HomeMy Public PortalAbout4919 GOLDEN WEST AVE_Electrical__ _ DES SA 25M SETS 7-47 '
APPP+LIICA'TI�OO`IaIFOR PERMIT
I3Et�ART1�+IENT OF BUILDING AND SAFETY �,iL �ELECTRIC
I'�/
COUNTY OF LOS ANGELES
M. FOX CHIEF ENGINEER
a NAMEr ti - DISTRICT NO. GROUP ZONE PERMIT NO.
ADDRzr
U CITY EL.NO. RECEIVED BY RNADY FOR DATE ISSUED
"
FIRST INSPECTION
J COUNTY
1+1 CERT.NO. EXPIRES
PLICANT FILL IN HEAVILY OUTLINED POI ON ONLY
4JOB
DESCRIPTION OF WORK ADDRESS
NUMBER OF OUTLETS ON CIRCUITS LOCALITY
LOCATION BY ROOMS NEAREST
LIGHT OUTLETS SW. PLUGS FIXT CROSS ST.
CIRCUIT A B C D E F G IH W NAME
Z MAIL
ADDRESS
O
CITY ( °r,a TEL.NO.
1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION..
ELECTRICIAN.
I AM THE LEGAL OWNER OF TRIC PROPERTY DFSCRIBF-r
ABOVE #" {/
r
O
' C CTIoNS
J
a
z
D
TOTAL
NO. OF OUTLETS ' $ =%' APPROVALS
r
I NO. OF FIXTURES $ > DATE INSPECTOR'S NAME
NO. OF MOTORS H.P. $ CONDUIT
NO. OF SIGNS TRANS. $ WIRING S
a
NO. OF RANGES OR4#E*Wg" $ ✓ FIXTURES
MISCELLA.NF.O S P $ POWER
PERMIT FEE $ .,UTILITY CO.NOTIFIED
TOTAL FEE FINAL
T
Te+eea-cEpoe ,-ee APPLICATION FOR ELECTRICA PERMIT
COUNTY OF LOS ANGELES
DEF!*RTMENT OF COUNTY ENGINEER BUILDING
• BUILDINGS AND SAFETY DIVISION, ADDRESS
JOHN.A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUP%RINTENDtNT OF BUILDINGLOCALITY
-i NEAREST
r�
FOR APPLICANT TO PILL IN CROSS ST.
RECEPT2" OWNER
MAIL
LIGHT TOTAL FIRST 20 .20 ADDRESS
SWITCH OVER 20 .10 -qaCITY TEL. NO.'
LAN CHECK
LIGHTING 1 TOTAL FIRST 20 .20 APPLICANT
FIXTURES Jj OVER 20 .10 ADDRESS
RANGE—DRYERWT TR.— CITY TEL. NO.
STA.COOK_DISP. A.U.-r/— CONTRACTOR
SPACE HTR. AIR COND. ADDRESS
CLOTHES WASH.ZDISHWASH/— CITY TEL. NO.
FANOTHER 1.00 LICENSE Nb. CLASS)
MOTORS,TRANSFORMERS RATING
IND. HEATERS, ETC. HP. KW. KVA. I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
SIZE h TYPE OVER TO AKD STATE THAT THE ABOVE Io CORRECT AND AGR[S TO COMPLY
WITH ALL COUNTY 0RDINA MC Ell AND STAT! LAWS REGULATING
ELECTRICAL WIRING.
0 — 1 11.00
IHERESY CERTIFY THAT I AM PROPERLY REGISTERED AND/OA
1 — 10 3.00 LIC S NSSD AS REQUIRE BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I M THE LEGAL NCR OF, AND rNTSN0 TO
10 — 50 5.00
RES
I-0E IM, THE A VE pESCR IPE SSIDENTIAL PROPERTY. O
s U
BO - 100 10,00 SIGNATURE
OF PERMITTEE p�
100 — Boo 15.00 DIS ICT
TUBEp.
G E P E
SIGN,OAS gIGN AND ONE CIRCUIT 3.00
, OR
MARQUEE ADDITIONAL CIRCUITS 1.002
NOTES:
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00
SERVICE OVER 600 VOLTS OR 200 AMP 5.00
TEMP SERVICE, POLE, Q APPURTENANCES 3.00 APPROVALS DATE WSPECTOR'S SIGNATURE
TEMP. POWER POLE
UNDERSL.AS WORK
ROUGH CONDUIT 1
PERMIT FEE (SUB TOTAL) WIRING
FIXTURES
PLAN CHECK FEE (50% PERMIT FEE)
POWER AUTHORIZED
PERMIT 13SUING FEE 2-00 UTILITY CO.NOTIFIED
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL
TOTAL FEE JOSEPH C. ROOHAN
SUPERVISING ELECTRICAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.D.�cAbry
LACO S 6 5 012 JUL 2 6_ 2 D 1 8-90, �
AEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
affirm
COMPENSATION DECLARATION 76- 10/81 APPLICATION FOR ELECTRICAL PERMIT
' `I hereby y aaffirm thh CE-806c,I have a certificate of consent to self CE-806c, ,
Insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
ora I c t r f (Sec. b.-C.
Poll ompany FOR APPLICANT TO RLL IN JOB
Certified copy Is hereby furn shed. EACH NO. FEE 'ADDRESS
New Residential Bldgs. 8 Pools
Certified copy Is filed with the county building Inspec- 1 8 2-Fa rnIIy, Sq. Ft. $ — f LOCALITY
tion dopa a Multi-famlly Sq. Ft. — NEAREST
CROSS ST.
Residential Swimming Pools OWNER OR
Dat Applicant FIRM NPJAEkk
CERTIFICATE OF EXEMPTION FROM WORKERS' Outleri: RecLlght Sw_ MAIL
COMPENSATION INSURANCE . ADDRESS
First 20
(This section need not be completed 1f the work Irrvolved by Total No Additional CITY Tel. N
the permle
lt Is for one hundred dollars ($100)or ss.)
RAN CH
I certify that In the performance of the work for which this APPucI�NTEOC
permit Is Issued, I shall not employ any person In any manner
so as to become wa' to the Worke Compensation Laws. Lighting Fixtures First 20 ADDRESS
Total No. Additional
CfTY Tel. No.
Date Appllcon Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, er making this Certificate of APPLICANT
Exemption, you should ome subject to the Workers' Range_ Heater`_D.W. —
Compensation provision the Labor Code, you must forth- Oven — Dryer —W.M._ App /
with comply with su provislons or this permit shall be Top — FAU —W.H. —
deemed revoked. Hood _ Fan _Other— CITY Tel N
LICENSED CONTRACTORS DECLARATION Dlsp. _ Room Air Cond. UCENSf Clan.
hereby affirm that I am licensed under provisions of Chapter 9 RE-1 NUM862
(commencing with Section 7000) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. BY
and Professlons Code,and my license Is In full force and effect. /
Size 8 Type HP, KW, KVA, or KVAR �L✓ a 8
License Number RX
Llc. C Up to I Incl. FINAL
Over 1 to 10 Incl. DA r V ATIlON
Contract Over 10 to 50 Incl. LLUF
F-1FINAL
I am exempt under Sec Over 50 to 100 Inc. BY p'
B.BP.C. for this reaOver 100 U)
reason Over
3 Q 3 A Z
Dote'
Services, Swbd., MCC 8 Panelboards ,
0 -200 Amp. Under 600 V
,
Signature 201 - 1000 Amp. Under 600 V o oo o ° 2
❑
Exemption for Reg. Malnt. Elect. Over 1000 Amp. or Over 600 V ° ° 1 a O O
O
SINGLE FAMILY Temp. Power Pole 8 Appurtenances ° 1 5 Q W S
HOME OWNER-BUILDER D TION Sign with One Branch Circuit
I hereby affirm that I am exempt from tF Contractor'sLlcense I G25-85
Additional Sign Branch Circuits
for the following reason (Sectio 7031.5, Business and
Professlons Code):
❑ I, as owner of the property, wlll do the work and the Mlac. Conduits 8 Conductor
structure Is not Intended offered for sale (Section Other (See Complete Fee Schedule)
41
70 , Business and Prof Ions Code
CONSTRUCTIOt/LENDING AGENCY
I hereby affirm that there isfa construction lending agency for
the performance of the 1 irk for which this permit Is Issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.).
/
PLAN CHECKING FEE
Lenders Name
PERMIT ISSUING FEE
Lender's Address 0
I certify 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 authorize representatives of this County to enter upon
I
ve-mentlo ope for Ins n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
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Signature o PermlHee pate