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Home My Public Portal About10119 GREEN ST_Electrical__ .0.4 .7BA663-CES06 4-6e APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS L JOHN A. AMBIE, COUNTY EmGiNo:xl COL<MAN W. JZNKINS, SUMRINTLIDGNT OF BUILDING LOCALITY ! NEAREST FOR APPLICANT TO FILL IN CRO SST. Ifj"Al OWNER RECEPT.L MAIL LIGHT TOTAL FIRST 20 .20 ADDRESS SWITCH_ OVER 20 •.10 CITY TL L. NO. PLAN CHECK LIGHTING 1 TOTAL FIRST 20 .20 APPLICANT FIXTURES Jj OVER 20 .10 ADDRESS RAN-GERYER—WTR.HTR.— CITY TEL. NO $TA.COOK—DISP.—F.A.U.— CONTRACTOR r L ! e SPACE HTR AIR COND.__/_ ADDRE CLOTHES WASH. DFSHWASH.— CITY 77d TEL. NO. FAN—OTHER 1.00 LICEN$E'NO. CLASS.- MOTORS, LASS.MOTORS,TRANSFORMERS FLAT INO IND. HEATERS, ETC. HP. KW. KVA. I HEREBY ACKNOWLEDGE THAT I HAV! READ .THIS APPLICATION SIZE 6 TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDIMANCE5 AND STAT! LAWS AEGU.LATIMS ELECTRICAL WIR IMG. i 0 — 1 1.00 1 . I HEREBY ClR71FY THAT I .Ay �ROFlRLY REGISTERED AND" 1 — 10 5.00 . LICENSED AS REQUIREp BY LOS ANGELES COUNTY AND STATE OF- CALIFORNIA OR THAT I AM THE L AL OW MER OF, AND INTEND TO 10 50 5.00 RES-113F IK, THE V[ DF5 B!D R[f IDl MTI L P FRTY, 50 r 100 10,60 SIGNATURE OF PERMITTEE p 100 - 500 15.00 ISTrAIOCT�N P N� PR ESSEQ BY C°, I GN,GASJ G TSUSE; OR BION AND ONE CIRCUIT 9.00 1 W MARQUEE ADDITIONAL CIRCUITS 1.0.0NOTE$: CL ��11 Vj SDMC1 NOT OVER 600 VOLTS OR 200 AAP 2.100 01 00 Z SERVICE OVER 600 VOLTS OR 200 AMP 5.00 [SUPPLEMENTARY SERV ICE, POLE, 6:AP PU RT ENANC£S 9.00 APPROVALS DATE INSPECTDR'S SIGNATURE TEMP. POWER POLE C'f JoUNDERSLAS WORK ROUGH CONDUIT WIRING MIT FEE (SUB TOTAL) D FIXTURES N CHECK FEE (50% PERMIT FEE) POWER AUTHQRIZED G MIT ISSUING FEE 2.00 UTILITY CO.NOTIFIED PERMIT ISSUING F EEJ 1.0-0 FINAL rKIBEACK L FEE Q JOSIrPH C. ROOHAN SUPERVISING ELECTRICAL ENGINEER LAN CHECK VALIDATIOIt CK. M.O. CASH PERMIT VALIDATION cK. M.O. CASH OF APPLICATION FOR COMPLETE FEE SCHEDULE WORKER 'COMPENSATION DEGLARAT1ON 78A853 10/ B1 APPLICATION FOR ELECTRICAL PERMIT I hereby►aM n dW I have a cuteoP consent to self Yue, or a certfMcate of Wbricsra' CorrQer:satidn Insurance, or a oertfned COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thared(sea 3800,Lab.C.) PC rt /4 e-5' sPA- Policy,4oCo pang TO.Ful. AD /o ! /q C-7.e tEX �T- Certftled copy b hereby furNehed. New Reaidenttal Btdge.S Poole EACH I NO. FEE �� ❑ Certified copy b filed with the oamty WIVLng Ylapeadorr 1 S 2-Fernty,S4 Ft $ — a LocALITY deperbner[t Muni Y Sq Ft NEAREST CROSS ST. A-1 Reafdanttal Swimnty Poole OR Applloent Fr� _ MNL CERTIFr-ATE OF EXEMPTION FROM WORKERS' Outlets:Roo_ Light —Sw. —mpieteADDRE✓� COMPENSATION INSURANCE (This Mction need not be ood hf Ow work tmnofvr d by the First 20 Total No parmtt M for one hundred doflgn($100)or kmm) Additional / CK L Tel. C! No ,2 I card y that In the performance of the work for whloh fhb permit � LA-,A9E,OQ- b baued, I shall not employ any person In arty rr n er so as to become wb)Dct to the Woricsre'Compeneetlon Laws. Llghtlng Fixtures First 20 ADDRESS Total No. Addftlonal CfIY Tbl.Na Date "IOWA FboDd Appgamcas Nd Ovar 1 HP PERWT NOTICE TO APPLICANT: If, a1fbaar maidnp th}s CerMkmte of APPLICANT D t4..'A-,Gj/9- Exprrption,You Should become subject to the Workam'ConxxxAstion Range— Heatar— D.W. — provWone of the Labor Code. You nxW kxthwttri comply with such Oven — Dryer — WAk— ADDRESS proA b or the permit shall be deerned revoked . Top — FAU — WJ-L — CITY Tbl.No. LICENSED CONTRACTORS DECLARATION Flood — Fan — Other_ I hereby aNUm that I am Iloeneed under provisions of Chapter 9 D}� — Room Air Cond. REQ � Cis (cortvnerclrg with Section 7000) of Nvblon 3 of the BI.Anese and Power Apparab-S Large Appbanoea OtsTt�CT /1 Profeeabres Code,and my Iicenae b tr furl force and effeof. Stze d Type HP,KW,KIAL,or KNAR Llcenee Number LJa Claes Up to 1 Ind. FINAL 1 to 10 IraL DATE Contraction VALIDAD Date Over 10 to 60 Ind. rj a � ❑ FINAL I am exempt under Sea Over 60 to 100 Ino. BY _ Over 100 BhP.C.for thio reason Servbee,Swbd,MCC s Panelboerds ^ I Z Dat« 0-200 Amp.Under 600 V , IrV•t� _�l �.�: •.-� Signature 201 - 1000 Amp.under 600 V 11 Over 1000 rip.or Over 600 V ❑ Exemption for Rea Mebrt Elect. str1GLE FAMILY Temp.Power Pole S Appurtenances 2 HOME O'WNEA-BUILDER DECLARATION Sign with One BrerVh Ctrnft I hereby affirm that I am exempt from the Contractor's LJcenee Law w�I+ i for the follow V reason (Section 7031.6,Buelneand Professions AddItignal Sign Branch Clraults ACCT■T Code): sa 3307 31.00 I.as Owner of the property,will do the work and the Structure Mleo.Conduits d Conductors 1 ITEMS Is not Intended or offered for sale (Section 7044, Budneee Other(See Ccrrpk+te Fee Schadule) — anld Professions Code). TOTAL 31. 00 CONSTRUCTION LENDING ENDING AGENCY OEM 31.00 I hereby affirm ffwd there Is a cor>atrucdon lending agency for the perfornvure of the work for which thte permit is Issued(sea 3097, PERMff FEE (Sub-Total) ■00 Ctv.a), PLAN CHECKING FEE PERMff ISSUING FEE �W t r Larders Nerve L 010ID- M.I1M✓'1 /-�5 J Lenders Address 0937 1' Ali I certify that I have read this ap loation and state that the above TOTAL FFA Infortnetlon Is oorred.I agree to comply with all County ordiru nose {J and State Jews reguhatIng Electrical wlJtq, and hereby authort- repreeerkativee of this County to enter upon the above-mentioned Property for Inspection perp— SEE REVERSE FOR EXPLANATORY LANGUAGE s-z�y signebue of Perm Date WORKERS'COIIdP)yiJSATTdN J3ECLAR,4 IOJd CE� (2-90) - A*PPLICAMN FOR ELECTRICAL 'PERMIT I hereby afftrm'that I have a ca; ificate-,,of coent.to self ` COUNTY OF LOS ANGELES BUILDING AND SAFETY Insure, or a certificate of Workers'Compepsatiod Irffurance,or A certified copy thereof(Sep. 3800,Lab.C.) p FOR APPLICANT tO FILL EACH N JOB Nd. FEE ADDRESS 8'r- Policy No. Com any 7Rd-_.ntl.IBldgs.&Pools El Certlfied copy Is hereby furnished. q. Ft.- _ — *' LdCALITY 7 a-*7,VLGF C fT .1Ft.�_ El Certified copy Y flied with the county bulldhtg hrspacttOn CAO 8T /¢L O OV department. mming Pools OWNEgOR s• rI 6 7- q� FLRM NAME r /`r Date Appljcant- Outlets: Rec?!DLighf�s, 17 ' MAIL A Inst 20 ADDRESS 70//'? Q 6WAI l 'SJr' CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY CIr Tal Nq.M 9,•ZO6 ' COMPENSATION INSURANCE PLAN CHECK APPLICANT �. b ('This section need not be completed if the wort hivoived � � Lighting Fixture; Fiat 20 by the permit is for one hundred doilt>;s (x100) or leas,) 3 I certify•that in he Total No. Additional' ADURE88 t performance of the work for which manner Fixed AppllarlceiNot Over 1 HP CITY7,0,*y V`0.�y). Tal No. 443-� 0 permit B issued, I shall note ploy any perioh in any manner I � PEFtMJT ,.• �j �te"12, to become wbJect do th� Workers' Compensatio❑ haws Range''_Heater D.W. PLIT Lil()van Dryer W.MADDRESS�'WApplicant r Top FAU W.H. Z F4god Fen Other_ CITY Tel No. NOTICE TO APPLICANT: If, after making t tate of Dlsp. L RooPn'Alr Cond— CEN Exemption, you should become subject to the Workers' REG.NU BER Claw Compensation provisions of the 14bor Code, you must forth- per with comply with such T Apparatus& Cefye 4ppllbnces- I8TRICT NO.�D XRSSEfl BY provisions- or thL permit shall be deemed revoked. Slie&Type HP,KW, KVA,or KVA Up to i Incl. Over to 10 Incl. DI EL t7 LICENSED CONTRACTORS DECLARATION Ovai,10 to 80 Incl. '� Y4LIDATION I hereby affirm that J am licensed under provisions of Chaoter Over Fj0 to 100 Inr,. FIN 9• (commencing with Sentlon 7000) of Division 3-of the Busi- BY OvQF 100 neat and Professions,Code, and my license Is in full fgrce and ' effect. Services ` Amp. Under 800 License Number Lic.Class- 201-1000 Amp, n r Contractor Data Over 1DW Amp.or Over 800 V HOME OWNER-BUILDER DECLARATION Temp. Power j3ole&Appurtenarx;a* I herebyaffirm that I am Sign with One Branch Circurt exempt trbm rise Contra Bust- Additional Sign Branch Circuits License L;w foFF she following reason (Section 7031.5, Bust- g t} fl, 1 A neva and Profeadons Code): MISC.Conduits&Conductors I, as owner of the property, will do the work and the, Other(Sm Complete Fee Schedule) 2 structure 4not Intended or offered for rale (Section !,o'o,'�,� � O 7044, Business and Professions Code). CONSTRUCTION LENDING AOVNCY . I hereby affirm that there is.a- construction lending agency c e o Y for the performance of the 'work for which this permit Is PERMIT FEE (Sub,Total) tssj�ad(Sec. 3097,Civ.C.). Lender's Name PLAN CHECKING FEE (Ona-Fourth Permit Fee) Lender's Address, PERMIT ISSUING FEE I certify that I hsie read this application and stale that the TOTAL FEE above tnformatlon Is correct.I agree to comply with all County ordinances and. State laws regulat" Electrical.wiring, and hereby author-lie reptesegtitives of this County to enter upon `t above—mentioned property f r inspection purposes. SEE-REVERSE FOR EXPL 14ATORY LANGUAGE Signature of Date