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Home My Public Portal About10134 GREEN ST_Electrical__ "A 8"-CE801 4 -.e>3 APPLICATION FOR ELECTR AL 6&lT� COUNTY OF LOS ANPELES 'DEPARTMENT OF COUNTY ENGINEER BUILDING / BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE, COUNTY ENo1N[[R COLEMAN W. JENKINS, SUPWRIN'TtNDKNT OT BUILDING LOCALITY NEAREST FOR APPLICANT TO PILL IN CROSS ST. 1 EACH FE RECEPT._ OWNER 12 y MAIL LIGHT TOTAL FIRST 20 .20 ZIPADDRESS SWITCH OVER 20 .10 CITY TEL. NO. Q(� PLAN CHECK LIGHTING TOTAL FIRST 20 .20 APPLICANT FIXTURES OVER 20 .10 ADDRESS RANGE—DRYERWTR.HTR._ CITY TEL, NO. STA.COOK_DISP._F.A.U._ CONTRACTOR f" SPACE HTR AIR COND. ADDRESS ?O I.•(,! !L/) CLOTHES WASH._DISHWASH— CITY TEL. 'NO. FAN—OTHER 1.00 LICENSE NO. CLASS. MOTORS,TRANSFORMERS PLAT INO IND. HEATERS, ETC. HP. KW. KVA. I HEREBY ACKNOWLEDGE THAT I HAVE HEAD THIS APPLICATION SIZE 6 TYPE OVER TO AMD !TATE THAT THE ASOVE ID CORRECT AND AGREE TO COMPLY WITH ALL COUNTY 0RDINANCEa AND STATE LAWS REGULATING ELECTRICAL WIRING. 0 — 1 1.00 IAHERE CERTIFY THAT I AM PROPERLY RE TERED AND/OR 1 — 10 3.00 LICENSED AS REQUIRED BY LOS ANGELES COU AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER , AND INTEND TO 10 — 50 8.00 RESIDE IN, .THE ASO OESCRIIIED RES NTIAL PROPERTY. SIGNATURE - 50 — 100 110.00 OF PERMITTEE C1—= 100 - Boo 15.001DIS ICT G UP ZONE PROCESSE BY w EIOH,GAD SIGN AND ONE CIRCUIT f2.00 TUBE, OR MARQUEE ADDITIONAL CIRCUITS \ — N T SERVICE NOT OVER 600 VOLTS OR 200 Alp SERVICE OVER 600 VOLTS OR 200 AMP 8.00 TEW SERVICE, POLE, 6:APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE TEMP. POWER POLE G UNDERSLAB WORK (. ROUGH CONDUIT PERMIT FEE (SUB TOTAL) WIRING FIXTURES PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED PERMIT ISSUING FEE 2.00 IJ UTILITY CO.NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL TOTAL FEE Jr JO PH C. ROOHAN SUPERVISING ELEC CAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH .20-EO n 7%70' iC,11 g 2 D 620- K BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE TeAee�1=eoe;I �1 APPLICATION FOR ELECTRICAL PE COUNTY OF LOS ANGELES PEPARTMENT OF COUNTY ENGINEER BUILDING L BUILDING AND SAFETY DIVISION ADDRESS S✓ f LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. OUTLETS NO, EACH I FEZ OWNER RECEPT._ MAIL �+ LIGHT TOTAL FIRST 20 � ADDRESS c aA* CITY -,7-"-c TEL. NO. SWITCH OVER 20 1p PLAN CHECK FI .10 RST 20 25 APPLICANT LIGHTING TOTAL FIXTURES OVER 20 ADDRESS RESIDENTIAL APPLIANCES CITY TEL. NO. PERMIT RANGE DRYER_WTR. HTR. APPLICANT STA. COOK DISP. F.A.U. ADDRESS /r ee SPACE HTR. AIR COND. CITY TEL. NO. 4e lza CLOTHES WASH. DISHWASH. LICENSE N0, f , ,3 CLASS.0- Q FAN OTHER 1.00 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE I1 CORRECT AND ASR[[ TO COMPLY MOTORS, TRANe FORM ERD RATIN[ WITH ALL COUNTY ORDINANCES AND STAT[ LAWS NK41ULATING IND. HEATEIR S, ETC. HP. KW. KVA. ELECTRICAL WIRING. SIZE G TYPE OVER TO I H[REEY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 - 1 1.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL O R OF, AND INTEND TO C 1 - 10 / Spp n P1 RES Ip[ IN, THE RIDE R IDE NT I/R PROPERTY. 8 Ne V V SIGNATURE / 10 - 60 0.00 OF PERMITTEEO b0 100 10.00 OIIjAjItT NO 4A11 P [as[ Y 100 - 500 10.00 TUBE, OR NOTEa GAS SIGN AND ONE CIRCUIT e00 S: TUB MARQUEE ADDITIONAL CIRCUITS IDG C• SERVICE NOTOVER BOO VOLTS OR 200 AMP J00 00 APPROVALS DATE pCOP[LTOMS SIGNATURE SERVICEOVER 600 VOLTS OR200AMP 10 TEMP.POWER POLE TEMP SERVICE,POLE, h APPURTENANCES 0.00 UNDERSLAB WORK TEMP LIGHT OR RECEPT. SYSTEM 9A0 ROUGH CONDIUT WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (SUB TOTAL) UTILITY CO. NOTIFIED PLAN CHECK FEE 7� PERMIT ISSUING FEE i SDO co FINAL TOTAL FEE If Q p PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALID I I C.K. M.O. CAW ^ 9 S 1 2 D 9.00 SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE • WORKERS'COMPENSATION DECIsARATION 2D-0019 DPW 3/� APPLICATION FOR E L E C '� .e RM I T O I He*e 'b�lrm that 1 have a certificate of consent to self 7&4,6637& Insurgr or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lab. C) Policy No Company FOR APPLFGANr TO FAL*d JOB Certified copy Is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDS 13 Certified copy Is filed with the county building Iruipec- 1 8 2-Family, Sq. Ft. S — ; LOCALITY r tion department. Multi-family Sq. Ft. NEAREST Residential Swimming Pools OV�RST. Date Applicant D J OR FIRM NAW CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Llght Sw._ MAMAR ?� s COMPENSATION INSURANCE -First 20 ADDRESS (This section need not be completed If the work Imrohr.d by Total No. Additional CITY Tel. No. D _ the permit is for one hundred dollars (=100)or less.) PLM CHECK I certify that In the performance of the work for which this APPLICANT permit Is Issued, I shall not employ anyPerson In any manner Lighting Fixtures First 20 ADDRESS to as to become subject to the Workers Compensation Lawa g g Additional Total No. CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of Ran Heater—D.W. _— Al'PLJCAT{ON Exemption, you should become subject to the Workers' Range— 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.-- CITY Tel. No. deemed revoked. Hood — Fan —Other— LICENSED CONTRACTORS DECLARATION Lim OR I hereby affirm that I am licensed under prov4lons of Chapter 9 Dlsp. — Room Air Cond. — REG NUMBER Claus (commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. PROCESSED BY >_ and Professions Code,and my license in in full force and effect. Size 8 Type HP, KW, KVA, or KVAR �� yyyLfd.C/ O License Number Lic. Clan Up to 1 Incl. FINAL U Contractor Dcrt6 Over 1 to 10 Incl. DATE 2� VALIDATION 0 Over 10 to 50 Incl. FINAL I-_ I am exempt under Sec. Over 50 to 100 Inc. BY U W B.BP.C. for this reason Over 100 a- Services, Swbd., MCC& Ponelboards , z Late: Z 0-200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600V Exemption for Reg. Malnt. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole&Appurtenances HOME GINNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Sign with One Branch Circuit .T Law for the following reason (Section 7031.5, Business and Additional Sign Branch Orcults Professions Code): 3307 J 1.[I 1 lel I, as owner of the property will do the work and the Misc. Conduits 8 Conductors 1 IMIS structure Is not Intended or offered for sale(Section 7044, Other (See Complete Fee Schedule}_ pool TIJT� 1 Business and Professions Code). CONSTRUCTION LENDING AGENCY t-�ECX 31.03 1 hereby affirm that there Is a construction lending agency for .W the performance of the work for which this permlt Is Issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). Lender's Name SAN CHECKING FEE � 1 6/1�r/�'1 PERMIT ISSUING Fid Lender sAddress / 1 1[I:'XI 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 l ordinances and State lows-regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the obove-mentioned property for Inspect)cirp rposes. SEE REVERSE FOR PJ(PLANATORY LAHG{JAti! / Signature of ParnlTrbeto `/�