The URL can be used to link to this page

Home My Public Portal About5303 GOLDEN WEST AVE_Electrical__ IE FILIPLE CRTY. . 76A663-CE806 8-62 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT UILD NG AND SAFETY DIVISION LDING ADDRESS BUILDING 71� JOHN A. A. JEN E, COUNTY ENGINEER /��, `f c`�� WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY / /LG i/ NEAREST FOR APPLICANT TO FILL IN CROSS ST. REC EPT. TOTAL NO. EACH FEE OUTLETS FIRST 20 $20 $ OWNER LIGHT 16ADD'L ADDRESS! (JSWITCH,. CCJ OVER 20 •10 _ TOTAL CITY '�GI TEL. NO.147 LIGHTING F1RST20 .20 ,0 FIXTURES I ADD'L 10 ELECTRICIAN k OV R 2O RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS GARB.DISP. STA.COOK CITY TEL. NO. DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.VA H.P.MAX.) .50 L!CENSE NO. MOTORS: OVER NOT OVER H.P. DISTR CT/I`L,D, GROUP Z/JQ��J1 P ESSED/sY O I 1.00 C��jj V L .rL L� I3 I.So INSPECTION RECORD 3 8 2.00 8 15 2.50 15 50 3.00 CL 50 100 5.00 0 SIGNS: NO.TRANS. DC NO.LAMPS O H SERVICE 0.60OV-Nor OVER 200A 1.00 w CL SERVICE 0.60OV-OVER 200 A. 2:00 H z SERVICE OVER 600V 5.00 - M I SC. PERMIT ISSUING FEE 2.00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE $ 0 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS /DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING _ ELECTRICAL WIRING. WIRING 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR � LICENSED AS REQUIRED BY LOS ANGELES COUNTY'AND STATE OF FIXTURES l CALIFORNIA ORZ=� AL WNE OF E ABOVE y✓- �! DESCRIBED RESI " POWER E /,ham ltd.n.5'�+!` SIGNATURE UTILITY CO.NOTIFIED iP v OF PERMITTE V- FINAL /CT LIDATION ARTHUR C. VEIT CK MOCASH SUPERVISING ELECTRICAL ENGINEER WORKERS' COMPENSATION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-906G insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. m1�Al Co pany FOR APPLICANT TO FILL IN JOB ❑ Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS ."`� 1 & 2-Family, Ft. $ — $ LOCALIT � _ Certified copy is filed with the7countuil inspe.c- Y, S9 NEAREST tion parLIA tment. Multi-family wi m CROSS ST. � Residential Swimming Pools ��Cd�L�` Date Applic OWNER OR p FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RecQ_LightSW-6— MAIL ADDRESS �3�3 " Y 3� COMPENSATION INSURANCE C This son need not be completed if the work involved b First 20 ( section P Y Total No. Additional CI7 LC TeL No.41Lfl_3ZyZ the permit is for one hundred dollars ($100)or less.) I certify that in the performance of the work for which this PLAN CHECK APPLICANT permit is 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 APPLICAN L A KL Ii 1V 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 with comply with such provisions or this permit shall be' Top FAU —W.H. — deemed revoked. CIT Tel. No LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_ Disp. Room Air Cond. LICENSE �/ Class I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMM 1BER tip qtal (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCESSED BY and Professions Code, and my license is in full force and effect. Power Apparatus& Large Appliances 0. Size &Type HP, KW, KVA, or KVAR' License Number Lic. Class Up to 1 Incl. FINAL 09 Over 1 to 10 Incl. DATE �f� _ VALIDATION O Contractor Date Over 10 to 50 Incl. FINAL � A � ❑ I am exempt under Sec. Over 50 to 100 Inc. BY B.&P.C. for this reason Over 100 Services, Swbd., MCC& Ponelboards Date: 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole&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 Law for the following reason (Section 7031.5, Business and Professions Code): 1 0 9 2 A ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors See Complete Fee Schedule)_ 2 ". o 0 0 0.0 structure is not intended or offered for sale (Section Other ( 7044, Business and Professions Code).. I 2 4 7 5 CONSTRUCTION LENDING AGENCY ' I hereby affirm that there is a construction lending agency for o'o 0 2 4:7 5= the performance of the work for which this permit is issued P p PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). - 0509-84 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 7 above information is correct. I agree to comply with all County ordinances and St laws re ulatin9 Elecirical wiring, and hereby. thoriz pre nt Ives of this County to enter upon the - ve-m lone p perty for inspection purposes. ,t QSEE REVERSE FOR EXPLANATORY LANGUAGE 411 .J J gnature o ermittee Dat WORKER'S COMPENSATION DECLARATION 9 DPW(72-91) ' APPLICATION FOR ELECTRICAL PERMIT 76A66 I hereby affirm that I have a certificate of consent to self insure, 76A663 or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. aF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec. 3800 Lab. C.) .9 Policy No. Company FOR APPLICANT TO FILL IN 306 1 e ADDRESS �p�.,&T El Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE $ $ LOCALITY ❑ Certified co s filed with the count building inspection 1 &2-Family,Sq.Ft. Py Y 9 P NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light SW. FORM NAOR ME COMPENSATION INSURANCE First 20 m. (This section need not be completed if the work involved by the L � Total No. Additional permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit ISWA QMANM CA% Tel -� is issued, I shall not employ any person in an anner so as to PLAN CHECK become subject to the Workers' Compensation aws. Lighting Fixtures First 20 APPLICANT 3d� Total No. Additional ADDRESS Date 1P•-1 941Applicant 77� NOTICE TO APPLICANT: If, of er making thi Certificate of RESIDENTIAL APPLIANCES NOT OVER 3 HP. CITY Tel.No. Exemption,you should become subj ct to the Work s'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you st forthwith omply with such provisions or this permit shall be deem evoke Power Apparatus&Large Appliances LICENSED CONTRACTORS DEC ARATION Size&Type HP,KW,KVA,or KVAR 69WS I hereby affirm that I am licensed under provisions of,Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000) of Division 3,of the Business and CITI� A_0 _ Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE O Imo,/ Clas/ 10 Over 50 t0 100 Incl. REG.NUMB 1—eye � �✓ 2 , II"`t® Over 100 DISTRICT NO. P CESSED BY O License Number Lic.Class U n -9` r, Services,Swbd., MCC&Panelboards ,v CC Contractor Date�•`� - ✓� 0-399 Amp.Under 600 V 6FINAL DATE O ❑ I am exam under S c. 400-1000 Amp.Under 600 V Ja _ lG VALIDATION V Over 1000 Amp.or Over 600 V FINAL LU B.&P.C:fo this reas n BRANCH CIRCUIT FEES BY C/) Date: 15A,or 20A, 120V,Lighting or Recept. 42 . Z 1 To 10 Branch Circuits Signature <s s_:_, a 11 To 40 Branch Circuits ❑ ` 41 Or More BranchT-r:^:� Circuits C Exemption for Reg.-Maint. Elect. 15A,20A,208V To 277V Lighting Br.Circuits - - SINGLE FAMILY f ;"' •2_s Temp. Power Pole&Appurtenances = r•1= �=:• _ HOME OWNER-BUILDER DECLARATION with One Branch Circuit n I hereby affirm that I am exempt from the Contractor's License Law Sign Ir.'�`;,;i'•: •'�;��=;•_ for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): ❑ I, as owner of the property,will do the work and the structure Misc.Conduits&Conductors is not Intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) ® �h-p-1,•,�R.-e-* and Professions Code). = p°•'-f •==-_ ii, 4 CONSTRUCTION LENDING AGENCY {" t r `t :- I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ. C.) PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE that the above information is correct. I agree to comply with all County z ordinances and State I regulating Electrical wiring,and hereby authorize representatives of s Countq to enter upon the above-mentioned property for inspection p poses. j ^� SEE REVERSE FOR EXPLANATORY LANGUAGE r� •31 Y SIGNATURE F PERMI EE DATE