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HomeMy Public PortalAbout5347 ENCINITA AVE_Electrical__ 76Ae563-0E866 3-69 APPLICATION FOR ELECTRICL PERMI 'COUNTY OF LOS ANGELES �., DE,PARTMENT OF COUNTY ENGINEER BUILDING x � BUILDING ATVD SAFETY DIVISION ADDRESS _r5 ""5 CV/7__ JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY .� r NEAREST Y j ev IC' FOR APPLICANT TO FILL IN CROSS ST. F. NO. EACH FEE $ $ OWNER RECEIPT. MAIL 0� f LIGHT� TOTAL FIRST 20 � .20 O ADDRESS J SWITCH OVER 20 .10 CITY TEL. 0. PLAN CHECK LIGHTING TOTALBQ;�_ .20 �Z. APPLICANT ADDRESS FIXTURES � .10 RANGE_DRYER_WTR. HTR. CITY TEL.NO. STA. COOK_DISP. _F.A.U. CONTRACTOR ��11i,�'� SPACE HTR AIR COND. ADDRESS CLOTHES WASH._DISHWASH. CITY r TEL.N0. '5 FAN OTHER 1.00 LICENSE NO. 6 CLASS.C- -IV MOTORS,TRANSFORMERS RATING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION IND. HEATER'S, ETC. HP. KW. KVA. ANo STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY SIZE & TYPE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. O — 1 1.001 1 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND 5TATEOF } 1 — 10 3.00 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN, THE ABOVE DES RI BED RESIDENTIAL PROPERTY. 7 O 10 - 50 5.00 1` V / () SIGNATURE 50 - 100 10A0 OF PERMITTEE O I-- 100 — 500 15.00 DISTRICT NO. GROU ZONE PROW C V SIGN,GAS SIGN AND ONE CIRCUIT 3.00 �� © Q N TUBE, OR, Z MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES: SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 SERVICE OVER 600 VOLTS OR 200 AMP 5.00 ` TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE /A,/rl 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 }"isr UTILITY CO.NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL TOTAL FEE JOSEPH C. ROOHAN SUPERVISING ELECTRICAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.0. CASH 1 ' Ir, 3 6 5 01C` FEDI Q 2 D 6.x.4 Or' �- SEE BACK OF APPLICATION FOP COMPLFTF FF_E WORKERS' COMPENSATION DECLARATION 10ie1 APPLICATION FOR ELECTRICAL PERMIT .-'I'here�'y affirm that I have a certificate of consent to self CE-806G insure, or a Sertificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or acertified copy thereof (Sec. 3800, Lab. C.) Policy4,o. O'01 Company FOR APPLICANT TO FILL IN JOB ❑ Certified co is hereby furnished. EACH NO. FEE ADDRESS PY Y New Residential Bldgs. & Pools 2 S Ft. $ — $ LOCALITY Certified copy is filed with the county building inspec- 1 & 2-Family, q tion d art Multi-family Sq. FL NEAREST CROSS ST. Residential Swimming Pools OWNER T. Date Applican OR le7)45? FIRM NAME C RTIFI ATE OF EXEMPTION FROM WORKERS' ! MAIL Outlets: Rec Light Sw. COMPENSATION INSURANCE �3 ADDRESS This on neednot completed if the work involved by First 20 ( section t b p .` d - the permit is For one hundred dollars (;100)or less.) Total No. Additional CITYTel. No. PLAN 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. Additional CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT 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 o with comply with such provisions or this permit shall be Top — FAU —W.H. — y deemed revoked. CITY Tel. No. 5 J LICENSED CONTRACTORS DECLARATION Hood Fan _ Other_ Disp. _ Room Air Cond. LICENSE OR Class. I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PRO D BY and Professions Code,and m license is in full force and effect. Power Apparatus& Large Appliances S S73 Size & Type HP, KW, KVA, or KVAR' ` �9 License Number / S 3 Lic. Class / Up to 1 Incl. %)FINAL Contractor, Date Over 1 to 10 Incl. DATE VAL ATION F1Over 10 to 50 Incl. FIN u I am exempt under Sec. Over 50 to 100 Inc. BY 1169 , B.&P.C. for this reason Over 100 // tff Services, Swbd., MCC & Panelboards Date: 0 - 200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V Over 1000 Amp. or Over 600 V �2 3 6 9 A IDExemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole &Appurtenances # 0 a 0 0 0 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit II o .2 0.25 1 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): o o o 2 Q 2 5 5 ❑ I, as owner of the property, will do the work and the Misc. Conduits & Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ , O p,7 l _85 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Nome PERMIT ISSUING FEE 1 U' Lender's Address I certify that I have read this application and state that the TOTAL FEE above information is correct. I agree to comply with all County ordina sand State laws regulating Electrical wiring, and here a thoriz� resentatives of this County to enter upon the bo a-ment d property for inspection purposes. ,r. SEE REVERSE FOR EXPLANATORY LANGUAGE A,ao, Signature of Permittee batl WORKERS' COMPENSATION DECLARATION 76A663 10/81 APPLICATION FOR ELECTRICAL PERMIT 1 hereby affirm that I have a certificate of consent to self CE-8066 insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES 7— BUILDING AND SAFETY or apertified copy thereof (Sec. 3800, Lab. C.) r/J PoliEy No.—Company t5 C!mpany �.+�` /- 7 FOR APPLICANT TO FILL IN JOB ❑ Certified co is hereby furnished. EACH NO. FEE ADDRESS v O L L C.L PY Y New Residential Bldgs. & Pools ❑ 1 8 2-Family, S Ft. $ _ $ LOCALITY "j'^C �^ j o� O Certified copy is filed with the county building inspec- Y q• tion department. Multi-family Sq. Ft. NEAREST CROSS ST. DateA---Applicant Residential Swimming Pools OWNER OR PP FIRM NAME � G CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE ADDRESS a 8 g 6.� Q, ! 4-4 k (This section need not be completed if the work involved by First 20 the permit is for one hundred dollars ($100)or less.) Total No. Additional CITY7—.1-4 C c r Tel. No� PLAN CHECK 1 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 5 Zt I" Additional Total No. CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making. this Certificate of APPLICANT 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 0 8 u v. S with comply with such provisions or this permit shall be Top FAU —W.H. CITY Tel. No. deemed revoked. ; (� C' (o (m Hood Fan _Other— LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cand. REG. NUMBER S� Class. (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCESSE BY and Professions Code, and my license is in full force alid effect. Power Apparatus & Large Appliances _ S-�f� O CL,'Ocense Size &Type HP, KW, KVA, or KVAR'z4s'Y�`�Number ;ic. Class Up to 1 Incl. J�FNAL A EL r ,Q��� Over 1 to 101ncl. � (� (1 VALIDATIONntractor t, Over I / VLU Over 10 to 50 Incl. j I am exempt under Sec. Over 50 to 100 Inc. BY r Over 100 B.&P.C. for this reason Date: Services, Swbd., MCC& Ponelboards , 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V 3 3 5,7 A Exemption for Reg. Maint. Elect. X000002 SINGLE FAMILY Temp. Power Pole& Appurtenances 1 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit - 2550 2 1 hereby affirm that I am exempt from the Contractor's License o Additional Law for the following reason (Section 7031.5, Business and Sign Branch Circuits Professions Code): o 0 0 2 5,5 0 ❑ I, as owner of the property, will do the work and the Misc. Conduits & Conductors ,0 ('09 —8 4 structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ , 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (/ (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Q Lender's Address I certify that I have read this application and state that the TOTAL FEE 6� above information is correct. I agree to comply with all County ordinances and State laws regulating ElectricqJ wiring, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Per to WORKERS'COMPENSATION DECLARATION"! -8063 I0181' APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate'of consent CE to self CE-806G, - insure, or a certificate of Workers' Compensation Insurance,: COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB ❑ Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS 5347 ENCIN:I.TAS F-1 — $ 80 Y LOCALIT Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. 2000 $ — TEMPLE tion department. Multi-family Sq. Ft. 'NEAREST OLIVE Residential Swimming Pools CROSS ST.OWNER OR Date Applicant FIRM NAME FA CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE First 20 9 ADDRESS 089 LAS. TUNAS (This section need not be completed if the work involved by Total No. Additional CITY TEMPLE CITY Tel. No. the permit is for one hundred dollars ($100)or less.) — I certifythat in the performance of the work for which this PLAN CHECK MARTIN EELCTRLC 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]_560 N. LASSE Total No. Additional CITNTAgTo Tel. No. 982-788 9=21-84 pp Fixed Appliances Not Over 1 HP PERMIT Dote9"2,1--84 Applicant MARTIN' ELECTRIC NOTICE TO APPLICANT: If, after making this Certificate of Range—.Heater_D.W. APPLICANT MARTIN ELECTRIC Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- Oven — Dryer W.M.— ADDRESS-1560 .N N. LASSEN with comply with such provisions or this permit shall be Top FAU —W.H. CITY ONTARIO deemed revoked. Tel. No-982-7880 Hood Fan _ Other— LICENSED CONTRACTORS DECLARATION LICENSE OR Disp. Room'Air Cond. REG. NUMBER 304982 Class. I hereby affirm that I am licensed under provisions of Chapter 9 C— (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCESS D BY and Professions Code,and my license is in full force and effect. Power Apparatus & Large Appliances Size &Type HP, KW, KVA, or KVAR' i V O License Number 3.04982 Lic. Class C 10 Up to 1 Incl. FINAL k) DATE J'�lCY Q(�� VALIDATION MARTIN ELECT C 9-21.-84 Over 1 to 101ncl. (�j/ Cl J @9 Contractor a e Over 10 to 50 Incl. ❑ FINAL V I am exempt under Sec. Over 50 to 100 Inc. BY Over 100 B.&P.C. for this reason Date:--- Services, MCC & Panelboards ► //!;/G 0 -2000 Amp. Under 600 V 7 Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION p Sign with One Branch Circuit �0$3, 1 A 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 # 0 0 0 0 0 2 Professions Code): ❑ 1, as owner of the property, will do the work and the Misc. Conduits& Conductors 0 ' 90.50 structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)— 36 7044, Business and Professions Code). 0009050Poo 5 0 CONSTRUCTION LENDING AGENCY 1005-84 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE 10 5 Lender's Address I certify that I have read this application and state that the TOTAL FEE 90. 50 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 above-mentioned property for in ection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date