HomeMy Public PortalAbout5319 GLICKMAN AVE_Electrical__ 76A663C- CE806B'I8/75 APPLICATION FOR ELECTRICAL PERMIT
BUILDING AND SAFETY DIVISION Al
FOR APPLICANT TO FILL IN JOB �� �?
EACH NO. FEE ADDRESS s
New Residential Bldgs.&Pools ,9 (/
1 &2 Finaily Sq. Ft. $ — $ LOCALITY � !
MUlti-family Sq. Ft. — NEAREST
CROSS ST.
Residential Swimming Pools OWNER OR � pp
FIRM NAME IdL� ��
Outlets: Light,Switch&Receptacle MAI L
ADDRESS
First 20
Additlbnal CITY" Tel. No.
PLAN CHECK
Lighting Fixtures APPLICANT
First 20 ADDRESS
Additional
CITY Tel. N�or.�-- `
Fixed Appliances Not Over 1 HP APPLICANT r-,�? !/eC CAc 55� <C
Range Heater_ D.W. ADDRESS . !60
Oven Dryer W.M.
Top FAU W.H. CITY zzz,
�^(�yv
Hood Fan �_ / G RECG.NNUMBFI
ER -3�— /33k— Class.
Disp. A.C. v
I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY Q
Power Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING I...
Size&Type HP, KW, KVA,or KVAR ELECTRICAL WIRING. W
Up to 1 Incl. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR C/)
Over 1 to 10 InCI. LICENSED AS REO DIRE BV LOS ANGELES O NTY AND STATE OF
CALIFORNIA OR THA AM THE LEGA O ER OF THE ABOVE
Over 10 to 50 Incl. DESCRIBED RESIDE 1 PROPE
Over 50 to 100 Incl. PERMITEE
Over 100 SIGNATURE
DISTRICT NO. PR CES D BY
Services �
0-200 Amp. Under 600 V
201 - 1000 Amp. Under 600 V APPROVALS D INSPECTOR'S
SIGNATURE
Over 1000 Amp.or Over 600 V
TEMP. POWER POLE
Temp. Power Pole&Appurtenances UNDERSLAB WORK
Sign with One Branch Circuit
Additional Sign Branch Circuits ROUGH CONDUIT
II
(Other) WIRING �• ��w
FIXTURES
POWER AUTHORIZED
PERMIT FEE (Sub-Total) UTILITY CO.NOTIFIED J
PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL '
PERMIT ISSUING FEE NOTES
TOTAL FEES
PLAN CHECK VALIDATION CK. .O. CASH RMIT VALIDATION cK. M.O. CASH
..,/�
8 '0 o.c=til;i �� � �3 1 5.7 0 -6
" WORKERS'COMPENSATION DECLARATION 76-663 10/81
CE-806G APPLICATION FOR ELECTRICAL PERMIT
4 aereby affKm that I have a certificate of consent to self insure,
or t certificat of Workers' Compensation Insurance, or a certified I COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec.3800,Lab.C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB (
ADDRESS 3 19 B I t
Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE
1 & 2-Family,Sq.Ft. $ — $ LOCALITY `� ��
Certified copy is filed with the county building inspection —
department. Multi-family Sq.Ft. NEAREST
� CROSS ST.
Date Applicant Residential Swimming Pools OWNER OR T
FIRM NAME `n�
CERTIFICATE OFEXEMPTI N FROM WORKERS', Outlets:Rec— Light —Sw.— MAIL ^2
COMPENSATION INSURANCE ADDRESS S J l V1�i
(This section need not be completed if the work involved by the First•20
Total No. Additional CITY' Tel.No.
permit is for one hundred dollars($100)or less.)
• _ `.� t LrY Cj
1 certifythat in the performance of the work for which this permit PLAN CHECK
P APPLICANT
Js 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
Total No. Additional
CITY Tel.No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT `
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT At-r-7rd
Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _
provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer w'M._ ADDRESS Q 5tl -(;p
provisions or LICENSEDCONTRACTORS DECLARATION Hood — Fan rtshall be deemed revoked. Top — FAU - Other_ CITY rjj Jt Tel.No. 35->-5-3 r`
I hereby affirm that I am licensed under provisions of.Chapter 9 Disp. — Room Air Cond. LICENSE OR �f . Class.
(commencing with Section 7000) of Division 3 of the Business and REG.NUMBER
Professions Code,and my license is in full force and effect. power Apparatus&Large Appliances DISTRICT NO. PR CESSED BY
q Size&Type HP,KW,KVA,or KVAR V
License Number /1�� Lic.Class O Up to 1 Incl. FINAL
Over 1 to 10 Incl. DATE ,//
�/ VALIDATION 0
Contractor �vV^ Lru Date Over 10 to 50 Incl. (O
WFIW
I am exempt under Sec. Over 50 to 100 Inc. CLB.&P.C.for this reason Over 100 N
Z
Date:
Services,Swbd.,MCC&Panelboards ,0-200 Amp.Under 600 V
Signature 1�� 201 - 1000 Amp.Under 600 V
❑ Over 1000 Amp.or Over 600 V
Exemption for Reg.Maint.Elect.
SINGLE FAMILY Temp.Power Pole& Appurtenances 2
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit "" ACCTA .
I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits I�iL I
for the following reason(Section 7031.5, Business and Professions 7
Code):
ITEMS❑,
Misc.Conduits&Conductors 1 1
I,as owner of the property,will do the work and the structure
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , Af 21.00 r r0
and Professions Code). ."' ....".. .� t gpAL1 L
CONSTRUCTION LENDING AGENCY CHECK 21.00
1 hereby affirm that there is a construction lending agency,for the
performance of the work for which this permit is issued(Sec.3097, PERMITFEE (Sub-Total)
Civ.C.).
PLAN CHECKING FEE OM
MMI 7/21/89
Lender's Name ; �l�J �!�!L/ 1/
PERMIT ISSUING FEE 4602 1 AM. 9:Q
Lender's Address ,
1'certify that I have read this application and state that the above TOTAL FEEL
information is correct. I agree to comply with all County ordinances
apd State laws regulating Electrical wiring, and hereby authorize
representatives of this County to enter upon the above-mentioned
erty for inspection purposes.
SEE REVERSE FOR EXPLANATORY-LANGUAGE
nature o Permittee Date