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HomeMy Public PortalAbout5632 CAMBURY AVE_Electrical__ • ��r/p,�� c � ?'y 76A364 EE818 - 3-69 APPLICATION FOR PERMIT q HEATING - VENTILATING - AIR CONDITIONING fl COUNTY OF LOS ANGELES BUILDING // DEPARTMENT OF COUNTY ENGINEER ADD R ESS�AP o BUILDING AND SAFETY DIVISION JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY G i COLEMAN W.JENKINS,SUPERINTENDENT OF BUILDING NEAREST CROSS ST. FOR APPLICANT TO FILL IN owNEa (PRINT OR TYPE ONLY) MAIL NO, TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS ABSORPTION SYSTEM, BTU CIT -�� TEL. NO: CONTRACTO AIR HANDLING UNIT, CFM BOILER, HORSEPOWER ADDRESS .• , CITY w TEL. NO. COMPRESSOR, HORSEPOWER STATE LIC. LICENSE N CLASS VENTILATION SYSTEM DISTRICT NO. GROUP ZONE [,,PROCESSED BY EVAPORATIVE COOLER r-- FURNACE: FAU GRAVITY FLOOR BTU d INSPECTION REC D f HEATER: SUSPENDED—UNIT— WALL USPENDED_UNIT_WALL ? a O V De O 0 V w� N NEW_ADDITION_ PERMIT S 3 00 j Z i ALTER--REPAIR_ TOTAL FEE $ PLAN CHECK APPLICANT NAME ADDRESS CITY TEL NO. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING HEATING,VENTI- LATING, AIR CONDITIONING. APPROVALS DATE IN CTOfl' YGNATURE IHEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF ROUGH CHAPTER 9, DIVISION 3 OF THE BUSINESS AND PROFESSIONAL FINAL CODE OF THE STATE 0 CALIFORNIA. / SIGNATURE �- JACK R. ALLEN, 6VPERVISIN MECHANICAL ENG'R. OF PERMITTE PERMIT VALIDATIONK. M.O. CASH PLAN CHECK VbZIDATION - _ ( A('n:4. 5 2 5APft1 64/1 D 7.00 SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE / V WORK,FRS'COMPENSATION DECLARATION CE 81 G APPLICATION tp 1p p y N p PERMIT p R M 4 I hereby affirm that I have a certificate of consent to self CE -828 f2-80) P9 1f- 1f- L IC P9 1 I O I tl �O I-'C Ir Y''(ItlE I 1 insure, or a certificate of Workers'Compensation Insurance,or HEATING-VENTILATING-AIR CONDITIONING 5'LJ'I a certified copy thereof(Sec. 3800,Lab. C.) Policy No. Company COUNTY OF LOS ANGEL BUILDING .. BUILDING AND SAFETY F-1Certifiedcopy is hereby furnished. Certified copy is filed with the county building inspection BUILDING department. FOR APPLICANT TO FILL IN- ADDRESS Date Applicant (PRINT OR TYPE ONLY) ( V / - LOCAL IT" CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE L_ -Y COMPENSATION INSURANCE - - - EA EST d (This section need not be completed If the work involved ABSORPTION UNIT, BTU CROSS ST. r.�1 V`—�F_y_ -�� O by the permit is for one hundred dollars ($100) or less.) - - - DISTRICT No. +I ORO _r U I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM �f""� I cc permit is issued, 1 shall not employ any person in any manner - (� G O so as to become subject to the Workers' Compensation Laws. BOILER, BTU _ PROVA C DPT INSPF.wR,s'LNAIRE LLJ Uate-J'��j�Yj2--'\pplicant / jjl\, I COMPRESSOR, ROVGH Z!3 yNOTICE TO APPLICANT: If, after making this Certificate of ` VENTILATION SYSTEM - - - - - Z Exemption, you should become subject to the Workers' FINAL ZZzNZJ Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATIONV with comply with such provisions or this permit shall be deemed revoked. 'I FURNACE: FAU_x GRAVITY6jnx/A� ,LICENSED CONTRACTORS DECLARATION FLOOR; STU_IQD K._ i,hereby affirm that I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT 9 (commencing with Section 7000)of Division 3 of the Busi- WALL' , ness and Professions Code, and my license is in full force and effect. - - License NumFert(-,(3y,,4-1_8_37 Lia Class_fj l Contractor I- Date_i—moi-?_ Z ElI am exempt from the licensing requirements as I am a I - licensed architect or a registered professional engineer Plan check fee 25%of above. acting in my professional capacity (Section 7051, Bus. iness and Professions Code). PERMIT ISSUI Lic.or Reg.No. Date TOTAL FEEX"'J HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT - I hereby affirm that I am exempt from- the Contractor's NAME. PA�f. �7C �j �• License Law for the following reason (Section 7031 5, Busi ness and Professions Code): ADDRESS "r J_20_2r�Rl3/J_7 2 5 3.5A . 0 I, as owner of the property, will do the work and the CITY TEL.NO. structure is not intended or offered for sale (Section min a4e -Z/q_5 �J #re le a;e'. 7044. Business and Professions Code). OWNER 7_ ����� pp I, as owner of the property, am exclusively contracting •�7AyasT,+0—/ -A�/1..�5Q e e 3 5(] with licensed contractors- to construct the project MAIL ^� ��+r, - ` (Section 7044, Business and Professions Code). ADDRESS rp3`_t„_/41A Jb( ftye3-$50U CONSTRUCTION.LENDING AGENCY CITYr /. TEL.NO/)�/_jU�O I hereby affirm that there is. a construction lending agency t_--['• LL f0 i - Q O'0 5.1'-8 2 for the performance of the work for which this permit is CONTRACTOR�j //� /, - issued (Sec.3097,Civ.C.). ((-'` 6GR5��'�Jy7-�D_G C@_ - Lender's Name ADDRESS• - i,25�•z- YaR3�s1` Lender's Address CITY TEL.NO. I cerjify that I have read this application and state that the STATE ,�]j���� op uC. QQ above information is correct. I agree to comply with all County LICENSE No_?_ `{_7 J CLASS iJ 1 ordinances and State laws regulating Heating, Ventilating and Air Conditmnnv and hereby authorize representatives of this . . SEE REVERSE FOR EXPLANATORY LANGUAGE ' County to �.er upon the cove-mentioned property for -- in5pectior .rpos•� Signc.ure of Permir'.c Date - 76A663-05806 3-69 1 ". APPLICATION FOR ELEC ICA PERNAITg� • - COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING 63Z GA f L BUILDING AND SAFETY DIVISION ADDRESS R7 JOHN A. LAMBIE, COUNTY ENGINEER GCILEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY T lG Gy FOR APPLICANT TO FILL IN NEARESTCROSS ST. ✓I/ O/S NO. EACH FEE $ $ OWNER �, �G L RECEIPT. MAILADDRESS LIGHT 'j��j TOTAL FIRST 20 .20 3 QQ / SWITCH_:?-- l OVER 20 .10 CITY /G C11 TEL.NO. PLAN CHECK LIGHTINGTOTAL FIRST 20 6 .20 APPLICANT FIXTURESig. V OVER 20 .10 ADDRESS RANGE_DRYER_WTR. HTR. CITY TEL.NO. STA. COOK_OISP. F.A.U. CONTRACTOR /� K SPACE HTR.—AIR COND. ADDRESS ^}^1 /` �4¢ CLOTHES WASH. DISHWASH._ CITY / C TEL N0.33. - Z FAN OTHER 1.00 LICENSE NO. 7 CLASS. G� MOTORS,TRANSFORMERS RATING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION IND. HEATERS, ETC. HP. KW. RNA. AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY SIZE $ TYPE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. D 1 1'00 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR LICENSED As REQUIRED BY LOS ANGELES COUNTY AND STATEOF 1 — 10 3.pp CALIFORNIA OR TXAT A TME LEGAL OWNER OF. AND INTEND TO d RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. O 10 — 50 5.00 V SIGNATURE BIG50 — 100 10DO OF PERMITTEE 0 F 100 — 500 15.00 DISTRICT NO. cRouv PR CE EDDY V Q w TUBE, A SIGN AND ONE CIRCUIT 3.00 J �Ca Z MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES: j SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 l SERVICE OVER 600 VOLTS OR 200 AMP 5.00 TEMP SERVICE, POLE, $APPURTENANCES 3.00 APPROVALS DATE INSPECTOR• SIGNATURE TEMP. POWER POLE UNDERSLAB WORK ROUGH CONDUIT WIRING PERMIT FEE (SUB TOTAL) FIXTURES PLAN CHECK FEE (50% PERMIT FEE) \ POWER AUTHORIZED PERMIT ISSUING FEE 2.00 'y Q'a UTILITY CO.NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL p rO TOTAL FEE JOSEPH C. ROOHAN SUPERVISING ELECTRICA.1 ENGINEER PLAN CHECK VALIDATION _ cK. M.o. CASH PERMIT VALIDATION cK, M.O. CASH. Ar-_ CS BEE BACK OF APPLICATION FOR COMPLETE FEE 4 � V �� �rR1 � � D 81.2 O~ e r e WORKERS'COMPENSATIONDECLARATION 76 CE8636G (2 80) APPLICATION FOR ELECTRICAL PERMIT {I LJ I hereby affirm that I have a certificate of consent,to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate of Workers'Compensation insurance,or a certified copy thereof(Sec. 3800, Lab. C.) FOR APPLICANT TO FILL IN JOB q Policy No. Company New Residential Bldgs.&Pools - EACH NO. FEE ADDRESS �3t4//7 VA _ 0 Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. 2�2 S — $ _ LOCALITY CL 4 ❑ —Certified copy ¢ Multi-family Sq. Ft. NEAREST filed with the county building inspection. CROSS ST (!241<department. - Residential Swimming Pools OWNER OR - FIRM NAME Date - Applicant Outlets: Rec.LO_Light Sw._?V MAIL �(�. First 20 Ski LO d ADDRESS d 4130✓� ' CERTIFICATE OF EXEMPTION FROM WORKERS' - Total No.=F— Additional O COMPENSATION INSURANCE 'CITY TeI No. / } _ PLAN CHECK el- (This (This section need not be completed if the work involved- APPLICANT U by the permit is for-one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS Total No. CJ Additional ¢O• I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. permit is issued, I shall not employ any person in any manner - PERMIT W so as to become subject to the Workers' Compensation Laws. Range_ Heater—D.W. �_ APPLICANT CI d Oven _ Dryer_W.M. ADDRESS Z DateA—/3— Applicant Top FAU _W.H. CITY - Hood I Fan —Other_ Q TeI No.573S_5,960 NOTICE TO APPLICANT: If, after making this Certificate of Disp. Room Air Cond.— Z . SCLICENSEOR Exemption, you should become subject to the Workers' REG.NUMBER2349 83 Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCES ED BY with comply with such provisions or this permit shall be Size&Type HP,KW, KVA,or KVAR (•=t© ('� deemed revoked. t� Up to 1-Incl. C' FINAL Over 1 to 10 Incl. DATE LICENSED CONTRACTORS DECLARATION . VALIDATION Over 10 to 50 Incl. / I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL % 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 BY ness and Professions.Code,-and my license is in full force and effect. ` / - . I Services . License Number23083 Lie.Class `B 0-200 Amp. Under 600 V y/ Q 201.1000 Amp. Under 600 V Contractor Date /0—/?— g/ Over 1000 Amp.or Over 600 V ♦yT E HOME OWNER-BUILDER DECLARATION - Temp.Power Pole&Appurtenances 1 hereby affirm that I am exempt from the 'Contractor's Sign with One Branch Circuit License.Law.for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits , nest and Professions Code): ' ❑ Misc.Conduits&Conductors I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)— structure is not intended or offered for sale (Section 21 Sj 1.4 A 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY e e e o o 2 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is PERMIT FEE . (Sub-Total) 2 e,e 3 0,17 Q issued(Sec. 3097,Civ.C.). Z� 1 Lender's Name o,e.o 3 Q-7 0 u PLAN CHECKING FEE (One-Fourth Permit Feel ' Lender's Address PERMIT ISSUING FEE' I certify that I have read this application and stale that the TOTAL FEE p above information is correct. I agree to comply with all Countv ' ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon - the ab e-mentioned p petty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature oTI Permittee Date -