances - --- HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 331]7 32.35 I hereby affirm that am exempt from the Contractor's License Law - for the fallowing reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits - -- ced� _ .. ii ITEMS I, as owner of the property, will do the work and the structure Misa Conduits&Conductors TOTAL 32 ® uc is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) - , and Professions Code). C:HEC, :12'+7•'85 CONSTRUCTION LENDING AGENCY CHANGE .I.113 I hereby affirm that there is a construction lending agency for the - performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ. c.) 0000-000 i ti; 2f43 PLAN CHECKING fEE ],f AM yl,; 1 1 Lender's Name 71�I�i PERMIT ISSUING FEE Lender's Adores. - - Icertify that I have read this appl anon and under penalty of perjury state TOTAL FEE that the above information is cor ct. I agree to comply with all County ordinances and State laws regulatin Electrical wiring,and herebyauthorize representatives of this County to enter upon the above-mentioned property for'nspection purposes. �`� SEE REVERSE FOR EXPLANATORY LANGUAGE GNAIDRE OF PERMITT !�' qTE✓