Loading...
HomeMy Public PortalAbout5219 FARAGO AVE_Electrical__ Y I 76ABC3 CEBOB 1157A�PPLICA►TION F'ORtELECTRIC PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING �/ BUMDING AND SAFETY DIVISION ADDRESS OHN A LAMBIE Cc t,Eag�aeer C SSATf D GRIFFIN Snp t of 1. Lu LOCALITY NEAREST FOR APPLICANT TO FILL IN CRo SST a PERMIT FEES OWNER J^ I T E M NUMBER EACH FEE OUTLETS a ) $ $ MAIL LIGHTS RECEPT �,J SW / 10 C/ ADDRESS LIGHTING FIXTURES 10 CITY TEL NO ELEC RANGES CLO DRYERS K I ELECTRICIAN WATER HEATERS 50 } ELEC SPACE HTRS DISHWASHERS ADDRESS GARBAGE DISPOSERS AUTO CITY TEL NO )e7J WASHERS STA COOKING UNITS 25 STATE LICENSE NO e- Id O�+J MOTORS OVER INC H P O — I/z 25 DIS R GR P O Y FOR IN READSPECTION V2 — 2 50 INSPECTION RECORD 2 — 5 100 5 — 15 150 �I Sc3 15 — 50 250 d���' Z V3 so— 200 500 26 /p}s © FL✓i' SIGNS NO TRANS NO LAMPS SERVICE O 600V 100 Q SERVICE OVER 600V 500 )'� M I S C t ` Aj 1r I �jf-N WIRING PERMIT 100 �Z /s8 .�� FIXTURE PERMIT 100 n P%tAAf A444- SUPPLEMENTARY , -SUPPLEMENTARY PERMIT 50 TOTAL FEE g O APPROVALS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION /DATE INSPECTOR SSIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING W I R I N --L�-' 111r 2S ) IIHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR S F_ m�r� LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES 5. c64 CALIFORNIA OR THAeAE THE LEGAL OWNER F HE ABOVE POWER �o DESCRIBED RESIDENT s SIGNATURE UTILITY CO NOTIFIED OF PERM[ EF d �j , • p�r FINAL SF'4�d ATION 'ART URC yEIT cK M0 CASH SUPERVISING ELECTRICAL ENGINEER LACp6A00cx:l No 6 2 A 360 76Ak6C1CE 06B 1=/75 APPLICATION FOR ELECTRICAL PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN �+ rResidentialal Bldgs & Pools EACH NO FEE AODBDRESS> 2- 1 7 Sq Ft $ — $ LOCALITY Sq Ft NEAREST /I CROSS ST ,iw-wimming Pools OWNER OR FIRM NAMESwitch & Receptacle AMAI L DDRESS Z/ First 20 _ Additional CITTel No �i 1 PLAN CHECK Lighting Fixtures APPLICANT First 20 ADDRESS Additional CITY Tel No PERMIT Fixed Appliances Not Over 1 HP APPLICANT Range Heater_ D W Oven Dryer W M ADDRESS Top FAU W H CITY Tel No y Hood Fan —/— LICENSE OR a REG NUMBER Class O Disp A C —A 115'e) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION O AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY Power Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING U Size&T ELECTRICAL WIRING Type HP KW KVA or KVAR LWN Up to 1 Incl 1 HEREBY CERT FY THAT 1 AM PROPERLY REGISTERED AND/OR Z Over 1 to 10 Incl LICENSEDAS REOU RED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA ORT AT I AM THE LEGAL OWNER OF THE ABOVE Over 10 to 50 Incl DESCRIBED RES IO ENTIAL PROPERTY Over 50 to 100 Incl PERMITEE �i j �� Over 100 SIGNATURE Services DISTRICT NO PROC ED BY 0 200 Amp Under 600 V 201 1000 Amp Under 600 V APPROVALS DATE INSPECTOR S SIGNATURE Over 1000 Amp or Over 600 V TEMP POWER POLE Temp Power Pole&Appurtenances UNDERSLAB WORK Sign with One Branch Circuit Additional Sign Branch Circuits ROUGH CONDUIT (Other) WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (Sub Total) UTILITY CO NOTIFIED PLAN CHECKING FEE (One Fourth Permit Fee) r70 FINAL PERMIT ISSUING FEE TOTAL FEE NOTES I PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION CK M O ASH 724 EL 13 :e D WORKERS' COMPENSATION DECLARATION 76A669oPw3is7 APPLICATION FOR ELECTRICAL PERMIT U h Aeby pffirm that I have a certificate of consent to self ce 8006G Os� or-a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS cr 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 leo ❑Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. — NEAREST CROSS ST. Residential Swimming Pools OWNER OR Date Applicant FIRM NAME 44 CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work involved by First 20 CITYTel. No. Total No. Additional lti the permit is for one hundred dollars ($100)or less.) PLAN HECK 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 Law . Lighting Fixtures First 20 ADDRESS Total No. Date ApplicantAdditional CITY Tel. No. s Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLI ANT: If, after making is erti icate of APPLICATION Cj 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 /p, with comply with such provisions or this permit shall be Top — FAU —W.H. — 3 deemed revoked. , CITY - i �• Tel. o � 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 'per. Class. (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PIS SSED BY >_ and Professions Code,and my license is in full f rce and effect. 0- • Size &Type HP, KW, KVA, or KVAR �( Y� Q Up License Number Lic. Class /s to 1 Incl. FINAL U ✓��1 - ! Over 1 to 10 Incl. DATE VALIDATION 0O Contractor f't l Date Over 10 to 50 Incl. FINAL F- ❑ I am exempt under Sec. Over 50 to 100 Inc. BY U LLJ 100 a- B.&P.C. for this reason Over d Servic MCC &. Panelboards U) Date: Z nder 600 V Signature 20 - mp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V .; SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp. Power Pole &Appurtenances I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): y 3 3L% ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors s structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ , 0 0 m Business and Professions Code). ' ' J''"' rte,s`?fy.: CONSTRUCTION LENDING AGENCY .• i:r -•- 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.). Lender's Name PLAN CHECKING FEE _ t!itL'• rI' -!1i i r. r,t �!!u!� :�ti.'4!! ``• PERMIT ISSUING FEE Lender's Address L•I-'••• t i l 3 !"•=r 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 the above-mentio d pro r for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Si ature P mit e Datib or ©S V WORKERS'COMPENSATION DECLARATION 20-0019 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT O I hew,•by,affirm that I have a certificate of consent to self cEAe�G suveor S certificate of Workers''Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy-thereof(Sec. 3800, Lab. C.) Policy-No. Company FOR APPLICANT TO FILL IN JOB J/ ❑Certified copy is hereby furnished. New Residential Bidgs. & Pools EACH NO. FEE ADDRESS ❑Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. NEAREST CROSS ST. Residential Swimming Pools OWNER OR Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light - Sw._ MAIL COMPENSATION INSURANCE ADDRESS G (This section need not be completed if the work involved by First 20 CITY G � Tel. No. the permit is for one hundred dollars($100)or less.) Total No. Additional 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 bome subject•to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Date TApplicant Additional Total No. CITY Tel. No. Fixed Appliances Not Over I HP PERMIT NOTICE fO A PLICANT: If, after rylaking this Certifi ate of APPLICATION 11VA L 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. CITY Tei. No Hood Fan —Other— LICENSED CONTRACTORS DECLARATION LICENSE OR Disp. — Room Air Cond. REG. NUMBER �j�r/ Class. 6_1(J I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY and Professions Code,and m license is in full force and effect. Size &Type HP, KW, KVA, or KVAR Q License Number I ic. Class Up to 1 Incl. FINAL V 6cTC7�BL Over 1 to 10 Incl. DATE D cr_ VALIDATION Contractor M1414 AAAFS�/lIA[ to Q ❑ Over 10 to 50 Incl. � FINAL I am exempt and Sec. Over 50 to 100 Inc. BY U B.&P.C. for r ason Over 100 ✓ �/ LU Services, Swbd., MCC& Panelboards Z f Z 0-200 Amp. Under 600 V Signature AR/ 201 - 1000 Amp. Under 600 V ❑ % Over 1000 Amp. or Over 600 V Exemption or eg. M int. ect. SIN E FAMILY HOM NER-BUILDER DECLARATION Temp. Power Pole &Appurtenances ` I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): M ❑ Misc. Conduits& Conductors = I, as owner of the property, will do the work and the - _ structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ 00 Business and Professions Code). „-.,•Er -iolsl"t CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for CHANGE- the H1-1NE-the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). AP PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE f , Lender's Address I certify that I have read this application and state that the TOTAL FEE Elm 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 ' ©s