HomeMy Public PortalAbout6025 HART AVE_Electrical__ �nmrpr_76A6E.3-CE80611-71APP UGQ4H FOR C�dCC��4G��C�a �n1U4�Q O4OO Q
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS 44
LOCALITY
FOR 'APPLICANT TO .FILL IN NEAREST
CROSS ST. 1��(
OUTLETS N0. EACH FEE . C
OWNER
$ $
RECEPT._ MAIL
FIRST 20. 25, ADDRESS
LIGHT TOTAL
OVER 20 CITY .I EL. NO..
SWITCH_ .10, PLAN CHECK
LIGHTING TOTAL FIRST 20 25 APPLICANT.-
FIXTURES
OVER 20 ADDRESS
.10
RESIDENTIAL APPLIANCES CITY TEL. NO.
PERMIT
RANGE DRYER_WTR. HTR. APPLICANT T
STA. COOK DISP. F.A.U. ADDRESS
SPACE HTR. AIR COND. CITY- ftNjpjA TEL. NO .. L
CLOTHES WASH. DISHWASH. - LICENSE NO. CLASS.
FAN OTHER 1.00 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATETHATTHE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS, TRANSFORMERS RATING W ITH ALL COUNTY ORDINANC ES AND STATE LAWS REGULATING
IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING.
SIZE & TYPE OVER TO
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 - 1 100 LICENSED AS REQUIRED BY LO ANGELES COUNTY AND STATE OF >
CALIFORNIA OR. THAT •1 AM.THE. EGAL OWNER OF, AND I TEND TO
1 - 10 3.00 RESIDE, IN,. T A OVE .DESVIBED,�;U P PERT Y. O
10 — 50 5.00 SIGNATURE
OF PERMITTEE O
50'— 100 10.00 DISTRICT NO. CLASS Z
ONE PR CES ED. W
100 — 500 t 5.00 `�
t�
SIGN, GAS SIGN AND ONE CIRCUIT 5.00 NOTES: ?
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00
SERVICENOTOVER 600 VOLTS OR 200 AMP 3.00
SERVI CEOVER 600 VOLTS OR 200 AMP 10.00 - APPROVALS DATE INSPECTOR'S SIGNATURE
TEMP.POWER POLE
TEMP SERVICE,POLE, &APPURTENANCES 5.00
UNDERSLAB WORK
TEMP_LIGHT OR RECEPT.SYSTEM 3.00
ROUGH CONDIUT
WIRING
FIXTURES
POWER AUTHORIZED
PERMIT FEE (SUB TOTAL)
UTILITY CO. NOTIFIED
'..PLAN CHECK FEE
FINAL 7Z
PERMIT ISSUING'FEE 3.00
TOTAL FEE t
PLAN CHECK VALIDATION CK. M.G. CASH
PERMIT VALIDATION CK. M. CASH +
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE +f
76AS63-CES067-88 All P DCA I�'f OO R FOR ELECTROC LL ERMT t;S
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY-ENGINEER
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
A..-_ .y, ... y -
FOR APPLICANT TO FILL IN c NEAREST - I
MUM �TCROSS ST.
1 T E MNUMBER EACH FEE OWNER _
OUTLETS: EC $ $ MAIL
LIGHTS REPT. SW. ,10 .� ADDRESS
LIGHTING FIXTURES .10 CITY /TEL. NO. A .
�5 ELEC. RANGES CLO. DRYERS ELECTRICIAN `
WATER H EATERS .50
ADDRES _
e ELEC.SPACE HTRS. DISHWASHERS -
CITY TEL. NO. $
• GARBAGE DISPOSERS AUTO.-'
STATE
`v WASHERS STA. COOKING UNITS .25 LICENSE NO.
MOTORS: OVER INC. H.P. -" '� ». ,". "":_�'.: - - ."+,» 't'c .••t-'H.:.r;-.
O— I/i .25 DISTRICT NO. GROUP ZONE `P CESSED BY
'
1/2— 2 1 .50 INSPECnOiV REtORD
2— 5 1.00
5— 15 1.50 / ///
15— 50 2.50 rn�/.Gra i pn / well
_
50-200 5.00 re1 ca ed p{/ F�(/✓I'C atr26 J V
NO. TRANS. - LN'. <;, ! )Yn nJ' l.:r L'I IA e A
SIGNS: `
NO. LAMPS
SERVICE 0-600V 1.00 An- b
1 Y L; ql ZS" X A/
SERVICE OVER 600V 5.00 ,
MISC. I - ! �n
. CvLt o�t1C.(�0
WIRING PERMIT 1.00 �, "X A f-Qr n
FIXTURE PERMIT 1.00 �L)<.-'f- n.f�. �..w.r1 nd) �`/J/ L�I.r('v-
SUPPLEMENTARY PERMIT .50 �(0l1,1.v.•n t.? V�.l�,:�'�i j,� >?. c'� ��
b TOTAL FEE $ APPROVALS
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL •COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING v r I'vc
1 HEREBY CERTIFY THAT 1 AM PROPERLY R ISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES C TY AND STATE OF FIXTURES v0
CALIFORNIA OR THAT M THE LEGAL ER OF THE ABOVE
DESCRIBED RESIDENTIAL PR PERTY. 9 POWER
SIGNATURE 1 UTILITY CO.NOTIFIED
OF PERMITTEE ` FINAL `�" `� l./%IV<vr,tt•wr
ATION ARTHUR C. VEIT,
CK Mo CASH SUPERVISING ELECTRICAL ENGINEER
LACO 3 7 3 8 n .MAil 20 2 A '220
76A668_CE80612.58 APPLICATION FOR E LE CT R,A CPERMIT
..
COUNTY OF LOS ANGELES
-.',DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION „ ADDRESS O`
-JOHN A.LAMBIE,COUNTY ENGINEER �(
'CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST d d
CROSS ST. -
PERMIT FEES
OWNER
ITEM NUMBER EACH FEE -
:OUTLETS' - - `/ //�; MAIL
LIGHTS�-' ,RECEPT:)'7�L:` SW. ;�V .10 ?(I ADDRESS -
LIGHTING FIXTURES �.?% .10 CITY TEL.NO. • -
ELEC,RANGES-' CLO.DRYERS
1.
' •�l " IP ® _ELECTRICIAN
�
ELECTRICIA
WATER sHEATERS .50 S
'7
ELEC.SPACE HTRS. DISHWASHERS . f
TEL.NO:
. - CITY -
GARBAGE D_IISPOSERS AUTO.- 3� �/\y/ STATE
WASHERS J .STA.COOKING UNITS LTi ..25 + V'Nu LICENSE NO. _
MOTORS: •OVER INC.. H.P: "STRhE N0.t, GR-,QLI,P ZONE PROCESSED BY
,O— 1/2 / A.1�
Y2- 2 '50 t7t INSPECTION RECORD
5— 15 1.50
-� -"
is— 50 2.50
3 50--200 5.00 --
c SIGNS: NO.TRANS.
NO. LAMPS -
SERVICED-600V' 1.00 -
'SERVICE OVER 600V 5.00 - -
�, MISC. -
WIRING PERMIT 1.00 f i ®
FIXTURE PERM-IT 1.00 t (�
SUPPLEMENTARY PERMIT .50 I '
L
OTAL FEE SIT t�-D' APPROVALS
EBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION DATE INSPECTOR'S SIGNATURE
ATE'THAT THE ABOVE IS CORRECT AND-AGREE TO COMPLY _
LL"COUNTY 'ORDINANCES AND STATE LAWS REGULATING CONDUITICAL WIRING. - WIRING
EBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/ORED AS REQUIRED BY LOS.ANGELES COUNTY AND STATE OFFIXTURESRNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVEBED RESIDENTIALPROPERTY. �"/' 1 P.OWERTURE !..'f / YL( UTILITY CO.NOTIFIED
ERMITTEE � 'c - FLNAL
®F ''
- /VALIDATION ARTHUR C. VEIT,
SUPERVISINGELECTRICAL E
ENGINEER MO
•A 2, 4,
4
.l
y110RKER'S COMPENSATION DECLARATION 76A663 DPW(12-91) APPLICATION �L FOR ELECTRICAL
n ECTRI A PERMIT
I hLTeby affirm that I have a certificate of consent to self insure, SIJ �y I� u�u
or a certificate of Worker's Compensation Insurance. or a certified COUNTY OF LOS'ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec.3800 Lab. C.),
Policy No. Company FOR APPLICANT TO FILL IN JOB
ADDRESS O S
❑ , C-rtified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE
$ $ LOCALITY
❑ Certified co Is filed with the count building inspection 1 &2-Family,Sq.Ft.
PY Y g P NEAREST
department., Multi-family Sq.Ft. CROSS ST.
Date Applicant Residential Swimming Pools ASSESSOR
MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' SW. FIRM AME 7, � OWN
Outlets:Rec. Light ER
COMPENSATIONN
INSURANCE
/� First 20 "' "" �""H
MAIL'
(This section need not be completed if the work involved by the Total No.�L Additional ADDRESS
permit is for one hundred dollars($100)or less.)
I certify that in the performance of the work for which this permit CITY Tel.No. t
is issued, I shall not employ any person in any manner so as to PLAN CHECK
become subject to 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.
provisions of the Labor Code, you must forthwith comply with such PERMITAtA
P y p Y Power Apparatus&Large Appliances APPLICANT (�
provisions or this permit shall be deemed revoked.
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS 15 L,
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. 14,
(commencing with Section 7000) of Division 3 of the Business and CIT '-•f Tel.No.
Professions Code,and my license is in full force and effect. Over 10 to 50 Incl.
LICENSE - Class.
Over 50 to 100 Incl, REG.NUMBB ER A
Over 100 DISTRICT NO. F ESSED BY Q
License Number Lia Class aA' ) V
Services,Swbd.,MCC&Panelboards "4(,��
Contractor Date
0 FINAL-399 Amp.Under 600 V c�
DATE G
❑ 400-1000 Amp.Under 600 V
I am exempt under Sec. VALIDATION C)
Over 1000 Amp.or Over 600 V FINAL W
B.&P.C.for this reason BRANCH CIRCUIT FEES BY
Date: 15A,or 20A, 120V,Lighting or Recept. Z
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
7
SINGLE FAMILY Temp.Power Pole&Appurtenances 2
HOME OWNER-BUILDER DECLARATIONA •L
I hereby affirm that I am exempt from-the Contractor's License Law Sign with One Branch Circuit ACCT
Sign
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits 3303 57.30
Code.
I ITEMSt
d
&C
it
d
Conus Conductors I, as owner of the property,will do the work and the structure Misc. _
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) D TOTAL 57
m ,.0
and Professions Code).
�?e3�
CONSTRUCTION LENDING AGENCY CHECK
1 hereby affirm that there is a construction lending agency for the CHANGE .00
performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) L)
Civ.C.) '
PLAN CHECKING FEE 0000-0001 5/31796
Lender's Name
PERMIT ISSUING FEE Q 6688 I AMI0=47
Lender's Address
I certify that I have read this application and under penalty of purjury state TOTAL FEE
that the 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
I or inspection urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
5 4
-SIGNATURE OF PERMITTEE DATE