HomeMy Public PortalAbout6210 GOLDEN WEST AVE_Electrical__ TE PLEt CITY �� 5
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DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION AD=D _ .�
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A JENSEN,SUPT OF BUILDING
FOR APPLICANT TO FILL IN NEAREST
PEMWT FEES CROSS ST. v
ITE M NUMBER EACH FEE OWNER
OUTLETS: . $ $ MAIL .� /"""�
ADDRESS i
LIGHTS RECEPT. SW. .1O , y� -
LIGHTING FIXTURES 10 CITYv TEL.NO �i
ol
ELEC.RANGES' CLO.DRYERS ELECT ICIAN
WATER H E A T E R S .50 ADDRESS �0
ELEC SPACE HTRS. DISHWASHERS I:.ITY TEL NO
GARBAGE DISPOSERS AUTO.-_ STATE f
WAAS�HEERSS STA COOKING UNITS 25 LICENSE NO
MOTORS' OVER INC H-P - DI ICT NE �P BY
O— 1/2 .25 0
1/2--- 2 .50 INSPECTION RECORD
2— 5 loo
1 so // V��
15— 50 250 !'IdInilrf
' 50—200 500
07 d/V/
NO TRANS /" -" " A�/td��
SIGNS:
NO LAMPS -
SERVICE 0-600V 100
SERVICE OVER 600V 500 / •,� /I�p� A� ,�C�A�ILfI�
MISC
WIRING PERMIT 100 Pr jz - /sqo
FIXTURE PERMIT 100 Y.
SUPPLEMENTARY PERMIT 50
1 TOTAL FEE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT
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 i AM THE LEGAL OWNER F THE ABOVE
DESCRIBED•RESIDENTIAL/ PROPERIT-. ` POWER
SIGNATURE UTILITY UTILITY CO.NOTIFIED '',.n�'�QJry',�f� p
OF PERM ITT E FINA A'6o
VAIJDAT� ARTHUR C.VEIT, �T
CK mo CASH SUPERVISING ELECTRICAL ENGINEER
9, 9- 3 0 2 D 2 t 5
WORKERS'COMPENSATIONDECLARATION 0 APPLICATION FOR ELECTRICAL PERMIT'
' � CE-806CE-806 G (2-801
I hereby affirm that I have a certificate of consent to self COUNTY OFIOS ANGELES �' C BUILDING AND SAFETY
insure, ora certificate of Workers,Compensation Insurance,or
a certified copy thereof(Sec 3800,La C)
New Residential Bldgs.&� FOR APPLICANT TO FILL IN JOB /j. _/
Policy No Compan "��G/ EACH NO FEE ADDRESS (r! Ie e ��IfG
_ Pools
C rtified copy is hereby furnished. 1 &2-Family,Sq. Ft $ — $ LOCALITY
Certified co .Multi-family Sq Ft — NEA'REST (� /
copy is filed with the county building inspection CROSS ST V H1
depart ent Residential Swimming Pools OWNER OR ./l
\� FIRM NAME N/ A � —U A,
Date j�Applica s Rec_Li ht Sw MAIL `J
g First 20 ADDRESS
CERTIFICATE•OF,EX TION FROM WORKERS' Total No AdditionalCITY _ r ��� TeI'No �J }
COMPENSATION INSURANCE, PLAN CHE K / CL
APPLICANT
(This section need not be completed if the work involved U
by_the permit is for one'hundred dollars ($1.00) or less.) Lighting Fixtures First 20 ADDRESS d
Additional r 0
' Total No.' %`/� / O
I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY �[ Tel N 77 yw I-
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 1111
a
Oven _ Dryer_W M. ADDRESS Z
Date Applicant Top _ FAU _W.H
q Hood— Fan_ Other_ CITY Tel,Nd I,
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 � � ��V Class
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO PROCE ED"By-
with comply with such 'v
p y provisions or,this permit shall be Size&Type HP, KW, KVA,or KVAR
deemed revoked: Up to 1 Incl
FINAL
� i
LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATE J'� VALIDATION
Over 10 to 50 Incl
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 Busi-� Over 100 BY
ness and Professions Code, and my license is in full force and
effect _ Services
0-200 Amp Under 600 V 9Q I
License Num r
Lw.Class
201-1000 Amp Under 600 V
Contract ate- -7X411,P Over 1000 Amp or Over 600 V
H E OWNER-BUILDER DECLARA ION Temp Power Pole&Appurtenances
I hereby affirm that I am- exempt Sign with One Branch Circuit
from the• Contractor's Additional Sign Branch Circuits
License L'a�v for the following reason (Section 7031 5, Busi- _ O Jr R
ness and Professions Code)
Misc.Conduits&Conductors '
�°1°')° 0 2
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 2010,32 0 0
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY o o o 32005
I hereby affirm that there is a construction lending agency i
for the per3097,Civ'-Cformance of the work for which this permit is
issued (Sec pERMIT,FEE (Sub-Total) 4 0 8_81 Y
) -�
Lender's Name PLAN,CHECKING FEET (One-Fourth Permit Fee) r
Lender's Address PERMIT ISSUING FEE .
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 ve-mentioned pr42perty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
S nature of Per- ittee, ate ,