HomeMy Public PortalAbout8724 GARIBALDI AVE_Electrical__ ' APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES BUILDING,SND SAFETY
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FOR APPLIGANrTO FI TN _OB R� 9 &(71, '
New Resident1aI Bldgs.&PoQls EACH Na FEE ASD Q V CLQ
1 &2-Family,Sq-Ft._r $ .025 — $ LOCALITY
Multl-fgmlly Sq.Ft. .02 — NLAREST44
` h
CROSS ST.
Residential Swimming Pools 25 N
Outlets Rem Light Sw. MAIL I•
First 20. .50 D ESS y`f
Total No. Additional .3D pciYT-Y CH,C -vTel.No. 7 2�
PPLICANTK
Lighting Fixtures First 20 .50 ADDRESS
Total No. Additional .30 Off,
Tel. No.
Fixed Appliances Not Over 1 HP PERMIT
Range—Heater—D.W.— APPLICANT
Chen—Dryer L W.M. ADDRESS
Top _FAU —W.H._ CITY Tel. No.
Hood—Fon _Other_ LICENSE OR
Disp.L Rao l Alr Cond. 2.50 d REG.NUMBER Class.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPUCA-
Power Apparatus 3 Large Appliances TION AND FATE THAT THE ABOVE l.S CORRECT AND AGREE TO
Sire S T HP, KW, KVA,or KVAR COMPLY WITH ALL-COUNTY ORDINANCES AND STATE LAWS
Type REGUI,TING ELECTRICAL WIRING
2.50 .
Up to 1 Irl. I HERESY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR V
Over 1 to,10 Ind. 5.00 UCENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
_ Over 1010 50 Incl. 12.50 CALIFORNIA OR THAT I AM THE LEGAL OWN F THE ABOVE
Over 50 to 100 Inc
25,0-0 DESCRIBED IAL PRQPERTY.
40.00 PERM[TEE
Over 100 SIGNATURE
Servkes DISTRICT NO. P E Y .
0-200 Amp. Under 600 V 12.50 a p
201-1000 Amp. Under 600 V 2 5.00
Over 1000 Amp.or Over 600 V 50.00
Temp. Power Pole&Appurtenances 10.00 Y
Sign with One Branch Circuit 10.00 a
Additional Sign Branch Circuits 2'00 IN$PECfION >
Mis-c.Conduhs b Conductors 10.00 INFORMATION
Other!See Complete Fee Schedule! ON RIEVE E 0 Q b A
SIDE
# o 0 0 0 02
P o o 29,50
PERMIT FEE (Sub-Total) - o o 2 9 5 0 H
Z
PLAN CHECKING FFE (One-Four}h Permit Fee) G09.22-78
PERMIT ISSUING FEE $7.0.0 +� p
TOTAL FEE ! S >
INSPECTION FI>IALEg
date: J��� By �
WORKERS'COMPENSATION DECLARATION - ,aa, APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm That I have a certificate of consent to self
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 POR A17LICAM TO FRI N
❑ Certified copy Is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS
F Certified copy Is filed with the county building Inspec- 1 8 2-Family, Sq. Ft. _ = $ LOCALITY
tion department. Multl-famlly Sq. Ft. CRCSS ST
Date Applicant Residential Swimming Pools O'Wt�OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Ight Sw. -M73L d y
COMPENSATION INSURANCE
(This section need not be completed If the work Invohred by Additional 5 I. No.
the permit Is for one hundred dollar (;100)or Jess.) Total No AAdd
PLAN CHECK
1 certify that In the performance of the work for which this
permit Is Issued, I shall not employ any persorr In shy hnanner
so as to become subject to the Workers'Compensation Ughting Fixtures First 20 ADDRESS
Additlanal
Total No. CITY Tel. No.
r Da O pllcant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, r making this Certlfi of APPLK:eN7
Exemption, you should become subject to the Workeri Range— Heater D.W. —
Compensation provisions of the Labor Code, you must Forth- Oven _ Dryer 0W.M. ADDRESS
with comply with such provisions or this permit shall be Top FAU —W.H. —
deemed revoked. CITY Tel. No.
EC
LICENSED CONTRACTORS DLARATION Hood Fan C LKENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 DIsp. Rgom Air Cond. REG NUMBER Class.
(commencing with Sectlon 7000) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. PROCESSED BY
and Professions Code, and my license Is In full force and effect. a�
Size 8 Type HP, KW, KVA, or KVAR
License Number I lc. Class .Up to Vinci. FINAL t.7
Contractor Date
Over 1 to 10 In4l. DATE VAUDATFON 09
❑ Over 10 to 50 Incl. FINAL rj
I am exempt under Sec. Over 50 to 110 Inc. BY LU
B.BP.C. for this reason Over 100
Date: Services, elboards —
Amp. Under 600
Signature
❑ Over 1000 Amp. or Over 600 V iPJr' 7 Q 1 A
Exemption for Reg. Malnt. Elect.
SINGLE FAMILY Temp. Power Pole 8 Appurtenances #Yo 0 0 0 0 2
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 2 0 0 3 2 0 0
1 hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business.and Additional Sign Branch Circuits _
Professions Code): ° ° ° 3 2 0
I, as owner of the property, will do the work and the Mlsc. Conduits $Conductors 0 9.30783
structure Is not Intended or offered for sole (Section mer (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 O
Lendees Name
PERMIT ISSUING FEE
Landow Address
I certify that I have read this application and state that the TOTAL Fly
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 p o for Inspection purposes.
2� SEE REVERSE FOR EXPLANATORY LANGUAGE
V
Signature of Permktee Date