HomeMy Public PortalAbout9941 GARIBALDI AVE_Electrical__ 76AG63-CE806 3-69 / '
APPLICATION FOR ELECTRRII- �A � MITZ
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING / /'
BUILDING AND SAFETY DIVISION ADDRESS (y
le, L3RL- Dl
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY
4 C4
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. f C
NO. EACH FEE
$ $ OW NER
RECEIPT.
MAIL / L ,
LIGHT_� TOTAL FIRST 20 .20 O ADDRESS i
/ CITY TEL. NO., 7
SWITCH-_t— �/ OVER 20 •10 PLAN CHECK
LIGHTING TOTAL FIRST 20 .20 L APPLICANT
FIXTURES } OVER 20 •10 ADDRESS
RANGE_DRYER_WTR. HTR. CITY TEL. NO.
STA. COOK_DISP. F.A.U. CONTRACTOR
SPACE HTR._AIR COND. ADDRESS LFN
kjRCLOTHES WASH._DISHWASH. CITY TEL.N0. 77
FAN_OTHER 1.00 LICENSE O,. / CLASS.7 X7 Q
MOTORS,TRANSFORMERS RATING I HEREBY ACKNOWLEDGAG/T A I HA READ THIS APPLICATION
IND. HEATERS, ETC. HP. KW. KVA. AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
SIZE & TYPE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING.
0 - 1 1.00 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATEOF
1 - 10 3.00 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. O
10 - 50 5.00 V
SIGNATURE �
50 - 100 10A0 OF PERMITTEE O
U100 - SOO 15.00 DISTRICT NOj>, GRO ZON PRO ES D B �
G^/o/� / �l.l
SIGN,GAS SIGN AND ONE CIRCUIT 3.00 ` N
TUBE, OR -- - Z
MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES: �� -
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 G
SERVICE OVER 600 VOLTS OR 200 AMP 5.00 r
TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE
TEMP. POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
WIRING
PERMIT FEE (SUB TOTAL) FIXTURES
POWER AUTHORIZED
PLAN CHECK FEE (50% PERMIT FEE)
PERMIT ISSUING FEE 2.00 0-0 UTILITY CO.NOTIFIED
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL
TOTAL FEE 4to JOSEPH C. ROOHAN
SUPERVISING ELECTRICAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CAS14
Ar, 6376c-_ 19 2 0 6.40~
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHFDULF
WORKERS'COMPENSATIbNDECLARATION CE-88M -80) APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate 'of consent to self COUNTY OF LOS ANGELES WILDING AND SAFETY
insure, or a certificate of Workers'Compens[tlon Insurance,or
a certified copy thereof(Sec. 3800,Lab.C.)
FOR APPLICANT TO FILL IN JOB
Policy Na. Company New Residential 81 EACH NO. FEE ADDRESS
0 dgs.&Pools `
Certified Copy is hereby furnished. 1 &2-Famlly,Sq. Ft. _ — = LOCALI
MultlNEARE
Certified copy b filed with the county building W Residential
Sq. Ft-
p g pectlon CROSS ST
department Rssldentlal Swiminlnq Pools OWNER OR
OILCC FIRM NAME
E Date App& utiets: Rec"LLlghtJ Sw.� MAIL
C' —Flrtt 20 ADDRESS
CERTIFICATE OF EXEMPT-40N FRO RKERS' Total No. Additional CITY Tel No.
COMPENSATION INSURANCE PLAN CHECK
I' (This section need' not be completed if the work invotved APPLICANT S
LTghting Fixtures First 20 U
by the permit Is for one h dotlara ($100) or less) ADDRESS
Total No. Additional 0
I certify that in the performance of the work for which this CIT1) C Tel No _
permit is Issued, I shall not employ any person its any manner Fixed Appllerices Not Quer 1 HP
PERM W
so as to become subject tq the Workpn' Compensation Laws. Renge� r HeateD.W. _ CAN.
Oven Dryer_W.M._ ADDRESS
Date Applicant Top _ FAU _W.H.
Hood Fen _Qth@r_ CITA Tel No.
NOTICE TO APPLICANT: If, 4fter making this Certificate of Disp. _ Room Air Cond� LICENSE
Exemption, you should become subject to the Workers' REP.NUMBE Class
Compensation psoVWons of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROC SSED BY
with compl3, with such provtsions or this permit shall be
deemed revoked Site&Type HP, KW,KVA,or KVA
Up to 1 Incl.
FINAL
I' Over A to 10 Incl. DATE
LICENSED CONTRACTORS DECLARATION Over 10 to 60 Incl. r VALIDATION
II hereby affirm that I am licensed under provisions of Chapter T Over 60 to 100 Inc. FINAL
' 9•(commencing with Section 7000)of Division 3 of the Bust- Over 100 BY
nass and Professfons.Code, and my license L in full force and
effect. Services
0-200 Amp.Under 600 V
License Number Lie.Class 201-1000 Amp.Under 600 V
' Contractoi!]KK 71% ate — — Over 1000 Amp.or Over 600 V
HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances
I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit 1 9 1 1 A
License Law for the following reason (Section 7031.5, Buss- Additional SI Branch Circuits
ness and Professions Code): o I ro'o 0 0 2
I, u owner of the ro Misc.Conduits&Conductors
p perty, wiII do the work and the Other (See Corrolete Fee Schedule)—
structure L not Intended or offered for sale (Section I °j° 2.a 5.0
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY 10;0 ° 2 8'5 0'5
I hereby affirm that there Is a construction lending agency 2 2 3-S
for the performance of the work for which this permit Is PERMIT FEE (Sub-Total) 4
issued(Sec. 3097,Clv.C.).
Lender's Name PLAN CHECKING FEE (One-Fourrh permit Fee)
Lender's Address PERMIT ISSUING FEE In
i
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 euthorlse representatives of this County to enter upon
tis above-mentioned pro orn purposes. SEE-REVE(LSE FOR EXPLANATORY LANGUAGE
Signature of ices Data
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