HomeMy Public PortalAbout4902 HALLOWELL AVE_Electrical__ 76A663-C-4.606V1 1/7010 APPLICATI J�� EL TRICA PERMITS s
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING J '4//
BUILDING AND SAFETY DIVISION ADDRESS
COLEMAN W. JENKINS SUPERINTENDENT OF BUIL ING LOCALI TY��
NEAREST
FOR APPLICANT TO FILL ItJ CROSS ST. ,r
OUTLETS NO EACH I FEE
OWNER
RECEPT. $ $ MAIL
FIRST 20 25 c,/ ) ADDRESS 'o7r
LIGHT ETOTAL /��
OVER 20 CITY t TEL. N0.
SWITCH 10 PLAN CHECK
LIGHTINGTOTAL FIRST 20 25 APPLICANT
FIXTURES 10
Z OVER 20 ADDRESS
APPLIANCES CITY TEL. NO.
PERMIT ` ••' ��
RANGE ORYER_WTR. HTR. APPLICANT J a
STA. COOKvv�� DISP.1—F.A.U.
SPACE HTR. 4 AIR COND. CITY TEL. NO.9.7;
CLOTHES WASH. DISHWASH. LICENSE N0. s CLASS. L
FAN / OTHER 100 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION -
AN0 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 AND/OR
0 - 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE-OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
1 - 10 •300 RESIDE IN, THE ABOVE OESCRIDED RESIDENTIAL PROPERTY. O
SIGNATURE u10 - 50 500 OF PERMITTEE/ �•
50 - 100 t00o X0
DI�STR CTN CLASS ZONE ' CESSE U
100 - 500 1500 /�V r
Lu
SIGN, GASSIGN AND ONE CIRCUIT 500 NOTES: Z
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 100
SERVICE NOTOVER 600 VOLTS OR 200 AMP 300
APPROVALS DATE INSPECTOR'S SIGNATURE
SERVICEOVER 600 VOLTS OR 200AMP 1000 ,
TEMP.POWER POLE
TEMP SERVICE,POLE, &APPURTENANCES 5DO ,
UNDERSLAB WORK
TEMP LIGHT OR RECEPT. SYSTEM 300
ROUGH CONDIUT
W I R I NG
FIXTURES
POWER AUTHORIZED
PERMIT FEE (SUB TOTAL)
UTILITY CO. NOTIFIED
PLAN CHECK FEE - �• •-
FINAL f
PERMIT ISSUING FEE 300 fi ,
JOSEPH R O'HAN
TOTAL FEE SUPERVISI E CTRICAL ENGINEER.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALI AT CK M o cAs
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91)
76A663 APPLICATION FOR ELECTRICAL PERMIT .
I hereby affift that I have a certificate of consent to self.insure, ;
ore certificate of Worker's Compensation.lnsurancelocertified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy therreeoo�f(Sec 3800 Lab. C)
PDIICy NO • ofnpany - FOR APPLICANT TO FILL IN - JOB
ADDRESS
❑ Certified copy is hereby furnished New Residential Bldgs &Pools NO EACH FEE
_ $ $ LOCALITY
Certified co is led with the count b n s e io 1 &2-Family,Sq Ft.
PY Y 9 P NEAREST
en Multi-family Sq Ft CROSS STDateJp
•Applicant Residential Swimming Pools' MAPBOOK
IPAPE PARCEL
1.t CERTIFICATE OF EXE PT N FROM WORKERS' Outlets.R6C —Light Sw FOWNER OR
IRM NAME
COMPENSA INSURANCE First 20
(This section need not,be•completed if the work involved by the ADDRESS
permit is for one'hundred dollars($100)-or-less:) Total No Additional
I certify'that in the performande•of the work for which this'permit Y� Tel No
is issued, I shall not employ any person in any manner so-as to PLAN CHECK
become sublecteto the Workers: Compensation Laws. Lighting Fixtures First 20 APPLICANT
Total No. Additional
ADDRESS
Date Applicant.. RESIDENTIAL APPLIANCES NOT OVER 3 HP
NOTICE TO APPLICANT If, after making,this Certificate of CITY Tel No
Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP
rovisi&rns of the Labor Code, P Y ou must forthwith coin I with such PERMIT
P Y APPLICA
provisions or this permit shall be deemed revoked' _ Power Apparatus&Large Appllarices
LICENSED CONTRACTORS-DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS
I hereby'affirm that'l-am licensed'under provisionsiof Chapter.9 Over 3to10Incl
(commencing with Section 7000) of Division 3.of'the Business and CI Tel No
Professions Code, and my license is in full force and'eftect: Over 10 to 50 Incl:
LICENSE 6R Clas d
Over 50 t0 100 Incl REG NUMBER
Over 100 DISTRICT NO PROCESSED BY O
License Number
Services,Swbd.,MCC&Panelboards- �O
0-399 Amp Under 600 V FINAL
Contr to 400-1000 Amp Under 600 V DATE l�— L _� V
I^ exempt under Sec. VALIDATION LU
Over 1000 Amp or Over 600 V FINAL i1
B&P.C.for this reason BRANCH CIRCUIT FEES BY Z
Date: 15A,or 20A,.120V,Lighting or Recept.
_. 1 To 10 Branch Circuits
Signature 11 To 40 Branch Circuits
-41 Or More Branch Circuits
❑- 'Exemption for Reg.Maint.Elect 15A,20A,208V To 277V Lighting Br.Circuits
SINGLE FAMILY Temp. Power Pole&Appurtenances �;(L; °g
HOME OWNER-BUILDER DECLARATION -Sign with One Branch Circuit �c
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason (Section 7031 5, Business and Professions Additional Sign Branch Circuits
Y
Code): a(ts�
❑ Misc Conduits&Conductors ;. —° m
I, as owner of the property, will do the work and the structure TOTAL _ a
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) t I B6
and Professions Code). `T_—
CONSTRUCTION.LENDING AGENCY CHANGE bi 111
I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec 3097, PERMIT FEE (Sub-Total)
CIV C.) t �J IT—
1300
PLAN CHECKING FEE 0 (` 1 LJ;'27't' '
Lender's•Namen` ?`1S 'r 1`�'°^_ '
PERMIT ISSUING FEE offO t � y+y y
Lender's-Address /
I certify that I have read this application and under penalty of purfury'state TOTAL FEE (�
that the above information is correct. I agree to comply dh all County
ordinances.a d State laws regulating Electrical wiri hereby authorize
represent es of thi ou ty t e er up above-mentioned p perty
on p rp es SEE REVERSE FOR EXPLANATORY LANGUAGE
I ATURE PER EE DAT -