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HomeMy Public PortalAbout5100 GLICKMAN AVE_Electrical__ J�l© o . Cat r�t►4 K °83-59 APPLICATION FOR ELECTRIC PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER f/ CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST PERMIT FEES CROSS ST. 1 T E M7, NUMBER EACH FEE OWNER ).. OUTLET $ $ MAIL LIGHTS ECEPT SW. .lO J �� ADDRESS LIGHTING FIXTURES 10 G� CITY TEL.NO. CLO.DRY ELECTRICIAN -(f 2 WATER HEATERS .50 / �) ADDRESS .SPACE H R3.-DISHWASHERS CITY TEL. NO. ARBAGE DIOBER AUTO.- STATE !� WASHERS STA.COOKING UNITS .25 LICENSE NO. MOTORS: OVER INC. H.P. DISTRI NO. I GROUP Z NE P CESSED BY 1/2— 2 .50 INSPECTION RECO 2— 5 1.00 5— 15 1.50 15— 50 2.50 �. 50-200 5.00 Y GW J SIGNS: NO.TRANS. A NO.LAMPS SERVICE 0-600V 1.00 SERVICE OVER 600V 5.00 / r MISC. /./ U WIRING PERMIT 1.00 4c, 7 o /a�,,/ - FIXTURE PERMIT 1.00 (� t.: ve'% Ai-/ C) 0 O SUPPLEMENTARY PERMIT .50 o �{' jr�:'f /- TOTAL FEE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT ELECTRICAL WIRING. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR WIRING LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES i CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. POWER SIGNATURE2 �� UTILITY CO.NOTIFIED OF PERMITTETr FINAL !' OF /VALIDATION ARTHUR C.VEIT, MO CASH SUPERVISING ELECTRICAL ENGINEER �c r f-c 16 1 2.10 2 q ,rvoxXle�tll I _ WORKERS'COMPENSATION DECLARATION 10/81 APPLICATION FOR ELECTRICAL PERMIT -� I hereby affirm that I have a certificate of cort;ent to self CE-806G �� insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES � BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN 'OB ` , Certified copy is hereby furnished. New Residential Bldgs. & Pools N EACH NO. FEE ADDRESS 100 r " Y 2-Famil . q• Ft: $ $ LOCALITY S _ Certified copy is filed with the county building inspec- 1 & tion department. Multi-family Sq. Ft. CROSS ST. Date Applicant Residential Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec�Light _� Sw.� MAIL COMPENSATION INSURANCE t� ADDRESS S First 20 (This section need not be completed if the work involved by Total No. Additional CITY Tel. No. WOQ the permit is For one hundred dollars ($100)or less.) PIAN CHECK I certify that in the performance of the work for which this APPLICANT �UA , Leo 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 `3 a ADDRESS _ Total No.- Additional CITY Tel. No. DateA Applicave ixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, aft ma Ing this Certi is of APPLICANT S Exemption, you should become subject to the Workers' Range_ Heater—D.W. — 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 _Other CITY Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR 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 DISTRICT NO. " PROCES ED BY and Professions Code,and my license is in full force and effect. Power Apparatus & Large Appliances .LaL-' �'� d Size &Type HP, KW, KVA, or KVAR' .S. O License Number Lic. Class Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE VALIDATION 09 Contractor DateOver 10 to 50 Incl. f 7 El FINAL I am exempt under Sec. Over 50 to 100 Inc. BY �j CLU L B.&P.C. for this reason Over 100 Z Date: Services, Swbd., MCC &Panelboards 0 -200 Amp. Under 600V �230,9A Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V 0,0,o o m 2 Exemption for Reg. Maint. Elect. 225,2,5 SINGLE FAMILY Temp. Power Pole &Appurtenances . . ' HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit o o.0 2 5,2 5 I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and 0 7.0 2 e 8`4 Professions Code): LtrlJ( I, as owner of the property, will do the work and the Misc. Conduits&Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ 7044, 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, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the TOTAL FEE y 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 nw al 71-4--84 ignoture of Permittee V Date