HomeMy Public PortalAbout5821 HART AVE_Electrical__ 76A663-CE806 1-67 Q PP C n 5MN RMLSL�,2 f1 2C5�O AL PERMN
COUNTY OF LOS ANGELES IS ll
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEERi
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING:, LOCALITY �Q_tw t
NEAREST ".
FOR APPLICANT TO FILL IN CROSS ST. --Z.
2
RECEPT. TOTAL NO. EACH FEE
OUTLETS FIRST 20 .,(/ 4..20
L OWNER
LIGHT__ U� / MAIL ry
SWITCH �G./ ADD'L ADDRESS
OVER 20
TOTAL FIRST 20 'CITY TEL. NO.
LIGHTING 1 FIXTURES
FIXTURES J( ADD'L CONTRACTOR
OVER 20 (, (? C �,,1
RANGES DRYERS WTR.HTRS. ADDRESS SID <Qa-Q- "v �'�
GARB.DISP. STA.COOK '_ { (� V -1 2 (�'7 7
CITY "� 2►W� TEL.NO. W1'
DISHWASH. AUTO.-WASH. STATE
SPACE HTRS. .50 STA. APPL. , ® L - . ,`t, 7
(,,/ LICENSE NO. (
MOTORS: OVER NOT OVER H.P. DISTRICT NO. G Z E PRO E ED
O 1 1.00Aj
1 3 1.50 INSPECTION RECORD
3 8 2.00
8 Is 2.50
1.5 50 3.00
s0 100 5.00 w_ " O
SIGNS: NO.TRANS
NO.LAMPS
O
0
SERVICE 0.60OV•NOT OVER 200A ® 1.00
a
SERVICE 0.600V-OVER 200 A. 2.00 to
SERVICE OVER 600V 5.00
OTHER (SEE COMPLETE FEE SCHEDULE)
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 APPROVALS GATE tNBPECTOR 981GNATUR¢
TOTAL FEE j F
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION UNDERS LAB WORK
AN D.STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING p ppry�Ag
" ,p
ELECTRICAL WIRING. WIRING fl� d A�..-aw.c+ lr/
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR `il' 1.. ra"
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES 1 f
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER F, AND INTEND TO' POWER
RESIDE IN,THE ABOVE DESCR ED RESIDENTIA PROP TY.
SIGNATURE 1 UTILITY CO.NOTIFIED J A 4 �._
OF PERMITTEE w
�, FINAL
(DATION JOS PH C. ROOHAN
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
9: 9 3 4 AUG 3 2 D 5.1.0
WORKERS'COMPENSATION DECLARATION 76A663 10/81` 2 g
I hereby affirm that I have a certificate of consent to self insure,.•- CE-806G ������� �®� ®� �LE.CT AL �LS��B u
'or a certificate of Workers' Compensation Insurance, or a__certified COUNTY OF LOS ANGELES BUILDING AND SAFETY'
copy thereof(Sec.3806.Lab.C)
Policy No. -Company• - { `'� a•^ °'r�lM' FOR APPLICANT TO FILL IN JOB6'"•'•""' ",
❑ Certified co is hereby.furnished. EACH NO. FEE . ADDRESS `w.+ 7 e. }
PY Y New Residential Bldgs.& Pools
❑� Certified.copy, is filed with the county building inspection 1 & 2-Family,Sq.-Ft. $ — $ LOCALITY ,
' deparrtmegt.r Mu Sq'.Ft. — NEAREST * rf y+
;a d" r' „?..�° Residential Swimming Pools CROSS ST. ,r/ 1 I1 ,rI �.
Date _,..✓ - Applicant +. .a.•... OWNER OR' ,,/ p�;•w 1 f;e�,r� f,.1;;%
' J f FIRM NAME G/ a•r•• f :,,
CERTIFICATE OF EXEMPTION FROM WORKERS' + i ' �. MAIL
Outlets:Req •Light Sw. —
COMPENSATION INSURANCE s' / ADDRESS,
( P y First 20 CF raatv';_
This section need not be completed if the work involved b the' ;4:` CITY Tel No
permit is'•for,one hundred dollars($100)or less)
Total'No. Additional a
I certify,that in."the performance:of the work,for which this permit - PLAN CHECK'
is-issued, I.shall'not employ any person in any manner s0 as t0 - - - �t✓ - �,k APPLICANT
become subject to'the Wo kers'Compensation,Lawsi Lighting Fixtures rI y 1 First 20 j:• ADDRESS
PX. • $ f 1 i
r
J Additional
S ' [' 7 wTotal No. CITY Tel No.'
Date Applicant k., r y {. w,{
Fixed Appliances Not,Over 1 HP
NOTICE TO' APPLICANT: If, PERMIT
after .making 'this Certificate of ,/ a tri
Exemption,you should become subject'to the Workers.Compensation. RangeHeater_ D.W. APPUCAN$,
provisions of the'Labor Code;°you must forthwith comply with such ' Oven Dryer W.M._ ADDRESSf
provisions or this permit shall be deemed revoked. Top FAU W.H. f ,,, .
LICENSED CONTRACTORS DECLARATION CITY , �{ �+ Tel Nola
Hood — Fan .— Other— K [ l r. ✓ 1
I hereby affirm that I am licensed under,provisions of Chapter 9 ✓ 5 __, LICENSE OR .� ^"”"
Disp. —'1 m Air Cond. -7 i Class. �;
REG.NUMBER f
(commencing with Section 7000),of Division 3"of the Business and <' •- ' -
Professions Code;and my license is in full force and effect.• " DISTRICT NO. M� PROCESSED BY .
Power Apparatus& Large Appliances . y V .
— Vii, 9g' " J� r Size&Type HP,KW,KVA,or KVAR a1 t•••'`' '
License Number < P r: °' Lic.Class "' f fV W
Up�to,1,Incl. ;f++� FINAL r, J_ '+
Over 1 to 10 Incl. V°
DATE. f
Contractor 1ar.--^ "��r 3 }may Date ^' VALIDATION
❑ Over 10ao 50,Inc]. FINAL W
I am ezempt'under Sec.. Over 50 to'100 Ince BY
B.&P.C.for this reason Over 100
Services,Swbd.,MCG&Panelboards. ; 1
Date: I ..: r;jr�f x..
O .
0- 200 Amp:Under 600,V W
Signature, 201 _ 1000 Amp:Under 600 V
y❑ Over 1000 Amp. or Over 600.V
Exemption for Reg:Maint.Elect:
SINGLE FAMILY' ?. Temp.Power Pole& Appurtenances
'HOME OWNER-BUILDER DECLARATIONSign with One Branch Circuit
1'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 „+
Code): 1
Misc.Conduits&Conductors,. j
0 1,as owner of the property,.will do the work and the structure f
is not'".-intended or•offered,for. sale'(Section7044, Business..,. Other.(See. Complete Fee Schedule)
.'and Professions Code).i � j�,��:�'�i &';1�1�2 i�•ti
CONSTRUCTION LENDING AGENCY ''
I hereby'affirm.that there'is a construction Iie4ng agency for the
performance of the work for which this permit is issued(Sec.3097,.' PERMIT•FEE. (Sub=Total)
Civ.C.). •: i I t f< h*i•1���a
c
PLAN CHECKING FEE f., f Ifwt yri
Lender's Name
PERMIT ISSUING FEE f
Lender's Address �
,I certify that-I have read this application and state that the above,' TOTAL FEE fr. .
CA-
informationjis.correct. I agree to.comply with all County ordinances
and State'laws regulati,� Electrical wiring, and hereby authorize"
represen{a�iyes'of thi�o�ntto.enter upon the above-mentioned
proper` for inspect'.rurboses.
SEE REVERSE FOR EXPLANATORY LANGUAGE
'��.�ignature of Permitt e` Date ` � -�l '