HomeMy Public PortalAbout5842 GOLDEN WEST AVE_Electrical__ 7GA663-CES06 10.62 APPLICATION FOR'- ELECTRICAL ERMIT
APPLICATION
COUNTY OF LOS ANGELES
DEPARTMENT OF-COUNTY-ENGINEER BUILDING ^ r
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
RECEPT. TOTAL NO. EACH FEE i+
OUTLETS FIRST 2O2OWNER V,65 . G $ L`!r
LIGHT 0 MAIL
ADD'L ADDRESS
SW ITCH
OVER 20 .tO
LIGHTING
TOTAL FIRST 20 .20 CITY TEL,. NO
/
FIXTURES / ADD'L ELECTRICIAN h /? ja�'c7-
I C
OVER 20 '•1O O
RANGES CLO DRYERS WTR.HTRS 1.00 ADDRESS O (!5 jg!!7
GARB.DISP STA COOK
CIT TEL. NO —Q lg� /
DISHWASH AUTO.-WASH STATE
SPACE HTRS. STA.APP.(r/g H P.MAX ) ,50 LICENSE NO
MOTORS OVER NOT OVER H P. DISTR,�CTr. G OUP Z
QrqE
PRO6ESSED BY
o t t.00 (1 J
1 3 1.50 INSPECTION RECORD
3 S 2.00
a
B 15 2.50 - Q
15 50 300 OC
50 100 Soo - 0
NO.TRANS 1IIILLLL
SIGNS NO LAMPS h
z_
SERVICE 0.600V-NOT OVER 200A foo
SERVICE 0.60OV-OVER 200 A. 2.00 ,
SERVICE OVER 600V 500 -
MISC.
r
PERMIT ISSUING FEE 2 00 - a
SUPPLEMENTARY PERMIT ISSUING FEE 100'
TOTAL FEE IS
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DA INSPECTOR'S SIGNATURE
AND STATE-THAT THE ABOVE IS CORRECT'ANO AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES '
CALIFORNIA OR THAT 1 A OWNER OF THE ABOVE
DESCRIBED RESIDENTIA ROPE _ POWER
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTEE \ /�
FINAL J /� I/n
LIDATION CA AR HU C.�El ITE
CK MO CASH SU ERVISING ELECTRICAL ENGINEER-'
L,�I�o 3 & 0 MAY 2 2 D 2.60—
��
WORKERS'COMPENSATIONDEC LARATION CE-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT �•
I hereby affirm 'that .I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY
insure,-or a certificate of Workers'Compensation Insurance,or
A certified copy thereof(Sec 3800,Lab C)
FOR APPLICANT TO FILL�IN SOB
Policy No Company ADDRESS Z6pC.j?V► (VeaT,,
New Residential Bldgs &,Pools ` EACH NO FEE
Certified copy,is hereby furnished 1 &2-Family,Sq Ft. $ — $ LOCALITY -reeqv'e G�
Multi-family Sq Ft CROSS ST (�
Cer{ified copy is filed-with the county building inspection Aa•S T
department Residential Swimming Pools OWNER OR_
�. i FIRM NAME hm •
Date E 2• Applicant - � G�"LL E "'C/ Outlets Rec _Light Sw MAILaa /�
First 20 ADDRESS J Z �C C(7�S
( CERTIFICATE OF EXEMPTION FROM WORKERS; Total No'• Additional {' CITYm / q Tel No '
\ COMPENSATION INSURANCE e' ��' v }
PLAN CHECK �-
- APPLICANT 0
(This section need not be completed if the work involved Lighting Fixtures First 20 U
by the permit is for one hundred dollars ($100) or less.) ADDRESS
Total No Additional , 0
I certify that in the performance of the work for which'this Fixed Appliances Not Over 1 HP CITY Tel No
permit is issued, I shall'not employ any person in any manner \ PERMIT 0
so as-to become subject to the'Workers' Compensation Laws Range_ Heater_D W APPLICANT Dim ezGf/�CL TOL L, W
Oven _ Dryer_W M ADDRESS LZZS- ' N Z
Date, Applicant ' Top _ FAU _WH _
�` Hoold — Fan _Other_ CITY 61 Tel No t,�y���'
,)NOTICE TO APPLICANT If, after making this Certificateiof• Disp _ Room Air Cond.— LICENSE OR, pp��
Exemption, you should become subject to the Workers', REG NUMBER 2'S0D(0 Class 4:::.
Compensation provisions of the Labor Code,'you must forth- Power Apparatus& Large Appliances' DISTRICT NO PROCESSED BY
with complyi with such proyisions or this permit shall be (" _
deemed revoked Size&Type HP, KW, KVA,or KVAR
Up to 1 Incl O ev jl
FINAL
Over 1 to 10 Incl DATE VALIDATION
LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl I �^
� r l
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 Bust- Over 100 BY
eness and'Professions Code; and my license is in full force and G
effect Serve -
License Number Z JcO��i Lic Class 4-10 Am Under 60 _
201-1000 Amp Under 600 V ;
Contractor Date, may Over,1000 Amp or Over 600 V
HOME OWNER-BUILDER DECLARATION Tempe Power Pole&Appurtenances
I hereby affirm that I am, exempt from the Contractor's Sign with One Branch Circuit -2,83„ ' ', •
License Law for the following reason (Section 7031 5,-Susi- Additional Sign Branch-Circuits - r8''A
ries and Professions Code) - o'0 0 0 0 2"
Misc Conduits& Conductors \
I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)
'structure is not intended or offered for sale (Section _
N
7044, Business and Professions Code) , a;o yo 2 5 rj 0 U
CONSTRUCTION LEDING AGENCY l R t �
I hereby affirm that' there is a construction•lending agency 0 1,.2�4l"-8 4,
for the performance of the work fog which this, permit is PERMIT FEE (Sub Total) _
issued (Sec 3097,Civ C). ,
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee)
Lender's Address PERMIT ISSUING FEE O ti
r
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 ab�td propert for inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
*' q Signature ofermittee ate - f