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Home My Public Portal About6012 BURTON AVE_Electrical__ 76A663-CE806 lOY72 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER JOB KESS BUILDING AND SAFETY DIVISION LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. OUTLETS NO. EACH FEE OWNFIRM ER OR RECEPT./ $ SAIL r.1 LIGHT_ TOTAL FIRST 20 / 25 ADDRES G OVER 20 CIT L 1 TEL, N Q SWITCH .10 PLAN CHECK , NG TOTAL FIRST 20 25 APPLICANT LIGHTI OVER 20 .t0 ADDRESS FI%TURES RESIDENTIAL APPLIANCES CITY TEL. NO. PERMIT T L. RAN GEORV ERWTR. HTR._ APPLICANT STA. COOK DISP. F.A.U. ADDRESSq SPACE HTR. AIR COND.— CLOTHES OND.CLOTHES WASH.l/—OI SHWASH._ L I CtNSL OR /' _ \ REG. NUM9ER z. CLASS. C- 100 V 1 HEREBY ACKNOWLEDGE THAT I HAVE PEAO THIS APPLICATION L VVV AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. SIZE 9 TYPE OVER TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR 0 - 1 100 LICENSED AS REOUIR`UO BS bOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER THE 4tl0 E- 1 - 10 3.00 DE5CFIC.ED RESIDEN�TIAL�P�O,PERRTTYY/. A CL. 10 - 60 500 SIGNATEE '/%✓'�""i" L(]- A U SIGNATURE O 50 - 100 1000 DISTRICT NO. PROLE E U j_ W 100 - 500 1'v 00 _•fj4/ Z SIGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS DRFel INSPECTOR'S SIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE SERVI CENOTOVER 600 VOLTS OR 200 AMP 3.00 - UNDERSLAB WORK SERVICEOVER 600 VOLTS OR200AMP 10.00 ROUGH CONDUIT ) TEMPSERVICE,POLE, &APPURTENANCES 5.00 WIRING TEMP LIGHT OR REC EPT. SYSTEM 3.00 FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED I, FINAL PERMIT FEE (SUB TOTAL) 2 NOTES: PLAN CHECK FEE PERMIT ISSUING FEE 3.00 �3 UD TOTAL FEE Lf 2 PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.D. CASH 7 7. 5,�NIJV 18 2 A 72 5 &to SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 15A683C CEa06612/>a ' QPPLICATIOa FOR ELECTRICAL PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN JOB ` I Ai. T') New Residential Bldgs. & Pools EACH NO. FEE ADDRESS l/ s 45 1 &2 Finaily Sq. Ft. S — S LOCALITY S)pMulti-family Sq. Ft. — NEAREST. i'7 Residential Swimming Pools C ROSSST OWNER OR FIRM NAME�/�by Outlets: Light, Switch& Receptacle /J I.� ADIDRESS 6012 First 20 .7 111777 C / Additional CITY-� e G Tel. No. PLAN CHECK Lighting Fixtures APPLICANT First 20 ADDRESS Additional CITY Tel. No.PER IT Fixed Appliances Not Over 1 HP APPLICANT Range Heater ✓ D.W. �—/K� C✓""rK c.J C. Oven Dryer W.M. ADDRESS Top FAU W.H. CITYvoce TO No. Hood Fan iJ LICENSE OR `1 L �J Class. o Dist. A.C. !� -- REG. NUMBER C�lJ C� U K I HERESYDeT ..IS ucnnoN p Power Apparatus& Large Appliances RDINANces AND :TATE LAWS REGULATING w Size&Type HP, KW, KVA,or KVAR ELECTRICAL WIRING.D ti Up to I Incl. Z I HERESY CERTIFY THAT I AIR HE..,AeNeo. O/OR — Over 1 to 10 Incl. LIF_A D STATE D Over 10 to 50 Incl. ESC HIS eD T-C^` a ADov Over 50 to 100 Incl. PERMITEER I�l PeR` Over 100 SIGNATURE Services DISTRICT NO. ROCES ED BY t 0-200 Amp. Under 600 V 201 - 1000 Amp. Under 600 V APPROVALS DATE IN CTOfFS Over 1000 Amp.or Over 600 V IGN ATURE TEMP. POWER POLE Temp. Power Pole&Appurtenances UNDERSLAB WORK Sign with One Branch Circuit Additional Sign Branch Circuits ROUGH CONDUIT (Other) WIRING FIXTURES 1 POWER AUTHORIZED PER IT FEE (Sub-Total) UTILITY CO.NOTIFIED PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL 1 PERMIT ISSUING FEE NOTES TOTALFEE PLAN CHECK VALIDASON CK. M.O."- CASR o Ab PERMIT VALIDATION CK, M.O. CASH CD IS 4-1 1 1A - o Da �✓� ✓/ �r� 0 sJ_ -71 J is to ° D -O O O IV D CH WORKERS' COMPENSATION DECLARATION CE 863 I0/81 APPLICATION FOR ELECTRICAL PERMIT hereby affirm that I have a certificate of consent to self CE806G insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or4J9(/er fie cry thereof`(Sec. 3800, La C.) Po *`+��L'6Trpany - FOR APPLICANT TO FILL IN ADDRESS eby furnished. New Residential Bldgs. 8 Pools EACH NO, FEE d with the county building inspec- 18 2-Family, Sq. FL $ — $ LOCALITY Multi-family Sq. Ft. — NEAREST taEliconplicant Residential Swimming Pools �yR l ` . CROSS ST. t s OWNER OR FIRM NAME CERTIFICATE OF EXEMPT46N FROM WORKERS' Outlets: Rec Light—a— t 1 t) t' ��AA' MAIL COMPENSATION INSURANCE First 20 6 N ADDRESS / (This section need not be completed if the work involved by Total No. Additional CITY Tel. No the permit is for one hundred dollars ($I00)or less.) PIAN 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.__R_ Additional CITY Tel. No. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over I HP PERMITAPPLICAN Exemption, you should become subject to the Workers' Range_ Heater—D.W. _ 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. CITY Tel. No. LICENSED CONTRACTORS DECLARATION Hood _ For _ Other_ RE I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUM Class. (commencing with Section 7000) of Division 3 of the Business Power Apparatus 8 LAliDISTRICT NO. PRO BY and Professions Code, and my waus Large license is in full force and effect. XL Size 8 Type HP, KW, KVA, or KVAR' License Num e / C C Lic. Class Up to I Incl. FINAL v Over 1 to 10]not. DATE Conlroctor /_ VAL ATION �' to ❑ Over 10 to 50 Incl. FIN LLLI am exempt under Sec. Over 50 to 100 Inc. B D.' 0 B.BP.C. for this reason Over 10 z Date: Services, Swbd., MCC 8 Ponelboards 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect, Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole 8 Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits23-300A Law for the following reason (Section 7031.5, Business and Professions Code): ❑ Misc. Conduits 8 Conductors # s s o e s2 I, as owner of the property, will do the work and the structure is not intended or. offered for sole (Section Other (See.Com plate Fee Schedule)_ D ( o o •) a Q O 7044, Business and Professions Code). o s a $,Q Q CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for n ( Q 2 5 8 rJ the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) V (Sec 3097, Civ. G). PLAN CHECKING FEE Lender's Name / PERMIT ISSUING FEE [ Q Lender's Address I certify that I have read this application and stale that the TOTAL FEE t 00 above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the abov$n ioned party for inspection purposes. /Y//)IhsRA �� SEE REVERSE FOR EXPLANATORY LANGUAGE Signal of a mittee0 �� 61e