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Home My Public Portal About9841 BROADWAY_Electrical__ I 76AW CE-806111 ,781 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLIC ANT TO F ILL IN JOB New Residential Bldgs.&Pools EACH Ni) FEE ADDRESS I &2 Family,Sq. Ft. S .025 — 8 LOCALITY Multi family Sq. Ft. 02 — NEAREST Residential Swimming Pools =5.�O CROSS ST. OWNER OR FIRM NAME Outlets: Rec_Light_Sw. MAIL First 20 .50 ADDRESS Total No. Additional .30 CITY - ,.- PLAN CHECK APPLICANT Lighting Fixtures First 20 .50 ADDRESS Additional .30 Total No. CITY Fixed Appliances Not Over 1 HE PERMIT Range_Heater_D.W. If APPLICANT Oven_Dryer_ W.M.— ADDRESS Top _FAU — W.H. CITY Tel No Hood_Fon —Other— LICENSE OR Disp.T Room Air Cond. 2.50 REG. NUMBER Gas,. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA- Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO d Size&Type HP, KW, KVA,or KVAR COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS O REGULATING ELECTRICAL WIRING. V . Up to 7 Ind. 2 50 5.00 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND,OR Over I }o 101nd. LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF I—y Over 10 to 50 Incl. 12.50 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE Over 50 to 100 me 25.00 DESCRIBED RESIDENTIAL PROPERTY. Over 100 40.00 PERMITEE SIGNATURE O Services 2.5G DISTRICT NO PROCESSED BY 0-200 Amp.Under 600 V � 201-1000 Amp. Under 600 V 25.00 Over 1000 Amp.or Over 600 V 50.00 = O Temp. Power Pole&Appurtenances 10.00 Q Sign with One Branch Circuit 10.00 G Additional Sign Branch Circuits 2.00 INSPECTION > o.oD INFORMATION W Mrsc.Conduits&Conductors Other.ISee Complete Fee Schedule)_ ON REVERSE xSIDE u Q C C i PERMIT FEE )Sub Total) • • t ; PLAN CHECKING FEE IOne-Founh Permit Feeo O _ PERMIT ISSUING FEE 87.00 0 TOTAL FEE > INSPECTION FINALED date: By a hs 760.663 11; ,79, APPLICATION FOR ELECTRICAL PERM.' IT COUNTY OF LOS ANGELES BUILDING ND SAFETY _ r FOR APPLICANTTO FILL IN JOB pp New Residential Bldgs.&Pools EACH NO. FEE- ADDRESS --- 1 &2-Family,Sq.Ft.' S .025 - b LOCALITY Nu Iii-family Sq. Ft. .02 - NEAREST +', i 25.00 CROSS 5T. -C. C c_Ur Oti Residential Swimming Pools - OWNER OR •• - - - - �-• FIRM NAME Outlets: Ret Light_Sw.L _ MAIL ' First 20 .50 (SI ADDRESS_ •" . - --_ __ Total No.�f0 Additional .30 CITY__ Tel.,No. PLAN CHECK APPLICANT -. Lighting Fixtures r' First 20 .50 ADDRESS s Additional .30 Total No. CITY -- - - Tel.No. Fixed Appliances Not Over 1 HP PERMIT- - - - - APPLICANT „+ Range_Heater— D.W. ADDRESS Oven_Dryer_ W.M. - - cJ / Top —FAU — W.H._ _ CITY el, No. - Head_Fan _Other_ LICENSE OR Disp: Room Air Cond. 2'50 J REG..NUMBER a Class, I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPUCA Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO & COMPLY WITH ALL COUNTY' ORDINANCES-AND STAT Size T PL'AWS Type HP�KW, KVA,or KVAR - 2 50 REGULATING ELECTRICAL WIRING. O Up_to I Incl. I HEREBY CERTIFY THAT-1'AM'PROPERLY REGISTERED AND/OR p Over 1 to 10 Incl. 5'00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF In t 12.50. c CALIFORNIA OR THAT I AM THE LEGAL OWNER OE THE-ABOVE, _0 Over.l0 o 50 Ind. DESCRIBED RESIDENTIAL PROPERTY. Over 50 to 1001nc 25-00 - ^ Over 100 40.00 PERMITEE, - SIGNATURE _ y Services - DISTRICT NO, PROCESSED / g 0-200 Amp. Under 600 V 12.50 201-1000 Amp- Under 600 V 25.00.Over 1000 Amp.or Over 600V 50.00 Z O Temp. Power Pole&Appurtenances 10.00 Sign with One Branch Circuit 10.00 o Additional Sign Branch Circuits 2'00 INSPECTION > INFORMATION u Misc.Conduits&Conductors 10.00. ON REVERSE Other(See Complete Fee Schedule)_ SIDE u Z �29628A y , O O O O i2, '500 PERMIT FEE - fSuo-Totall 2 - 1 Z PLAN CHECKING FEE (One Fourth Permit Feel O - 4y 00015.00 PERMIT ISSUING FEE _ $7„00 TOTAL FEE B > r INSPECTION FINALED n W dote: 3 �3 � f.By r. 1• � /./� /(��L(,L�/_'�//�C/ ]6A663-CE8061-6] APPLICATION 'F((�'�[� EII ETRI II PF�L�� IT 1 , COUNTY OF LOS ANGELES 1Cl� gg91111 LLQ Iv L��(��J� II ILJI DEPARTMENT OF COUNTY ENGINEER BUILDING p p - BUILDING AND SAFETY DIVISION ADDRESS 70 JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY / e Ig C1 'jL if NEAREST FOR APPLICANT TO FILL IN CROSS ST. C, RECEPTTOTAL NO. EACH FEE LIGHT OUTLETS FIRST 20 6 $.20 $ -2 OWNER 1 r JY" T 11`( MAIL SWIT"4 J ADD'L 10 ADDRESS p (j_ A OVER 20 1 TOTAL FIRST 20 .20 CITY _ TEL. NO. LIGHTING l FIXTURES FIXTURES J ADD'L to CONTRACTOR OVER 20 RANGES DRYERS WTR.HTRS. I.DO ADDRESS GARB.DISP. STA.COOK CITY DlsNwwsH. AUTO.-WASH. STATE SPACE HTRS. STA. APDL. .50 LICENSE NO. MOTORS: OVER NOT OVER I H.P. DISTRICT GR UP ZO E P CE -D BY, 0 f 1.00 Q .>; 1 3 1.50 INSPECTION RECORD 3 8 2.00 B 15 2.50 15 50 3.00 V VAli O so too 5,00 V SIGNS: NO.TRANS- NO.LAMPS Q f SERVICE 0-60OV-NOT OVER 200A 1.00 W d SERVICE 0-60OV-OVER 200 A. 2.001 Z SERVICE OVER 600V 5.00 — OTHER (SEE COMPLETE FEE SCHEDULE) PERMIT ISSUING FEE 2.00 U SUPPLEMENTARY PERMIT ISSUING FEE 1.00 APPROVALS DATE INSPECTOR'S SIGNATUM TOTAL FEE $ 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION UNDERSLAB WORK AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT Is WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING, WIRING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF 1 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO POWER RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL P OP RTY. SIGNATURE UTILITY CO.NOTIFIED e OF PERMITTEE L T FINAL Srl' ell VALIDAT� JOSEPH C. ROOHAN CK MO CASH SUPERVISING ELECTRICAL ENGINEER .' ,`�LJ�:G 0 s j 5--G SEP 11 _2 D - 4.210~ / ' WORKERS'I have a certificate DECLARATION 76-663 10/81 APPLICATION FOR ELECTRICAL PERMIT {1 I hereby alum that I have a certificate of consent to self insure, Ge-Bose LJ or,a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY - Mop thereof(Sec.3800,Lab. C:) , I ..III e2lL�1 Company ' FOR APPLICANT TO FILL IN ❑ _ EACH NO. FEE LOCALITY Certified copy is he furnished. New Residential Bldgs.8 Pools 1 & 2-Family,Sq:Ft. $ — $ LOCALITY Certified copy Is filed-with the county bulldln inspection NEAREST de rt ent. t - Multi-family Sq.Ft. - — CROSS ST. Date _ Applicant Residential.Swimming Pools . OWNER OR FIRM NAME ( t ) MAIL -CERTIFICATE OF.EXEMPTION FROM WORKERS' Outlets:Rap—Light Sw ,COMPENSATION INSURANCE ADDRESS ' (This section need not be completed,if-the work involved'by the -First 20 .permit is for one hundred.dollars ($100)or less.) Total No. Additional CITY Tel.No. . _ ,I certify that in the performance of the work for which this'permit PLAN CHECK APPLICANT .is issued„bjl not employ any person,in any.manner so as to , become subject to the WorkersCompensation Laws. , Lighting Fixtures First 20 ADDRESS * .. Total No. Additional CITY - Tel.No. Date Applicant Fixed Appliances Not Over 1 HP NOTICE,TO If, after making this Certificate of PERMIT Exemphon,you should become subject to the.Workers'Compensation Range__Heater_ D..W APPLICANT n provisions of,the Labor Code, you,must forthwith comply with such Oven_ Dryer W.M..— ADDRESS lid provisions or this permit shall be deemetl revoked.` Top — FAU W.H. ^ _ LJCENSED CONTRACTORS DECLARATION Hood _ Fan Other— , to ` D - 'CITY _ Tel.No. hereby affirm that I am licensed under provisions of Chapter,9 Disp. _ Room Air Cond. r LICENSE OR (commencing with S,ection'7000)-of Division 3 of the Business and REG.NUMBER Professions Cade,and m license is in,full force and effect DISTRICT NO. PR SSED BY Y Power,Apparatus 8 Large Appliances ��. • O , �i/�// /" Size 8 Type HP,KW,KVA,or KVAR 'rJ License Number Lia Class�fJ V �( . ( �— Up to 1 Incl. FINAL - U oam :b'— Over 1 to 10 Incl r DATE VALIDATION 0O Contractor ate"�.�� Over 10 to 50 Incl. V FINAL ❑ I am exempt under Sec. Over 50 to 100 Inc. I BY .. LU ILI BAP.C..for this reason Over 100 Services,SWILL.MCC&-Panelboards D • - - Z • Date: - 0-200 Amp..Under 600 V 1 Signatures 201 - 1000 Amp:Under 600 V - - Over 1000 Amp..or Over 600 V Y El Exemption for Reg:_Maint.Elect. -' - SINGLE FAMILY - Temp.Power Pole& Appurtenances 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit , I hereby affirm that I am exempt from the Contractor's License Law -r' ' AMAfor the fallowing reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits,_ Code): .sL_ ,. . . .lM ... _ M.40 - I,.as owner of the property,will do the work and the structure El is Conduits 8 Conductors - is not intended or offered for sale (Section 7044, Business Other (See Complete Fee Schedule) D and Professions Code): VL P T 'yr CONSTRUCTION LENDING AGENCY - - 'z:.• - - TOTS IT 1 a 40 I hereby affirm that there is a construction lending agency for the rl - - ' performance of the work for which this permit is issued(Sec:3097, PERMIT FEE (Sub-Total) - _ L L Civ. C.). - CHECK 01.40' - PLAN CHECKING FEE - Lender's Name CH/YV12E .� PERMIT ISSUING FEE bfvVlW Lender's Address - I certify that I have read this application and state that the above. TOTAL FEE _ MM 1 ' information is correct. I agree to comply with all County ordinances • ^ - 8/25/95 and State laws regulating Electrical wiring, and hereby authorize _ y1�� representatives of this County to entery upon the above-mentioned " - „_. '- 2M ' 1 0101j4 4 prepert r ection purposes. _SEE REVERSE FOR EXPLANATORY LANGUAGE Signaturle of Mermittee Date