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HomeMy Public PortalAbout6022 BURTON AVE_Electrical__ 76A663-CE806 8/63 APPLICATION FOR ELECTRICAL PERMIT .COUNTY OF LOS ANGELES LI DEPARTMENT OF COUNTY ENGINEER BUILDING 6022 N. Burton BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITY San Gabriel nY ..'. n. :. _. NEAREST FOR APPLICANT TO FILL IN CROSS 9T. REOf PT. 3.1 TOTAL NO. EAC. FEE ourLETs FIRST 20 20 $2D 9 0o OWNER Ledden LIGHT 1 MAIL '1 I1 Ir AOD'L ADDRESS SWITCH. ,L.9 /I 6�_ OVER 20 .10 O TOTAL CITY TEL. NO. I- LIGHTING , q [FIRST 201 .20 �y� FIXTURES ADO'L 10 ELECTRICIAN R. L. Conlee & Son OV R 20'L RANGES CLO.DRYER6 W1R..TRS, 1 1 1 00 ADDRESS O 0 N. Grandview Ave. A� GARB.DISP. 1 BTA.COOK CIT TEL. NO. 2007 �. o16NWATR 1 AUTO.-WASH. STATE (� SPACE NTR6. BTA.APP. H.P.MAX.) 2 ,$Q 1 0o LICENSE NO. 137567 C-10 . MOTORS: OVER NOT OVER M.P. DISTRICT-NO. I G P Z P 0 1 1.00 1 s 1.50 INSPECTION RECORD 3 — e 2.00 9 — 15 2.50 IS SO 3.001 - C 50 100 5.00 SIGNS: NO.TRANS - IILJ N O.LAMPS a _Z SERVICE O-600V-NOT OVER 200A 1 1.00 1 00 SERVICE 0.60OV-OVER 200 A. 2.00rr SERVICE OVER BOOV 5.00 // misc. ._ "- L 7 f i I PERMIT ISSUING FEE 2.00 2 00 • SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE 17 10 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DA C INE OR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY L CONDWT p WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING Y( ELECTRICAL WIRING. WIRING j' I HEREBY CERTIFY THAT.I AM PROPERLY REGISTERED ANO/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT LOAM THE LEGAL OWNER OF THE ABOVE _ U DESCRIBED RESIDENTIA PROAEiTTY. POWER SIGNATURE _ UTILITY CO.NOTIFIED OF PERMITTEE +�^ / ✓�' 'T(7 . z_.• -. - - ... .'. -..;.'/ FINAL 0IDATION ARTHUR C. VEIT MO � CASH SUPERVISING ELECTRICAL ENGINEER CK 0628-" r:P16 2 A 1 '7.10- WORKERS'COMPENSATION DECLARATION 76A663 10/81 APPLICATION pp ,,}}�� p Epp F� I� pp �p. p p I hereby affirm that I have a certificate,of consent to self CE-9066 APPLICATION FOR ELECTRICAL PERMIT insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lob. C.) Policy Company - FOR APPLICANT TO FILL IN JOB - �7 G Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS ) ❑ 1 82-Famil $ Ft. $ — $ LOCALITY Certified copy is filed with the county building inspec- y . NEAREST tion department. Multi-family$q. Ft. — .i CROSS$T. { �n !i/ Residential Swimming Pools OWNER OR �ate�`.—/ Appl imn P t FIRM NAME - . CERTIFICATE OF EXEMP� FROM WORK -MAR Outlets: Rec_Light_$w._ ADDRESS - COMPENSATIO NSURANCE r - This section need not be co feted if the work involved b First 20 ( p T Total No. Additional CITY Tel. No. the permit is For one hundred dollars ($100)or less.) that in the performance of the work for which this _ PLAN CHECK I certify P 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. Additional CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of ��/ Exemption, you should become subject to the Workers' RaHeater_D.W. — APPLICANT nge_ _ kAWL f_' Compensation provisions of the Labor Code, you must forth- Oven _ Dryer — W.M.— ADDRESS r -7 with comply with such provisions or this permit shall be Top _ FAU —W.H. 'CITY Tel. No.'1 �' 6 deemed revoked. Hood Fan _ Other_ LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of.Chapter 9 Disp. —, Room Air Cond. REG. NUMBER _YQ Q / Class. 4 [y (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCESS BY and Professions Code, and my license is in full force and effect. Power Apparatus 8 Large Appliances 0. Size 8 Type HP, KW, KVA, or KVARO cense Number Lic. Class Up to 1 Ind. FINAL ,�/ _ �{7 V Contractor Date Over I to 10 Ind. DATE Iy / � VALIDATION p ❑ Over 10 to 50 Incl. FINAL �/ / H I am exempt under Sec Over 50 to 100 Inc. BY /fes //�s.� W B.BP.C. for this reason Over 100 -� u W Date' Services, Swbd., MCC 8 Panelboards D , 0 - 200 Amp. Under 600-V Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. 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 Circuits Law for the following reason (Section 7031.5, Business and Professions Code): PP. 3'S Q 6 A ❑ 1, as owner of the property, will do the work and the Misc. Conduits 8 Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ D # e e.e oe2 7044, Business and Professions Code). ,2? 2*5 5 0 CONSTRUCTION LENDING AGENCY o e e ,�5 5 O U I hereby affirm that there is a construction lending agency for r . the.performance of the work for which this permit is issued PERMIT FEE (Sub-Totol) Qx ) i7_g(}, (Sec. 3097, Civ. C). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE © , Lender's Address I certify that I have read this application and state that the TOTAL FEE G above information is correct. I agree to comply with all County ordinances and Stale laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above- entianed property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE $j nature of Permits e� Date