HomeMy Public PortalAbout5632 GOLDEN WEST AVE_Electrical__ 76A663-•?_"E806 10474 APPLICAI4N FOR jiECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER JOB 1
BUILDING AND SAFETY DIVISION ADDRESS
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
O�LETS NO EACH FEE OWNER OR
FIRM NAME
RECEPT $ $ MAIL -
LIGHTOTAL
FIRST 20 25 0 ADDRESS
T
CITY TEL N
SWITCH OVER 20 10
PLAN CHEC
FIRST 20 25 APPLICANT '
LIGHTING TOTAL _
FIXTURES
OVER 20 10 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 CLASS.
REG. NUMBER
FAN OTHER 100 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 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 LICENSED AS REOU IRED BY LOS ANGE4,"= Y AND STATE OF
CALIFORNIA THAI I AM T NER OF THE ABOVE c"
1 - l O 300 DES CR IP.E RE IDENTIAL PRO 6.)
PERMIT �
10 - 50 500 SIGNATURE I-
U
50 - 100 1000 W
DISTIR I 0. 0 SSED BY d
100 - 500 t 5 00 •5j G • Z
SIGN, GAS SIGN AND ONE CIRCUIT 500 APPROVALS DATE INS TOR'S SIGNATURE,
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 100 TEMP. POWER POLE
SERVI CE NOT OVER 600 VOLTS OR 200 AMP 300 UNDERSLAB WORK
SERVI CE OVER 600 VOLTS OR 200 AMP 1000 ROUGH CONDUIT
TEMPSERVICE,POLE, &APPURTENANCES 500 WIRING, ,
TEMP LIGHT OR RECEPT SYSTEM 300 FIXTURES
POWER AUTHORIZED ✓�
UTILITY CO NOTIFIED
FINAL
PERMIT FEE (SUB TOTAL) NOTES `
PLAN CHECK FEE
PERMIT ISSUING FEE 300 300
TOTAL FEE � )
PLAN CHECK VALIDATION CK M 0 CASH -PERMIT VALIDATIONCK M 0 CASH
8 T21till AUG 6 2 0 8.5 0 m
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE '
WORKERS'COMPENSATION DECLARATION 76A663'
s
CE806G (2-Bo) APPLICATION FOR ELECTRICAL' PERMIT '
I hereby affirm'that I have a certificate of consent to self COUNTY OFl LOS ANGELES BUILDING AND SAFETY
insure, or a certificate of Workers'Compensation Insurance,or )
a_c r fled copy hereof(Sec 38.00,Lab C)
�f '�rj ��C ( FOR APPLICANT TO FILL' IN ` JOB ��
Po icy No I `l Company ADDRESS
- a New Residential Bldgs &Pools EACH � NO FEE ,
❑ Certified copy is,hereby furnished 1 &2-Family,Sq Ft $ \ — $ LOCALITY
Multi-family Sq Ft — NEAREST /
Certified copy is filed with the county budding inspection' i CROSS ST
department ' Residential Swimming Pools OWNER OR
P: FIRM,NAME
Date�Apphcant E Outlets Rec�L'fight j� Sw � I CJ MAIL
/ First 20 ADDRESS
CERTIFICATE OF EXE PTION"FROM WORKERS' Total No ,/$ Additional CITY Tel No r }
COMPENS ION INSURANCE -
PLAN CHECK d
APPLICANT { 1
(This section need not be completed if the work involved �U
Lighting Fixtures First 20
by the permit is for one htindred dollars ($100) or less.) ADDRESS
- ) ,AdditionalTotal Not - ,
I ,certify that,in the performance of the work for which thisF Fixed Appliances Not Over 1 HP CITY- Tel No
permit is issued, I shall not employ any person m any manner PERMIT
so'as,to become subject to the'Workers' Compensation Laws Range_ Heater_D W APPLICANT 2iy) L• .chi i d
Oven Dryer_W M ADDRESS 7, f
Date '- Applicant
h• Top — FAU _W H' f Z
r' Hood Fan _Other_ CITY Tel No
NOTICE TO APPLICANT If,after making this Certificate of Disp Room Air CondLICENSEOR �0
Exemption, you should become subject to the Workers' REG NUMBER 0 3 Class
Compensation provisions'of the Labor Code,•you must forth' Power Apparatus& Large Appliances DISTRICT NO PROCESSED BY
with comply with such provisions or this permit shall be Size&'Type HP, KW, KVA,or KVAR
deemed revoked
r Up to 1 Incl
FINAL
Over 1 to 10 Incl DATE
LICENSED CONTRACTORS DECLARATION - � `� 'VALIDATION
OOver 10 to 50 Incl
I hereby affirm,that I am licensed under provisions of'Chapter Over 50 to 100 Inc FINAL
9 (commencing with Section 7000) of Division 3,of the Busi- Over 100 BY
ness and Professions Code, and my license is in full force and
effect. ` Services
License Nu e r 4 0� Lac Class ��� 0-200 Amp. Under 600 V' `1 -
201-1000`Amp Under 600 V
Contractor G' Date' /rf t Over 1000 Amp or Over 600 V
ME OWNER-BUILDER DECLAR TION Temp. Power Pole&Appurtenances r
I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit 2,5 4 4 2 A
License Law for th'e-following reason (Section 7031.5, Busi- ' Additional Sign Branch Grcuits /
ness and Professions Code) W "10 0-a 2
Misc Conduits& Conductors
❑ I, as owner of the property, will do the work and the Other (See Complete.Fee Schedule)— - _ 2 s o 11,O 0
structure is not intended or offered for sale (Section1
7044, Business and Professions Code) f x
CONSTRUCTION LENDING AGENCY 0 e.�•1 7 "
I hereby affirm that there is a construction lending agency I -
for the performance of the work for which this permit is 0'E 2T—811
issued(Sec 3097,Civ C ) PERMIT,FEE 1 (Sub-Total) r
Lender's Name r f
PLAN CHECKING FEE (One-Fourth Permit Fee)
Lender's Address PERMIT ISSUING FEE
I certify,that I have.read this application and state that the i TOTAL FEE
above information is correct I agree to,comply with all County
o0mances and State laws regulating"Electrical wiring, and
hereby or,"a representatives of this County to enter upon,
the ove entionedroperty spection purposes.
� � � � • 7 /�t J SEE REVERSE FOR EXPLANATORY LANGUAGE
�
gnature of Permittee to O