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HomeMy Public PortalAbout5021 GLICKMAN AVE_Electrical__ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of County Engineer �������� DIVISION OF UILDING & SAFETY WILL[ FOX, County Engineer FO PLICANT FILL IN DISTRICT NO. GROUP' ZONE PERMIT NO. ELECTRICIA `�— / A / �T��/ - R CEIVE BY READY FOR DATE IMUED ADDRESS ^1Z -�(// -� FIRST INSPECTION CITY ,C:.! TEL NO. T.SD !,/G��v �'`,'- .. � COUNTY LICENSE NO. ,'' " EXPIRES 0 BUILDING PERMIT FEES ADDRESS !r NU ER EACH FEE LOCALITY _ _717 C LIGHT OUTLETS NEAREST RECEPTACLES CROBB ST. WALL SWITCHES OWNER TOTAL OUTLETS 5c $ MAIL ELEC. RANGES 25 ADDRESS ELEC. HEATERS 25 CITY TEL. NO. FIX}URES S 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE 19 CORRECT NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. MOTORS 1 CERTIFY THAT 1 OBSESS THE ABOVE VALID L05 NUMBER HORSEPOWER FEE ANGELES COUNTY ENSE, OR 1 AM THE LEGA OWNER NEw MVD. HP OVER INC. EACH OF THE RESIDENT PROPERTY ESCRIBED ABOV I/2 a LEES $ .25 SIGNATURE OF 34�^" „ I/2 2 .50 PERMITTEE 2 5 1.930 INSPECTION RECORD 5 15 1.50 15 50 2.50 SO 200 5.00 200 500 10.00 __ J 500 1000 15.00 Q _ Z OVER 1000 20.00 (� _ M.G. HET/FREQ. CHANGER-HP Q' WELDERS: AC-KVA O GENERATORS - KW TRANSFORMERS - KVA _ TEMP. MOTORS (75% OF ORIG•) MOVED MOTORS (75% OF ORIG.) _ MISC. SIGNS NO. NO.TRANS. APPROVALS NO. NO. LAMPS — FOR EACH PERMIT: DATE INSPECTOR'S NAME_ WIRING $1.00 CONDUIT FIXTURES $1.00 WIRING r" !• - ' FIXTURES SUPPLEMENTARY .50 POWER TOTAL FEE / UTILITY CO.NOTIFIED ✓✓✓ FINAL 76A663 DBS#5A 4-52 Fl, COUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of County Engineer ELECTRIC 1 DIVISION O BUILDING & SAFETY WILLI J. FOX, County Engineer "1P6 I DISTRICT NO. GROUP I ZONE PERMIT NO. FO PPLICAN TO j IN k�r O ELECTRICI ,art; a RECEIVED BY READY FOR DATE ISSUED ADDRESS / Y s ,M[' FIRST INSIDE TION fJ �, CITY ,/ _TEL. N d� ``'` _ :> I •J COUNTY LICEN9E NO. BUILDING PERMIT FEES ADDRESS q '"` �c•' .+��-4` NUMBER EACH FEE LOCALITY LIGHT OUTLETS NEAREST / CRDeB RECEPTACLES ' �ej WALL SWITCHES .� OWNER b6' TOTAL OUTLETS 5O $ (. MAIL ELEC. RANGES 255 ADDRESS ELEC. HEATERS 25 CITY TEL. NO. FIXTURES 3 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWN REGULATING ELECTRICAL WIRING. MOTORS I CERTIFY THAT I POSSEBN THE ANOVE VALID LOS NUMBER I HURSEPOWE1FEE ANGELES COUNTY ENHE, OR 1 AM THE LEGAL OWNER NEW MVD. HP OVER INCEACH OF THE RESIDENT _L.,PROPERTYoODEaCRISED ABOVE BINNATURE OF %2 Z 60 PERMITTEE ' —� _- N 1'013 INSPECTION RECORD A 16 t.so is 50 /C' .sD 60f 200yyk`'. 1500,, _10.00 -J 1 5130- 11`7`1'7'0 15.00 z O4 Il00VI 20.00 0 t SFT/FREQ. CHI AGER-HP WELDERS:AC-KVA I O GENERATORS - KW TRANSFORMERS - KVA _ TEMP. MOTORS (75% CF ORIS.) MOVED MOTORS (75% OF ORIG.) MISC. SIGNS N0. NO.TRANS APPROVALS NO. NO.LAMPS FOR EACH PERMIT: DATE INSPECTOR'S NAME WIRING $1:00 yvsl CONDUIT _ FIXTURES $1.00 WIRING SUPPLEMENTARY .50 FIXTURES f] POWER TOTAL FEE 8 /1 UTILITY CO.NOTIFIED ��— �� FINAL 7GA663 DBS#5A 4-52 affirm irmthat ECOMPENSATION DECLARATION 76A663 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT O I hereby athat I have a certificate of consent to self CE 806G insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lab. ) Policy No. Company FOR APPLICANT TO FILL IN JOB ❑Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESSC3 _ 'I1�[IL�,Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ LOCALITY , T"tion department. y//j �� Multi-family Sq. Ft. — NEAREST CROSS Date —Applicant -Ili / Residential Swimming Pools OWNER SOR' T. Ips o PF r FIRM NAME Ci CERTIFICATE OF EXEMPTION FR M WORKERS' Outlets: Rec Light 1 Sw.� MAIL �. COMPENSATION INSURANCE ADDRESS z ��,Q First 20 ' (This section need not be completed if the work involved by Total No. Additional CITY J Tel. IN the permit is for one hundred dollars ($100)or less.) PLAN CHECK I certify that in the performance of the work for which this APPLICANT 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 Additional d� � Date Applicant Total No.. CITY Tel. No. NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range— Heater—D.W. — APPLICATION ` Compensation provisions of the Labor Code, you must forth- Oven —. Dryer =W.M.— ADDRESS '1/17/ s with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. CITY Cz_ Tel. No. Hood Fan —Other— LICENSED CONTRACTORS DECLARATION LICENSE OR --� _G- I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. — REG. NUMBER Class. (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY and Professions Code,and my license is in full force and effect. �• Size &Type HP, KW, KVA, or KVAR / U License Numbed f 1J Lic. Class Up to 1 Incl. FINALDATE Com/ U Over 1 to 10 Incl. r VALIDATION Cc Contractor Date l Over 10 to 50 Incl. FINAL O ❑ r / I am exempt under Sec. Over 50 to 100 Inc. BY . 4 U dB.&P.C. for this reason Over 100 � Services, Swbd., MCC& Panelboards Date: 0-200 Amp. Under 600 V Signature. 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole&Appurtenances y HOME OWNER-BUILDER DECLARATION r I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit _ Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): ❑ Misc. Conduits&Conductors I, as owner of the property, will do the work and the t 4 structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ '=-_ Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency forthe performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE U Lender's Address I certify that I have read this application and state that the I TOTAL FEE , o above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby a rize represent Lives of this County to enter upon thea mentioned pr rty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Wo Z�_-44iC/ ignat re o Permittee 4/Aate ©s �I WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that 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.) P❑OIICy N0. Company FOR APPLICANT TO FILL IN JOB ADDRESS 16ZI21 GSC% "LG Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY 1 &2-Family,Sq.Ft. _ $ $ Cert'f' d copy is filed with the county building inspection NEAREST de toren. Multi-family Sq.Ft. CROSS ST. C Residential SwimmingPools ASSESSOR Date !� Applicant MAP BOOK PAGE PARCEL' CERTIFICATE OF EXEMPTIO FROM WORKERS' Outlets:Rec._Light Sw. OWNER OR COMPENSATION SURANCE FIRM NAME J First 20 MAIL (This section need not be completed If the work involved by the permit is for ADDRESS Total No. Additional one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITY erj Tel. ,^�U 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 / /�'(//, r Total No. Additional ADDRESS DateL r `�r ' f Applicant v RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this C tificate of CITY LG / 2 el.No. Exemption,you should become subject to the Workers' Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code,you must forthwith comply with such PERMIT P Y P Y provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I amlicensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000) of Division 3 of the Business and CITY ;�� z Tel.No.�la�r j Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR J Over 50 to 100 Ind. REG.NUMBER �� ClasR a Over 100 DISTRICT NO. P O ESSED BY O License Number (((/ (rAJ JLic.Cla s D� 0 e Ser v' es d.,M C&Panelboards Z' Z �� � FINAL Contractor Sir / Date 0-399 Amp.Under 600 V DATE / o ❑ 40 - Amp.Under 600 V VALIDATION V I am exempt under Sec. UJI Over 1000 Amp,or Over 600 V FINAL B.&P.C.for this reason BRANCH CIRCUIT FEES BY Date: 15A,or 20A,120V,Lighting or Recept. 6 ti_ 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits - Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances A ^ Q HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law -S} �_, for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): r j,;t�= Misc.Conduits&Conductors - - El I,as owner of the property,will do the work and the structure 3 S E M di— is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). , ;HE'C'K CONSTRUCTION LENDING AGENCY 're'e'te3•_::_ 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.) .)'s t ®/ / PLAN CHECKING FEE e= '- '-4101 V Lender's Name � r AtR-;s o PERMIT ISSUING FEE �� d __ _ t..e L_ s Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE that the 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 inspegtion purpose SEE REVERSE FOR EXPLANATORY LANGUAGE - � y NATU OF P RMITT DATE WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) 76A663 APPLICATION FOR ELECTRICAL PERMIT I hereby a:MFm.that have a certificate of consent to self insure, 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 F1 'y Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY ❑ 1 &2-Family,Sq.Ft. _ $ $ Certified copy is filed with the county building inspection NEAREST de ar men q.Ft. CROSS ST. Date ' G A licant Residential Swimming Pools ASSESSOR PP PAGE 1PARCEL CER IFICATE OF EXEMPTION F OM WORKERS' Outlets:Rec._Light / Sw' 1 OR l� ^ COMPENSATION INSURANCE Or RM NAME r� First 20 MAIL (This section need not be completed if the work involved by the Total No.-t2!?_ Additional ADDRESS D2f LZC_ `VL'Lf permit is for one hundred dollars($100)or less.) CY I certify that in the performance of the work for which this permit CITY �•��( 7e1.No. '�a3 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 RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT-: If, after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers' Compensation OTHER APPLIANCES NOT OVER 3 HP. . provisions of the Labor Code,you must forthwith comply with such PERMIT 7— p, Y P Y LICANT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances LICENSED'CONTRACTORS DECLARATION Size&,�T..,,ype�/kisP✓✓KW,KVA,or KVAR p ADDRES "," 0-14 A l-a— I hereby'affirm that I am licensed under provisions of Chapter 9 �/U Over 3to10Incl. /a CITY (commencing with Section 7000) of Division 3 of the Business and Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR >_ Over 50 to 100 Incl. REG.NUMBER J �-✓� Class. („•—'L�, a /y Over 100 DISTRICT NO. RWSSED BY 0 License Number Lia Class 2V �-- ✓L� U Services,Swbd.,MCC&Panelboards Q W_ Contractor dr" Date 7, 0-399 Amp.Under 600 V DATE 400-1000 Amp.Under 600 V ❑ I am exempt under Sec. VALIDATION Over 1000 Amp.or Over 600 V FINAL -B.&P.C.for this reason BRANCH CIRCUIT FEES BY U) Date: 15A,or 20A,120V,Lighting or Recept. 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits W Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 1 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) - "L75 and Professions Code). CONSTRUCTION LENDING AGENCY n�,11 G I hereby affirm that there is a construction lending agency for the' performance of the work for Vhich this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ.C.) -- PLAN CHECKING FEE Lender's Name // - ( ` PERMIT ISSUING FEE Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE that the 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 fo s ecti oses. SEE REVERSE FOR EXPLANATORY LANGUAGE 6 7 TURP OP P RMITTEE ATE