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Home My Public Portal About5338 GOLDEN WEST AVE_Electrical__ 7°A66` "="°6 ; F' APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS /ANGELES DEPARMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS ` .'ti w L kk-At I L"I'-,1'� JOHN A. LAMBIE. COUNTY ENGINEER WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITY `--� NEAREST FOR APPLICANT TO FILL IN CROSS ST. M c/7/f P PERMIT FEES OWNER 1 T E M NUM13ERI EACH FEE MAIL L Ii OUTLETS: $ $ ADDRESS L LIGHTS �' RECEPT., SW. .10 4 // CITY �,� TEL. NO. LIGHTING FIXTURES 10 ELEC. RANGES CLO. DRYERS i ELECTRICIAN W A T E R H E A T E R S .50 �� ADDRESS L �` .SIS/ IV GA.,�.! ELEC.SPACE HTRSIDISHWASHERS CITY rlk.- �� TEL NO.I ^ S GARBAGE DISPOSERS: AUTO.- STATE WASHERS STA.COOKING UNITS ,25 /1,5 LICENSE NO. J MOTORS: OVER INC. H.P. DISTRICTO. G7t'3'PE ESSED BY (PN 1/2- 2 .50 INSPECTION RECOR -- 2— 5 / / � b � � 1.00 ? 0 5— 15 1.50 !/{- ('/d /a b j- Ai Ti IS— 50 2.50 "y/ 50— 200 5.00 ~ _ L W SIGNS: NO TRANS. NO.LAMPS Z SERVICE 0.600V1.00 _ f 9 ' _ SERVICE OVER 600V 5.00 misc. S�! /! WIRING PERMIT 1.00 FIXTURE PERMIT 1.00 I SUPPLEMENTARY PERMIT 50TOTAL FEE $ j 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICAAPPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COWITH ALL COUNTY ORDINANCES AND STATE LAWS REGULACONDUIT ELECTRICAL WIRING.I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANWIRING LICENSED ASREQUIRED BY LOS ANGELES COUNTY AND STATFIXTURESCALIFORNIA OR THAT I AMTHE LEGAL OWNER OF THE ADESCRIBED RESIDENTIAL PROPERTY. POWER SIGNATUREOF PERM TTEE " i UTILITY CO.NOTIFIED FINAL �IDATIONOCA-91 CASH ARTHUR C. VEIT MOSUPERVISING ELECTRICAL ENGINEER [ 5 5 i 9 : �v �g a 13.70 WORKERS' COMPENSATION DECLARATION 76- 10i61 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, CE-806806G or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB ❑ Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS ❑ Certified co 1 & 2-Family,Sq.Ft. $ — $ LOCALITY copy is filed with the county building inspection department. Multi-family Sq.Ft. NEAREST CROSS ST. Residential Swimming Pools OWNER OR Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec Light Sw. MAIL COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work involved b the First 20 p y Total No. Additional CITY Tel.No permit is for one hundred dollars ($100) or less.) PLAN CHECK I certify that in the performance of the work for which this permit APPLICANT 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. Date Applicant Additional CITY Tel. No. NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. APPLICANT provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M. _ ADDRESS provisions or this permit shall be deemed revoked. Top — FAU _ W.H. CITY Tel.No. LICENSED CONTRACTORS DECLARATION Hood Fan Other_ I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR Disp. — Room Air Cond. REG.NUMBER Class. >Z (commencing with Section 7000) of Division 3 of the Business and OL Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY V Size& Type HP, KW,KVA, or KVAR LLI License Number Lic. Class Up to 1 Incl. FINAL —f Over 1 to 10 Incl. DATE VALIDATION LJ.. Contractor Date Over 10 to 50 Inc].❑ FINAL I am exempt under Sec. Over 50 to 100 Inc. BY B.&P.C.for this reason Over 100 d 1 Services,Swbd., MCC& Panelboards Date. 0- 200 Amp. Under 600 V , LL1 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 Circuits I hereby affirm that I am exempt from the Contractor's License Law it h Ci B Sign gn rancCircuits for the following reason(Section 7031.5, Business and Professions Additionali Misc.Conduits& Conductors ' I,as owner of the property,will do the work and the structure Other(See Complete Fee Schedule) is not intended or offered for sale (Section 7044, Business , TOT& 44. 41 and Professions Code). t CONSTRUCTION LENDING AGENCY CHO,, 44.4 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 � 1 t1 yri Lender's Name tl6.P t PERMIT ISSUING FEE "� I Am sl:! Lender's Address I certify that I have read this application and state that the above TOTAL FEE information 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 the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee 'Date WORKERS'COMPENSATION DECLARATION 76-663 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have•a certificate of consent to self insure, CE-606G or a certificate of Workers' Compensation.Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec 3800,Lab C) Policy No Company FOR APPLICANT TO FILL IN JOB ❑7 Certified,copy,is hereby furnished EACH NO FEE ADDRESS New Residential Bldgs & Pools� • ❑ 1 & 2-Family,Sq Ft U $ — $ LOCALITY, Certified copy is filed with the county building inspection department Multi-family Sq Ft — NEAREST CROSS ST Date i Applicant Residential Swimming Pools,' OWNER OR r j �r�r • _ •FIRM'NAME' CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL COMPENSATION INSURANCE• Outlets Rec Light Sw ..ADDRESS (This section need not be completed if the work involved by the First 20 CITY 'T' ��' Tel No `, - I permit Is4or.one hundred dollars ($100)or less) Total No Additional l Pill ; �I i •v _ I certrfy"that in the performance of the work for which this permit PLAN CHECKAPPLICANT is issued, I shall not'employ any person in any,manner so as to become»subject to the Workers'Compensatiori Laws Lighting Fixtures First 20 'ADDRESS, s Additional ±• 5u, Total No CITY r Tel No ; Date Applicant Fixed Appliances Not Over,1 HP PERMIT NOTICE TO- APPLICANT. If, after making,this Certificate of APPLICANT Exemption,you should become subject to the Workers'Compensation Range_ Heater_ DW provisions of'the Labor Code,,you must forthwith comply with such Oven Dryer'_ WM ADDRESS provisions or this permit shall be deemed revokedTop , — FAU W H CITY " ' Tel No LICENSED CONTRACTORS DECLARATION, Hood Fan Other_, I hereby affirm that I am'licensed under provisions of Chapter 9 LICENSE OR - r Disp ROOM Air Cond REG NUMBERERESSED Class-(commencing with Section 7000) of Divisron 3 of the Business and Professions Code•and my license is in full force and effect DISTRICT NO BY Power Apparatus•& Large Appliances p Size& Type HP,KW,KVA,or KVAR', OQ 01 License Number Lic Class Up to 1 Incl " FINAL"' V Contractor'.'1 a Date _ Over 1 to 10 Incl DATE Y VALIDATION 0 Over 10,to 50 Incl V FINAL"I r ❑ I am exempt under Sec Over 50-to 100 Inc BY W B&PC for this-reason Over 100 Services,Swbd,MCC& Panelboards Date 0-200 Amp Under 600 V 1 Signature 201'--1000 Amp Under 600 V ✓ ,• ElOver 1000 Amp or Over 600 V Y Exemption for Reg Maint Elect y ,��" "�.S�j+•)e• Ur L � ` � ' "SINGLE FAMILY + Temp_Power,Pole& Appurtenances, (7 On HOME OWNER-BUILDER DECLARATION Sign with e Branch Circuit I hereby affirm that I am exempt from the,Contractor's License-Law ;• - for the f lowing reason (Section 7031 5, Business and Professions Additional Sign Branch Circuits, y Code 3 303 4`�f 1'. ,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) and Professions-.Code) _ TOTAL CONSTRUCTION LENDING AGENCY 1 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)• / d - MAHE Civ C) r PLAN CHECKING FEE Lender's Name i��t� �Q '' :'!f'19/95 ' PERMIT ISSUING FEE_ p� , 0 , Lender's Address T -1387 - 1 r Al,-9:59 I certify that I have read this application and-state that the above TOTAL FEE /D ; information is correct I agree to comply with aIl,County ordinances and State laws•regulating Electrical wiring, and hereby authorize " representatives of this County to enter upon,the above-mentioned property or i spection purposes SEE REVERSE FOR EXPLANATORY,-LANGUAGE qS Sig natur oF,Pef"miffee ate