HomeMy Public PortalAbout5606 GOLDEN WEST AVE_Electrical__ DBS-5At2-S4 Y A LICATION FOR ELECTRIC, PERMIT
DBS-SA
DIVISION OF BUILDING,AND SAFETY
Dep=tment of County Engineer
County Of LOS Aagele8 BUILDING h/� /� ,
WM. J. FOX, COUNTY ENGINEER ADDRESS V 4
-CASSATT D. GRIFFIN, SUPT OF BUILDING
_ FOR APPLICANT TO FILL IN LOCALIT ��
PERMIT• FEE CROSS L4 FEES NEARES ��_/
.
NUMBER EACH _
LIGHT OUTLETS OWNER 4f
LIGHT
RECEPTACLES l- - MAIL
ADDRESS AQ 197_W
WALL SWITCHES
TOTAL OUTLETS 5E $ ` CIJV TI/ �JC�Jyd�E J J�''TEL NO ��_
ELEC RANGES 25 _ ELECTRICIAN
ELEC HEATERS 25 ADDRESS
KW EA
_ --T CITY - TEL NO.
FIXTURES 5' _�V LICENSE NO
NUMBER OF LIGHT CIRCUITS '
DIST NO G) UP ZONE READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS- ,fir� "
MOTORS
NUMBER 'HORSEPOWER- FEE / INSPECTION RECORD
NEW MVD HP OVER INC EACH
1�-@ LESS `$ 25 n //
1/2 2 .50' .
2 _ 5 1 00
5- 15 -I ,-9 50 - - -
15 50 2 50
.50 200 5 00
M I Si:.
NO SIGNS_ NO TRANS'
NO SIGNS NO,LAMPS
FOR EACH PERMIT
WIRING - $1 00 � - -
FIXTURES - $1 00
SUPPLEMENTARY - 50
APPROVALS
TOTAL FEE f DATE• INSPECTOR'S SIGNATURE
1 HEREBY ACKNOWLEDGE THAT I HAVE READ 'THIS-APPLICATION CONDUIT —�—�—
.AND tSTATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING
ELECTRICAL WIRING I `
IHEREBY CERTIFY THAT I AM T ROPERLY•REGISTERED.AND/OR FIXTURES -
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE_OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF E ABOVE POWER
DESCRIBED RESIDENTIAL PROPERTY
• UTILITY CO NOTIFIED 1 I• w tl �
SIOF PEURE E FINAL (OI.�o ��y� sA Ir-11 0
WILLIA J. F . Co NTY dl Ir ID ION
AY
® Q,_
jyDEPUTY
�, � S
76A663-CE8061-67 APPLICATION FOR ELECTRI AL PERM
r COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER FNEAREST
G �+ _ l�
BUILDING AND SAFETY DIVISION /v
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDINGY G�
FOR APPLICANT TO FILL IN CROSS ST. 1 b ze-l"/g'
RECEPT. jTOTAL NO EACH FEE
OUTLETS FIRST 20 $.20 $ OWNER �7-J�./..�
LIGHT MAIL
SWITCH ADD L 10 ADDRESS
OVER 20
TOTAL FIRST 20 .20 CITY TEL NO
LIGHTING 1 FIXTURES 7N I
FIXTURES )( ADD'L
OVER 20 10 CONTRACTOR
RA4E8 DRYERS WTR HTRS. 1.00 ADDRESS �^
RB.DISP. STA COOK
CITY TEL NO.
DISHWASH AUTO-WASH. STATE 1�
SPACE HTRS BTA. APPL .50 LICENSE NO e�
MOTORS OVER NOT OVER H P. DISTRIC/T� Nk G 7 Z �;Z�WED
O 1 1.00
1 3 150 INSPECTION RECORD
3 S 200
8 15 2.50
15 50 3 00
a
50 100 500 �/ / /j, O
SIGNS NO TRANS (� (' OC
NO.LAMPS O
SERVICE 0.60OV-NOT OVER 200A 1.00 j
d
SERVICE 0-600V-OVER 200 A. 200 W
SERVICE OVER 600V 5.00
OTHER (SEE COMPLETE FEE SCHEDULE)
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 APPROVALS DATE INSPECTOR'S SIGNATURE
TOTAL FEE
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION UNDERS LAB WORK
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
1 HEREBY C IFY THAT I AM PROPERLY GISTERED AND/OR FIXTURES
LICENSED AS E UIRED BY LOS ANGELES
UNTY AND STATE OF
CALIFORNIA R T AT 1 A HE LEGAL W R AND NTE D TO POWER
RESIDE IN,TH A OV
CRIBE RE DE TI ROPERT
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITT
FINAL
(DATION JOSEPH C.
CK MO CASH SUPERVISINGG ELECTRICAL ENGINEER
i. y 8 0 y' X26 2 D 5:5 ON clo
WORKERS'COMPENSATION DECLARATION CE- 10/87 APPUCATION FOR. ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self insure, CE-806G
or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec.3800,Lab.C.)
Potrt No. Compan FOR APPLICANT TO FILL IN JOB
ADDRESS (t% (/ (�
0 ,Certified copy,is her urnished. EACH NO. FEE
New Residential Bldgs.& Pools
' 1 & 2-Family,S Ft. $ — $ OCALITY
Certifie py is filed wit the county building inspection y q
depar ment. Multi-family Sq.Ft. — NEAREST
CROSS ST.
Date Applicant• Residential Swimming Pools OWNER oR y�� /y-c �® z
. `} FIRM NAMES G `�T `' ,7I eZe
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec Light . Sw. MAIL `
COMPENSATION INSURANCE. ADDRESS qh
completed if the work involved b First 20
(This section need not be com P y the Total No. Additional. CITY !i� �! 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 Y '` APPLICANT
is issued, I shall not employ any person in any manner so as o
become subject to the Workers'Compensation Laws.. Lighting Fixtures First 20 ' "••�'» ADDRESS
�' ✓ / / Total No. Additional CITY Tel.No.
Date �" / iApplicant X/
i L Fixed Appliances Not Over 1 HP PERMIT ,a/ L /� dr r
NOTICE TO APPLICANT: If, after mavng this Certificate of /71,7E`�� �C
Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. APPLICANT
provisions of the tabor.Code, you must forthwith comply with such Oven _ Dryer— W.M._ ADDRESS( w85i
G1'
provisions o LICENSEDthis (CONITRACTORS DECLARATION Hood — Fan _ Other_ CITY Al /A j2� +e Tel.No.2 D Z'S�6
I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR / /' L
Disc. Room Air Cond. "REG.NUMBER r( 616 - Class. C!
(commencing with Section 7000) of Division 3 of the Business and
Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY
Size& Type HP,KW,KVA,or KVAR �O
License Number `f�)! C� �/',`+ Lic.Class
/��/ Up to 1 Incl. FINAL V•
�� i/'�'/ �/1 f"� Date < /` Over 1 to 10 Incl. DATE VALIDATION O
Contractor Over 10 to 50❑ Incl. !r/ U FINAL
I am exempt under Sec. Over 50 to 100 Inc. BY LL1
B.&P.C.for this reason Over 100 n,
Services, Swbd.,MCC &Panelboards ® Z
Date:`?�� 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.
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 Law
`,s;�na
for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits
J:R' f153
Misc.Conduits& Conductors ;—� -
l,as owner of the property,will do the work and the structure 3 i h N.-
is not intended or offered for sale (Section 7044, Business Other.(See Complete Fee Schedule) _ _
and Professions Code). ® r!AL .:--'" 65
CONSTRUCTION LENDING AGENCY CI")L''IK'
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) CHANGE `'10
Civ. C.).
PLAN CHECKING FEE
Lender's Name _ I F iT €k i_; °=?I 6/
PERMIT ISSUING FEE '3
Lender's Address l '' i yNiCii'-`
I certify that I have read this application and state that the above TOTAL FEE J �.
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
litnaPF6-6f Freffittee ` ate `/