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HomeMy Public PortalAbout6127 GOLDEN WEST AVE_Electrical__ OB S-A 12.49 25M APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES ELECTRIC , 1 ` 'WM. J. FOX CHIEF ENGINEER a NAME /' DISTRICT NO. GROUP ZONE,, PERMIT NOO.� ADDRESS /1 �A(L� ��/ C/� I CITY U TEL.NO.'1. RECEIVED BY READY,FOR DATE ISSUED J COUNTY / FIRST INSPECTION W I CERT.NO. EXPIRES APPLICANT FILL IN HEAVILY OUTLINED POMM O/NLLYJOB D�Y�/ DESCRIPTION OF WORK ADDRESS 05;; ',y��J / �//��L NUMBER OF OUTLETS ON CIRCUITS LOCALITY {b�J ,, LOCATION BY ROOMS NEAREST V LIGHT OUTLETS SW. PLUGS FIXT CROSS ST. CIRCUIT` A B C D E F G- H NAME Z MAIL ,: ADDRESS O CITY TEL.NO. 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION.. ELECTRICIAN. I AM THEWNER OF E PROPERTY DESCRIBED ABOVE OWNER. ' CORRECTIONS J a Z 2 0 -H- :::FR TOTAL )) aa / NO. OF OUTLETS / J $ Cpv APPROVALS NO. OF FIXTURES 'T $ DATE NII\NSPECTOR'S NAME NO. OF MOTORS H.P. $ CONDUIT J� yf� NO. OF SIGNS TRANS. $ WIRING /'�'J /'\V NO. OF RANGES OR HEATERS $ FIXTURES r LLANEOUS $ POWER T FEE $ UTILITY CO.NOTIFIED 'FEE �� / Q FINAL �a • �^ n 76A663-CE806 4.66 APPLICATION FOR ELECTRI PERMIT cul COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY NEAREST o FOR APPLICANT TO FILL IN CROSS ST. RECEPTACLE TOTAL No EACH FEE 1 OUTLETS FIRST 20 $.20 $ OWNER LIGHT J} _MAIL SWITCH ADD ADDRESS 2 OVER 20 .10 � r �y TOTAL FIRST 20 .20 CITY TEL. NO. 'j 0` LIGHTING 1 FIXTURES FIXTURES 1 ADD'L 1O 'CONTRACT05'R OVER 20 RANGES CLO DRYER9 WTR HTRS 100 Q"U ,ADDRESS y GARB DISP e K /J q CITY - T N0.7 `IL DISHWASH AUTO.-WASH. STATE SPACE HTRS. STA.APP ('/.H P.MAX.) ,SO [LICENSE NO. MOTORS OVER NOT OVER H P. DIST I G P ZONE P O 1 1.00 1 3 ISO INSPECTION RECORD 3 8 2.00 8 15 2.50 15 50 300 O U 50 100 5.00 CC SIGNS NO TRANS O NO LAMPS W SERVICE 0.60OV-NOT OVER 200A 1.00 N SERVICE 0.60OV-OVER 200 A. 2.00 Z SERVICE OVER 600V 5.00 OTHER (SEE COMPLETE FEE SCHEDULE) PERMIT ISSUING FEE 2.00 SUPPLEMENTA13Y PERMIT ISSUING FEE 1.00 TOTAL FEE s S` APPROVALS DATE INSPECTOR'S SIGNATURE I.HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 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 ` I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO POWER RESIDE IN,THE ABOVE CRIB RESID N A PROPERTY, SIGNATURE UTILITY CO.NOTIFIED OF PERMITTEE FINAL DATION JOSEPHrC. ROOHAN ICK',-410 CASH SUPERVISING ELECTRICAL ENGINEER z4 LACo 1 3 5 3 APR 1'8 2 D 5.5'O N r kd D8 5-A 12-43 25M DEPARTMENT' OF BUILDING ANO SAFETY DEPARTMENT B'EIt114i� COUNTY OF LOS ANGELES ELEC 1TRIC WM. J. FOX CHIEF ENGINEER z DISTRICT NO. GROUP ZONE PERM NO. ,a NAME �,v� A q rrF ADDRESS ,,r / rp 5i }/ U RECEIVED 13Y READY FOR DATE ISSUED W CITY TEL.NO. FIRST INSPECTION t . J COUNTY J�� �•+SL 41 CERT.NO. EXPIRES 111 APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY DESCRIPTION OF WORK DDRESS NUMBER OF OUTLETS ON CIRCUITS LOCALITY c-F' LOCATION BY ROOMS NEAREST LIGHT OUTLETS SW. PLUGS FIXT CROSS ST. CIRCUIT A 13 C D E F G H 0: NAME Z MAIL 3 ADDRESS a O CITY TEL.NO. 1 AM THE LEGAL POSSESSOR OF THE VE LOS ANGgLES COUNTY CERTIFICATE OF QUALIF AT ON.. ELEC RIC AN. I AM THE LEGAL O O E ROPFRTY RIBED ABOVE 7����v�g 7� OWN CO D CTIONS l J - Q Z O LL NO. OF OUTLETS" / $ APPROVALS NO. OF FIXTURES $ DATE INSPECTOR'S NAME NO. OF MOTORS H.P. $ CONDUIT NO. OF SIGNS - TRANS. $ WIRING NO. OF RANGES OR HEATERS $ FIXTURES MISCELLANEOUS $ POWER a[...L PERMIT FEE $ UTILITY CO.NOTIFIED TOTAL FEE S FINAL WORKERS'COMPENSATION DECLARATION CE-806 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.) 1 � �.f Policy NoWdiblGt'f� 72a I KN,1110YUt+ em�I�V FOR APPLICANT TO FILL IN JOB � ) /� Company EACH NO FEE ADDRESS (, 1V v New Residential Bldgs.&Pools Certified copy is hereby furnished. 1 &2-Family,Sq. Ft $ — Is LOCALITY a i Multi-family Sq Ft — NEAREST FS-1 Certified copy is Bled with the county building inspection CROSS ST ('I+ department . Residential Swimming Pools OWNER OR i FIRM NAME. �•4 �. ' lVi kJ Date 42-410 Apphcantffl,,A,_A,, VA IPYNvtelll- Outlets Rec_aLight SwMAIL First 20 e�© Qo 1�' ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' Total No A_ Additional y0 CITY Tel No ' COMPENSATION INSURANCE } • PLAN CHECK � d (This section need not be completed if the work involved APPLICANT 0 by the permit is- for one hundred dollars ($100) or less.) Lighting Fixtures First io ADDRESS tY Additional Total No._1_� O 1 certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No; U permit is issued, I shall not employ any person in any manner PERMIT so as to become subject to the Workers' Compensation Laws. Range_ Heater D W APPLICANT ` C'`�• ) ���lv: llf' 1�1 CL Oven _ Dryer_W M ADDOESS °l UP1 5{ Z Date Applicant Top _ FAU _WH'_ � Hood Fan —Other_ CITY L_c G R11f e_Ae- Tel No NOTICE TO APPLICANT If, after making this Certificate of Disp Room Air Cond.— LICENSE OR Exemption, ,you should become subject to the Workers' ' REG NUMBER Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO PROCEQS ED BY with comply with such,provisions or this permit shall be Size&Type HP,KW, KVA,or KVAR Is`,O Q -t AQ1� deemed revoked. C] W Up to 1 Incl FINAL Over 1 to 10 Incl DATE LICENSED CONTRACTORS DECLARATIONOver 10 to 50 Incl VALIDATION I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc B`NAL 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 ness and Professions Code, and my license is in full force and , effect. Services License Numbers 3 4 Lic Class 0-200 Amp. Under 600 V Y�(% I�GTs. If!� •��- "/� / 201-1000 Amp. Under 600 V Contractor Ill •yAFertWi I1�1 Date j'Z`r 8 Over 1000 Amp:or Over 600 V HOME OWNER-BUILDER DECLARATION Temp Power Pole&Appurtenances I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit License Law for the following reason (Section 7031 5, Busi- Additional Sign Branch-Circuits ness and Professions Code) Misc Conduits&Conductors El I, as owner of-the property, will do the work and the Other(See Complete Fee Schedule)— structur6 is not intended or offered for sale-(Section 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work,for which this permit is PERMIT FEE (Sub-Total) 7J 5 8 A issued (Sec 3097,Civ C) C) Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) _ # o'o'o.o o 2 Lender's Address PERMIT ISSUING FEE 2 0{0 2,2,5 0 I certify that I have read this application and state that the TOTAL FEE Z g o 0 o 2.2 5.0 above information is correct I agree to comply with all County ordinances and State laws regulating Electrical wiring, and O 3 0 4 8'2 hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes C SEE REVERSE FOR EXPLANATORY'LANGUAGE i� 1 rH 2 a 0 C'e)1- t C 2 Signature of Permittee D to