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HomeMy Public PortalAbout5120 FARAGO AVE_Electrical__ 179-? �1 76AS63-CESOG-6-57 APPLICATION FOR ELECTRIC PERMIT COUNTY COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER gDDRE s 120 Farago St BUILDING AND SAFETY DIVISION • JOHN A.LAMBIE,COUNTY ENGINEER t CASSATT D.GRIFFIN,Sup'T OF BUILDING LOCALITY Tem le City NEAREST FOR APPLICANT TO FILL IN CROSS ST. PERMIT FEES OWNER Andrew Grad LIGHTS RECEPTACLES SWITCHES 1 NUMBER 1 T E M EACH FEE MAIL 46 TOTAL OUTLETS $ .10 $ • 60 ADDREfF120 - Farago 9t. _ ELEC. RANGES, WATER HEATERS, CITY Temple Ci}y TEL.NO. CLOTHES DRYERS .50 ELEC. SPACE HEATERS, STAT-Y. COOK- ELECTRICIAN ING UNITS, GARBAGE DISPOSERS, ADDRESS8608 E Artesia �gd AUTO WASHERS, DISHWASHER .25' LIGHTING FIXTURES ,10 CITYBel I f1cmere r. TEL.Ndde-35113 MOTORS ATE LICENSE Na10/c]v DISTRICT NOGRT Y HORSEPOWER UP ZONE READY FOR INSPECTION H.P: OVER INC. . n�� 1/2&LESS .25 ,,NJ +i2 — 2 .50 INSPECTION RECORD 2 — 5 1.00 5 — 15 1.50 15 50 2.50 50 200 5.00 MISC. - SIGNSI NO.TRANS, NO,LAMPS SERVICE O-600V 1.00 3 00 SERVICE OVER 600V 5.00 WIRING PERMIT 1.00 1.1 00 FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT .50 APPROVALS TOTALFEE is 8� I " DATE INSPECTOR'S SIGNATURE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I A1IY HFTLEGAL) OWNER*OF THE ABOVE POWER DESCRIBED SIGNATURE RESIDENTIAL PRDIs£fD �^"�� UTILITY CO.NOTIFIED OF PERMITTEE L��`�® ' „,. FINAL 6 JOHN A.LAMBIE. DATION ARTHU R C.VETT, COUNTY ENGINEER SUPERVISING ELECTRICAL ENGINEER _ CK MO CASH 0 1.6-5 I uRIY '7 - 8.70. 2 a d1 i+1 yy� T ERS'CI have certif DECLARATION CE-806 ID/BI APPLICATION FOR ELECTRICAL PERMIT I tie-r�.�af that I have a certificate of consent to self CE-806G insure, ors-o certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. —'—E.rr�pat n y FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS -9)-20 -4 ir ano Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. LOCALITY $ — $ G [ 1 tion department. Multi-family Sq. Ft. NEAREST CROSS ST. Er Date Applicant Residential Swimming Pools \f%/_ / OWNER OR Vv FIRM NAME �V CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec light Sw._ AIL COMPENSATION INSURANCE ADDRESS O c u0 First 20 a (This section need not be completed if the work involved by Total No. CITY M '� Tel. No.91$"Llyy,© '7 the permit is for one hundred dollars ($100)or less.) Additional C 2 i JJ 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 W ers'Compe tion ws. Lighting Fixtuws First 20 ADDRESS f Total No. Additional Date)Q _Z ^ Applicant CITY el o. 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 with comply with such provisions or this permit shall be Top FAU —W.H. — deemed revoked. Hood _ Fan ^ Other_ CITY Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR W I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. REG. NUMBER Class. (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROC S BY a' Power Apparatus & Large Appliances and Professions Code,and my license is in full force and effect. Q Size &Type HP, KW, KVA, or KVAR 6, U License Number Lic. Class Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE ry_� VALID ON �: Contractor Date Over 10 to 50 Incl. FINAL W I am exempt under Sec. Over 50 to 100 Inc. BY N B.&P.C. for this reason Over 100 Z_ Date: Services, Swbd., MCC & Panelboards 0 -200 Amp. Under 600 V xv Signature 201 - 1000 Amp. Under 600 V Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole & Appurtenances ;93225A HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License0 0 o e o '2 Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Pr essions Code): ( o o 2 5 5 0 I, as owner of the property, will do the work and the Other Conduits& Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ , 0 0 - 25505 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 1021 =85 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 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 ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon t bove-mentio pro erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT L1 I hereby affirm that I have a certificate of consent to sett insure, 76A663 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. 3800 Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB 1 `— Certified copy is hereby furnished. New Residential Bldgs.&Pools NO.. EACH FEE ADDRESS _❑ $ $ LOCALITY Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. department. Multi-familyS Ft. — NEAREST r q� cRoss sr. Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' � OWNER OR FIRM NAME Outlets:Rec. Light Sw' COMPENSATION INSURANCE / First 20 o (This section need not be completed if the work involved by the < MAIL permit is for one hundred dollars($100)or less.) Total No. yL_ Additional ADDRESS p) U 1 certify that in the performance of the work for which this permit CITYTel.No. y 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 r7 110!7 APPLICANT Total No. PLAN CHECK Additional � ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, 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 PERMIT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000) of Division 3 of the Business and CITY Tel.No. Professions Code, and my license is in full force and effect. Over 10 to 50 Incl. >" Over 50 to 100 Incl. LICENSE Cl REG.NUMBB ER ass. d License Number Lic.Class Over 100 DISTRICT NO. P O SSED BY O Services,Swbd.,MCC&Panelboards /.0Q �' (c 0-399 Am Contractor Date p' Under 600 V FINAL O DATE 400-1000 Amp.Under 600 VW ❑ I am exempt under Sec. � /-4 VALIDATION Over 1000 Amp.or Over 600 V AL B.&P.C.for this reason BY / d BRANCH CIRCUIT FEES I;n Date: 15A,or 20A, 120V,Lighting or Recept. Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Exemption for Reg.Maint. Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION :.-.:•.�• I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits :3 Code): I,as owner of the property, will do the work and the structure Misc.Conduits&Conductors i C_ fiti is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) 20 CONSTRUCTION '_ and Professions Code). 20 ^`S'L F ' °° CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the "CHA'51F performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) / Q Civ. C.) PLAN CHECKING FEE Lender's Name , - PERMIT ISSUING FEES i f k:° y Lender's Address ,H I certify that I have read this application and under penalty of purjury state TOTAL FEE j that the above information is correct. I agree to comply with all County ordinance and State laws regulating Electrical wiring,and hereby authorize represent fives of this County toe er upon the above-mentioned property for•nspe ' n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE za SIGNATURE OF PERMITTEE DATE _ ,,WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) 76A663 APPLICATION FOR ELECTRICAL PERMIT I •asffirm that I have a certificate of consent to self insure, or ber'tificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(sec. 3800 Lab, C.) Policy No. Company FOR APPLICANT TO FILL IN JOB � '•� ADDRESS2120 ' 0a V d g AV e• ❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE ❑ Certified co is filed with the count building 1 &2-Family,Sq.Ft. $ $ LOCALITY copy y g inspection _ dedepartment. Multi-family S Ft. NEAREST P Y q CROSS ST. f"'re f✓j- Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. OWNER OR �eh►1 t•5 C hdNt COMPENSATION INSURANCE First 20 FIRM(This section need not be completed if the.work involved by the MAIL permit is for one hundred dollars(5100)or less.) r pQ Total No. Additional ADDRESS Eara cr olVe• I certify that in the performance of the work for which this permit CITY Tem ' Tel.No. J-��O V is issued, I shall not employ any person in any manner so as to PLAN CHECK �+ become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT �[ � Total No. Additional ADDRESS Date (Applicant � NOTICE ' e RESIDENTIAL APPLIANCES NOT OVER 3 HP.O APPLI ANT: If, aft r making this Certifof CITY Tel.No. Exemption,you should become subject to the Workers'Co ensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT }�, � �0 l provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT y h LICENSED CONTRACTORS DECLARATION Size&Type HP,KW A,or KVAR ADDRESS Sz5 E _ L4d "'' V_ I hereby affirm that I am licensed under provisions of Chapter 9 , to 10 Incl. r (commencing with Section 7000) of Division 3 of the Business and CITY '���� Tel.No Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. } LICENSE OR r Class. Over 50 t0 100 Incl. REG.NUMBER 0 6 ���'16 0- dci55 C-1 O UC© Over 100 DISTRICT NO. SSED BY 0 Pl License- umaL 4iLic.6kesa JJ D� Services,Swbd.,MCC&Panelboards T_ � !�y� FINAL b II[[ l V 0-399 Amp. Under 600 V Contractor - n ®C�'Y.Date DATE U ❑ 400-1000 Amp.Under 600 V VALIDATION I am exempt under Sec. Over 1000 Amp.or Over 600 V FINAL LLI d B.&P.C.for this reason BRANCH CIRCUIT FEES BY Cl) Date: 15A,or 20A, 120V,Lighting or Recept. Z_ 1 To 10 Branch Circuits Signature '11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Exemption for Reg.Maint. Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit z= for the following'reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits • ,_`a Code): ❑ Misc.Conduits&Conductors ' L"f - I, as owner of the property,will do the work and the structure _ is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) ?i_`:•!i; »:_ e and Professions Code). r CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the •i!i�s'i':iE performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ. CJ PLAN CHECKING FEE 0ILS;;,-0 00 1 94, Lender's Name i �p a PERMIT ISSUING FEE �lp r_ z Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE /�� / l that the 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 inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF PERMITTEE DATE