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Home My Public Portal About5459 GOLDEN WEST AVE_Electrical__ 76A663A-C &06A 4/72 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER 7ADDRE , _ JAS BUILDING AND SAFETY DIVISION 17 1. C FOR APPLICANT TO FILL IN OUTLETS NO. EACH FEE$ $ OWNER RECEPT._ MAIL LIGHT TOTAL FIRST 20 ADDRESS CITY T TEL. NO. S SWITCH OVER 20 PLAN CHECK LIGHTINGFIRST 20 APPLICANT TOTAL ADDRESS �- FIXTURES OVER 20 RESIDENTIAL APPLIANCES CITY TEL. NO. RANGE DRYER WTR. HTR. PERMIT_ APPLICANT �S 4 G /'I G .O STA. COOK DISP. F.A.U. ADDRESS SPACE HTR. AIR COND. CITY -7e, -iL TEL. CLOTHES WASH. DISHWASH. LICENSE NO. 9 CLASS.4f-/(,) FAN OTHER IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY O MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING V IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. SIZE & TYPE OVER TO C I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR � 0 - 1 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF V CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO W RESIDE IN, THE ABOVE DESCRIPED RESIDENTIAL PROPERTY. y 1 - 10 Z 10 - 50 SIGNATURE e OF PERMITTE 50 - 100 DISTRICT NO. CLASS ZONE PROCE SED B 100 - 500 ^ SIGN, GAS SIGN AND ONE CIRCUIT NOTES: TUBE, OR MARQUEE ADDITIONAL CIRCUITS SERVICENOTOVER600VOLTS OR200AMP / kf�V APPROVALS DATE INSPECTOR'S SIGNATURE SERVI CE OVER 600 VOLTS OR 200 AMP TEMP.POWER POLE TEMPSERVICE, POLE, &APPURTENANCES UNDERSLAB WORK TEMP LIGHT OR RECEPT. SYSTEM ROUGH CONDIUT WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (SUB TOTAL) UTILITY CO. NOTIFIED PLAN CHECK FEE �y < -Z-� PERMIT ISSUING FEE S-D FINAL / TOTAL FEE Qp PLAN CHECK VALIDATION CK. M.0. CASH PERMIT VALIDATION C M.O. CASH g 9 4r--JUL 29 2 0� 9.0 0 9 �? 76A663C- CE8068 12,75 APPLICATION FOR ELECTRICAL PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN JOB New Residential Bldgs. & Pools EACH NO. FEE ADDRESS 1 &2 Finaily Sq. Ft. $ — $ LOCALITY e Multi-family Sq. Ft. — NEAREST CROSS ST. Residential Swimming Pools OWNER OR FIRM NAME P Outlets: Light, Switch& Receptacle ® MAI L First 20 . ADDRESS ,-,S Additional CITY e- , Tel. No. PLAN CHECK Lighting Fixtures APPLICANT / : OG First 20 ADDRESS Q S 76��rwNA.S Additional CITY Tel. No. PERMIT Fixed Appliances Not Over 1 HP APPLICANT Range Heater D.W. ADDRESS Oven _ Dryer W.M. Top FAU W.H. CITY 0—Tel. No. Hood Fan LICENSE OR >_ REG. NUMBER Class. Disp. A.C. v I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND OMPLY STATE THAT THE ABOVE IS CORRECT AND AGREE TO CO Power Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ♦— ELECTRICAL WIRING. C..7 SizeHP, KW, KVA,or KVAR � Up to 1 Incl. 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR Over 1 to 10 Incl. LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAJL/L OWNER )( 01 THE ABOVE Over 10 to 50 Incl. DESCRIBED RESIDENTIALg' ROPER /' V Over 50 to 100 InCI. PERMITEE Over 100 SIGNATURE' DISTRICT NO. ESSED Y Services �� o 0-200 Amp. Under 600 V 201 - 1000 Amp. Under 600 V APPROVALS DATE I . T Over 1000 Amp. or Over 600 V SIGNNAATUURREE TEMP. POWER POLE Temp. Power Pole&Appurtenances UNDERSLAB WORK � 7 Sign with One Branch Circuit Additional Sign Branch Ci rcu is ROUGH CONDUIT (Other) WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (Sub-Total) UTILITY CO.NOTIFIED 17-17,;7- 721 PLAN CHECKING FEE (One-Fourth Permit Feel FINAL / -17,772 PERMIT ISSUING FEE TOTAL FEE NOTES PLAN CHECK VALIDATION CK. " M.O. ASH PERMIT VALIDATION M.O. CASH l_ � r IORKERS' COMPENSATION DECLARATION CE-806G '°'B' APPLICATION FOR ELECTRICAL PERMIT ' I herEy7 df{'tm hotel hove a certificate of consent to self 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. Company FOR APPLICANT TO FILL IN JOB / Certified copy is hereby furnished. EACH Residential Bldgs. & Pools EACH NO. FEE ADDRESS ❑ 1 & 2-Famil '5 Ft. $ — $ LOCALITY pat C1 I, Certified copy is filed with the county building inspec- Y. q 6S Residential tion department. - Multi-family Sq. Ft. CROSS ST. N Date Applicant Residential Swimming Pools FIOWNER OR ��yQ , i� RM NAME rIN � O � CERTIFICATE OF EXEMPTION FROM WORKERS' q �e Light Sw. ,MAIL �- COMPENSATION INSURANCE Outlets: Rec ADDRESS e ( completed if the work involved by Total No.l/*This section need not be com First 20 � _ the permit is for one hundred dollars ($100)or less.) (j CITY Additional ` Tel. No. I certify e that in the performance of the work for which this PLAN CHECK P 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. l� Additional oS -J.� CITY 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' Range_ Heater D.W. — q� Compensation provisions of the Labor Code, you must forth- Oven _ Dryer W.M.— ADDRESS �C'SG7� /V, ' with comply with such provisions or this permit shall be Top — FAU —W.H. deemed revoked. CITY n+(.G�, Tel. No. t�3 / LICENSED CONTRACTORS DECLARATION Hood Fan _Other_ Disp. — Room Air Cond. LICENSE OR. Class. I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER (commencing with Section 7000) of Division 3 of the BusinessDISTRICT NO. PROC SED BY Y and Professions Code, and m license is in full force and effect. Power Apparatus 8 Large Appliances L /� y� Size &Type HP, KW, KVA, or KVAR' i AA c� ( v9 License Number Lic. Class - Up to 1 Incl. ;IFINAL Over 1 to 10 Incl. DATEVALIDATION Contractor Date Over 10 to 50 Incl. FINAL � ❑ 1 am exempt under Sec. Over 50 to 100 Inc. BY Over 100 8.&P.C. for this reason tH Services, Swbd., MCC& PonelboardsZ Date: 0 -200 Amp. Under 600 V 5r0" I/ 0 Signature 201 = 1000 Amp. Under 600 V 2 2 8 Q 4 A ❑ �7 Exemption for Reg. Maint: Elect. Over 1000 Amp. or Over 600 V d� o°o° �J '�i 'r 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 8 2 8-8 Jr. Law for the following reason (Section 7031.5, Business and Professions Code): ❑' I, as owner of the property, will do the work and the Misc. Conduits &Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ ► 7044, Business and Professions Code). 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) (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 rl above 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