HomeMy Public PortalAbout10018 GREEN ST_Electrical__ '°A"'-10612-°° APPLICATION FOR ELECTRIC PERMIT 1.
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESH
JOHN A.LAMBIE,CouNTY ENGINKIR
CAIMATT D.GRIFFIN,sul T OF UILDINO LOCALm
FOR APPLICANT TO FILL IN NFAREST
PEMM F'EFS .
OWNER
1 T E M HUMBKRI EACH FEE
O MAIL
uGHTS RECE'T. SW. lb ADDRESS
LIGHTING FIXTURES .10 CITY O
ELIC.RANGES CLO.DRYQSSEC-1%CIAN
WATER HEATERS .150 ADDRESS
ELEC.SPACE HTRS. DLSHWASHERS
CITY TEL NO.
QAYMAOE DISPOSERS AUTO.- STATE
WASHERS STA.COOKING UNITS .215 LICENSE NO.
MOTORS: OVEt IHC. H.P. D19970. J.GP
0— .25
v.— 2 .150 IIWEG'YION RECORD
1- D 1.00
5— 15 1.150
115— 50 2.150
50-200 15.00
81GND: NO.T1lANS.
No.LAMPS
SERVICE 0-600V 1.00
SERVICE OVER 1500V 5.00
Yisc-
WIRING PERMIT 1.00
FIXTURE PERMIT t.00
6UPPL JMdENTARY PERMIT .150
I� TOTAL FEE s APPROVALS
LD'=SCIRINXD
HERESY ACKNOWLEDOE THAT 1 HAVE READ THIS APPLICATION DATE INSPICTOWS SIGNATURE
STATE THAT THE ABOVE 1■ CO RPIECT AND AGREE TO COMPLY
ALL COUNTY ORDINANCES AHD STATE LAWS REGULATING CONDUIT
TRICAL WIRING. RING
HERESY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
?itta AS REOUIRID SY LO1 ANGERS COUH'fY AHD STATE OF FUCTU REB
PORNIA OR THAT I AM THE LiGAL OWNER OP THE AAOVE
RESIDEH'f1AL PROPERTY. f� T" POWER
NAT4JRE UTILITY CO.NOTIFIED
PERMI
Or VALMA gRTHUR C. VETT,
C.K [p UPERVISING Ll?CTRICAL ENGINEER
Lfo 6 7 8 2 i'LAY 21 2 A 220
7fA6G3-CX20
B 12-58 PLICATION FOR ELECTRIC PERMIT 1
CONTY QF LOS AN6EI
DEPARTMENT QF COUNTY ENGINEER BUILDING
0 _
BU nG AND SAFETY DIV4SION
JOHN A.�A 8%4 Cog;r Ir EHa"
ev
cAASATT 0.aR�rEN,8vrr of wiuzmm LoawLITY �- Al C3
FOR APPLICANT TO F L.L IN &X=5-r n/
T F�$ , OWNER
0s s MAIL
LIOHTI Sv. .,O ADDRESS
LIGHTING FIXTURES .10 Ciry TEL.NO.
CLLXC.R(ANNb[1�/_ OLO.DRYER• ELECTRICIAN `L
&� sir.R T Ck H[A T[R• .SO ADDRESS
[ J�
clrY
O[DISPOi[RS AUTO.- D STATE d fL'7
WASHERI STA.COOKING UNfTS .215 _]
MOTORS: ov[rt INC. H.P. DLST CT NO. I GR ZONE PROS��ED Ry
0— va '2— .26 0 J tip
I r
v.— Y .50 INSP=ON RECORD
a— Ia 1L0
16— DO 4.150
y�
150-20.0 15.00
BIONS: NO.TRANS.
HO.LAMPS
SERVICE 0-000V 1.00 D
SERVICE OVER 800V 15.00
M,SC.
WIRING PERMIT 1.00 O
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .ao
TOTAL FEE APPHOVALS
I HI)RIBY AC•I010WL1D0[ THAT 1 HAVE RIAD THI■ APPLICA OX DATE IHSPXCTOR'■510HATURI
AXD STATE THAT TH[ ASOV[ IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY
ORDINANCES AND STAT[ LAW■ RIOUL.ATINO CONDUIT
o.scnRlcAL WIRING. � WIRING
-71a g�59
1 HIRLY CERTIFY THAT I AM PROPERLY RIOISTERID AM&/OR
LICENSED AS REGUIR[D BY LOS AHGXL" COUNTY AND STAT[ OF
PINTA REB /
CALIFORNIA OR THAT I AM THE. LEGAL OWNER OF 7HE ASOVE
DESCRIBED RXB Durrw.. POWER
SIGNATURE UTILITY CO.NOTIPIED
OF PERMITTL�
FINAL
VALIDA� 9aRTHUR C.�rr.
cx Mo { UPERVIS1Na CTRICAL EkaINa3LR
444r AN 2)4 2 A
1590
worm that
COMPENSATION cafe of
4 taa, APPLICATION FOR ELECTRICAL PERMIT -- -
I herebyr affirm that I have a certlfimte of consent to self � -
Iruuro, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES / BUILDING AND SAFETY
fopy thereof ( c 30, b. ,)wa Sy
Poll o. ompany FOR APPUCAh T TO ILL IN JOB
ADDRESS
Certified copy Is hereby famished. New Reildentlal Bldgs. 8 Pools EACH NO. FEE /
_ _ $ LOCALrrY
Certffled copy Is filed with the co my bulldlnq Inspec- 1 b 2-Family, Sq. Ft. NEAREST
flan de rtment. Multi-family Sq. Ft. CRCS5 ST
Date Ilcant Residential Swimming Pools OWNER OR
APP RM NAAAE '
TIFICATE OF EXEAAP1lON FROM WORKERS'
COMPENSAT10N INSURANCE Outlets: Rec Ight Sw._ 11919
(This secMon need not be comRleted if the Mork involved by Total No Flrt 20 =PLAN ,
Tel. No.
the permit Is for one hundred dollars(:100)or less.) Addltlorwl
I certify that In the performance of the work for which this APPLK�4Nr
permit Is Issued, I shall not employ any Person Inany manner Lighting Frxtures First 20 ADDRESS
so as to become subject to the Workers Compensation Laws. q fl
Total No. Additional CITY Tel. No.
Date An,nlicant Fixed Appliances Not Over 1 HP pERM1T
NOTICE TO APPLICANT: If, after making `this Certificate of
Exemption, you should become subject to the Work" Range— Heater_D.W. —
or
Compensation provisions of the Labor Code, you,must forth- Oven —Dryer — W.M_— ADDRESS
with comply with such provisions or this permit shall be Top — FAU —W.H. Crry Tel. No.
deemed revoked.
LICENSED CONTRACTORS DECLARATION Hood — Fan —Other— LCENSE OR
that r
I hereby affirm at I ars licensed under provisions of Chapter 9 Dlsp. Room Air Cond. �G NUMBER CI
(commencing with Section 7000) of Division 3 of the BusinessDISTRICT NO. BY
Po
and Professions Code,and my license Is In full force and effect. "ef Apparatus 8 Large Appliances. _ d
S 8 Type WVA, q KVAR' i� O
License Num c. Class f UpY I'i}nci�5� NAL Im
Over 1 to 10 Incl. DATE VALJDATON 0
Contractor 1�_9OOver 10 to 50 Incl.
71 FINAL
EJ 1 am exempt under Sec Cher 50 to 100 Inc. BY
B.BP.C. for this reason Over 100
Services, Swbd., MCC b Panelboards ► ��/ Z
Date: 0 -200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600 V
❑ Over 1000 Amp. or Over 600 V
Exemption for Reg. Malnt. Elect.
SINGLE FAMILY Temp. Power Pole 8 Appurtenances
HOME OWNER-BUILDER DECLARATION Slgn with One Branch Circuit
I hereby affirm that I am exempt from the Contractors Llcerse Additional Sign Branch Circuits 5 4 2 2 A
Law for the following reason (Section 7031.5, Business and
Professions Code): # o o c o • 2
Misc. Condults 8 Conductor
I, as owner of the property, Will do the work and the t
structure is not Intended or offered for saie (Section Other (See Complete Fee Schedule)— ► 2,o 0 1 5,2,5
704, BvsIn.on and Professions Code}. o a o 1 5 2 5 iS
CONSTRUCTION LENDING AGENCY '
I hereby affirm that there Is a constructlon lending agency for 0 9.2 0 8 3
the performance of the work for which this permit Is Issued PERMrr FEE (Sub-Total)
(Sec. 3097, Civ. C.)_
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FP
Lenders Address
I certify that I hqve read this application and state that the TOTAL FEE s
above Inforrrwtlon 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 vo-mentloned props for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
S ghature r ee