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HomeMy Public PortalAbout4945 HALLOWELL AVE_Electrical__ 76A663-CE806 12/75 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER JOB gDDRESS BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN LOCALITY New Residential Bldgs & Pools EACH NO. FEE NEAREST 1 & 2-Family, Sq. Ft. $ .025 — $ CROSS ST. O Multi-family Sq. Ft. •02 — FIRM ENAME Residential Swimming Pools 20.00 MAIL ADDRESS y ° Outlets: Light, Switch & Receptacle CITY l? / {At Tel. First 20 .50 PLAN CHECK J Additional 30 ® APPLICANT ADDRESS Lighting Fixtures First 20 .50 CITY Tel.No. Additional 30PERMIT APPLICANT Fixed Appliances Not Over 1 HP ADDRESS a /7 Range—Heater--D.W. CITYf Tel.Nod Oven_-Dryer_W.M.� LICENSE OR �� ��� Top FAU W.H. REG. UMBER Class.G/ Hood ©p Fan __ Z.00 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION Disp. A.C. __ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. Power Apparatus& Large Appliances Size& Type HP, KW, KVA, or KVAR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR YP LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF Up t0 1 Incl. 2.00 CALIFORNIA OR THAI I AM HE LEGAL OWNER OF THE ABOVE A. DESCRIF.ED RESIDENTIAL PERT Y. ! 0 5.00 Over 1 to 10 Incl. " 4i Over 10 t0 50 Incl. 10.00 PERMITEE 20.00 SIGNATURE Over 50 to 100 Incl. � Over 100 30.00 DISTRICT NO. PRO SSED BY Services LU 0- 200 Amp. Under 600 V 12.50 �� INSPECTOR'S C. 201.1000 Amp. Under 600 V 25.00 APPROVALS DA-V(/ SIGNATURE 4A Over 1000 Amp. or Over 600 V 50.00 TEMP.POWER POLE UN DERSLAB WORK Temp. Power Pole& Appurtenances 10.00 Sign with One Branch Circuit 10.00 ROUGH CONDUIT r Additional Sign Branch Circuits 2.00 WIRING Gam`✓ < < (Other) FIXTURES POWER AUTHORIZED UTILITY CO.NOTIFIED �9 y ]FINAL PERMIT FEE (Sub-Total) J�3 NOTES PLAN CHECKING FEE (One-Fourth Permit Fee) PERMIT ISSUING FEE $6.00 �i o TOTAL FEE PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. MO. CASH 59.20 ,6% SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE WORKERS'COMPENSATIONDECLARATION CE-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT CE-806 I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELESILD Ci,W SAFETY insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab. C.) FOR APPLICANT TO FILL IN JOB Policy No. Compan EACH NO. FEE ADDRESS 6v r New Residential Bldgs.&Pools Certif copy is hereby furnished. 1 & 2-Family,Sq. Ft. $ — $ LOCALITY Multi-family Sq. Ft. NEAREST J� Cer if'e copy 's file ith the county ing inspection CROSS ST G C ent.. R idential Swimming Pools OWNER OR FIRM NAME Date pli Outlets: Rec._Light Sw. MAIL First 20 ADDRESS RTIFICATE OF EXEMPTION FROM WORKERS' Total NO. Additional CITY Tel No. ?S 4 COMPENSATION INSURANCE PLAN CHECK (This section need not be completed if the work involved APPLICANT V by the permit is for one hundred dollars Fixtures First 20 ADDRESS s ($100).or less.) OC Total No. Additional O I certify that in the performance of the work for which thisFixed Appliances Not Over 1 HP CITY . Tel No. U permit is issued, I shall not employ any person in any manner PERMIT // tL so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICAN GLL CL Oven _ Dryer_W.M. ADDRESS r,0 Z Date - Applicant Top FAU _W.H.._ CITY Tel No. / Hood — Fan _Other_ NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Condi LICEN EOR Exemption; you should become subject to the Workers' REG. NUMB R l� / Class Compensation provisions of the Labor Code, you must forth- power Apparatus&Large Appliances DISTRICT NO. PROCE SEDKBY with comply with such provisions or this permit shall be Size&Type HP,KW, KVA,or KVAR deemed revoked. i d!J Up to 1 Incl. TT FINAL Over 1 to 10 Incl. v DATE LICENSED CONTRACTORS DECLARATION ` VALIDATION Over 10 to 50 Incl. I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. ,FINAL r � 2 4 ee 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 BY ness and Professions Code;and my icense is in full force and effect. Services �� 0-200 Amp. Under 600 V Lice umber Li c. ass 201-1000 Amp. Under 600 V C n ate Over 1000 Amp.or Over 600 V Z 91 HOME OWNER-BUILDER DECLARATION _Temp. Power Pole&Appurtenances I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit License Law for the,following reason (Section 7031.5, Busi- Additional Sign Branch Circuits ness and Professions Code): Misc.Conduits& Conductors 0 1, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— Q 8 7 9 A structure 'is not intended or offered for sale (Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY } 0 0 0 0 0 2 I hereby affirm that there is a construction lending agency 2 0 R 1 2 for the performance of the work for which this permit is PERMIT FEE (Sub-Total) 00 issued (Sec. 3097,Civ.C.). 0 0 0 1 2 0 0 0 Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) r Lender's Address PERMIT ISSUING FEE 08,24-81 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 ordinances and State laws regulating Ele rical wiring, and hereby authorize=resentatives of this Cou ty to enter up t ve-m ioned pr ty for inspection urpose SEE'REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee ate