HomeMy Public PortalAbout8761 GARIBALDI AVE_Electrical__ 16A8&3-CE@06 &82 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER rLOCALr
BUILDING AND SAFETY DIVISIONJOHN A. LAMBIE, CouNTY ENamxim
WILLIAM A.,JE:NBXN,SUPT OF SUILDINCI TY
N XA REST
FOR APPIJ T TO FILL IN CROSS ST.
R KCEFT. TOTAL "'
KACH
OUTLETS FIRST 20 No •2d i O OWNER
LIQHT MAIL !
ADD'L •f0 ADDRRVG
!WITCH. OVER 20 �
LIGHTING TOTAL FIRST 20 .20 CITY T. 0.
FIXTURES oAD^20 •10 ELECTRICIAN -
RANao CLO.DRY10tS MTM.HTR.. noo ADDRMS loole, 04011,
GAM 13LW. STA,DOOR - C T>� O.
DISH�►ASH. AUT0..1•Alfl. /TAT=
SNLCi HTRS. STA.AFr,(14 H.P.[MAI.) .50 ,
LICJZNS[ NO. `
MOTORS, Ovot NoIrOVOt KJ- DISTRI •NO. GROUP P SSE BY
O 1 11.00
1.50 INSPECTION RKORD
2 ,S 2.00
S 1D I 2.50 �•
a
15 00 2..00 0
50 100 5.00 OG
S1aN1� NO.
H0.LLAMPSAJd" W
n.
8271VIC=O.500V•NOT OVQ 20QA 1.00
Z
SKRVICL 0.500V-OV=200 A. 2.00
516ZVICE OV)OZ 500V 5.00
MISC.
PERMIT IMU1Na F6= 2.00
SUPPLirma TASY!1'ERYIT imul d FQ 1.00
TOTAL FEE .
1 H»Y AA=lD*O IRJmQi THAT I HAVI RAD THu AlTLICATlpHAMOYALS OATK
AND STATI THAT THI AL0 1/ COMM= AND AM=TO COMPLY C)NDUIT
VrrrH ALL {COUNTY ORDINAHCK8 AND STAT[ LAWS wmn AT Na
"'TNW ' Mme WIRING
il V
I H>DtRY CKPMFY THAT 1 APROFtOtLY RCQIS .MI
'i'Olm D/OR
RO
LJCJOCNM AS UEMM SY LOSIH� lm/ iS COUNTY ASTATS OF F XTURM
CALPORHIA. Oa OF THS S
THAT I Ait THE L GAL CMMM OTS AOVS
DtSdR!>M� !Sd POWER
aOtr�yRi IV _ UTILITY CO.N FI d�
FINAL
LIDA710N ARTRUR C-
CK YO CASH SUPKFMGINa SI[CTRICAL EN41MMM
I LALo 0 3 2 6t2 JM 2 9 2 A 3.8 d- '
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APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELED
DEPARTMENT OF COUNTY ENGINEER suit=
BUILDING AND SAFETY DIVISION AriDR><si
JOHN A. LAMBIE, COUNTY EN3INKgR
WILLIAM A.J12,MEN, Sup T OF euILDIma L
N[A
CR0, gT.
RECKP TOTAL NOFAC31 r=
OUTLETS FIRST 20 �20 t WNER
LIGHT .20111
MAIL
�^ ADD'
SWITCH. 2
L �J X70 ADDjlSSS
OVER 20 7
LIGHTING 1 TOTAL FIRST 20 .10 CITti' NO. Aya 91
FIXTURES J AOD'L1O ELECTRICIAN
ov a 20
RAMS"
aLo. 1.00 ADDRiIs
rrw cbD `
Dl4FIp -WASH. � FTTY Tl[L N
STATt
SPACE►T VA1 ixL . .) .e0 O LICENSI NO.
htOTOHs. ovnL DIST NO. SRO[n(rAPpQCESSED BY
O 1 LOO
t 3 1.eo INSPECTION RECORD
a e 12.06
6 in Le0
15 - ISO 3.00
ea T 100 mob O
•IaNs, Ito.TIIAIH/-
MO.LAb"
O
SERVICt O-eOw-NO'T OVUM 100A 1.00
S><RVICIO-eUOV-OVtt s00 A. 9.00
StRVICE Ovot Sow 5.00
MISc.
PHRMTT ISSUINQ Ftt A.
6UPrLXMI TTAQY PIMMIT ISSUMG FtI 1.Q0
TOTAL FQE
1 HESOY AGbgWLEDO= THAt 1 HAYS Nl D THIS AITLJCAn ON DAa
MID STATE THAT THE ASOVK l/ COMMEC r AND AORIQ TO COiMPI-Y CONDUIT
WITH ALL -C=?rrY ORDIHkPKXB Alm STATE LAWS PWOULA- MrO '
KLKCTMPM� Wp"CL . WIRING
I HEASY — IFY THAT I All PROOMMLY MOISTLI® M/D/QPM
L1CO1>m AS IQQUIIMID WY LOG AHOELt/ C7DUHTY AND STATE OF FIICTLIRts
tALIFOIRIIA 011 THAT 1 AIF THE t KaAL OWHIIM OF THE A10Y[
DilgMmm IOy PGI11VIlQl
SIF ftRMGNATURt LITY
O
Fl-NAL
rr-
LIDATION ARTHUR C. V113T
CK NO CASH . SUPKKVISING HLKcTIUCAI,ENcummm
LA;o 1 6 5 5G W 4 2 A 1 8.3 0
WORKERS' COMPENSATION DECLARATION lo/at APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self CE-806G
Insure, or a certificate of WorkCE-806ers' Compensatlor5 Insurance, COUNTY OF LOS ANGELES ��. BUILDING AND SAFETY
or a certified copy thereof (Sec. 3800, Lab. C,)
Policy No. Company FOR APPtKJMr TO PI_L IN JOB
Pol
Certified copy Is hereby�the
New Rssldentlal Bldgs. 8 Pools EAO1 NO. FEE ADDRESS
❑ Certtflad copy Is filed �countyilding Inspec- 1 8 2-Family, Sq. Ft. $ _ s LocNs Y s
tion department Multi-family Sq. Ft. �
CRO55 ST.
Date Ilcant Residential Swimming Pools OWNER OR
APP FIRM NAA1E
CERTIFICATE OF D(EMPTION FROM WORKERS' N
ML
COMPENSATION INSURANCE Outlets: Rx Light Sw. ADDRESSFirst 20
(This section mead riot be completed If the work Involved by Total No Additioncil CITY V. Tel. No.
the permit is for one hundred dollars ($100)or less.)
LAN CHECK
I certify that In the performance of the work for which this ARP CA i
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.
Dat llca FLx d Appliances Not Over 1 HP PERMTf
NOTICE O ICANT: 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. Hid _ Fan _Other_ CITY Tel. No. .G
LICENSED CONTRACTORS DECLARATION LICBJSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Dlap. _ Room Air Cond. RfIS NUMBER Class.
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO. BY
and Professions Code,and my license Is In full force and effect. Power Apparatus 8 Large Appliances
/ 'j fi /� ��� Size 8 Type HP, KW, KVA, or KVAR'
License Numb`✓/ Llc. Class / ��+U`p to 1 Incl. FINAL V
�/' -Over 1 to 10 Incl. DATE —�� VALIDATION 0
Contra mat Over 10 to 50 Incl.
❑ FINAL G
I am exempt under Sec. Over 50 to 100 Inc. BY - �� �►+
B.BP.C. for this reason Over 100 n Z
Date: Services, Swbd., MCC 8 Ponelboards .l r
0 -200 Amp. Under 600 V
Signaturn 201 - 1000 Amp. Under 600 V
❑ Over 1000 Amp. or Over 600 V
Exemption for R/, w
int. Elect.
E FAMILY Temp. Power Pole 8 Appurtenances 3 5 9.7 A
HOME OWILDER DEC TION Sign with One Branch Circuit
I hereby afflrm that I ampt from a Contractor's License $ o o o o o 2
Law for the followingn (Sect] 7031.5, Business and
Additional Sign Branch Circuits
Professions Code):
❑ I, as owner of ps , will do the work and theMlsc. Condulb 8 Conductors �,° °
structure Is not or offered for saie (Section Other (See Complete Fee Schedule)_ a.2 — U
7044, Business Ions Code}.CONSTRLENDING AGENCYI hereby afflrm that th construction lending agency forthe performance of k for which this permit is Issued PERMIT FEE (Sub-Total)
(Sec. 309ZNom
PLAN CHECKING FEF
Lender's PERMIT ISSUING FEE /O
Lender'sI certify read this application and state that theTOTAL Fffabove Incorrect. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby authoriz representatives of this County to enter upon
the ov za
perty for Inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Dater