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Home My Public Portal About5133 GOLDEN WEST AVE_Electrical__ 76A663 DSS SA ll-SD APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY ELECTRIC COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTfRIC3iNO. C3ROl�P ZONE PERMIT NO. ELECTRICIAN41 J -�ji // ADDRESS RECEIV DATE IS SUED BY FIRST INSPECTION CITY TE ^� � L N � COUNTY LICENSE NO. zo f EXPIRES —1?4V-W BUILDING PERMIT FEES FEE ADDRESS NUMBER EACH LOCALITY .�iY)'l//�' LIGHT OUTLETS i NEAREST CROSS ST. RECEPTACLES ja WALL SWITCHES ` OWNER TOTAL OUTLETS 5c $� MAIL ELEC. RANGES 25 ADDRESS ELEC. HEATERS 25 CITY TEL. NO. FIXTURES 5 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. MOTORS 1 CERTIFY THAT 1 POSSEBS THE ABOVE VALID LOS NUMBER HORSEPOWERANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER FEE NEW MVD. HP OVER frac EACH OF THE RESIDENTIAL PROP DESCRIBED ABOVE. 6 LESS >$ .25 SIGNATURE OF � 2 .50 PERMITTE r 2 s 1.00 INSPECTION RECORD s is 1.50 1B s0 2.50 50 200 5.00 ZOO BOD 10.00 J 6Q0 10043 15.00 Z OVER 1000 20.00 [�J M.G. BET/FREQ. CHANDER-HP Q' WELDERS]AC-KVA O GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (75% of DRIM.) MOVED MOTORS (75 Of DRUG.) MISC. 81ONS NO. NO.TRANS. APPROVALS NO. NO LAMPS FOR EACH PERMIT: DATe INSPECTOR'S NAME WIRING $1.00 CONDUIT / _FIXTURES $1.00 / WIRING >7 rV SUPPLEMENTARY .50` FIXTURES POWER TOTAL FEE 6 410' b� UTILITY CO. NOTIFIED FINAL /�'�~ WORKER S'COMPENSATIONDECLARATION �.CE806G (2-80) APPLICATION FOR ELECTRICAL PERMIT Iherebiy a,tem that I have a'certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY rnghiti;oi� rUficate of Workers'Compensation Insurance,or a certified copy thereof(Sec 380.0,-Lab C) ' —1 FOR APPLICANT TO FILL IN r ,JOB Policy No Company - ADDRESS '1`•� New Residential Bldgs.&Pools ? EACH NO FEE Certified copy is hereby,furrirs d ,1 &2-Family,Sq Ft $• — $ LOCALITY--/_ ❑ �"` Multi-family Sq Ft — NEAREST ' Certified cop 'Iefiled wrth'the county building inspection CROSS ST departmentResidential Swimming Pools " OWNER OR FIRM NAME ,Date Applicant Outlets Rec_Light<e'a_- Sw MAIL ry'7 f First,20 ADDRESS' - ✓-Jx'- f CERTIFICATE OF EXEMPTION FROM WORKERS' Total No Additional CITYG Tel No COMPENSATION-INSURANCE ii I } PLAN CHECK a (This section need `not be completed if the work involved APPLICANT 0 First 20 ADDRESS fixtures ures by'the permit is for one hundred dollars ($100)'or less.), LigAdditional, 5 O - Total No I certify that in the performance of the work for.which this CITY Tel No F ernirt is issued, I shall not employ any Fixed Appliances Not Over 1 HP p p y y person in any manner PERMITOLW so as to become subject to the Workers' Compensation Laws. Range_ Heater_D W. APPLICANT` a Oven Dryer_W M. ADDRESS* N Dat i *,A'pplic rTt ^'- Top FAU WH'� •� Hood Fan Other 2 J, n CITY .t_ Tel No NOTICE TO APPLICANT If, after making this Certificate of Disp _ Room Alr Cond._ Jt��" •/ V LICENSE OR C- 0 Exemption, you should become subject to the 'Workers' REG NUMBE s Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO PROC SED BY with comply with such,provisions'or this permit shall be ize& y HP, KW, KVA,or KVAR Iq 06 eemed revoked ! 0 9 _ Up to.1 Incl '� Over fro 10 Incl DATE FINAL AEL � LICENSED CONTRACTORS DECLARATION - VALIDATION. Over 10 to 50 Incl /7 I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc FINAL 9 (commencing with Section 7000) of Division 3 of the,Busy- Over 100 BY i Hess and Professions Code, and my license is m full force and' CJ /� effect. Services License Numb L�MZ'- L-ic Class201 0 200 Amp. Under 600 V - Over 000 Amp Under r 6 o Contractb� � Date � Over 1000 Amp or Over 600 V HOME OWNER-BU ILDER-DEC LARAT ON Temp' Power Pole&Appurtenances !;� e a 3&7 5 I hereby affirm that' I"am exempt from the Contractor's Sign with One Branch,Circurt' ; License Law-for the following reason (Section 7031 5, Busi- Additional Sign Branch Circuits ness and Professions Code): `� _ - Misc-Conduits&Conductors ¢ �• Ell, as owner of the property, will d the work and the Other (See Complete Fee Schedule)— p structure is not intended or offered for sale.(Section 7044, Busmess•and Professions Code). I CONSTRUCTION LENDING AGENCY 1'hereby affirm that there is"a construction lending agency for the performance of the work for which this permit is PERMIT FEE (Sub-Total) issued (Sec 3097,Civ.•C^)� Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address/I i PERMIT ISSUING FEE I certify that I have read'this application and state that the TOTAL',FEE �7 above reformation 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 tt}e`above-mentioned operty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee: Dasf = , ��{{�� ►t - WpJRKERS'COf PENSATdC7N�ECLAR C -663 ,D 8;' APPLICATION' FOR ELECTRICAL PERMIT �..I herebyraffirm;that'I have`a certificate of consent,tb self ins"' CE-Bose' or a pertificate of Wprkers=Compensation Insurance, or-a certified, COUNTY OF LOS,ANGELES BUILDING AND SAFETY �T C copy,thereof(Sec 3800;Lab C) s Policy No _i a -• "�� Company ' FOR APPLICANT TO FILL-IN.','�' _ m JOB' - ?.�`,• /� /'y► ,' ,( , . . ry ADDRESS', Q' Certified copy fs hereby furnished '`i, 3t { New,Residentral Bldgs &Pools EACH NO FEE _ , • $• $ _ LOCALITY .,, Certified copy is filedwith the county budding inspection 1,8;2-Family,Sq Ft X department Z�V•Z'.. ;( „+ Multi-family % Ft ' 'NEAREST t' r,.+ • - •�." � � 'CROSS ST*' •e; �' r 1 � ResidenhaP' wimmin Pools° "'4';'. `rt« '�� ti ti -Date° .w ` Applicant' "� ,�' , g -,�'`` ,'k,r' ,x .^�i , OWNER OR, ` . ,.•/�`1 (�`-y'h �' s,.w -.` u _ - • -i. �,�r-. to: .g s' 4F 'C NAME - ,,,J';LCERTIFICATE OF�EXEMPTION FROM WORKERS fS +` ' ` "` "+'b '.MAIL' t Outlet's Rec Light Sw,, t- s COMPENSAT•IONINSURANCE ', „ti. € :• .�� fi" y,: �; ADDRESS ' �f 1 S VA� 5' ;•. (This section need notbe completed rf theiwork involved.by,•the �i9 First.20�°, `. y -VL a ' °CITY t" x Tel-No Total No Additionalt l '' = + "" -,-•,; b .permit is for one•hundred,dollars ($1'00)or less) ,`; ., °• ,'r '<' - t PLAN CHECK,' •1h, I'cerstify that,in the,performance of the,work:'for which this•permit APPLICANT• ;' •- F v�. is issued, I shall not•emplcy4any person. ny,man �so gas toy .• r,;• '.. .�, become}subject°to`th pWorke'rs'Compens t, Laws m'. Lighting Fixtures First 20,+ ADDRESS• tiw) �a' Total No ;CITY Tel No Date Applicant �� "� NOTICE O� AP LICANT if,' afar-ima' is,Certificate of Fixed:Apphances Not Over'1 HP' S PERMITr' a • 'S - , APPLICANT,' SSC �• C S c`Exeniption,you should become sutilect,to,the Workers;Comperisation,t Rarige— Heater_ DW"r_' 4'; yaprowsions of'the;Labor Coder.you must forthwith comply'with`such'• Oven Dryer—W M v'' ." '' ADDRESS � �' provisions or this.permit.shall be deemed revoked w -, To FAU; _'WH ' LICENSED CONTRACTORS DECLARATION T• p' T di ` `' CITY'•= :� ' Tel.Nom '2 Hood--•tFan, Other— 4 IL,hereby affirm.that I am•hcensed under provisions•of Chapter 9 r' LICENSE OR „ r Disp —rf3oom Air Cond � �� 24�E, 'Class (commencing;with Section•7000)df'Division 3�of the Business and REG-NUMBER (7 JP cofbssions Code,and,my license•is m"full force,and effect-' a"' ,' ' DISTRICT NO,. P,ROC ED BY Po, &•Large Appliances, _ Z�U S•�=r Size&,TYpe•HP,KW,KVA, or, �, . t :•�, License`Numbe Lic Class ` Up,to 1 Incl FINAL O Q>�/1 / �� fi,, / Over 1.to 10 Incl` DATE-. xY C L!` /`/ V A VALIDATION j Contractor Date ;❑ /v Over�10 to 50 Incl FINAL X9'2&4 .am exempt under Sec Over 50 to 100.Inc. gYA A U + B&PG for this reason y. W r A- -Over # o` o.oao'o 0W. �,a " • • ' '" r ., , •- "Services,Swbd,MCC•& Panelboards=- Z Date f/0-200 Amp Under 600-V 4, -0 ' .•Signature _201 7'1000-Amp Under-600,V Y ^F Over,1000�Amp or'Over 600 V Exemption for'Reg Maint Elect ' • r , :'s, ' SINGLE FAM'IL-Y Temp 'f owe`r Pole &' Appurtenances HOME OWNER-BUILDER DECLARATIONCircuit." Sign, Orie Branch • , :I�hereby,affirm'that l am exempt from-the Contractor's,License Law 'f • ,' for`the following reason(Section 7031.5„Business rand.Professions Additional Sign,Branch Circuits - 'Code) Misc Coriduds,&'Conductors I,as owner of the property,will do,the.work,and'the structure wfi Other. See'Com lete•Fee,Schedule f' is not intended or offered•for sale`•(Section 7044, Business ( p ) - a. and'Prof •r�, essions Code)' i `s., ° �4 '” �• s . . ,r a. • ., a CONSTRUCTION LENDING-AGENCY, �.,a a , _ �. �` ..,' '1'hereby affirm't'hat there is a�construction lending agency !6r-the' �� erformance'of the work for, whichlthis ermd'is Issued Sec 3097; d ' ° P P ( PERMIT FEE`-'•,- { (Sub-Total) Civ'C) PLAN CHECKING FEE r, ? '�" ayr '• "v �, 'b '� Cender,s,Name ' PERMIT ISSUING FEE Leri /01 der's Address' I certify that,I•,have read this application and.state that the above TOTAL' '.informahon.is•correct I agree to comply,-with all County ordinances 4at *regulat', Elie�trical,wiring„and hereby authorizer upon the above-mentioned. SEE REVERSE FOR,•EXPLANATORY,LANGUAGE;• i '�� :.',,� ' -, •. i .. ., •• _ •� •� � r