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Home My Public Portal About4844 FIESTA AVE_Electrical__ r � 76A663 CE806 1 68 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A LAMBIE COUNTY ENGINEER COLEMAN W JENKINS SUPERINTENDENT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST � NO EACH FEE � rRRECEPT� r $ $ OWNER H 71MAIL AVGHT(1TOTAL FIRST 20 /d 20 �j� ADDRESSITCH 0 OVER 20 fo 10 �Q CITY TEL NO LIGHTING FIRST 20 20 r PLAN CHECK �B APPLICANT FIXTURES �TOTAL � OVER 20 10 ADDRESS RANGE—DRYER—WTR HTR — CITY TEL NO STA COOK_DISP —F A U COATRAC T'OR 6 SPACE HTR AIR COND ADDRESS U' O Q CLOTHES WASH Z-DISHWASH CITY TEL NO FAN L OTHER 1 00 LICENSE IJO Q CLASS e, Q MOTORS TRANSFORMERS RATING IND HEATERS ETC HP KW KVA I HEREBN ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 1 WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING 0 - 1 1 00 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 1 - 10 3 00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO 10 - 50 5 00 RESIDE IN THE ABOVE DESCRIPED RESIDENTIAL PROPERTY O SIGNATURE V 50 - 100 10 00 OF PERMITTEE ix too — soo is oo DISTRICT,P40 GJ9WP ZONE PC SS Y �j TUBE SIGNGOR AS SIGN AND ONE CIRCUIT 3 00 / ��11711d MARQUEE ADDITIONAL CIRCUITS 1 00 N NOTES Z 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 INSPECTORS SIGNATURE TEMP POWER POLE UNDERSLAB WORK WL-kA-,- ROUGH ROUGH CONDUIT PERMIT FEE (SUB TOTAL) WIRING FIXTURES PLAN CHECK FEE (507 PERMIT FEE) POWER AUTHORIZED PERMIT ISSUING FEE 2 00 UTI LITYCONOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1 00 FINAL TOTAL FEE Jtv JOSEPH C ROOHAN SUPERVISING ELECTRICAL ENGINEER PLAN CHECK VALIDATION TCK M 0 CASH PERMIT VALIDATION 0 M o CASH Lj-o s:� �� 1 2 0 1 5.2 O N f EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE 0 WORKER S COMPENSATION DECLARATION 20 DPW(12 91) APPLICATION FOR ELECTRICAL PERMIT 76A663 I hereby affirm that I have a certificate of consent to self 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 �y —j Certified copy Is hereby furnished New Residential Bldgs &Pools NO EACH FEE ADDRESS LOCALITY Sq Ft 1 &2 Family — $ $ ❑� Certified copy is filed with the county building Inspection _ NEAREST department Multi family Sq Ft CROSS ST Cis c Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK GE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERSOutlets Rec Light g —L—Sw OWNER OR COMPENSATION INSURANCE FIPM NAME irD / (This section need not be completed M Fst 20 MAIL the work Involved by the Total No 75 Additional ADDRESS permit Is for one hundred dollars($100)or less) I certify that in the performance of the work for which this permit CITY Tel N 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 I Date 2—O APP ►n ESIDENTIAL APPLIANCES NOT OVER 3 HP Z Applicant �+ Total No Additional ADDRESS NOTICE TO APPLICANT If after making this Certificate of CITY Tel No Exemption you should become subject to the Workers Compensation )THER APPLIANCES NOT OVER 3 HP provisions of the Labor Code you must forthwith comply with such 7 P MIT provisions or this permit shall be deemed revoked Power Apparatus&Large Appliances PPLICANTJJ0�},g6-4e , LICENSED CONTRACTORS DECLARATION Size&Type HP KW KVA or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 2�� Over 3 to 10 Incl (commencing with Section 7000) of Division 3 of the Business and CITY , _ Tel No -2 Z Professions Code and my license Is In full force and effect Over 10 to 50 Incl Over 50 to 100 Incl REG LICENSE NUM ER Class �ZQ a- �13G3 u a '7 Over 100 DISTRICT NO PROCESSED BY 0 License Number "Al 03�C=:) Llc Class — `. p Services Swbd MCC&Panelboards OY cc FINAL Contractor�S�\aSh¢a., t�eAk-: to J Z' 2 t�'�-!J 0 399 Amp Under 600 V DATE 0 F1 am exampt under Sec T 400 1000 Amp Under 600 V / / k7/, A /J Over 1000 Amp or Over 600 V FINAL VALIDATION W B&P C for this reasonBRANCH CIRCUIT FEES BY CO Date 15A or 20A 120V Lighting or Recept Z 1 To 10 Branch Circuits �Signatur 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits i✓ (/ 6�(/ ,� Exemption for Reg Maint Elect 15A 20A 208V To 277V Lighting Br Circuits SINGLE FAMILY Temp Power Pole&Appurtenances A�1 Tea HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractors License Law JiV/ �t.re4 r for the following reason (Section 7031 5 Business and Professions Additional Sign Branch Circuits Code) i ITEMIS ❑ I as owner of the property will do the work and the structure Misc Conduits&Conductors TUTAL 43 . 43 is not intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule) ® a and Professions Code) _ If HEt i'. 43.tt3 CONSTRUCTION LENDING AGENCY arlJh GE oDu I hereby affirm that there Is a construction lending agency for the 5,C71ii IVG performance of the work for which this permit is Issued (Sec 3097 PERMIT FEE (Sub Total) Civ C) _ PLAN CHECKING FEE t�01713 eol 1 /2$/92 _ t Lender s Name PERMIT ISSUING FEE K4S I AM 10:25 Lender s Address i {� I certify that I have read this application and under penalty of purjury state TOTAL FEE -7-,;A7` 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 1� _ SEE REVERSE FOR EXPLANATORY LANGUAGE Z 19, W Z— SIGNATURE OF PERMITTEE DATE