HomeMy Public PortalAbout5336 BUTTONS AVE_Electrical__ ]6P5E) aE.ePCR .O/]] APPLICATION FOR ELECTRICAL PERM1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER JOB
BUILDING AND SAFETY DIVISION ADDRESS 9
FOR APPLICANTTO FILL IN LOCALITY
New Residential Bldgs.&,Pools EACH NO. FEE NEAREST
1 &2-Family,Sq. Ft. $ .025 — $ CROSS ST.
MultiOWNER
OR$q. Fr. .02 — FIRM NAOR
Residential Swimming Pools 25.00 MAIL
ADDRESS
Outlets: Ret Light_Sw., CITY Tel.No.
' First 20 .50 PLAN CHECK
Total No. Additional .30 APPLICANT
ADDRESS
Lighting Fixtures First 20 .50 CITY Tel, o.
Additional .30 PER IT
Total No. AP LI
Fixed Appliances Not Over I HP ADORES �Q
Range—Heater—D.W._ CITY _ TeL No.
Oven —Dryer_WW_ LICENS R /
Top — FAU —W.H._, REG.NUMBER � Ol 7
Hood—Fan _Other
Disp. — Room Air Cond. 2'50 HEREBY ACKNOWLEDGE THAT HAVE REPO THIS APPLICATION AND STATE
THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDIN.
ANCES AdNETHEZVED
EATING EL ICAC WIRING
Power Apparatus&Large Appliances
Size&Type HP, KW, KVA,Or KVAR I HAM P P Y REGISTERED AND/OR LICENSED AS
REQUIREOUNTY STATE OF CALIFORNIA OR THAT I AM Y
Up to I Incl. 2.5D THE LEGAL D RESIDENTIAL PROPFRTV.
CD
Over 1 to 10 Ind. 5.00 v
Over 10 to 50 Incl. 12.50 PERMIT
Over 50 to 100 Inc. 25.00 SIG V
Over 100 40.00LJ
DISTRICT NO U 6 I ED B n rn
Services �'T'✓�-t Z
0-200 Amp.Under 600 V 12.50ECTOR'S
201 I000Amp.Under600 V 25.00 APPROVALS DATE GNATURE
Over 1000 Amp.or Over 600 V 50.00 TEMP. POWER POLE
UNDERSLAB WORK
Temp. Power Pole'8 Appurtenances 10.00
Sign with One Branch Circuit 10.00 ROUGH CONDUIT
Additional Sign Branch Grcuits 2.00 WIRING
Misc.Conduits&Conductors 10.00 FIXTURES
Other ISee Complete Fee ScheduleI POWER AUTHORIZED
UTILITY CO.NOTIFIED
FINAL lr a Lam'
PERMIT FEE (Sub Totoll NOTES
PLAN CHECKING FEE (One Fourth Permit Feel
PERMIT ISSUING FEE
_LOIAL.EEEL, > v0 AF-)ENSATION
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION MO.M.O. CASH
)L(CY HOLDER: G',,_ ��e . 5 0 '5 0Wf ,,g 2 32.0 0 05$
)LICY NUMBER: C' 2- 3 b ys-is
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
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76A663-cE006 9-64
APPLICATION FOR ELE TRVCAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING .J
BUILDING AND SAFETY DIVISION ADDRESS (/
JOHN A. LAMBIE, COUNTY ENGINEER /! -
COLEMAN W. JENKINS, SIIP'T. OF BUILDING LOCALITY C(yK Tj6
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. •u�-'
REC SPT. TOTAL NO. EACH FEE
1I1 OUTLETS FIRST 20 62OS OWNER
LIGH (' MAIL
11 AD L ADDRESS
SWITCH. OVER 20 .10
LIGHTING TOTAL . 11120 ,20 C CITY TEL. NO.
(J
FIxTUR Es Gj ADD'l ELECTRICIAN
.10 (� _
OVER 20 1 GJ q
RANGES CLO.DRYERS WTR.RITES. 1.00 ADDRESS
GARB.DISP. STA.COOK !! q
CITY _ �'tiL C"(A-L h, TEL. NO.L �/sl
DISHWASH. AUTO.tAr w`yC ! STATE
SPACE HTRS. / STA.A/PP.p//a H.P`.4M-AX.) ,50 LICENSE NO. lJ .✓ ff V ✓
MOTORS: OVER NOT OVER H.P. DISTRICT N GROUP ZONE P CESSED BY
O 1 1.00 _ L
I — 3 1.50 INSPECTION RECORD-
3 B 2.00 a
e1s 2.501 UO
15 50 3.001 IY
50 100 5.00
SIGNS: NO.TRANS- a
NO.LAMPS
N
Z
SERVICE 0-600V-Noi OVER 200A 1.00
SERVICE 0.60OV-OV ER 200 A. 2.00
SERVICE OVER 600V 5.00
MISC.
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE 1,L
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT I ,1
WIT. ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING �.i/MMi/lI/LLILA/
I HEREBY .CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR FIXTURES 5 �?l40 / 17
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE O
CALIFORNIA OR THAT I A THE LEGAL OWNER F. AND INTENDTO • v P V
REST BE IN, THE ABOVE DESCRIBED RESIDER PROP Y. POWER
SIGNATURE L(�♦ 1/." j,.l UTILITY CO.NOTIFIED �GI/ff'']]
OF PERMITTEE aT � `
FINAL T
�LI JOSEPH SI ROOHAN
CK MOO CAS CASH SUPERVISING ELECTRICAL ENGINEER -
0
27 3 5 G JUPd 16 2 D0"n
'D.-.A II'SS APPLICATION FOR ELECTRIC PERMIT
76A6.3
61VISION OF BUILDING AND SAFETY . . - ,
Department of County Engineer BUILDING
County of Los Angeles ADDRESS 3 1� )�
JOHN A. LAMBIE, COUNTY ENGINEER
CASSATT D. GRIFFIN, SUPT OF BUILDING _ LOCALITY r
FOR APPLICANT TO-F7 IN NEAREST
PEPMT FEES CROSS ST. cy
HUMBE
OWNER t
LIGHT OUTLETS MAIL
RECEPTACLES ADDRESS
WALL SWITCHES FEE CITY _ TEL. NO.
TOTAL OUTLETS @ S4 $ 3 ELECTRICIAN
ELEC. RANGES 25'
Iry
ELEC. HEATERS 25 ADDRESS
KW EA CITY
STATE
FIXTURES 5 LICENSE NO.
MOTORS DISTR:C�. ]GROUP 7yONE READY FOR INSPECTION
�. It
lK..11
rv"GER HORSEPOWER FEE
NEW MVO. HP OVER INC. EACH
3^ a LED9 $ .zs INSPECTION RECORD
Yz 2 .50 C�4yLre. 'D�-p. 14
2 5 1.00 ,Ta Ou
5 f5 1.50'
IS 50 2.50
50 200 1 5.00
MISC.
NO.SIGNS NO.TRANS. I
NO. SIGNS NO. LAMPS
FOR EACH PERMIT:
WIRING $1.00
FIXTURES $1.00
SUPPLEMENTARY .50 APPROVALS-
TOTAL FEE $ DATE INSPECTOR'S SIGNATURE
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AA
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT �\
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING S 1
ELECTRICAL WIRING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT P THE LEGAL OWNER OF THE ABOVE POWER .{ p
DESCRIBED RESIDEN P TY. UTILITY CO.NOTIFIED 10 'B•'1e.,.�.wR _e...... ,�.
SIGNATURE _
OF PERMITTEE FINAL �I 1�
JOHN A.LAMBIE,COUNTY ENGINE - MOVAIJ A793N� ARTHUR C.VEIT.CHIEF ELECT.INSPECTOR
CK CA9
ti � 2. 6 APR 23 2 7.8 5 F,
WORKER'S
have COMPENSATION DECLARATION 200019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT LI
60863
I heyeby 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.y3B00 Lab..C.) �-
Policy No, Company FOR APPLICANT TO FILL IN gpDR 6 g v TT SNS-121 v e
❑' •-Certified copy is hereby'furnished. New Residential Bltl s &Pools NO. EACH FEE
❑ Certified copy is filed with the county building inspecti rt 1 &2-Family,Sq.R. NEAREST 1 e
department. _. , n/ Multifamily Sq.Ft. — CRDSS Sto
D L/� y "G. '
-X�b9ar�Z ,u Residential Swimming Pools ASSESSOR
.� f y V Ppf'�
MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM.WORKERS' O
COMPENSATION INSURANCE Outlets:Rea_Light Sw. ` P c7
First 20 _ / _
permit s4fon rieetl not d completed 0 the work Involved by the Total No. Additional U S
permit is'for int hundred dollars f the or less.) T _
1 certify That irithe performance of the work for which this permit ���
is issued. shall not employ any person in sny manner se as t0 PLAN CHECK
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT
.,. Total No. Additional ADDRESS
Dad7_-2 Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE,TO AP .LICANT: It, after making this Certificate of CITY Tel.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 P T e R ,Z
provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances „
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVARDVV -y Al A lee i
I hereby affirm that I am licensed under provisions-of Chapter 9 ��� �- lJ
-F"-ate— Over 310 10 Incl. / Q e_G �—
(commencing with Section 7000) is Division 3 of Business and 'G.
Professions Code,and my license is in full force and effect. Over 10 to SO Incl. }
Over 50 to 100 Incl. a S E aess.�— (� a.
License oe 9 y Lia Classe—/o Over 100 DISTRICT NO. PRWSSED BY l 0
,o _ ppf Servi d.,MCC Panel/b{f,qQ[aar��tltlyysEE ��� rtf���v cc
Pe,�,ee��G \CDate O 9 f 0-399 Ame�1500N I NAL 0
DAT❑
400-1000 Amp.Under 600 V F
I am exempt under Sec. VALIDATION V
Over 1000 Amp.or Over 600 V FINAL Il.l
B.&P.C.for this reason BRANCH CIRCUIT FEES _ BY
Date: 15A,or 20A, 120V,Lighting or Recept. Z_
Signature 1 To 10 Branch Circuits \
11 To 40 Branch Circuits ,-
❑ . .. 41 Or More Branch Circuits a
Exemption for Reg.Maint.Elect. 15A.20A,208V To 2T7V Lighting Br.Circuits _ ACC:T.q
SINGLE FAMILY Temp.Power Pole&Appurtenances - - - L�)T-7 100,G�
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
1 hereby affirm that I am exempt from the Contractor's License Law - 1 1TEI FJ
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits
Code): TOTAL 100 - 95
❑ 1,as owner of the property, will do the work and the structure Misc.Conduits&Conductors - �•�
Is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule)_ CHECK 1 1,.1.,!
and Professions Code). - -- eHAN�E .00
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the 1 OOOO—I�C101 (l�Cl�9
performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) T
CIV.c.> 0201 1 Ail 9=07
PLAN CHECKING FEE
Lender's Name /
PERMIT ISSUING FEE a(o
Lender's Address
I certify that I have read this application and under penalty of purjuryslats TOTAL FEE /d—L
that the above information is correct. I agree to comply with all County
ordinancesand State laws regulating Electrical wiring.and hereby authorize
representatives of this County to enter upon the above-mentioned property -
for ins ption purp sea. SEE REVERSE FOR EXPLANATORY LANGUAGE
7'&,:t, -y3
GNATURE OF PERMITTEE pAtE