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Home My Public Portal About4855 GOLDEN WEST AVE_Electrical__ 7eAea S-C¢eoe 3-69 .APPLICATION FOR ELECTRICA PERMIT I&P * COUNTY OF LOS ANGELES DQPARTM$NT OR COUNTY ENGINEER FAD ILDING BUIL-DING AND SAFETY DIVISION DRESS JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDINGCALITY C FOR APPLICANT TO PILL IN CROSSST. 2 US NO. EACH F[[ 3 OW HER RECEIPT._ MAIL ADDRESS "7 /4 LIGHT TOTAL FIRST 20 .20 �� fd CITY TEL.N0. SWITCH OVER 20 .10 PLAN CHECK LIGHTING TOTAL FIRST 20 ,20 APPLICANT FIXTURES OVER 20 10 ADDRESS RANGE_DRYERXWR. H . CITY TEL.N0. TTR STA. COOK( DSP. F.A.U. CONTRACTOR SPACE HTR. AIR COND. ADDRESS CLOTHES WASH._DISHWASH. CITY TEL.NO. FAN_OTHER / 1.00 LICENSE NO. CUSS. MOTORS,TRANSFORMERS RATING I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION IND. HEATER! ETC. HP. KW. KVA. AND STATE THAT THE ABOVE la CORRECT AND AGREE TO COMPLY SIZE Q TYKE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. O — 1 1.00 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STAT[OF 1 — 10 9.00 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. O 10 - SO 5.00 � t ` V SIGNATURE SO - 100 1000 OF PERMITTEE OC 100 — 500 15.00 DISTRI ry0. or I N[ PR C [ SIGN,GAS SIGN AND ONE CIRCUIT 9.00 ' /Vp/+ TUBE, OR Z MARQUEE ADDITIONAL CIRCUITS 1,00 NOTES: J6 SERVICE NOT OVER 500 VOLTS OR 200 AAP 2.00 SERVICE OVER 600 VOLTS OR 200 AMP 5.00 TEMP SERVICE, POLE, &APPURTENANCES 9.00 APPROVALS DAT[ 348P[CTORG SNWLATU1[ TEMP. POWER POLE UNDERSLAB WORK ROUGH CONDUIT WIRING PERMIT FEE (SUB TOTAL) FIXTURES PUN CHECK FEE (SOX PERMIT FEE) POWER AUTHORIZED PERMIT ISSUING FEE 2.00 UTILITY CO.NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1,00 FINAL TOTAL FEE JOS H C. ROOHAN SUPERVISING ELECTRICAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK.' M.O. AB :00—B2 y 5 $-QS aFP 3 2 D 3.-00— SEE EE RACK OF APPLICATION FOR COMPLETE FEE ■CH[DULF 75AO&S-CESOO 3-59 ,APPLICATION FOR ELECTRIC L PER IT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS 4855 GOLDEN WIW JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY TpL,$ CITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NO. EACH FEE • S OWNER ]IRI RECEIPT. MAIL LIGHT TOTAL FIRST 20 .20 ADDRESS SAMR SWITCH OVER 20 .10 CITY TEL.NO. PLAN CHECK LIGHTING TOTAL FIRST 20 ,20 APPLICANT FIXTURES } OVER 20 ,10 ADDRESS RANGE_DRYER_WTR. HTR. CITY TEL.NO. STA. COOKDISP. _F.A.U. CONTRACTOR SPACE HTR_ AIR COND. ADDRESS 1042 S. SAN GABRIEL BLVD. CLOTHES WASH. DISHWASH. CITY SAN GARRIRL TEL.NO. FAN_OTHER 1.00 LICENSE NO. 201026 CLASS. C10 MOTORS,TRANSFORMERS RAT IIIA 1 HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION IMD..HEATERSL ETC, HP. KW. KYA. AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY SIZE TYPE QUER TO WITH ALL COUNTY ORDINANCES AND STAT[ LAWS REGULATING ELECTRICAL WIRING. D 1 1.00 1 HERESY CERTIFY THAT 1 AM PROPERLY REGISTERED A.NDIOR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STAT[OF 1 - 10 3.00 CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN, THE ABOVE DEDCRIS[D RESIDENTIAL PROPERTY. 10 — so a.00 SIGNATURE SO - 100 10D0 OF PERMITTEE 100 - 500 is.00 DISTRI T NO.✓ • ZON PR [ SIGN,GAS SIGN AND ONE CIRCUIT 3.00 a(/ TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES' SERVICE NOT OVER 600 VOLTS OR 200 AMP 1 2.00 2 SERVICE OVER 600 VOLTS OR 200 AMP 3.00 TEMP SERVICE, PEE, &APPURTENANCES 5,00 APPROVALS DAT[ •ISP[C7OR'1 SKINATURt TEMP. POWER POLE UNDERSLAB WORK ROUGH CONDUIT WIRING PERMIT FEE (SUB TOTAL) 2 00 FIXTURES POWER AUTHORIZED PLAN CHECK FEE (50% PERMIT FEE) PERMIT ISSUING FEE 2.00 2 00 UTILITY CO.NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1,00 FINAL TOTAL FEE 4 JOSEPH C. ROOHAN SUPERVISING ELECTR ENGINEER PLAN CHECK VALIDATION DK. M.D. CASH - PERMIT VALIDATION CK. M.O. CASH .00-SI Arm 8 2 0 6g DE03 0 2 D 4.00- SEE E[ BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE pp- 76A663-CE806-10.56 A PI (C A T I O N FOR ELECTRIC PERMIT 1 BUILDING AND SAFETY DIVISION Department of County Engineer BUILDING County of Los Angeles ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN C'Oss T PERMIT FEE OWNER r �L�-L_� �2 C�- -- LIGHTS 11V = RECEPTACLES SWITCHES NUMBERI I T E M EACH EE MAIL ADDRESS TOTAL OUTLETS $ .10 $ ELEC. RANGES, WATER HEATERS, CITY TEL. NO. CLOTHES DRYERS .50 ELECTRI IAN ELEC. CE HEATERS, STAT'Y. LOOK- ING UN S, G GE DISPOSERS, .ADDRES AUTO WASHERS, .25 LIGHTING FIXTURES _10 CITY TEL. NO Awj !� MOTORS STATE LICENSE NO. v� HORSEPOWER DISTRICT NO. JGR P ZONE 1;70R I CT ION H.P. OVER INC. ! _ Ir 14 4 1/2 &LESS .25 )� �, 1h - 2 .50 INSPECTION RECORD 2 5 1.00 5 15 1.50 15 50 2.50 50 200 5.00 MIBc y SIGNSI NO.TRANS NO.LAMPS SERVICE O-600V 1.00 SERVICE OVER 600V 5.00 WIRING PERMIT 1.00 FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT •50 APPROVALS TOTAL FEE $ / DATE INSPECTOR'S SIGNATURE I HEREBY ACKNOWLEDGE THAT i HA READ THIS dPAICATfiON AND STATE THAT THE ABOVE IS CORRECT AND AGREE O COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ,1 ELECTRICAL WIRING. WIRING I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE CALIFORNIA OR THAT M E LEGAL OWNER OF THE ABOVE POWER DESCRIBED RESIDEN P RTY. I SIGNATURE UTILITY CO. NOTIFIED OF PERMITT FINAL JOHN A. LAMBIE. DATION ARTHUR C.VEIT. COUNTY ENGINEER CK i MO IO SUPERVISING ELECTRICAL ENGINEER welrm that COMPENSATION DECLARATION CE 10/61 APPLICATION FOR ELECTRICAL PERMIT R .I hereby Iafflrm that-I have a certificate of consent to self CE-%6r, Insure, or a certificate of Workers'Co pensatlon Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certlfl copy thereof (Sec. 3900, b. ) cy ompany FOR APPLFCANT TO FLL INEl ADDRESS Certlfled copy Is hereby.furnished. New Resldentlal Bldgs. 8 Pools EACH NO. FEE Certified copy Is filed with the county building Inspec- 1 8 2-Family, Sq. Ft. f — $ LOCALITY tlon department. Multi-family Sq. Ft. —I N� Dote licant , Residential Swimming Pools 01�R OR APp FIRM NAME CERTIFICATE OF E)KEMPTION F WORKERS' Outlets: Rec�lght�Sw. MAIL COMPENSATION INSURANCE ADDRESS (This s@cHon need not be completed H the work involved by Flat 20 Total No the permh Is for one hundred dollars ($100)or lots.) Additional CIN Tel. No 1 certify that In the performance of the work for which this APPLICANT PLAN CHICN permit Is Issued, I shall not employ any person In any manner to as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No.— e-;L— Additional CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PST NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' Range_ Heater_D.W. ANT 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— CfTY I. No 46,0 LICENSED CONTRACTORS DECLARATION DI�' _ Room Air Cond. LICENSE5E OR Z I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER Class. (commencing with Section 7000) of D10sion 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. PROCESSED BY and Professions Code,and my Ilce9se Is In full force a effect. Size 8 Type HP, KW, KVA, or KVAR License Number c. Class Up to 1 Incl. FINAL Contractor "nde, - Date Over 1 to 10 Incl. DATE ✓ VALDATFON �jj Over 10 to 50 Incl. FINALIam exeOver 50 to 100 Inc. BY C>ver 100 � L B.BP.0 for this reason Date: Date. Services, Swbd., MCC 8 Ponelboards 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 8 Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Jr r3 A Low for the following reason (Section 7031.5, Business and Profoulons Code): # o o 0 0 0 2 El1, as owner of the property, will do the work and the Misc. Conduits 8 Conductor structure Is not Intended or offered for sale (Section Other (See.Complete Fee Schedule)_ , To o 1 6 5 Q 7044, Business and Professions Code). 1 5 O CONSTRUCTION LENDING AGENCY o --- I hereby affirm that there Is a construction lending agency for 07,29 .86 the performance of the work for which this permit Is Issued PERMIT FEE (Sub-Total) (Sec. 3097, Cly. C_). PLAN CHECKING FEF Lendees Name PERMIT ISSUING FEE Lender's Address I certlfy that I have read this application and state that the TOTAL FEE above Information Is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and here y authorize'representatives of this County to enter upon the ve-mentl ned property for Inspectlon purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Slgnatu a of Permits Doe}e} L