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HomeMy Public PortalAbout6046 GOLDEN WEST AVE_Electrical__ 76A663 APPLICATION FOR ELECTRIC PERMIT DBS-5A 12.54 DIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los-Angeles BUILDING WM. J. FOX. COUNTY ENGINEER ADDRESS CASSATT D. GRIFFIN. SUPT OF BUILDING FOR APPLICANT TO FILL IN LOCALITY PERMIT FEES NEAREST CROSS ST NUMBER EACH FEE LIGHT OUTLETS ' OWNER RECEPTACLES MAILADDRESS 14 0 WALL SWITCHES TOTAL OUTLETS 5! $ CITY TEL No ELEC RANGES 25 ELECTRICIAN ELEC HEATERS 25 ADDRESS KW EA CITY [/ TEL NO 1 4`)- YQ FIXTURES 5 ,LICENSE NO. NUMBER OF LIGHT CIRCUITS DISTRICT NO GROUP �,LN,% I READY FOR INSPECTION NUMBER OF RECEPTACLE CIRCUITS MOTORS NUMBER HORSEPOWER FEE ' INSPECTION RECORD NEW MVD HP OVER INC EACH _ 112&LESS S :25 1/2 2 .50 2 5 1.00 5 15 150 15 50 2 50 50 200 500 misc. NO SIGNS NO TRANS NO SIGNS NO LAMPS FOR EACH PERMIT. ' WIRING S1 00 FIXTURES $1 00 (J V SUPPLEMENTARY 50 '/�) APPROVALS TOTAL FEE $ �" P(� DATE INSPECTOR'S SIGNATURE 1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES _ w 7 V,Af LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF POWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDE IAL PROPERTY. UTILITY CO NOTIFIED �J . SIGNATURE OF PERMITTEE FINAL /D !n 'n / 1/f� WILLIAM J. FO OUNTY ENGINEER VALIDATI 4 0 0�7 S MAY 23 2:7' - BY DEPUTY- © LLL���'�LLL Lr 7&A6&3 CE-806(11 /78) i4PPLICATIOIV `FOR ELECTRICAL PERMIT� - .` - � .�-_ - -- -�-';_ �._.-f..-.�z_�...i•.:-,ra....-,..,,,.Jy.....�.;;•-moo.' -. COUNTY.OF LOS ANGELES i BUILDING ANDSAFETY-h_-... FOR APPLICANT TO FILL IN JOB ' New'Residentiol Bldg"sv&'Pools EACH' NO FEE ADDRESS - Q DG E T- -=r. 1 &2 Family Sq Ft V '025 — $ LOCALITY ".`, '02 ' — NEAREST -Multi-,family,Sq Ft CROSS ST 'C.�„ - �• 01 Residential' m Swiming Pools_ 25 00 OWNER OR /�,r -��-- �.- --- i• FIRM NAME c .Outlets Rec•• Light ;Sw -M'A11 First 20 X50 ADDRESS - - :Total-No Additional., 30 CITY - •_,•� __ t Tel o S , PLAN CHECK _ _ • APPLICANT Lighting Fixtures First 20 50 ADDRESS Total No Additional, 30 . CITY' Tel"Nd. Fixed Appliances,Not Over 1 HP- ... _ _ PERMIT­ - Range_Heater_D W APHLIGANT 7A ' Ove _Dryer--W M__` S •ADDRESS= D :Top _FAU W H CITY` ! Tel N , H71, ood Fon 'Other= LICENSE'OR rY Dsp _Room•Air Cord' '2 50. REG NUMBER Clas -� I-HEREBY•ACKNOWLEDGE-THAT I-HAVE=READ.THIS APPLICA' Powe us&'Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE'TO S¢ei&T,ype HP _ ' ' -COMPLY,-WITH-ALL-COUNTY -ORDINA'NCES'-AND"STATE 'LAWS' , KW;KVA,or KVAR, REGULATING ELECTRICAL WIRING Up to 1 Incl 2.50 F O' •-- - '- "( HEREBY-CERTIFY-THAT-1-AM-PROPERLY REGISTERED-AND/OR- -V Over 1 to 10 Incl 5 00 LICENSED AS REQUIRED BY,LOS ANGELES COUNTY AND STATE OF o ` Over 10 to-50 Incl 1T2 50._ CALIFORNIA OR THAT, I AM THE LEGAL OWN R OF THE ABOVE _O, Over 50 to 1 00 Inc 25-00 DESCRIBED RESIDEN �PROPERTY ' 40 00 PERMITEE + Over'100 '^' ' SIGNATURE - s ti Vf Services ! DISTRICT NO"' 0-200 Amp Under 600 V. 12 50 25 00 201-1000 Amp Under-600-V" 5000 Over'l000-Amp or Over 600 V, Z QTemp Power Pole&'Appurtenances' 10 00 4 Sign+with One Branch Circuit y'_': 10.00 4' o 2 k. Additional•Sign Branch Circuit; INSPECTION, > Misc Conduits&Conductors „+, lb' o INFORMATION' Other(See Complete Fee Sched%uie) ; -ON REVERSE�" x 1 y _ SIDE, _ Z +_ YI J �047. 1A -f„O^O O'o o 2 ' PERMIT FEE (}' Sub-Totall ' 1 PLAN CHECKING FEE (One Fourth Permit Fee). �~ O o,o"Ak505 PERMIT ISSUING FEE - $7'00 -• a 05,22=80 TOTAL FEE a' ,�a _ ;> INSPECTION FINALED date_`I :By .O? WORKERS'\COMPENSATION DECLARATION CE 806G'(2-B0, APPLICATION ,FOR ELECTRICAL PERMIT 1 I hereby affirm :that I have a certificate of consent to self COUNTY OF LOS ANGELES --/" BUILD1 NG'AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or a certified-c7opy thereof(Sec 3800,Lab C) �� FOR,APPLICANT TO FILL IN JOB j Policy Nb Company -� EACH NO FEE', ADDRESS L ❑ - � � - � New Residential Bldgs &Pools , Certified copy is hereby furnished 1 &2-Family,Sq Ft $ — s, LOCALITY Multi-family Sq Ft — NEAREST Certified copy,is filed wi county buil msp n CROSS ST department C/rF fY Residential Swimming Pools OWNER OR _ v 1 FIRM NAME Date �� �pphcanty Outlets Rec,LLight S MAIL - First 20 ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' Total No Additional CITY Tel No g - COMPENSATION INSURANCE { - � } PLAN CHECK tO APPLICANT' (This section need not be completed if the work involved U Lighting Fixtures First 20, by the permit is for one hundred dollar`s ($100) or less.) ADDRESS. Total No' Additional cc I certify that in the performance of the work-for which this CITY Tel(No' 0 permit is issued, I shall not employ an Fixed Appliances-Not Over 1 HP p p y y person in any manner PERMIT r W so as to Jbecome subject to the Workers' Compensation Laws Range_ Heater—D W APPLICANT £ 1 Oven _ Dryer_W M ADDRESS ' 1' UY Z Date Applicant Top _ FAU _W H r Hood Fan _Other_ CITY Tel No� ` NOTICE TO APPLICANT If, after making this Certificate of Dlsp Room Air Cond.— LICENSE OR //►► _3 OZ Exemption, you should become subject to the Workers' REG NUMBER TO Class,C� Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO PROCE SED BY r with comply with such provisions or'this permit shall be deemed revoked. Size&Type HP,.KW, KVA,or.KVAR S 0 �/ Up to'l InclFINA a Over 1 to 10 Incl ( DA EL LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl ( (j (�JG- VALIDATION I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc FINAL / p 9 (commencing with Section 7000) of Division 3iof the Busi- Over 100 BY ness and Professions Code, and my license is in full'force and effect Services � +( � 0 200 Amp. Under 600 V m License 97.,-Ir is Clas§ �� ^�/ 201=1000 Amp Under 600 V f Contrac r ate I �Ctij ��� Over 1000 Anip or Over 600 V HOME•OWN R-BUILDER DECLARATION Temp Power'Pole_&Appurtenances I hereby affirm Sign vvith One Branch Circuit that I am exempt from the Contractor's , Licenge Law for the following reason,(Section 7031 5, Busi- Additional Sign Branch Circuits ness and Professions Code) 2'7'5 TA Misc Conduits&Conductors' I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— ! #lo o;ol o o 2 structure`is not intended or offered for sale (Section r 7044, Business and Professions Code) i 0 0 ' 'CONSTRUCTION LENDING AGENCY � - i 2. 1 2 1 •O• ` I hereby'affirm that there is a construction lending agency.. _ for the performance of the work for which this permit is _ o?o o,1 2 1 0 / issued(Sec ,3097,Civ PERMIT C ) - FEE- (Sub-Total) W V -0.1,27-82 Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) G Lender's Address PERMIT ISSUING FEE I certify that I have read this application and state that the TOTAL FEE _ � �.2 �• _ , above information is correct I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby'a horize representaVes of this County to enter upon the ab v -mentione properly for ins ectl'bn purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee ® Date