HomeMy Public PortalAbout5005 HELEO AVE_Electrical__ pa�I 1�
]6A663-CE806 10-62 APPLICATION LICATI®N E®.R ELECTRICAL PERMIT �
COUNTY OF LOS ANGELES '
DEPARTMENT OF COUNTY ENGINEER BUILDING
/ BUILDING AND SAFETY, DIVISION, ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER 1
WILLIAM A. JENSEN, SUPT OF BUILDING ji LOCALITY Lr
NEAREST
FOR APPLICANT TO FILL IN I CROSS ST.
RECEPT, j TOTAL NO. EACH FEE
`^ OUTLETS FIRST 20 �O S 20 $ 6 OWNER I-1 A
LIGHT d— MAIL
swlrc H. ADD'L ^ J ADDRESS
OVER 20 K I .tD
TOTAL CITY TEL. NO.
LIGHTING 1 v FIRST 20 �'L .20 'Q - _
FI%TURES / L-- A
oven 20 .to ELECTRICIAN ^ // �,�
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADn RE55 �j [L((_(/L
GARB.DIBP. STA.COOK
CITY Cl CA"1-4- TEL. NO.
DISHWASH. AUTO.-WASH. STATE >
SPACE HTRS, STA.APP.Iyz H.P.MAX.) -50 _ LICENSE NO. •�.�l
MOTORS: OVER NOTOVER H.P. DISTRICTr.. GROUP ONE Pf��O�C SL BY
O 1 1.00 I -7 �'f/
1 3 1.50 'INSPECTION RECORD ..
3 8 2.00 Y
a
a — 15' 2.50 - O
15 50 3.00 p�
50 100 5.00 A O
NO.TRANS. IUL
SIGNS:c . NO.LAMPS y'
SERVICE 0.60OV-NoT OV ER 200A 1.00 Ot L
SERVICE 0-60OV-OVER 200 A. 2.00 -
SERVICE OVER 600V 5.00 -
MISC.
PERMIT ISSUING FEE 2.00 QO '
SUPPLEMENTARY PERMIT ISSUING FEE _F-o0
TOTAL'FEE
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE 15 CORRECT AND.AGREE TO COMPLY CONDUIT I w /A
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING .(�• _
ELECTRICAL WIRING. WIRING /D ^
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR •� • I \ - �/•
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE /
DESCRIBED RESIDENTIAL P OPERTY. POWER
SIGNATURE ` UTILITY CO.NOTIFIED
OF PERMITTEE ��� v v• —'
FINAL
(
ALIDATION ARTHUR C. VETT , -
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
L'11o9"5 6 7� AUG29 2 D 1 3,3:0- a
WORKER'Shave 6A663 COMPENSATION 2D-0014DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self insure, '
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.)
Foley Nc_ � � Company' FOR APPLICANT TO FILL IN JADDOB fJt�
RESS (/
Certified copy is hereby furnished. New Residential Slogs.&Pools NO. EACH FEE
$ $ LOCALITY
❑�. Certified-copy.is filed with the countybuilding inspection. 1&2-Family,Sq.Ft. NEAREST
department. .Multi-family Sq.Swimming
DROSS OR
/, / q ��� t Residential Swimming Pools ASSESSOR
Dater_ / AppICBN_(( MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER OR /.
COMPENSATION INSURANCE Outlets:Rec._Light Be. FIRM NAME r
First 20 MAIL
(This section need not be completed if the work involved by the ADDRESS
permit is for one hundred dollars(3100)or less.) Total No. Additional - J
I certify that in the performance of the work for which this permit CITY Tal.No. G /
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. PERMIT
provisions of the Labor Code, you must forthwith comply with such power Apparatus&Large Appliances APPLICANT
provisions or this permit shall be deemed revoked.
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR _ ADDRESS
I Hereby affirm thatI am licensed under provisions'of Chapter 9Over3to 101nc1.
(commencing with Section 7000) of Division 3 of Me Business and / CITV'� tel.No�/�if 2�
Professions Code,and my license is in full force and effect. Over 10 to 50 Ind. LICENSE be O� }
Over 50 to 100 Incl REG.NUMBER 2)'1/ dCL
License Number �l�n d Lic.Class �O Over 100 DISTRICT NO. P OCqE$BED BY Q
.� ' / Services,Swbd.;MCC&P/n�e/l�bcJa{�idgg / G �lyi'_se�-r/&-ol ate cr
/ v �O .0-399 Amp.t der 600 V FINAL U
Contractor / ` /r (� Date - DATE C� ' F
E] xJYam exempt under Sec. 400-1000 Amp.Under 600 V
VALIDATION U
Over 1000 Amp.or Over 600 V FINAL W
B.&P.C.for this reason - BRANCH CIRCUIT FEES BY 1 U)
[/
te: 15A,or 20A. 120V,Lighting or Recept. - Z
'- - Lwe 1 To 10 Branch Circuits
S'gnat e ' �'�', y, .11 To 40 Branch Circuits
❑- 41 Or More Branch Circuits
Exemption far Reg. Main'.Elect. 15A;20A,208V To 277V Lighting BIT.Circuits
SINGLE FAMILY - Temp.Power Pole 8 Appurtenances t
L
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ACCT.
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 _. ` I_ '�1.T
Code): 7 7 ;
❑. I, as owner of the property,will do the work and the structure Misc.Conduits&Conductors 1 iTEN'S
is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) D TOTAL I HL a vi-5
and Professions Code). r p 3
CONSTRUCTION LENDING AGENCY CHECK 79.W,
I hereby affirm that there is a construction lending agency for the CHA1'4C,PEE
performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) - -
Civ. C.)
PLAN CHECKINGFEE .. CI[IG0—iIUr1 ' 4/ 7/9Z.Lender's Name
PERMIT ISSUING FEE -t.� 6 _ 91391 1 AN r.=`'-2
Lender's Address - - -
I certify that 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 p
ordinances and State lawsregulating Electrical wiring,and herebyauthorize �� U
representatives of this County to enter upon the above-mentioned property -
forms tion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
31 -Tu9F FIRIMITMEWGATE