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HomeMy Public PortalAbout5450 HILTON AVE_Electrical__ 'SA663 DBS66 11.59A APPLICATION FOR ELECTRIC PERMIT 1 DMSION OF BUILDING AND SAFETY _ Dep. ent of County Engineer Bull DING /" County of Los Angeles ADDRESS JOHN A. LAMB1E• COUNTY ENGINEER CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST PERM FEES CROSS ST. / NUMBER- OWNER �iS LIGHT OUTLETS MAIL �L S RECEPTACLES ADDRESS WALL SWITCHES FEE CITY TEL. NO. OUTLETS ® SC S 7 TOTAL OUTLb� / r ECTRICIAN ELEC. RANGES2ADDRESS 5 ELEC. HEATERS 2S LSc,�a KW EA CITY � h/P TL NO STATE FIXTURES 5 LICENSE NO. / MOTORS DISTRICT NO. GRO,U.PZONAE READY FOR INSPECTION NUMBER HORSEPOWER FEE I I�/� NEWMVD. HP OVER INC. ' EACH INSPECTIONrRECORD }i a LESS S .25 ,J /i 2 .50 2 5 1.00 5 15 1.50 1S 50 2.50 50 200 1 5.00 MISC. ei7 S Com/ NO. SIGNS NO.TRANS. NO. SIGNS NO. LAMPS FOR EACH PERMIT: WIRING $1.00 ' FIXTURES $1.00 I SUPPLEMENTARY .50 APPROVALS _ TOTAL FEE DATE INSPECTOR'S SIGNATURE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT .II -I1 WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ���� � //��, ELECTRICAL WIRING. WIRING IO' �,Ol sr. ASY/VOL. ._� I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY 40S ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I W THE LEGAL OWNER OF THE ALIOVE POWER DESCRIBED RESIDENTIAL OPERTY. SIGNATURE UTILITY CO.NOTIFIED 1 n OF PERMITTEE _ A-+•=1^� n-cicA.J FINAI L %' VI EMMMOMMMMA JOHN A.LAMBIE,CouNTY ENGINEER VALIDATION ARTHUR C.VEIT.'CHIEF ELECT. INSPECTOR CK NO CASH { LACCI 6 4 ©A OCT 23 2 7.2 5 0 m WORKER'S COMPENSATION DECLARATION 20.0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT � I hereby affirm that I have a certificate of consent to self insure, 76A663 or a certificate of Worker's Compensatbn InsurHnce, 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 AB / <���� ADDRESS ✓ /-r Certified copy is hereby furnished. New Residential Bldgs.8 Pools NO. EACH FEE ❑ — s $ OCAUTY T�rnJi r C 7 T� Certified copy is tiled with the county building inspection 1 ut i--Family,Sq.Ft. NEAREST department. Multifamily Sq.FL CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Li ht Sw. MR., R OR COMPENSATION INSURANCE g RM NAME /r x�/./ (Z. / /�5'tiM✓ . First 20 MAIL l (This section need not be completed If the work Involved by the Total Nost Additional r ' ADDRESS permit is for one hundred dollars(5100)or less.) ,v I certify that in the performance of the work for which this permit CITY -fel R G C lT• Tei 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 APPLICANT Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP NOTICE TO APPLICANT: If, after making this Certificate of . CIN Tet.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 PERMIT provisions or this permit shall be deemed revoked. Power Apparatus 8 Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9Over 3 to 10 Ind.(commencing with Section 7000) of Division 3 of the Business and CITY Th.No. Professions Code, and my license is in full force and effect. Over 10 to 50 Ind. >_LICENSE OR Class. Over 50 to 100 Incl. REG.NUMBER EL License Number Lic.Class Over 100 DISTRICT NO. Pi BY 0 Services,Swbd., ppC&P b r �D� Contractor Date �Itry.Ander FINE 66 0 ❑ 1 am exempt under Sec. 400-1000 Amp.Under 600 V J VALIDATION U Over 1000 Amp.or Over 600 V FINAL LU B.&P.C.for this reason BRANCH CIRCUIT FEES BY to Date: /5A,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.Mamt.Elect. 15A,20A,208V To 277V Lighting Br.Circuits A A SINGLE FAMILY Temp.Power Pole 8 Appurtenances HOME OWNED-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law !©QB,ifF'7 for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits lCode): X I I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors T is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ. C.) PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE !J. 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 in to up ) c / � s— o { SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF PERMITTEE DATE WORKER'S haveCOMPENSATION DECLARATION 260019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT 6A01 I hereby affirm that I have a certificate of consent to sell insure, or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. Cepy thereof(Sec. 3800 Lab. C.) Policy No.35!! ip Company FOR APPLICANT TO FILL IN JOB � ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY `r G' 1 &2-Family,Sq.Ft. — $ $ dCertifiedartm copy is filed with the county building spection _ department. /� v Multi-family Sq.Ft. CR059 9T. Date 5 I "7�pplicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WO ERS' OWNER OR Outlets:RCL._Light Sw. FIRM NAMEfii aL COMPENSATION INSURANCE First 20 MAIL (This section need not be completed the work Involved by the Total NoAdditional ADDRESS permittIsis for one hundred dollars(51000 .)or less.) Cl� I certify that in the performance of the work for which this permit Cl e Tel.No.iii IS issued, I shall not employ any person In any manner so as to become subjectPLAN CHECKto the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT ( �� Total No. Additional ADDRESS IL9 �-�� Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certificate of CITY ��v(/�I Cti el.No.351-_93( Exemption, you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisionPERMITs of the Labor Code, you must forthwith comply with such power Apparatus 8 Large Appliances APPLICANT _ provisions or this permit shall be deemed revoked LICENSED CONTRACTORS DECLARATION Size&Type HP,Ii ki or KVAR ADDRESSJjorJ C� 1 hereby affirm that I am licensed under provisions of Chapter'9 O� p� ,n Over1to lDQncl. jje6kii Y'r (commencing with Section 7000) of Division 3 of the Business and CITY Y'r l_ el.No. Professions Code, and my license is In full force and effect. Over 10 to So Ind. Inc LICENSE OR A } rs� ^ Over 5010 100 . REG.NUMBER a��aa� Class&Iv d - Q C(O tl Over 100 DISTRICT Ni jY PROCESSED BY O License Number $aa� Lia Class S.AoV I '` Services,Swbtl.,MCC&Panelboards d .�4-fJ� 5+14-q� FINAL O Contractor I PZ�0 Date 0-399 Amp.Under 600 V ❑ 400-1000 Amp.Under 600 V DATE Z.$�' S 0 I am exempt under Sec. VALIDATION W Over 1000 Amp.or Over 600 V FINAL d BAP.C.for this reasonBV BRANCH CIRCUIT FEES Z Date: 15A,or 20A. 120V,Lighting or Recept. I To 10 Branch Circuits Signature i 1 To 40 Branch Circuits ❑, 41 Or More Branch Circuits Exemption for Reg.Mainz.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit - +Tt-i •e' 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 Code): 3303 4`.90 ❑ I, as.owner of the property, will do the work and the structure Misc.Conduits&Conductors I ITEIS is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule)_ _ and Professions Code). ' i'+TAI. '&° 90 CONSTRUCTION LENDING AGENCY ICHECK °'`•n9nQ 1 hereby affirm that there is a construction lending agency for the ref.hl,( •VV C:-HHI.aE performance of the work for which this permit is issued (Sec. 3092 PERMIT FEE (Sub-Total) Civ. C.) PLAN CHECKING FEE Lender's Name -1nro-L�O�= 5/i9/95 PERMIT ISSUING FEE 0496 "' Ah 924 Lender's Address M L I certify that I have read this application and under penalty of fluttery slate TOTAL FEE .`YX that the above information is correct. agree to comply with all County ordinances and State laws regulating Electrical wiring,and hereby authorize repress tatives of this County to enter upon the above-mentioned property for in action u sea. SEE REVERSE FOR EXPLANATORY LANGUAGE 5 i s T E OF E MITT DATE GATE /