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HomeMy Public PortalAbout5130 GLICKMAN AVE_Electrical__r . I, 76"66-';ct-;soG5io-59 APPLICATION FOR ELECTRIC PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING �--�3 D �p�i BUILDING AND SAFETY DIVISION ADDRESS K a JOHN A. LAMBIE, COUNTY ENGINEER WILLIAM A.JENSEN,SUPle- FOR T OF BUILDING LOCALITY /'� A-F /S /C FOR APPLICANT TO FILL IN NEAREST �? PERMT FEES CROSS ST. e e- G)< S �d ITEM NUMBER EACH FEE OWNER GI N MAIL f J OUTLETS. S $ $ .O ADDRESS S- /O 4v LIGHTS RECEPT. W. .10 � LIGHTING FIXTURES 10 /G CITY re a a! e-- TEL.NO. /'f, /`' 9y ELEC.RANGES CLO.DRYERS ELECTRICIAN Cl .' u 9 ✓ L_/eC'- WATER HEATERS .50 ADDRESS ELEC.SPACE HTRS. DISHWASHERS CITY TEL. NO. GARBAGE DISPOSERS AUTO.- STATE WASHERS STA.COOKING UNITS .25 LICENSE NO. MOTORS: OVER INC. H.P. DISTRICT NO. I GROUP Z.PNF4S D BY 0— 1/2 .25 � oe 1/2— 2 .50 INSPECTION RECORD 2— 5 1.00 5— 15 1.50 IS— 50 2.50 50-200 5.00 SIGNS: NO.TRANS. NO.LAMPS SERVICE 0-600V 1.00 :zfl SERVICE OVER 600V 5.00 { MISC. -���. �:1'. i WIRINGPERMIT 1.00 d� FIXTURE PERMIT 1.00 Q�, SUPPLEMENTARY PERMIT .50 TOTAL FEE S IH ACKNOWLEDGE THAT 1 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 I AM PROPERLY REGISTERED AND/OR WIRING LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT �AMHE L OF THE ABOVE DESCRIBED RESIDE A POWER SIGNATURE UTILITY CO.NOTIFIED OF PERMITTEE - f FINAL OF A IDATION ARTHUR C.VEIT, MO CASH SUPERVISING ELECTRICAL ENGINEER CK 7 O 30 47 2 A 2.20 / y 26A666-CES064-60 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A.LAMBIE, COUNTY ENGINEER wr WILLIAM A. JENSEN, SUP'TOF BUILDING LOCALITY (� FOR APPLICANT TO FILL IN NEAREST Ross sT, PERMIT FEES OWNER E►P_ �✓ 1 TE M NUMBER EACH FEE MAIL OUTLET . ` c1!i $ $ /11 ADDRESS LIGHTS RECEPT - SW./ _1_ •10 (J ' � CITY TEL.NO. LIGHTING FIXTURES 1 .10 C. R GEjj. CLO. DRYERS ELECTRICIAN yu _ d WATER H EATERS .50 ADDRESS t� f C> ELEC.SPAC ISHWASHERS CITY TEL. ARBAGE DISPOSERB AUTO.- STATE LICENSE NO. WASHERS STA.COOKING UNITS ! .25 MOTORS: OVER INC. H.P. +� DISTRICTN GRQUP Z E PRO SED BY - 2 INSPECTION RECORD ,/2 50 2 5 1.00 _Lti."�f-t'"! O 5 15 1.50 U i5 — 50 2.50 Q H 50 — 200 5.00 U W NO TRANS. O_ SIGNS: N NO. LAMPS Z SERVICE 0.600V 1.00 SERVICE OVER 600V 5.00 misc. WIRING PERMIT 1.00 �Q FIXTURE PERMIT 1.00 0-la) SUPPLEMENTARY PERMIT .50 TOTAL FEE IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS 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 �+ 1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR - LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES "- CALIFORNIA OR THAT 1 AM THE LEGAL O}(�NER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. ,AV POWER SIGNATURELGL/ UTILITY CO. NOTIFIED OF PERMITTE FINAL VALIDATION ARTHUR C.VEIT, i�, Ctc Mo CASH SUPERVISING ELECTRICAL ENGINEER % �.. J1_ affirm that COMPENSATION DECLARATION 76A663 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT O 76A663 I hereby affirm that I have a certificate of consent to self CE-806G insure, or a certificate of Workers' Compensati n Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a cert�� py,thf (Sec. 380`, La Policy N //l/L��� Company FOR APPLICANT TO FILL IN JOB ❑Certified copy is hereby furnished. ��� New Residential Bldgs. & Pools EACH NO. FEE ADDRESS jr _ LOCALITY ertified copy is filed with the c unty building inspec- 1 &2-Family, Sq. Ft. $ $ tion r t. Multi-famil S FT. NEAREST y q CROSS ST. Date Applicant Residential Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE ADDRESS First 20 A 4A y (This section need not be completed if the work involved by Total No. Additional CITY Tel. . G 9310 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 Lighting Fixtures First 20 ADDRESS so as to become subject to the Workers' Compensation Laws. Additional Total No. CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT IL NOTICE TO APPLICANT: If, after making this Certificate of APPLICATI N 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. LICENSED CONTRACTORS DECLARATION LICENSE OR Disp. — Room Air Cond. — ClaUZO 1 hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PRO ESSED BY and Professions Co� }nc(�y lic n is m full fgcge and effect. �l((jj(( cid Size &Type HP, KW, KVA, or KVAR ®� t� 0 License Numb Lic. Class Up to 1 Incl. FINAL U Over 1 To 10 Incl. DATE VALIDATION O Contractor Date Over 10 to 50 Incl. I~_ El tBY AL I am exempt under,Sec. Over 50 To 100 Inc. LU B.&P.C. for this reason Over 100 U) Services, Swbd., MCC& Ponelboards ® Z Date: Z 0-200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ElExemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole &Appurtenances j a HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 1 hereby affirm that I am exempt from the Contractor's License n_7 7 Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits �,i{;} _, Professions Code): I H M- Conduits&Conductors -75 ❑ I, as owner of The property, will do the work and The Misc. - s:' ..�� _ s structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)— )i•.1 t AL Business and Professions Code). ® C{'L' -F?= Y•HECK CONSTRUCTION LENDING AGENCYS;- �Itll I hereby affirm that there is a construction lending agency for / -CHAINGE the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) / (Sec. 3097, Civ. C.). PLAN CHECKING FEEI-i i?i0'= z L= Lender's Name i_ PERMIT ISSUING FEE -s 'y Lender's Address I certify that I have read this application and state that the TOTAL FEE above informs is correct. I agree to comply with all County ordinances a d S to laws regulating Electrical wiring, and hereby auth rize r res ntatives of this County to enter upon the ab ve- entio d p perty for inspecti n pure ses. SEE REVERSE FOR EXPLANATORY LANGUAGE ©s Signature of Permittee Date