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HomeMy Public PortalAbout5465 GOLDEN WEST AVE_Electrical__ 76A1663-CE80,6 10,74 APPLICATION F ELECTRICAL PER MIT COUNTY OF LOS ANGELES DtPARTMENT OF COUNTY ENGINEER 74ADDRESS L,( ',(( Cj�" BUILDING AND SAFETY DIVISION LOCALITY ej NEARET FOR APPLICANT TO FILL IN CROSS ST. OUTLETS NO. EACH FEE OF N NAME RECEPT./ $ $ ADDRESS57 E�LIJ N LIGHT TOTAL FIRST 20 [� OVER 20 CITY A ; w TEL. NO.2p88 ,5_�'ZZ& SWITCH / .10 PLAN CHECK LIGHTINGTOTAL FIRST 20 6 y APPLICANT FIXTURES 10 OVER 20 ADDRESS RESIDENTIAL APPLIANCES CITY TEL. NO. PERMIT RANGE DRYER_WTR. HTR. APPLICANT STA. COOK DISP. F.A.U. ADDRESS SPACE HTR. AIR COND. CITY TEL. NO. CLOTHES WASH. DISHWASH. LICENSE OR VCLASS. REG. NUMBER FAN OTHER 1. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING - WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW, KVA. ELECTRICAL WIRING. SIZE & TYPE OVER TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 - 1 100 LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF y, CALIFORNIA OR THAI I AM THE LEGAL OWNER OF THE ABOVE O 1 - lO 3.00 DESCRIPED RESIDENTIAL PROPERTY. U 10 - 50 5.00 SIGNATURE CD F_ U 50 - 100 10.00 ILLA DISTRICT NO. SSED BY h 100 - 500 15.00 57, 03 N SIGN, GAS=AND ONE CIRCUIT 5.00 APPROVALS DATE INSPECTOR' SIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE. SERV[CENOTOVER 600VOLTS OR200AMP 3.00 D UNDERSLAB WORK r'/�•- � � �.,� SERVI CE OVER 600 VOLTS OR 200 AMP 10.00 ROUGH CONDUIT TEMPSERVICE,POLE, &APPURTENANCES 5.00 WIRING TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED FINAL PERMIT FEE (SUB TOTAL) NOTES; PLAN CHECK FEE PERMIT ISSUING FEE TOTAL FEE PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 2 2 .3PR, 8 2 U 1 2.10 SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 76A663 CE•806(6/78) APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN JOB New Residential Bldgs.'&Pools EACH NO. FEE ADDRESS d i�' '7- 1 1 &2-Family,Sq. Ft. $ .0.25 — $ LOCALITY � G 17-- Multi-family Sq..Ft. .02 — NEAREST Residential Swimming Pools 25.00 CROSS ST. OWNER OR FIRM NAME Outlets: Rec-i—Light Sw.1 MAILADDRESS First 20 .50 19 Total No. 12 Additional .30 CITY Tel. No. PLAN CHECK -9 APPLICANT Lighting Fixtures First 20 .50 ADDRESS Additional .30 Total No. CITY Tel.No. Fixed Appliances Not Over 1 HP PERMIT APPLICANT Range—Heater_D.W. _ ADDRESS Oven_Dryer_ W.M. Top _FAU — W.H. _ CITY Tel.No. Hood_Fan —Other p +� LICENSE OR Disp._Room Air Cond. 2'50 l oma' REG.NUMBER Class. IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA. Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO Size&Type HP, KW, KVA,or KVAR n COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. L=S Up 2.50 U to 1 Incl. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR Over 1 to 10 Incl. 5.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF Over 10 to 50 Incl. 12.50 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE Over 50 to 100 Inc. 25.00 DESCRIBED RESID TIAL PROPERTY. Over 100 40.00 PERMITEE SIGNATURE Qui Services DISTRICT NO. OCES ED BY 0-200 Amp.Under 600 V 12.50 201-1000 Amp. Under 600 V 25.00 V (J Over 1000 Amp.or Over 600 V 50.00 Z' O Temp. Power Pole&Appurtenances 10.00 Q Sign with One Branch Circuit 10.00 Additional Sign Branch Circuits 2'001 Q 9 A INSPECTION > r1(^ Misc.Conduits&Conductors INFORMATION u x 0 0 0 0 0 2 10.00 ON REVERSE i Other(See Complete Fee Schedule) SIDE u 2 o 0 2 1.5 0 Z o 0 621.50 0 :01 c79 PERMIT FEE (Sub-Total) Z PLAN CHECKING FEE (One-Fourth Permit Feel O r PERMIT ISSUING FEE $7.00 c J TOTAL FEE > r INSPECTION FINALED arc W date: �� By a 9L ©s WORKERS' COMPENSATION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT I herAby affirm,that I have a certificate of consent to self CE-806G inure,`or'a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY ora certified copy thereof (Sec. 3800, Lob. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB s Certified co is hereby furnished. EACH NO. FEE ADDRESS 54(0:5 Y New Residential Bldgs..& Pools ❑ Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi'family Sq. Ft.' — NEAREST Residential Swimming Pools CROSS ST.OWNER OR Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' � MAIL Outlets: Rec Light Sw.� _ _ COMPENSATION INSURANCE First 20 4'' DDRESS — - G (This section need not be completed if the work involved by Total No. "� CITY�e Tel. No. the permit is for one hundred dollars ($100)or less.) Additional �:.M�' C IT .� Z I certifythat in thformonce of the work for which this PLAN CHECK e P erAPPLICANT 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. I Additional �O Fc23 CITY Tel. No. Date plicantp � 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: — t 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. Hood Fan' _ Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER Class. (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 A. Size &Type HP, KW, KVA, or KVAR' -_� y`� O License Number Lic. Class Up to l Incl. FINAL Ei Over 1 to 10 Incl. DAT�h Contractor Date / J VALIDATION ❑ Over 10 to 50 Incl. FIN 1 am exempt under Sec. Over 50 to 100 Inc. B B.&P.C. for this reason Over 100 Date: Services, Swbd., MCC & Ponelboards 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 100 0 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): 2 0 94�O A ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors # o o o o o 2 structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ pop.7044, Business and Professions Code). Io -.1575 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for 0 ° 0 1 5 7 5 0 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). .1023-84 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 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 bove-mentioned ro erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature Permittee Date WORKERS'COMPENSATION DECLARATION 76-663 tD/at ya P"P" IC/>a�' ON FOR E L.ECTRICAC PERMIT 1 hereby affirm that I have a certificate of.consent to self insure, CE-806G 6'�,Ml'" L� '�a/�U Il�l1 or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy,thereof(Sec.3800.Lab.C.) "fl Policy No. Company FOR APPLICANT TO FILL IN JOB ❑ Certified copy,is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE ADDRESS Certified copy is filed with the.county building inspection 1 & 2-Family,Sq.Ft. $ — $ LOCALITY __.. ���� �17-r department. Multi-family Sq.Ft. — NEAREST CROSS ST. �Ppj¢�Q�cJja DateResidential Swimming Pools O, Applicant OWNER R FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec_162- Light -1— Sw. O MAIL COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work involved by the Firs! 20 permit is for one hundred dollars ($100)or less.) Total No. Additional. CITY Tel.No.Zp5�- 2 J1 I certify that"in the'performance of the work for which this permit PLAN CHECK APPLICANT is issued, I shall not employ Any person in any manner so as to become subject to,the Workers'Compe ation Laws. Lighting Fixtures First 20 ADDRESS Additional Total No. 1Z_ Additional Tel.No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after makirg this Certificate of 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. LICENSED CONTRACTORS DECLARATION Hood — Fan -I— Other_ CITY 0- VVTel.No. I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR (commencing with Section 7000) of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER Class. Professions Code,and my license is in full force and effect. DISTRICT NO. a PRO D BY Power Apparatus& Large Appliances /^ f ye Size& Type HP,KW,KVA,or KVAR v 0 License Number Lic.Class Up to 1 Incl. FINAL U Over 1 to 10 Incl. DATE = Contractor Date dl VALIDATIO 0 ❑ Over 10 to 50 Incl. FINAL ~ I am exempt under Sec. Over 50 to 100 Inc. BY ( W B.&P.C. for this reason Over 100 N Date: Services,Swbd.,MCC& Panelboards ® Z 0-200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V ❑ Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. J SINGLE FAMILY Temp.Power Pole& Appurtenances r' HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law 4a _ for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits -t-7e Code): j^F ..,F - s ---- I,as owner of the property,will do the work and the structure Misc.Conduits& Conductors rI�,3"�;- is not intended or offered for sale (Section 7044, Business Other (See Complete Fee Schedule) and Professions Code). ® i OTA{_ r_56 CONSTRUCTION LENDING AGENCY CHECK I hereby affirm that there is a construction lending agency for the CHACC - performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) jt3 _ Civ:C.). PLAN CHECKING FEE Lender's Name 1Fi •( -; Il;i; ?,•''.-7;;i1 PERMIT ISSUING FEE a 3 �; Z Lender's Address =+66 i ;-r,i,;,_;.-` 1 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 proper for inspection purpo, s. SEE REVERSE FOR EXPLANATORY LANGUAGE Z7 Signature of Pe ittee Date