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Home My Public Portal About5447 HILTON AVE_Electrical__ DO$-5A 3.59 APPLICATION FOR ELECTRIC PERMIT OB9.9A DIVISION OF BUILDING AND SAFETY Deportment of County Engineer _ County of Los Angeles BUILDING C A A/ / T/O h S 1 WM.J. FOX. COUNTY ENGINEER ADDRESS ✓ T /'f/ T CASSATT D. GRIFFIN. SUP'T OF DUILMING LOCALITY FOR APPLICANT TO FILL IN / PERMIT FEES NCRoss sr. NUMBER EACH FEE OWNER /P LIGHT OUTLETS RECEPTACLESY MAIL ADDRESS WALL SWITCHES 7 /- TOTALOUTLETS _ 5¢ $ CITY /�P" OIL C TEL. NO. ELEC. RANGES 25 ELECTRI IAN / A ELEC. HEATERS 25 ADDRESS DO s CITO 10 e KW EA CITY Z(I n�/XA-A TEL NO BZ, I-A FIXTURES 5 LICENSE NO. T NUMBER OF LIGHT CIRCUITS ]DISTRICT J� NO. I GROUP I ZONE I flEAOY FOR INSPECTION NUMBER OF RECEPTACLE CIRCUITS N MOTORS NUMBER HORSEPOWER FEE INSPEC.T^ION1 RECORD NEW MVD. HP OVER INC. EACH SL r,I�Ttn P'IA1V1 ll�lu.�� Ih 8 LESS S .25 V2 2 .50 _ 2 5 1.00 _ 5 15 1.50 15 50 2.50 _ 50 200 5.00 MISC. NO.SIGNS NO.TRANS. NO.SIGNS NO.LAMPS FOR EACH PERMIT: _WIRING $1.00 FIXTURES $1.00 SUPPLEMENTARY .50 /� APPROVALS TOTAL FEE g (Q �O DATE INSPECTORS SIGNATURE 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLIC TION CONDUIT _ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY pp WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING. 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE POWER A A DESCRIBED RESIDENTIAL PROPERTY. SIGNATUREUTILITY CO.NOTIFIED OFPERMITTEE FINAL LA WILLIAM J.FOX, COUNTY ENGINEER VALIDATION A. C.VEIT. CHIEF ELECT.INSPECTOR I An 4 7 1 5.S JUN 14 2 6.8 D in WORKER'S haveCOMPENSATIONcertificate DECLARATION 76A663 0PW(12-91) APPLICATION FOR ELECTRICAL PERMIT IJ 6-663 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.) Policy No. Company FOR APPLICANT TO FILL IN AOR 'Fu u 7 / rtl (�1 w / lle rPoli ADDRESS 1 1 / ('�L L/ fk" Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY oe copy is tiled with the county building inspection 1 ul i- Family,Sq.Ft. dNEAREST /^1�� departmartm ent. Multi-family Sq.Ft. CROSS ST. V( L DAte Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER OR ��v�� r[`�^,- COMPENSATION INSURANCE Outlets:Rec._ fight Sw. FIRM NAME l7 1 7 /' c j� Filet 20 MAIL (This section need not be completed If the work Involved by the Total No. Additional76 ADORESS permit is for one hundred dollars(5100)or less.) I certify that in the performance of the work for which this permit CITY 2� i CL r T.I.No. 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 PPLICANT Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: It, 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 APPLICANT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to tO Incl. (commencing with Section 7000)of Division.3 of the Business and CITY Tel.No. Professions Code, and my license is in full force and affect. Over 10 to 50 Ind. } SE OR Over 50 to 100 Ind. RIEGNNU BER Class. Q. Over 100 DISTRICT NO. PROC SED BY 0 License Number Lic.Class »» Services,Swbd.,MCC&Panelboards Contractor Dale 0-399 Amp.Under 600 V FDATE INAL O ❑ 400-1000 Amp. Under 600 V _U'(' VALIDATION C) I am exempt under Sec. Over 1000 Amp.or Over 600 V W FINAL — n. B.&P.C.for this reason BRANCH CIRCUIT FEES BY Cn Date: 15A,or 20A,120V,Lighting or percept. Z 1 To 10 Branch Circuits .. Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits . Exemption for Reg.Maint.Elect. 1SA.20A,208V To 277V Lighting Br.Circuits {�. . 2 SINGLE FAMILY Temp. Power Pole&Appurtenances d a HOMEOWNER-BUILDER DECLARATION I - W.C.T•W + I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit = - f1-/ 9. for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits ,r„x S30 4�•=I'J { '- "' _ 1 TTEM3 Code): `^- I,as owner of the property,will do the work and the structure Misc.Conduits 8 Conductors Ce is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) _ '"\' `' _ "T�ILC�TAL 'TECs m 55 and Professions Code). �, k,. - •-" CHFCY 5.I �#L�i.�- CONSTRUCTION LENDING AGENCY - , CHANT C _ .00 k hereby affirm that there is a construction lending agency for the ..^. Ill '`IVV�� l performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) 'ro`.` " Civ.C.) 7. .. ,,n PLAN CHECKING FEE _ I _ 010-000 1 11/25/92 Lender's Name - PERMIT ISSUING FEE _ 12711 1 AM 4%1` Lender's Address I certify that 1 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 for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE .�4xa�.( /1/2'o/fz- SIGNATURE OF PERMITTEE DATE WORKERS'COMPENSATIONDECLARATION 63 CE806G (2-80) APPLICATION FOR ELECTRICAL PERMIT I hereby affnin that 1 have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or ' a certified copy thereof(Sec. 3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB , New Residential Bldgs.&Pools EACH NO. FEE ADDRESS Certified copy is hereb rshed• 1 &2-Family,Sq. Ft. $ — $ LOCALITY ❑ Multi-family Sq. Ft. NEAREST Certified is filed with the county building inspection Residential Swimming Pools CROSS ST it pa ent. g OWNER OR FIRM NAME Dat Applicant Outlets: Rec._Light_ Sw. MAIL First 20 ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional COMPENSATION INSURANCE CIT Tel No. — } PLAN CHEC 0 (This section need not be completed if the work involved - APPLICANT 0 by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS Additional _ Total No. O 1 certify that in the performance of the work for which thisCITY o. U permit is issued. I shall not employ any person in any manner Fixed Appliances Not Over 1 HP PERMIT so as to become subject to the Workers' Compensation Laws, Range_Heater—D.W. APPLICAN / 1 /� Oven _ Dryer T W.M._ 1 ADDRESS Z Ua / Applicnn Top — FAU L W.H. Hood _ Fan _Other_ CITU TO No. N ICE TO APPLICANT: if, after making this Certificate of [lisp. _ Room Air Cond.— t LICENSE OR G / Exemption, you should become subject to the Workers' REG. NUMBER 7L lass Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCESS D BY with comply with such provisions or this permit shall be Sire&Type HP,KW,KVA,or KVAR 1 deemed revoked. (f Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE LICENSED CONTRACTORS DECLARATION VALI ATION Over 10 to 50 Incl I hereby affirm that 1 am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL . 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 6V ness and Professions Code, and my license is in full force and effect. / �Y•—/5 Services 6 /� License Number t/�'`""Lic.Class `^ �� 0-200 Amp. Under 600 V �.•' 201-1000 Amp. Under 600 V ::2 4.6 2 A Contract Dat I� J Over 1000 Amp.or Over 600 V 1 # o a o a a 2 HOME OWNER-BUILDER D CLARATION Temp. Power Pole& Appurtenances I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit 1003600 License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits o a,o 36005 ness and Professions Code): Q 7, 6-85 . Misc.Conduits& Conductors 1, as owner of the propert ill do the work and the Other (See Complete Fee Schedule)— structure is not inten or offered for sale (Section 7044, Business and ofessions Code). CONS CTION LENDING AGENCY I hereby aff that there is a construction lending agency for the formance of the work for which this permit is PERMIT FEE (Sub-Total) issued ec. 3097,Civ.CJ. Len is Name ,PLAN CHECKING FEE (One-Fourth Permit Feel ' Lender's Address PERMIT ISSUING FEE U I certify that I have read this application and state that the TOTAL FEE A6O 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 proper for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �i Signature of Permittee ate �