HomeMy Public PortalAbout6018 GOLDEN WEST AVE_Electrical__ 76A663-CE806 9-66 APPLICATION FOiELLt TRICA PERMIT A f''IJ�IIII
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COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
RECEPT, 1 TOTAL NO. EACH FEE
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OUTLETS FIRST 20 $.20 $ OWNER
LIGHT MAIL
SWITCH ADD'L 10 ADDRESS
OVER 20
TOTAL FIRST 20 .20 CITY TEL. NO.
LIGHTING FIXTURES
FIXTURES ADD'L
OVER 20 10 CONTRALTO
RANGES DRYERS WTR.HTRS. 1.00 ADDRESS off;
GARB.DISP. STA.COOK GC
QQ
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DISH WASH. AUTO.-WASH. CITYTEL. NO. 7'�_2 v
STATE
SPACE HTRS. STA. APP L. ,50
LICENSE NO. a
MOTORS: OVER NOT OVER H.P. DISTRICT
�IN GROUP Z E P C S ED BY
O 1 1.00 �j,,+'
1 3 1.50 INSPECTION RECORD
3 S 2.00 c;
8 15 2.501
15 50 3.00
50 100 5.00 O
SIGNS: `NO.TRANS SIGNS:
NO.LAMPS
SERVICE 0-600V-NOT OVER 200A 1.00 oo CL
6 J
SERVICE 0.60OV-OVER 200 A. 2.00 N
SERVICE OVER 600V 5.00
OTHER (SEE COMPLETE FEE SCHEDULE)
PERMIT ISSUING FEE 2.00 U(f'
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 APPROVALS DATE INSPECTOR'S SIGNATURE
TOTAL FEE $ Q
I E HEREBY ACKNOWLEDGE THAT I HAVREAD THIS APPL CATION UNDERSLAB 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 L _
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR TH T 1 AM THE LEGAL O NER OF,AND INTEND TO
RESIDE IN,TME A O DE,6 IBED I T L PROPERTY. POWER
SIGNATURE UTILITY CO.NOTIFIED J /�/� _17 1X//�/��� �•
OF PERMITTE 41A / //, /J '� r -
FINAL f/
VALM JOSEPH C. ELECTRICAL
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
_ LAS 8 y 9 �+ � JUN 9 2 D 4.0 0-
' 1
tWORKERS'COMPENSATION DECLARATION -7G 10181
CE-806E-806G
APPLICATION FOR ELECTRICAL. PERMIT
I hereby affirm that I have a certificate of consent„•to self insure,`
o :*Certificate of Workers' Compensation'Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec.3800,Lab.C.)
Policy NO. Company FOR APPLICANT TO FILL IN JOB
❑ Certified copy is hereby furnished. EACH NO. FEE ADDRESS
New Residential Bldgs.& Pools
❑ 1 & 2-Family,S Ft. $ — $ LOCALITY
Certified copy is filed with the county building inspection y, q
department. Multi-family Sq.Ft. NEAREST
CROSS ST.
Date Applicant Residential Swimming Pools OWNER OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' + Outlets:Rec Light _ Sw. MAIL
COMPENSATION INSURANCE ADDRESS U C .
This section need not be completed if the work involved First 20
( b p Y the CITY Tel.No.
permit is for one hundred dollars ($100)or less.) Total No. Additional 7-7yZ
I certify that in the performance of the work for which this permit PLAN
CRStK
APPLICANT
is issued, I shall not employ any person in any manner so as to
become su ject to the Workers' Com ensation Laws. Lighting Fixtures First 20 ADDRESS
Date
Additional
Fixed Appliances Not Over 1 HP PERMIT
Total No. CITY Tel,No.
NOTICE, O Applicant APPLICANT: If, after making this Certificate of APPLICANT
Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W.
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 DECLARATIONCITY Tel. No.
Hood — Fan _ Other_
I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR
Disp. Room Air Cond, REG.NUMBER Class.
(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%0. , PROC ED BY
Size& Type HP, KW, KVA,or KVAR �j 0/ 0
License Number Lic. Class Up to 1 Incl FINAL V
Over 1 to 10 Incl. DATE
Contractor Date VALIDATION 0
❑ Over 10 to 50 Incl.
FINAL; 4 U
I am exempt under Sec. Over 50 to 100 Inc. BY W
BAP.C.for this reason Over 100 f2
Services,Swbd.,MCC& Panelboards f Cj t /�y Z
Date: 0- 200 Amp. Under 600 V /v ® Aj 1. ' [ r✓� ®”
Signature 201 - 1000 Amp. Under 600 V
❑ Exemption for Reg:Maint.Elect. Over 1000 Amp. or Over 600 V
SINGLE FAMILY Temp.Power Pole & Appurtenances 2
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Law QICCrT
A
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits
Code): 3307 CMS 25.50
I,as owner of the property,will do the work and the structure Misc.Conduits.& Conductors 1 ITE
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) ®
and Professions Code). TOTAL
OTAL 2-5o -500
CONSTRUCTION LENDING AGENCY
CHECK 25050
1 hereby affirm that there is a construction lending agency for the CHANGE .011
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total)
Civ. C.).
Lender's Name V
PLAN CHECKING FEE 0000-0001
00 i0-000 3 9/ 6 v/49
PERMIT ISSUING FEE �52 1 PM12tl05
Lender's Address
I 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
PLY
for inspection purpos s.
SEE REVERSE FOR EXPLANATORY LANGUAGE
SigMTrtbrYof Permitted Date I
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