HomeMy Public PortalAbout10014 GREEN ST_Electrical__ 76A663-CEE06 10/72 APPLICATION FOR ELECTRICAL PE I
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION SS
LOCA L1 TY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. L t-J JAI
OUTLETS No. F[ OWNER OR
FIRM NAME
RECEPT._ MAIL
LIGHT TOTAL
FIRST 20 ADDRESS
CITY TEL. N0.
SWITCH OVER 20 .10
PLAN CHECK
LIGHTING TOTAL FIRST 20 .25APPLICANT
FIXTURES
OVER 20 •ip ADDRESS
RESIDENTIAL APPLIANCES - CITY TEL. NO.
PERMIT L T�
RANGE DRYER_WTR. HTR. APPLICANT i
STA. COOK DISP. F.A.U. ADDRESS ✓E
SPACE HTR, AIR COND. CITY � C, TEL. NO.
CLOTHES WASH. 01SHWASH. pEG. HUM 6CLASS.C-
FAN OTHER 1.00 1 HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND [TAT[ THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS TRANSFORM[RS MTING WITH ALL COUNTY ORDINA LACKS AND B.TATE LAWS REGULATING
IND. HIEATERS, [TC. HP. KW. RVA. ELECTRICAL WIRING.
SIZE TYRE OVER TO
IHSR[BY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 - 1 100 LICE HIED M R[QU IRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE y,
1 - 1O 3.0101 DESCRIBED RESIDENTIAL PERTY. G
PERMITEE
10 - 80 JO.DO
SIGNATURE
�O
60 - 100 DISTRICT NO D BY Iyj
1 DO - 600
o
Z
SIGN, GAS SIGN AND ONE CIRCUIT B.00 APPROVALS DATE 1WECTOPMeSISINATURK
TUBE, OR
MARQUEE ADDITIONAL CIRLUITS 1DO TEMP. POWER POLE
SERVICENOT OVER 600VOLTS OR200AMP 3A0 UNDERSLAB WORK
SERVICEOVER 600 VOLTS OR 200AMP 10.00 ROUGH CONDUIT
TEMP SERVICE,POLE, &APPURTENANCES B.00 WIRING
TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES
POWER AUTHORIZED
UTILITY CO. NOTIFIED 13 04F
FINAL
PERMIT FEE (SUB TOTAL) NOTES:
PLAN CHECK FEE
PERMIT ISSUING FEE 3m 00
TOTAL FEE
PLAN CHECK VALIDATION CR. M.0. CASH PERMIT VALIDATION CK. N.O. CASH
1 3 8 473 MKI 31 2 D 6.0 0-
SIR
- CQS[[SAC( OF APPLICATION FOR COMPLETE SCHEDULE
r -
76AGGS-CEBOG-6-57 APPLICATION FOR ELECTRIC PERMIT 1 ,
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A.LAMBIE,COUNTY ENGINEER
CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
PERNIIT FEES
OWNER
LIGHTS RECEPTACLES SWITCHES
NUMBER ITEM EACH FEE MAIL
TOTAL OUTLETS $ .10 ADDRESS
�
ELEC. RANGES, WATER HEATERS, CITY TEL.NO
CLOTHES DRYERS .50
ELEC. SPACE HEATERS, STAT-Y. COOK- ELECTRICIAN
ING UNITS, GARBAGE DISPOSERS, ADDRESS
AUTO WASHERS, DISHWASHER .25
LIGHTING FIXTURES JO CITY TEL.Nqaj
MOTORS STATE
LICENSE NO.
HORSEPOWER
H.P: OVER INC. O DISTRICT NO. GRNE I READY FOR INSPECTION
%&LESS .25
1/2 2 .50 INSPECTION RECORD
2 - 5 1.00
5 - 15 1.50
15 - 50 2.50 '
50 200 5.00
MISC. A"3
P_
SIGNS NO.TRANS
NO.LAMPS
SERVICE O-600V 1.00
SERVICE OVER 600V 5.00
WIRING PERMIT 1.00
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .50 APPROVALS
TOTAL FEE g �j
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES - i�G Y"..i.;;• �`
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL O^ER OF THE ABOVE POWER
DESCRIBED RESIDENTIAL?PROPERTY.
SIGNATURE r UTILITY CO.NOTIFIED
OF PERMITTE '3. '" '
FINAL
JOHN A.LAMBIE. _ IDATION ARTHUR C.VEIT.
COUNTY ENGINEE CK MO CASH SUPERVISING ELECTRICAL ENGINEER
JL02 7 2 8.; SEP 2 7 2 3.81") M
WORKER'S COMPENSATION DECLARATION �Bo�o oPW(12-91) APPLICATION FOR ELECTRICAL PERMIT
I her6byaffirm tbal I have a oerdflc tte of consent to self InsJre,
or a cehlfloate of Worker's Compenaatlon Insurance, or a oertlned COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
oopy thereof(Sec.3800 Lab.C.)
Pol"No. Companyorf/ � +T To N JOB
❑ nooa�sa
C«ifMd copy ls hemby fumistred. New Raeldential Bldge.✓4 Pools NO. EACH FEF
❑ q '� _ LOCALITY
Certified copy Is filed with the oounty bulking I 1 S 2-Family,Sq.Ft.- 2— / H �
depa M-1- Mut-famlly Sq.Ft — pipes BT.
v APP� 5R I Reeidendal Swlmrning Pools /�- AflCB
OR ���3
PnoE 64J P
�
NER OR
CERTIFICATE OF Ex2EMPTI0N FROM WORKERS' Outkft Rec.3A Light 0--Sw, FIIRRM NNAWE
NC
COMPENSATION INSURAE
20 -MAfL
(This seoUon need not be completed If the work Involved by the 5V FirstA ESS
perml-t Is for one hundred dollar($100)or Isar.) Total No. Additional
I oerdfy that In the performance of the work for which this permit CfTY
Is Issued, I shell not employ any person In any manner so as to pt yI C pl
become subject to the Workers'Compensation Laws. Llg"ng Fbduree Fhsi 20 APPLK ANr
Total No.- Additional
ADDRESS
Dole APPft-Tt RESIDENTIAL NOT OVER 3 HP.
NOTICE TO APPLICANT: If, after making this Certlfloate of CITY_ Tst-7f2L
Exemption,you should become subject to the Workers' Compensation OTHER APPLIANCES NOT OVER 3 HP. .r
provlelona'of the Labor Code, you must forthwith comply with such Pi ER&AFr
provlslons or this permft shall be deemed revoked. Power Apparatus 8 Large A`ppflancee
ANT
LICENSED CONTRACTORS DECLARAT10N Stra S Type HP,KW,KVA,or KVAR ADDRESS
I hereby afnrm that I am licensed under provisions of Chapter 6 Over 3 to 10 Ind.
(oommencing with Seotlon 7000) of Division 3 of the Buslneaa and CfTY TeL N0'
Professions Code,and my license Is In full force and effect. Over 10 to 60 Ind. LrL'�OR }.
Over 60 to 100 Ind. NL%GMN Ojees d
Lknrm Number 449 1( ✓ LIc.Gess� over 100 ot8TA1CT NO. P BY
Services,Swbd.,MCC 14 Pandboards ✓'D" 0
0-360 Amp.under eco V
5� RINA F—
❑ I em exempt under Seo 400-1000 Amp.Under 800 V VAL1DA11ON LU
Over 1000 Amp.or Over 800 V F*01- d
B.BP.C.for this reason BRANCH CIRCUIT FEES BY z
Date: 16A,or 20A, 12OV,Lighting or Recep'L
1 To 10 Branoh Clroufts
Sign burn STV I 11 To 40 Branch Clroutln
1. 41 Or More Brenoh Circuits
❑ Exemption for Reg.Malnt.Elect: 16A,2A 208V To 777V Br.CYaff
SINGLE FAMILY Temp.Power Pole d Appurtenances 2
HOME OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law SlUn with One Brarroh Clrouh ACV,
for the following reason (Section 7031.6, Business and Profeeslons Addftioru l Sign Branch Circuits
Code): ] ?59.10
❑ I,as owner of the property,will do the work and the structure Misc.Conducts 8 Conductors 1 I 1 C
Is not Intended or offered for sale (Section 7044, Business Other(See Cornplete Fee Schedule) , TOTAL 299 - 3-0
and Professions Code). r{r��+t� �y�p
CONSTRUCTION LENDING AGENCY CI-ECY, ?59.10
I hereby efnrm that there Is R construotlon lending agenoy for the .0000
performance of the work for which this permft is Issued (Sec. 3087, PERMIT FEE (Sub-ToW
Ctv.C.)
PLAN CHECKING FEE 0000-0001 6/26/95
Lenders Name
PERMrr ISSUING FEE go, 101?9 1 AM 10:r—
Lenders Address p
I aertffy that I have reed this epplbntbn and under peruttty of pudury this TOTAL FEE g, /
that the above Information Is oorteoL I aRoo to oompty with all County
ordlnancee and State{ewe regulating Eleotrioal wlring,and hereby authortre
repreeerttattvee of this County to enter upon the tloned property
for Inspection pLLL2WL@&
r SEE REVERSE FOR EXPLANATORY LANGUAGE
J
aNN" OF P6seTfEE TE