Loading...
HomeMy Public PortalAbout10238 GREEN ST_Electrical__ 76A663-CE806 10/74 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES /�?? DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION G� LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST OUTLETS NO. EACH FEE OER OR N NAME RECEPT.� $ $ MAIL LIGHT_ TOTAL FIRST 20 ��' -••-� ADDRESS3-4 SWITCH OVER 20 CITY TEL. NOy PLAN CHECK FIRST 20 1Q ( APPLICANT LIGHTING TOTAL ADDRESS OVER 20 FIXTURES 1C I� RESIDENTIAL APPLIANCES CITY TEL. N0. PERMIT RANGE DRYER_WTR. HTR._ APPLICANT STA. COOK DISP. F.A.U. ADDRESS /.S- SPACE HTR. AIR COND. CITY TEL. N0. CLOTHES WASH. DI SHWAS H. REG. NUMNR [' CLASS.0 FAN OTHER X44914 �/� I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION v ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. SIZE IN TYPE OVER TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR 0 - 1 1.00 LICENSED AS RED IREO BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE 1 - 10 3.00 DESCRIBED RESIDENTIAL PROPERTY. _ CD V PERMITEE 10 - 50 5.00 SIGNATURE E CD 50 - 100 10.00E c� DISTRICT N0. ROCSED BY LV a 100 - 500 15.00 SIGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS V CJ DATE INSPE R'S SIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE SERVICENOTOVER600 VOLTS OR 200AMP UNDERSLAB WORK SERVICEOVER600VOLTS OR200AMP 10.00 ROUGH CONDUIT TEMPSERVICE,POLE, &APPURTENANCES 5.00 WIRING TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED FINAL PERMIT FEE (SUB TOTAL) NOTES: PLAN CHECK FEE PERMIT ISSUING FEE 3.00 d/ ,1-0 TOTAL FEEO PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.0. CASH 470-4 :r, 4 2 8 27.90A et SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE APPLICATION FOR 'ELECTRIC PERMIT 1 t COUNTY OF LOS ANGELES DBUILD NG AND SAFETY DIENT OF COUNTY VISION FAT8 Dal ��.d S T' JOHN A.LAMBIE.COUNTY ENa1NEER CA"ATT M GRIFFIN,SurT or EuiLmms TY 49 FOR APPLICANT TO FILL IN ST. DAg PE WT FEES I T N Y HU Y�ZIt [ACH FQR ° ,M .t0 BS LIGHTING FIXTURES 10 =XcL RANGII M.O.DI{YIQts ELECTRIC WATiR HtAT[R1 DO ADDRESS KUM DIIHWA/HKM ai Dlrrornv AUrO.- TEL.N WAANIC" /TA.COOKING UN3T/ se N0. A RSi JW H.f. 0— V. .25 DISTRICT N 7 77R>�r. It lK"W,=0N ;& — s .150 s — e 1.00 INSPECTION HECOHD D — to 1.D6 10 — 50 2.150 150— 200 15.00 s1ON81 No TRAM& NO.1A M SEPIVICE 0-600V 1.00 Q SERVICIS OVER COOV 15.00 - M 18G WIRING PM:tMrr 1.00 CIO FIXTURE PH"IT 1.00 sLFPPLEIAENTARY PER11 rr .l cy TOTAL FEH 157 AMOVALS 1 T A OWLME THAT 1 HAVE READ BIS APP CATIO DA IMBPHCTOR'd dIGNATUQli AND STATS THAT E ABOVE 13 CORRECT AND AGREE TO COIFLT CONDUIT WM ALL COUNTT ORDINANCES AND STATI LAWS REGULATING .piECTAICAL WMNG. WIRING HIAEBT CEYTI THAT I Al PROPERLT. GIDTERED AILD/OR LICENSED AS REO BT LOS ANGELES AND STATE OF FIXTU CALIFORNIA OR 1 Al THE LE F THE ABOVE POWER DISCWBED RSSW Em. GiIGNATURI! UTIL.rIY CO.NOTIFIED .14 OF Pt'�Y F A<•�O� I:3UT. !'lRYltL%11LiGTRICJIL ENOII�rIe (. OK YO OATH . 2.6 9 2OR -APR $ 2 A 920 9 WORKERS'COMPENSATION DECLARATION zoao,vDPW ve7 APPLICATION FOR ELECTRICAL PERMIT O ` I hereby affirm that I have a cerilflcate of consent to self '� p,y� Insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or clcertlfie� copy thereof (Sec. 3800, Lab. C.) Pal Icy r x],19116 8 Company FOR A"UCAMT To Fu LN roe ❑Certifled copy 1s hereby fumished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS ©Certified copy Is flied with the county building Inspec- 1 8 2-Family, Sq. Ft. $ $ LOCALITY Temple Cit tion department. Multi-family Sq. Ft. t�AlEST Residential Swimming Pools 0053 Date.3-14-91 Applicant ow'3R cop RM NAA CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: R& Ught Sw._ COMPENSATION INSURANCE ADDRESSFirst 20 ame (This section need not be completed If the work InvoNed by Total No. Additional CfTY Tel. No. the permit Is for one hundred dollop le (;100)or as.) PLAN CHECK I certify that In the performance of the work for which this APPLJ permit Is Issued, I shall not employ any Person In any manner Lighting Fixtures First 20 ADDRESS so as to become subject to the Workers Compensation Laws. Additional Total No. � CITY Tel. No. Data Applicant Fixed Appliances Not Over 1 HP pgZMrT NOTICE TO APPLICANT: If, after making this Certificate of - ­Exemptlon;-you should 6ecome--tubject -to -the•-Workers'-•y Rangp._,Heater--DEW. Aj1R Compensation provisions of the Labor Code, you must forth- Oven Dryer W.M.— r ' ADDRESS 195 South C St. with comply with such provisions w this permit shall be Top FAU W.H. — deemed revoked. Hood — Fan —Other— CITYTustin, C3. Tel. No. LICENSED CONTRACTORS DECLARATION Disp. Room Air Cond. U Claw. I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)of Dlvlaron 3 of the Business w Power Apparatus 8 Large Appliances DISTRICT NO. P BY and Professions Code,and my license is In full force and effect. Size 8 Type HP, KW, KVA, or KVAR 0License Number 589544 Llc. Claw C-20 Up to 1 Incl. FINAL U —4j J-' Over 1 to 10 Incl. DATE��'7" ✓�Aj� VALIDATION IM Contract i�rr e _ �� Over 10 to 50 Incl. FINAL %,++' C) I am exemp urAiKer�ec. Over 50 to 100 Inc. BY W B.BP.C. for this reason Over 100 a z Services, Swbd., MCC 8 Ponelboards Z 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 pp Pole 8 Aurtenances 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby of Irm that I am exempt from the Cora tors License Sl fStACCT�a Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits T Professions Code): 33117 27.LU ❑ I, as owner of the property, will do the work and the Miac. Conduits 8 Conductors 1 1TEMS structure Is not Intended or offered for sale(Section 7044, Other (See Complete Fee Scheduled ® Ti ITFL 27 - 00 Business and Professions Code). CONSTRUCTION LENDING AGENCY CHEU,i 27.f?CI I hereby affirm that there Is a construction lending agency for I�j the performance of the work for which this permit Is Issued PERMIT FEE (Sub-Total) ev (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FIS L -01W 1 33!'21./91 ' Lender's Address 6167 1 AM 8'27 1 certify that I have rood this application and state that the I TOTAL FEE B,o 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 above-mentioned property for Inspedlon purposes. / 4 SEE REVERSE FOR EXPLANATORY LANGUAGE SI tura of Permittee Date �s