HomeMy Public PortalAbout4851 GLICKMAN AVE_Electrical__ 76A663-CE806_9, APPLICATION FORE C T R I C PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING -�
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A.LAMBIE.COUNTY ENGINEER �r
CASSATT D.GRIFFIN.SUPT OF BUILDING LOCALITYNEAREST
FOR APPLICANT TO FILL IN CROSS ST.
PERMIT FEES q�/
ITEM NUMBERI EACH FEE OWNER ®
OUTLETSL. $ $ MAIL
LIGHTS ff
ADDRESS
LIGHTING FIXTURES C .10 CITY TEL.NO.
ELEC.RANGES CLO.DRYERS ELECTRICIAN
WATER HEATERS .50 A D D R ESS
ELEC.SPACE HTRS. DISHWASHERS
GARBAGE DISPOSERS AUTO.- STATE
CITY Gr.� +� TEL./N O. L1I .'�C
WASHERS STA.COOKING UNITS .25 LICENSE NO. . 47 �✓ L'iL-�
MOTORS: OVER INC. H.P.
DISTRICT G5?14P Z NE R A o N PEC
O — 1/2 .25 11 I
of /
1/2 — 2 .50
INSPECTION RECORD
2 — 5 1.00
5 — 15 1.50
15 — 50 2.50
50— 200 5.00
SIGNS: NO.TRANS.
NO.LAMPS
SERVICE 0.600V 1.00
SERVICE OVER 600V 5.00
MISC.
WIRING PERMIT 1.00
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .50'
TOTAL FEE g APPROVALS
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING r r
1HEREBY CERTIFY THAT I AM PR 1`.REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ES COUNTY.AND STATE OF FIXTURES
CALIFORNIA OR THAT I AM OWNE OF THE ABOVE POWER
DESCRIBED RESIDENTIAL /
SIGNATURE ,. 4- UTILITY CO.NOTIFIED
OF PERM ITT FINAL
�ATION SUPE UR C.VETT.
CK Mo CASH SUPERVISING ELECTRICAL ENGINEER
1
I
WORKER'S COMPENSATION DECLARATION 9 DPW 9/89 APPLICATION FOR ELECTRICAL PERMIT
76A66
I hereby affirm that I have a certificate of consent to self insure, 76A663
or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec. 3800 Lab. C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB
ADDRESS
Certified co Is hereby furnished. EACH NO. FEE
PY Y New Residential Bldgs.&Pools $Ft $
Sq. .El LOCALITY
—
Certified copy is filed with the county building inspection 1 &2-Family, NEAREST
department. Multi-family Sq.Ft. CROSS ST.
Date Applicant Residential Swimming Pools ASSESSOR
MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec. Light Sw. OWNER OR
FIRM NAME
COMPENSATION INSURANCE
(This section need not be completed if the work involved by the First 20 MAILADDREss
permit is for one hundred dollars($100)or less.) Total No. Additional
I certify that in the performance of the work for which this permit CITY Tel.No.
is issued, I shall not employ any person in any manner so as to PLAN CHECK
become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT
Total No. Additional
ADDRESS
Date Applicant 15 OR 20A,120V BRANCH CIRCUITS
NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No.
Exemption, you should become subject to the Workers'Compensation 1 TO 10 INCLUSIVE EACH
provisions of the Labor Code, you must forthwith comply with such 11 TO 40 INCLUSIVE EACH PERMIT
APPLICANT }
provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH d
LICENSED CONTRACTORS DECLARATION ADDRESS O
I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH U
(commencing with Section 7000) of Division 3 of the Business and CITY Tel.No. W
Professions Code, and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR J
Gass.
Power Apparatus&Large Appliances REG.NUMBER LL
License Number Lic.Class Size&Type HP,KW,KVA,or KVAR DISTRICT NO. PROCESSED BY
Up to 3 Incl. Q
Over 3 to 10 Incl. FINAL )Z
Contractor Date DATE
Over 10 to 50 Incl. d
I am exempt under Sec. Over 50 to 100 Incl. VALIDATION
B.&P.C.for this reason Over 100 FINAL
ev LLJ
Services,Swbd.,MCC&Panelboards
Date: 0-200 Amp.Under 600 V
Signature 201 -1000 Amp.Under 600 V
❑ Over 1000 Amp.or Over 600 V
Exemption for Reg.Maint.Elect.
SINGLE FAMILY Temp.Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits
Code):
I, as owner of the property,will do the work and the structure Misc.Conduits&Conductors
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) ,
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 (Sec. 3097, PERMIT FEE (Sub-Total)
Civ. C.)
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE S
Lender's Address
I certify that I have read this application and state that the above TOTAL FEE
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 APPLICANT OR AGENT DATE