HomeMy Public PortalAbout9658 GARIBALDI AVE_Electrical__ 76A663-CE806- ,.,, APPLICATION FOR ELECTRIC PERMIT 1
BUILDING AND SAFETY DIVISION
Department of County Engineer BUILDING /�jr
County of Los Angeles ADDRESS T!!�� lf��Tf�/
JOHN A. LAMBIE, COUNTY ENGINEER
CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN _F sT +U
PERMT FEES
OWNER /!✓�[/S
LIGHTS RECEPTACLES SWITCHES I
NUMBER 1 T E M EACH FEE MAIL
ADDRESS
TOTAL OUTLETS $ .10 S .�
ELEC. RANGES, WATER HEATERS, CITY _ TEL. NO.
CLOTHES DRYERS 'SO ELECTRICIAN
ELEC. SPACE HEATERS, STAT-Y. COOK-
ING UNITS, GARBAGE DISPOSERS, ADDRESS
AUTO WASHERS, DISHWASHER .25 / T�
LIGHTING FIXTURES ,10 CITY f.�/.��/� TEL NC r-p
MOTORS STATELICENSE NO.
HORSEPOWER
H.P. OVER INC. DISTRICT NO. GROUP I ZONE I READY FOR INSPECTION
S:LESS .25 '
1/2 — 2 .50 INSPECTION RECORD
2 5 1.00
5 15 1.50
15 50 2.50
50 200 5.00
MISC. -- j
SIGNS I NO.TRANS
NO.LAMPS
SERVICE O-600V 1.00
SERVICE OVER 600V 5.00
WIRING PERMIT 1.00
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .50 /j APPROVALS
TOTAL FEE V DATE INSPECTORS SIGNATURE
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THI A ICATION "Ll
/'AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY VWITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. -Z S1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFCALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPE _��'SIGNATURE --OF PERMITTEE
JOHN A. LAMBIE, ATION ARTHUR C. VEIT,
COUNTY ENGINEER O CASH
SUPERVISING ELECTRICAL ENGINEER
CK
0 0 6 5 0-11n JUL 2 5 2
WORKER3 GOfvll5Et18AllbN DECLARATION 10,81 APPLICAMON,FOR ELECTRICAL PERMIT
I N"by amrul tl,at r have a certlfloWe of ooneent to sex Insure, .
or a pwtfrlo&e of WIJt'kers' Ccnx)areation lnazamc%.or a certtW COUNTY OP LOS ANGELES BUILDING AND SAFETY,
' oo�y B,ereof(Sea-3800.1 ab C.)
r _
Poky tip ry FOR AmnJGANT TO FILL IF, ibe
�} Certified Dopy feB4Y furnished. - F EACH NO. FEE ADDRE86 (Q
�z+ Neh AasiC�mb l Wo,S Pude LOOAL.ffY
Certified copy is filed Wtth $,e obun y bU6dlrp lnepoc$ 1 4 2-Fatn1ty,SQ.Ft —
i ¢epertrr>�• Mufti-iamEy Sc.Ft — rtE�FtEST
De 1!ppllct Rgeldential 3wimmrng Poole qyp�
CERTWI,CATE'OF EXEMPTKDN FROM WORKERS" Outlet& Roo' Ltpht T�Svc-� � MAk
COM PFNSATI O I N$U RNJCE.
Mctlori nd;604 be cang*t/d H the work�mrofv�d by.the Prot
er20 CtLY Tel rJo
I k for one Ixrhdreq dolKm(S,1ob)or 1 .4-)
Total Na Ad�ftldael
I I oertlty that•An the'pertormenoe of the work roc,wbicfi ifiB permit APPUCANT.
Ip..ieahed I shall not ertrpft ary.panaon•In say.rn3naec b
Deoo7rie sub it,e,Wot#Cere' UQhdrp Fbduree Flyer 20 ADDFiES$ -
y o Adkfonai GtTY 7eL No.
Date 2Wd bo.
sd NOTICE Ak�RIjCANT4 ff,.ti af69t .rRaFdnG thb of f °
Not Over 1 HP PST
,Fximpd w,you'dhould bei.mp)9c#to ttle. s' R6ngb Neatw,_ P,W. _
prolWorm of,V-Labor C•o¢e,r—mvst brt�(Atteoanpfy' such. Oven Dr>w_ `IVJA. �_ ' ADDRESS
PM1. ' ,4r it,1e oermit'ahall be.deemed.rgvokad , .- top FA1J W.FL
CfTY Tel:Na
LJCf�J3ED 93NN T,A�[O•R3 DECL,A�i�T10M Hood Fan •T Other_ ",
I-h&Pb- affirm that I,,am-fbegeQii.,}rxlef prOvftr" of Chapter 9 _ QF
(comhwdrQ with Section 7000) of DMelon 3 of the Bueh,ees and p faoonl Alr Gond. FJ£(�N / C
Promesbre Code,and.my ko"le to cull force and WOOL ,. � Power Apparaiue d Larpe Applfancee
Y- �J �•-I •- Stre d •fyp9 H? Kw,KA br KW4R
uowl.sa. LkL Cieas � Up to 1.boL F1f�Ai' CCC��7
1 • q ^ Over-r jo 1.0 i ncL DATE .
' Contreofor Dpte / _
_ Over 1-0,{n 60 Y,o1' Fl
El 1 a,b.exempt undfir_sec Y . Over 6b.to-t00 h,c VA/IL
W
BARC,.Tor tHs reeaorl —7— Over 110.0 U
3Qrvbm SWbd.,MCC S Petielboerge , Z
ate 0-200 Amp.U,r d r e0D v
Slgnahre 20� 1064 Amp:Under eco V
Ov+sr 1000 Amp.or Over 800 V
Ezefpptlorr for Reg.Malt Elect. +y
SINGLE'FAMILY Temp,Paver.Poie d Appurtenances _ iy �+
110ME QWNFf BUILDER DECLAMATION sign wttb OmQ prarch Clrnutt - f]CCT.
I hereby affirm that I am exempt wort, the adore.LJoertae LRvv
for.the rdlowing reason ($ectia, 7p31.6, end ProtesdonaA&pfns Cimufta - 3307 t r"13.90
Gode
❑ 'J.as.ovshend tl1el Y wll do the work 13*tw dtruchre Mlsc a corduc �;yT�lt1 IiC]'tSi �}
he not intended or Werbd for Seip (SWiDh 7P44, BueJr,e�Q ��(�. ��S�te�T ti � 1 S 11t' 3*���`�
and Profe>aebrre Code).,,.
. •. . . - . . •ti �C�4. ,13.90
CONSTFdXT nLENDINO AGENCY LV
I hereby afflnn fhat thele Is A ion.fending age" for the O ■
00
perMdrMW"Of the Wor fbr whidh this permf(to kma (Seo.3067, Pf RWrf FEE
qv. c.). PtAN,CHEGfgNG FEE, Q -OOQ1 4/ 3190
Lendara'Narna
PERMfT I 11Ti8 FEE DO
9369 1 41 7&S5
L.eodels Addre�e
I certfry tf,af I have read thle appiloatbn end state that the above -- T0-p1L F _ ' _
Mormatbn Is coned. I agree to oompfy with,All County ordlnanoe4.
and State tawe reguiaffng E wlrtn4 and hereby euthortre _
representadwe of &ds enter upon the a xAo rnentionec"
SEE REVERSE FOR EXPLANACTf3R1f LANOUAOE -
!WORKERS'COMPENSATION DECLARATION 20-0°19DPW 31°7 7�, APPLICATION FOR ELECTRICAL PERMIT
affirm that I have a certificate of consent to self O
cF-0oeG
re, or•u certtflcate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
a certlfled copy thereof (Sec. 3800, Lab. C-)
s �
Pbllc No Company FOR AnLFCANf 70 PILL IN ADDRESS
��Certified copy Is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. Fff
bis
❑Certified copy Is filed with the county building Intpec- 1 8 2-Family, Sq. Ft. $ —Is LOCALITY �u
tion department. Multl-famlly Sq. Ft. NEAl�ST
CROSS ST.
Date Appllcant Realdentlal Swimming Pools
IRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Re•c Llght Sw._ MAIL
COMPENSATION INSURANCE ADDRESS
(This section rsoerd not be.completed If the work Involved by First ti CITY Tel. ¢¢
the permit Is for one hundred dollars(=100)or loss.) Total No. Additional ; p�$ a
I certify that In the performance of the work for which this PLANAPPLI� C-If 9 7�o
permit Is Issued, I shall not employ any Penson In any manner Lighting Fixtures First 20
so as to become subject to the Workers Compensation Laws. g n9 ADDRESS
pp �-y Additional
Data �� -6 —O/Applicant_�1�C�JL. (.-,� Total No. CIN Tel. No.
Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of APPLICATIONExemption, you should become subject to the Workers' Range— Heater—D.W. —
Compensation provlsions of the Labor e, you mutt 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 LNS
CEE OR
t I hereby affirm ffwt I am licensed under prcvRlons of Chapter 9 DIS' — Room Air Cond. — UMBER Class.
(commencing with Section 7000)of Divislon 3 of the Business Power Apparatus 8 Large Appllances DISTRICT B }
and Professions Code,and my license Is In full force and effect. d
I p� �.� Size 8 Type HP, KW, KVA, or KVAR i , _ n 0
OY
License Number (t /3 �8 Llc. Clars7s� �' o/ C Up to 1 Incl. FINAL U
Contractor �'aC` l!'/ cz.� n,,e Uhf, tr �O eer 1 to 10 Incl. �� j Z Z� VALfDATFON 0
❑ Over 10 to 50 Incl. I F-
I am exempt under Sec. Over 50 to 100 Inc. Fi U
Over 100 W
B.BP.C. for this reason d
_ \ , Z
11 Sary as, Swbd., MCC 8 Panelboards U
co
�• j�0-200 Amp. Under 600 V Z
Signature 201 - 1000 Amp. Under 600 V
❑ Over 1000 Amp. or Over 600 V
Exemption for Reg. Malnt. Elect.
SINGLE FAMILY }
Temp. Power Pole 8 Appenances
HOME OWNER-BUILDER DECLARATION urt
Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractors License AC.Cj.T
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Clrcults
Professions Code): B07 25.50
❑ I, as owner of the o Mlsc. Conduits 8 Conductors 1 ITE]'f5
prop", will do the work and the Oih&r �Complete Fee Schedule
structure Is not Intended or offered for sale Section 7W4, ( P , TOTAL 25-50
Business and Professions Code). 1'JI
CONSTRUCTION LENDING AGENCY CWV� 25.50
I hereby affirm that there Is a construction lending agency for .0119
the performance of the work for which this permit Is Issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE
Len �1 12/ 6/89
Lender's Name 1
Lender's Address PERMIT ISSUING FEE 7315 1 AM10:48
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-mentioned property for Inspection purposes, SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permlttea �� Date �s