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HomeMy Public PortalAbout5147 GOLDEN WEST AVE_Electrical__ l 76A663-CE806 9-64 APPLICA ION FOR ELECTRICAL PERMIT nmCOUNZY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER -- COLEMAN W JENKINS, SUPT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN cRoss sr. RECEPT r TOTAL , NO. EACH FEE f FIRST 20 W $ $ OWNER / O LIGHT 4,- OUTLETSjI,. / '"71 O ,20 dU MAIL ), Pyr 3 ADD'L ADDRESS SWITCH /�[ OVER 20 ,10 3d -f TOTAL CITY TEL. NO. LIGHTING � FIRST ZOI 8 .20 �O FIXTURES _ ADD'L 1O ELECTRICIAN OYER 20 J RANGES CLO DRYERS WTR HTRS. 1.00 ADDRESS GARB.DISP. STA COOK �_ CITY � TEL NO. DISHWASH. AUTO-WASH STATE SPACE HTRS STA.APP,(%H.P.MAX.) .50 LICENSE NO. O 1/1 MOTORS OVER NOT OVER H P. DIST C/T�1��j(3� G UP NE P C D BY O 1 1.00O V t 3 n 5o INSPECTION RE,COOg�R-D p � 3 8 200 0' 8 15 250 � I .A A 15 50 3.004, .4' i OL so too 500lb > �' J f h 4 �.,,�� SIGNS: NO.TRANS 1-4 NO.LAMPS �.� �. t` EJ*� 4vi Z SERVICE 0.600V-NOT OVER 200A / 1.00 OO W SERVICE 0-600V-OVER 200 A. 2.00 SERVICE OVER 600V 5.00 _4 _ M I SC / �i/f a _y�frv'�'Gt`�� ��'7♦ �^ ' i .�� PERMIT ISSUING FEE 200 SUPPLEMENTARY PERMIT ISSUING FEE 100 TOTAL FEE 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INHPECTOR'H SIGNATURE' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT / WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 4�/ul ELECTRICAL WIRING. WIRINGI HEREBY CERTIFYTHAT 1 AM PROPERLY REGISTERED AND/OR FIXTURESLICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO YRESIDE IN, THE ABOVE DESCRIBED E51 NTIAL PROPERTY POWER SIGNATURE UTILITY CO.NOTIFIEDib f i OF PERMITTEE FINAL (DATION JO PH C. R00HAN '•' CK MO CASH SUPERVISING ELECTRICAL ENGINEER , ;,�02 3.0 6- JUN 4 2 D 8'�0� 4 WORKERS'COMPENSATION DECLARATION 20-0019 DPW 3/87 / 76A663 APPLICATION FOR ELECTRICAL PERMIT L heraffirm that I have a certificate of consent to self CE-806G insure, ora certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec 3800, Lab C ) meq- �X �(/�D FOR APPLICANT TO FILL IN JOB Policy No Company y FICertified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS ! � c"tw(A T ertified copy is filed with the county building inspec- 1 8 2-Family, Sq Ft $ "— $ LOCALITY C tionde artment Multi-family Sq Ft -- NEAREST Residential Swimming Pools CROSS ST Date9EY Applicant OWNEAA OR FIRM NAME /` Q S. CERT FICATE OF EXEMPTION FROM ORKERS' Outlets Rec LightSw�' MAIL COMPENSATION INSURANCE ADDRESS First 20 (This section need not'be completed if the work involved by Total No Additional � 1� CITY Tel No _� 17 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 so as to become subject tb the Workers',Compensation Laws Lighting Fixtures First 20 ADDRESS Additional J Total No � CITY Tel No Date Applicant Fixed Appliances Not Over 1 HP PERMIT ` t NOTICE TO APPLICANT If, after making this Certificate of APPLICATION 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 (-t4y with comply with such provisions or this permit shall be Top — FAU W H — deemed revokedHood — Fan Other, l CITY �N� Tel No LICENSED CONTRACTORS DECLARATION _ LICENSE OR aa f Disp — Room Air Cond IL REG NUMBERClass Ll�f I hereby affirm that I am licensed under provisions of Chapter 9 -W (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO PROCESSED Y ' >- and Professions Code,and my license is in full force and effecta Size &Type HP, KW, KVA, or KVAR O License Number Lic Classs/ 8-1 Up to 1 Incl FINAL U Contractor / I� 4 Over 1 to 10 Incl DATE VA ATION Date ❑ Over 10 to 50 Incl ( F— //—, Z__�/_) 11,_/12 0 IN �;" S A h" am exe pt under Sec Over 50 to 100 Inc BY U LU B &P.C for this reason Over 100 /ZA 4� We' e • 9 02 a_ Dote Services, Swbd , MCC & Ponelboards Id� • e,2 2-7 5 Z 0- 200 Amp Under 600 V Signature 201 - 1000 Amp Under 600 V e o e 2 2 7 5 U El Exemption for Reg Maint Elect Over 1000 Amp or Over 600 V Q 7,':1 5,Y 8 8, SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp Power Pole 8 Appurtenances Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Sigf Law for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits Professions Code) y 1:11I, as owner of the property, will do the work and the Misc Conduits&Conductors Complete Fee Scheduleom lSee C Other structure is not intended or offered for sale(Section 7044, ( P )— Business and Professions Code) I CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the'performance of the work for which this permit is issued PERMIT FEE (Sub-Total) ti (Sec 3097, Civ C ) PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address 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 jaws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above-me tinned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 5 ©s Signature of Permit a t Ocife