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Home My Public Portal About9823 BROADWAY_Electrical__ .76P66'3-DE806 9-67 APPLICATION FOR ELECTRIC PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION gDOR Ess Q JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. NO. EAC FEE RECEP7.L 5,25 OWNER �J LrL. LIGHT *3 TOTAL FIRST 20 .20 ® ADDRESS SWITCH-Z— OVER 20 .10 ,V+ CITY T TEL. NO. LIGHTING lTOTAL FIRST 20 .20 CONTRACTOR b. 'g FIXTURES I -5OVER 20 .10 ADDRESS .O06 Ci < RANGE_DRYER—WTR.HTR.— CITY SfYN IOV19S TEL. NO. STA.COOK—DISP. F.A.U.— LICENSE NO. SPACE HTR. I-- AIR COND.— I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CLOTHES WASH. DISH WAS H._ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. FAN_OTHER 1,00 ®® 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF MOTORS,TRANSFORMERS RATING CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO IND. HEATERS, ETC. HP. KW. KVA. RESIDE IN, THE ABOVE DE CRIBED RESIDENTIAL PROPERTY. SIZE & TYPE OVER TO SIGNATURE O - 1 1100 OF PERMITTEE 1 O I — 10 3.00DISTRICT O. O NE CE 5 D BY U 10 — 50 5.00 'S O 5C - 100 10.00 NOTES: G W 100 — Soo 15.00 0. N SIGN,GAS SIGN AND ONE CIRCUIT 13.00 TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 Z O SERVICE OVER 600 VOLTS OR 200 AMP 5.00 TEMP SERVICE, POLE, &APPURTENANCES 3.00 A PPRO VP LE DATE INSPECTOR'S SIGNATURE TEMP. POWER POLE UNDERSLAB WORK ROUGH CONDUIT WIRING ISSUING FEE 2.00 Z O FIXTURES SUPPLEMENTARY ISSUING FEE 1.00 POWER AUTHORIZED > PERMIT FEE UTILITY CO.NOTIFIED PLAN CHECK FEE (50`e PERMIT FEE) FINAL TOTAL FEEJOSEPH C. ROOHAN SUPERVISING ELECTRI AL ENGINEER PLAN CHECK VALIDATION CK, M.o. CASH PERMIT VALIDATION CK. M.O. CASH LRGO 5 3:8 9 J& 9 2 D 8.0 0 SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE ,76A663-CE806 9-66 APPLICATION FOR ELECTRIC PERMIT ' COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING �j rj BUILDING AND SAFETY DIVISION Ao oREss ! X JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. LG REC EPT. l TOTAL NO. (EACH FEE _ OUT—ETS FIRST 20 J 1$.20 S a OWNER LIGHT J} / MAILA SWITCH p ADO'L 1O ADDRESS P� OVER 20 IGHTING TOTAL FIRST 20 .20 Igo CITY TEL. NO. L 1 FIXTURES FXTURES 1 �/ ADO'L 1O CONTRACTOR J OVER 20 RANGES DRYERS WTR.HTRS. 1.00 ADDRESS ®O GARB,DISP. STA.COOK �J p CITY TEL. NO. rJ J -I f DISHWASH, AUTO.-WASH. q STATE SPACE HTgB.,/ STA. APPL. / �O D V LICENSE NO. LAG MOTORS: OVER NOT OVER H.P. DI CT N GRO ZON P O - SED O 1 1.00 1 3 1.501 1 INSPECTION RECORD 3 8 2.00 8 15 2.501 1 15 50 1 13.00 1 d SO 100 IS.00r I 0 SIGNS: NO.TRANS d' NO. LAMPS O SERVICE 0.600V-NOT OVER 200A .001 O0 d SERVICE 0.60OV.OVER 200 A. 2.001 w SERVICE OVER 600V 1 15.00 ? OTHER (SEE COMPLETE FEE SCHEDULE) I I PERMIT ISSUING FEE 2.00 OO SUPPLEMENTARY PERMIT ISSUING FEE 1.00 APPROVALS DATE INSPECTOR•E SIGNATURE TOTAL FEE $ S 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION UNDERSLAB WORK AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING. 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO POWER RESIDE IN.THE ABOVE DESCRIBE RE IDE TIAL PROPERTY. SIGNATURE UTILITY CO.NOTIFIED i OF PERMITTEE FINAL VALIDATION JOSEPH C. ROOHAN UCK MO CASH SUPERVISING ELECTRICAL ENGINEER tlo5` 3 ;5m XL 82 D 820- _ WORKER'S I haveCOMPENSATION DECLARATION 76A663 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT I hereby.affirm that I have a certificate of consent to self insure, 76Afi63 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.) /) qq Polley No. Company ��'r FOR APPLICANT TO FILL IN JOB ❑ ADDRESS fl Certified copy is hereby furnished. New Residential Bldi&Pools NO. EACH FEE LOCALITY 11'I copy y g p Certified co is filed with the count building inspection i &2-Family,Sq.Ft. _ S S .TC NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK OJ d PAGE/15X PARCELI CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:ReaLight Sw. p OWNER OR COMPENSATION INSURANCE /�Q �/ FIRM NAME gni/ L{� First 20 MAIL (This section need not be completed if the work involved by the Total No. /O Additional ADDRESS ZU3 permit is for one hundred dollars(5100)or less.) I certify that in the performance of the work for which this permit p CITY Tel,No. is issued, I shall not employ any person in any manner so as to O Q PIAN CHECK become subject to the Workers'Compensation Laws. Lighting Fixtures ' First 20 APPLICANT Total No. �.J Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP NOTICE APPLICANT: after making this Certificate of CITY Tel.No. Exemption..you should become .sublect to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT S'ydflYf LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS 1 hereby affirm that I am licensed under provisions of Chapter 9 Over 3l0 10 act.(commencing with Section 7000) of Division 3 of the Business and CITY v T.I.No. Professions Cade, and my license is in full force and effect. Over 10 to 50 Incl. >_LICENSE �7 /_/ Class. Over 5010 100 Ind. REG.NUMBER"!—/ /�CO Q License Number 71�� Lic.Class R Over 100 DISTRICT NO PRO SSED BY 0 7 u Services,Swbd.,MCC&Panelboards Contracto Date cS/ 0-399 Amp.Under 600 V DATE O ❑ I am exempt under Sec. 400-1000 Amp.Under 600 V —9' W VALIDATION Over 1000 Amp.or Over 600 V FINAL EL B.&P.C.for this reason BRANCH CIRCUIT FEES BY - 00 15A,or 201 12OV,Lighting or Recept. Z Date: - 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Exemption for Reg.Maine Elect. 15A,20A,208V To 2T7V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances Ai(`nT s HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ACC 'r I hereby affirm that I am exempt from the Contractor's License Law S (} for the following reason (Section 7031.5. Business and Professions Additional Sign Branch Circuits ,1�I 3 Cede): ; I1EN3 ❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors T 43 - 60 is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule)_ TOTAL f?L and Professions Code). CHECK 47. C. CONSTRUCTION LENDING AGENCY ,-.LIA..,t )}(} I hereby affirm that there is a construction lending agency for the '-HAN(a performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ. C.) �QEdi PLAN CHECKING FEE � n 1—I ( 5/17/T Lender's Name �} PERMIT ISSUING FEE pt :I224 1 AN 2"26 Lender's Address J I certify that I have read this application and under penalty of purlury state TOTAL FEE J that the above information is correct. I agree to comply with all County ordinances and Stale laws regulating Electrical wiring,and hereby authorize re tentative t this C/ntyl enter upon the above-mentioned pr party f r inspection rp a SEE REVERSE FOR EXPLANATORY LANGUAGE tIGNATtI .pFP MITT V