HomeMy Public PortalAbout9659 GARIBALDI AVE_Electrical__ 7SA441C_ CUS"O,111/75 APPLICATION FOR ELECTRICAL PERMIT
BUILD�ABAFZTY DIVI81
FOR ArrUCAPIT TO FILL IN JOB 1�'
� New Residential Bldgs-&Pools EACH NO. FEE
AD REBS 1 d
1 &2 Finally Sq. Ft — $ LOCALITY re164,1171t IS
Multi-family Sq. Ft — NEAREST
I Re>tfdentlel Swimming Pools CROSS ST.OWNER OR
IRM NAME r� e
Outlets: Light,Switch&Receptacle MAI L s
ADDRESSFirst h G
20
Addi Ib ��O �a
� Additlbnel CITY �'MA. � [ Tal. No. /ti•cJe7
PLAN CHEC
Lighting Fixtures APPLICANT
First 20 ADDRESS
Additional
CITY Tel. No.
PERIT
Flxdd Appliances Not Over 1 HP APPLICANT ;4fDt'NJ ICf C4'j C
Range_ Heater_ D.W. /ADDRESS 0 IS ld �1
Ogen Dryer W,N&
Top FAU W.H. CITY QIe--14!J Tel. No. �. 0 hp a
Hood Fen LICENSE OR r1 Q p
Disp. AC REG. NUMBER Z_ CI U
1 HEw EET ACmmOWLEDOA THAT 1 HAVE READ THIS APFL+CATION 0
n.��� AND ■TAT■ THAT THE AEOVE f■ COww ECT AHD AOR« TO COMPLY Fes'
row Apparatus& Large Appliances AIT. ALL COUNT`/ OR DINANOE■ AND STATE LAWS. RWOULATINS (W�
Size&Type HP,, KW, KVA,or KVAR ELAcT"'r_6AL
Up to 1 Incl. I HEREBY Cf<RTIFY THAT I AY MOPERLY REOISTEw ED AND/OR
1 to 10 Incl. 1-10 UCENSED AS RESIU."D ■Y LO■ NEtLE■ NTT Amb STAVE OF
GUFORNIA OR TH 1 AY OS LAOAL R OF THE AEQVE
Over 10 to 50 loci. pESCRISED IIESID L 1 RofE Y.
Over 60 to 100 Incl. p[RMITCC
Over 100 SIGMATUR
DISTRICT N � D B
Services
0-200 Amp. Under 800V "
201 - 1000 Amp. Under 600 V APPROVAJ..S DATE
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) UTI LITY CO.NOTIFIED
PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL
PERMIT ISSUING FEE
NOTES
TOTAL FEE
PLAN CHECK VALIDATION CK. M.O. CASH PER CK. M.O. CASH
- r-
5 1 9r--AUG -SO 2 ® 13.50A-98
RATION
:ir r I h&4y affirm tthatCOMPENSATION
Ihave a cerrtificatteeAoff consent to self DPW 3/97 APPLICATION FOR ELECTRICAL PERMIT
Insure, or a certtflcate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS O
or a certified copy thereof (Sec. 3800, Lab. C.)
Po ry No. Company FOR APPLFUNT TO RLL 1N JOB / J
Certified copy Is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE A b tj
R►
❑Certlfied copy Is filed with the county building Inspec- 1 8 2-Family, Sq. Ft. $ — $ LOCALITY
tlon department. Multi-family Sq. Ft. NEAREST
cRcss ST. E'
Date Appllcant Residential Swimming Pools I
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RUS � MAIL
COMPENSATION INSURANCE ecghtw. 2 ff
(ten
Flet 20 J
(This section need not be can Ploted if the Work Imofved by Total No. f Additional CIN Telri&m . No. (�
the permt!Is for one hundred dollars (:100)or less.) RAN o-EOC
I certify that in the performance of the work for which this
permit Is Issued, I shall not employ any person In any manner
so as to become subject to the Workers'Compensatidn Laws. Lighting Fixtures First 20 ADDRESS
Additional
,.s Total No.�_ GTY Tel. No.
Datil 'e Applicant Fixed Appliances Not Over 1 HP p�T
NO T APPLICANT: If, after making this Certifica of APPLICATN
Exemption, you should become subject to the Workers' Range— Heater—D.W. IO
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. Hood — Fan —mer— CITY Tel. No.
LICENSED CONTRACTORS DECLARATION UCENSE OR
Dlsp. — Room Air Cond. NUMBER Class.
i I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. BY a
and Professions Code,and my license is In full force and effect.
Sian 8 Type HP, KW, KVA or KVAR �/� O
License Number .—Llc- Class Up to 1 Incl. FINAL U
Over 1 to 10 Incl. DAAV T10N I—zf—l�;� O
Contractor D"te Over 10 to 50 Incl. Fl
N.
❑ I am exempt under Sec Over 50 to 100 Inc. BY U
W
B.BP.C. for this reason Over 100 CL
Services, Swbd., MCC b Panelboards z,
Date: Z
0-200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600V
❑ Exemption for Reg. Malnt. Elect. O'er 1000 Amp. or Over 600 V Q 6 3.8 A
SINGLE FAMILY Temp. Power Pole&Appurtenances # o 0 0 0 0 2
HOME OWNER-BUILDER DECLARATION
I her arm that I am exempt from the Contraors Llceme Sign with One Branch Circuit
Law hereby ct
the following reason(Section 7031.5, Business and Additional Sign Branch Grcults ( ° - 2625
Professions Code): 2 6 2 5
❑ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors
structure Is not Intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ ► o 9. 0 9-8 8
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, Clv. C.).
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE u
Lenders Address
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 prop4irty for Inspectlon purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date
t.