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Home My Public Portal About6203 GOLDEN WEST AVE_Electrical__ -DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMITCOUNTY i .. " COUNTY OF LOS ANGELES ��g� WM. J. FOX CHIEF ENGINEER ' Z NAME DISTRICT NO. GROUP ZONE PERMIT NO. U ADDRESS Ga - � U CITY a ��yjO,rJy} TEL. - ®�� CEIVED BY READY FOR DATE ISSUED _ Of FIRST INS E13 CTIO --CERT.NO. EXPIRES I' Aa1�1 `p� f�"'a` APPLICANT FILL IN HEAVQ:Y OUTLINED PORTION ONLY DESCRIPTION OF WORK A DRESS �' s eA NUMBER OF OUTLETS ON CIRCUITS LOCALITY LOCATION BY ROOMS NEAREST �.� LIGHT OUTLETS JSW. PLUGS FIXT CROSS ST. CIRCUIT A B C I D I E F G H a: NAME Z MAIL bb p/�a 3 ADDRESS A Y 5�10 b` O. CITY TEL:NO. I AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERT FICATE OF QUALIFICATION.. 14 ELECTRICIAN.- I AM Tft LEGAL OWNER OF THE MOPEJRTY DESCRIBED ABOVE OWNER. CORI ECTIONS, Z - C] TOTAL To ;7 NO. OF OUTLETS' s "PROVALS NO. OF FIXTURES / $ DATE. INSPECTOR'S NAME NO. OF MOTORS H.P. S CONDUIT (� NO. OF SIGNS TRANS. E WIRING NO. OF;aiRMS�OR HEATERS -$ � FIXTURES MISCELLANEOUS $ POWER PERMIT FEE �,y $ UTILITYCO.NOTIFIED II TOTAL FE FINAL WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self Insure, 76A663 or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF'PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof,(Sec 3800 Lab C) Policy NO Company h FOR APPLICANT TO FILL IN- JOB 2�f'1 ,�IJ-.:-AJ � ADDRESS /�(f v Certified copy is hereby furnished New Residential Bldgs &Pools NO EACH FEE f t- $ $ LOCALITY _e ' ❑ Certified copy Is filed with the county building Inspection 1&2-Family,SQ Ft _ NEAREST - department Multi-family Sq Ft CROSS ST V Residential Swimming Pools ASSESSOR Date' "-* Applicant + '1 - - f/ F ¢ *.MAP BOOK -_ PAGE PARCEL I a CERTIFICATE OF EXEMPTION FROM WORKERS' ' Q t ~ OWNER OR , 1•• i , - Outlets RBC Light SW —/6,0 FIRM NAME COMPENSATION INSURANCE First 20oe5 MAIL (This section need not be completed'if the work i6volved by the ' ` ADDRESS permit'is for ohe hundred dollars($100)or less.) Total No Additional C�IJ- t I certify that In the performance of the work�for which this permit CITY_.7 7L lel No is Issued, I shall not employ any(person in'any manner so as t0 PLAN CHECK become subject to.the Workers' Compensation Laws Lighting Fixtures First 20 APPLICANT Total No Additional - ADDRESS Date ,Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP NOT.ICE,TO APPLICANT,If, after making this Certificate of .CITY Tel No Ex' nptio n,,,you should become;subfect`o the Workers' Compensation OTHER APPLIANCES NOT OVER 3 HP provisions of the Labor Code, you must•forthwith comply with such 7PERMIT provisions or this permit shall be'deemed revoked Power Apparatus&Large Appliances APPLICANTZ�9f LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that 1 am licensed under provisions of Chapter 9 Over 3 to 10 Incl `(commencing with Section 7000) of Dlvision'3 of the Business and CITY Tel No ,Professions Code,and my license Is in full force and effect Over 10 to 50 Incl` } LICENSEClass _ - - Over 50 t0 100 Incl REG NUMB ER a - - 'OGer 100 DISTRICT NO P OC SSED BY O License Number Lic Class 0 Services,Swbd-MCC,&Panelboards sQ a ContractorDate 0-399 Amp Under 600 V FINALDATE 9 O ❑ 1 am exempt under Sec 400-10Amp Under 600 V �// / 00 W ' Over 1000 Amp or Over 600 V FINAL CL VALIDATION B&P C for-this reason' - BY (1) BRANCH CIRCUIT FEES Date 15A,or 20A, 120V,Lighting or Recept Z 1 To 10 Branch Circuits _ Signature 11 To 40 Branch Clrcuds 416r More Branch Circuits } ❑Y Exemption for Reg Maint Elect 15_A,20A,208V To 277V Lightorg,Br Circuits Y SINGLE,FAMILY Temp Power Pole&Appurtenances ^t t.g r HOME OWNER-BUILDER DECLARATION t4 %iass Sign with"One'Branch•Circwt I hereby affirm that I am exempt from the Contractor's License Law r jtr for the following reason (Section 7031 5,"Business and Professions Additio-nal Sign Branch Circuits r Code) - T 1 ITEMS a 25 1,as owner of the property,will do the work and the structure Mise Conduits&Conductors i T11 t _7 , Is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) i,H ii ,iL,i s and Professions Code) i CONSTRUCTION LENDING AGENCY CHANGE .0t€ I hereby affirm that there is a construction lending agency for the performance of the'work for which this permit Is issued (Sec 3097,' PERMIT FEE (Sub-Total) / Civ C) - 0000-011(L'1 �!r, 2.193 PLAN CHECKING FEE ! O` er Lender's Name' _ 005 PERMIT'ISSUING FEE p?� Lender's Address EE : I certify that I have read this application and under penalty of purlury state TOTAL FEE that the above'orformation is correct I agree to comply with all County ordoranc s and State laws regulator ect cal wir g,and hereby authorize rep se tatives of this unty toe up n theovetmentioned p operty for ns coon purpose SEE REVERSE FOR EXPLANATORY LANGUAGE `_51 MATURE OF PERMI E DATE , WORKER'S COMPENSATION DECLARATION 20-19 DPW c12-91> 76A663 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self Insure, or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS ' BUILDING AND SAFETY DIV copy thereof(Sec 3.800 Lab C)- Policy NO Company FOR APPLICANT'TO FILL,IN JOB ADDRESS a Al, Certlfled copy is hereby furnished New Residential Bldgs-&Pools NO EACH FEE LOCALITY GO- tz _ter 1 &2-Family,Sq Ft $ $ ❑ 'Certified copy Is,hled with the county,building Inspection _ NEAREST x department, Multi-family Sq Ft CROSS ST AJ Date _ Applicant Residential Swimming Pools _ -,ASSESSOR p (,MAP BOOK ,PAGE CA9 1 PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Sw T OWNER OR K' COMPENSATION,INSURANCE Cutlets Rec �0 Light FIRM NAME �,•r •, a ,, Rist 20 MAIL This section need not be completed If the work Involved by the Total No Additional ADDRESS /- permit Is for one•hundred dollars($100)or less.) 'I certify that in the performance of the work for which this permit -r CITY610' kf p�M t Tel No �O IS Issued, I shall not employ any person In any manner so as to PLAN CHECK - become_subject to the Workers'Compensation Laws Lighting Fixtures First 20 APPLICANT -- Total No Additional ADDRESS Date ' Applicant RESIDENTIAL APPLIANCESNOT OVER 3 HP NOTICE TO„APPL ,ICANT If, after making this Certificate of CITY Tel No Exemption, you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP provisions of the Labor Code, you must forth'wrth comply with such PERMIT N Power Apparatus&Large Appliances APPLICANT provisions or this permit shall be deemed revoked LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby"affirm that•I am lidensed under provisions of Chapter 9 Over 3 to 10 Incl r (commencing with Section 7000) of Division 3 of the Business and CITY Tel No Professions Code,and my license is In full force and effect Over 10 to 50 Incl w' LICENSE OR Class a - Over 50 t0 100 Inc[ REG NUMBER License Number Lic Class Over 100 DISTRICT NO P OC SSED BY O C:d�2L' z°�D r —• - Services,Swbd,MCC&'Panelboards CC_ � m� ' Contractor Date, 0-399 Amp Under 600 V FINAL E / ✓/� O ❑ I am exempt under Sec Over -1000 Amp Under 600 V �[ / LV VALIDATION Over 1000 Amp or Over 600 V FINAL i CL B&P C for this reason BRANCH CIRCUIT FEES BY (n Date 15A,or 20A,120V,Lighting or,Recept _ 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits k 71 41 Or More Branch Clrcu s ;` � IJ Exemption fog Reg•Maint Elect 15A,20A,208V To 277V Lighting Br Circuits ITEMS i SINGLE FAMILY Temp Power Pole&Appurtenances 1 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit -e I hereby affirm that I am exempt from.the Contractor's License Law g j)�T' L 61 . 65 for'the following,reason (Section 7031 5, Business and Professions Additional Sign Branch Circuits {y is Code) CHECK 60.6.1 ❑ I,as owner of the property,will do the work and the structure Misc Conduits&Conductors - ,t1c�.�` 1001 I, is not Intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) t iL and Professions Code) CHANGE .00 CONSTRUCTION LENDING AGENCY I hereby affirm`that there is a construction lending agency for the ,,��•ss 3/26/93 3 performance of the work for which this permit Is issued (Sec 3097, PERMIT,FEE (Sub-Total) oo�—oom `-'f�6 y` CIV C PLAN CHECKING FEE s i7G87 "� a�+V J Lender's Name PERMIT ISSUING FEE 61-15 Lender,'s Address I certify that I have read this application and under penalty of purjury state TOTAL FEE 4T. Information Is co ect I gree to comply with all County State laws reg t Ele ncal wiring,and hereby authorize, of this ounty e er u on thAabove-mentioned property urpo SEE REVERSE FOR EXPLANATORY LANGUAGE R ATE ,