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HomeMy Public PortalAbout6142 IVAR AVE_Electrical__ 76A663 CE 806R 10/77 APPUCAIWN FOR ELECIrMICQL PERNT f COUNTY OF LOS ANGELES 1 J DEPARTMENT OF COUNTY ENGINEER JOB BUILDING AND SAFETY DIVISION ADDRESS FOR APPLICANT TO FILL IN LOCALITY ' New Residential Bldgs.&Pools EACH NO. FEE CROSS ST. 1'&2-Family,Sq. Ft. $ .025 — $ OWNER OR Multi-family Sq. Ft. •02 — FIRM NAME Residential Swimming Pools 25.00 MAIL ADDRESS 61 en Outlets: Rec "L Light_Sw. CITY Tel.NO. First 20 .50 PLAN CHECK Total No. Additional 30 APPLICANT ADDRESS Lighting Fixtures ' First 20 .50 y' CITY Tel. No. Additional .30 PERMIT Total No. APPLICANT Fixed Appliances Not Over 1 HP ADDRESS Range—Heater_D.W._ �� CITY �,yt �, . Tel. N-,,?S6 Oven Dryer W.M._},G LICENSE OR Top —FAU —W.H._ REG.NUMBER Class. Hood—Fan _Other_ Z 5 HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION AND STATE 2.50 � �' THAT TIHE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDIN DiSp. _ ROOm Air Cond. ANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. Power Apparatus&Large Appliances Size&Type HP, KW, KVA,or KVAR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED.AND/OR LICENSED As REQUIRED BY LOS ANGELES COUNTY AND STATE.OF CALIFORNIA OR THAT I.AM -� Up to 1 Incl. 2.50 THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. 1O Over 1 to 1'0 Incl. 5.00 c.) Over 10 to SO Incl. 12.50 PERMITTEE 25.00 SIGNATURE o Over 50 to 100 Inc. U Over 100' 40.00 DISTRICT NO. PROC SED B d Services - z 0-200 Amp.Under 600 V 12.50 { 1 L SV INSPECTOR'S 201-1000 Amp.Under 600 V 25.00 APPROVALS DATE SIGNATURE Over 1000 Amp.or Over 600 V 50.00 TEMP. POWER POLE UNDERSLAB WORK Temp: Power Pole&Appurtenances 10.00 Sign with One Branch Circuit 10.00 ROUGH CONDUIT Additional Sign Branch Circuits 2.00 WIRING Misc.Conduits&Conductors 10.00 FIXTURES Other(See Complete Fee Schedulei POWERAUTHORIZED I UTILITY CO.NOTIFIED FINAL L- l d/ ' r 7 G PERMIT FEE (Sub-Total) T NOTES PLAN CHECKING FEE (One-.Fourth Permit Fee) PERMIT ISSUING FEE $7.00 7. v TOTAL FEE ' PLAN CHECK VALIDATIONCK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE - . j.Z`f,F,'�_QW�,iRKERS'COMPENSATION DECLARATION 76As63 10/81' ���p ��/� �®np ��� �p' 2�aTR�Cga'pj��R�(„j�T 'affirm•that'1 have'a'certificate of consent to self insure, CE-Bose. L� !W II V LLC Iy /�U tL- I� IIFYII or-a cer:Nficate of Workers' Compensation Insurance,_or a certified' COUNTY OF'LOS ANGELES BUILDING AND-SAFETY' copy thereof(Sec.3800.Lab. C.) Policy No: ,.Company'T ° OR APJOB, ` t F PLICANT,SO FILL IN A f,�..., Certified copy is hereby furnished. New Residential Bldgs:& Pools E CH NO. FEE ADDRESS. d / !/ 1 & 2-Family,Sq.Ft: $ $ LOCALITY° C 17 Certified copy is filed'with the°county building'inspection _ NEAREST department.'' Multifamily Sq.,FtCROSS ST: L Date Applicant Residential SwimmingIll.' I ��u Pools n OWNER OR FIRM CERTIFICATE:OF EXEMPTION FROM WORKERS,... outlets:Rec Light Sw. r v MAIL. ' cr E COMPENSATION INSURANCE , c� C ADDRESS.. (This section needsnot be completed.if the work involved by the o t 20, CITY_ Tel.No: Firs y /� Ipcertif '#hat,ins for nethe pedford dollars;($,100)or less.) :..Total N . J V Additional•° / v C? 1,2 9 -I-11 / l • " PLAN CHECK, y mance of-the,work for which this permit APPLICANT is issued; I shall:noten ploy.any. person in any,man.ne'r so as,to •become subfect to'the Workers'Compensation_Laws. 'Lightmg Fixtures First.20 -D ADDRESS •• •,•. Total NoAdditional . ' ' CITY Tel.No. d Date Applican Fixed Appliances'Not Over 1 HP PERMIT NOTICE'-J.0 APPLICANT: _If,, .after, making;.'thi C ificate .of Exemption,you should become subject to,thelWorkers. ompensation Range_ Heater_ D.N/ — proAPPLICANT vsions of the Labor Code, you musf'forthwith comply"with such'' Oven— Dryer; W'M ADDRESS v �' a �. provlslons%c. this permit•sHall.be deemed revoked "' Top — FAU.,._, W. :- 6I ENSED CONTRACTORS DECLARATION Hood Fan Others " ^' CITY s°AA1 9IFTel.'No. • ©; ;2 I.hereby affirm 'that,I am licensed ,under.,provisions, of Chapter 9 Di p. Room Air.Cohd. L o mencing with':Section 7000) LI (comof Division,3 of the Business and Professions Code,and my'license is-in full force and effect. r - DISTRICT NOR 0j) PROCE S., Y; d Power Apparatusv& Large Appliances } L _ Size&Type HP,KW,KVA,or.KVAR v License Number"'.[ ✓ / Lia Class Up to 1 Incl. FINAL Over 1 to,10 Incl y Z O Contractor ate • 'DATE G �/' VALIDATION A am exempt;.under;"Sec, Over 50'to 100n1hc. Ove 10 'FINAL •W B:&P.C. for-this reason ' CO O 0 BY c Services;Swbd„MCC&Panelboards _ Date: 0-:200 Amp.Under 600 V .` Signature 201 1000 Amp.Under.600 V' .61Si. T _.. Over 1000 Amp.or Over 600 V Exemp I ri'for Reg.Maint.Elect. fLEi ♦'' ' -x I:►All SINGLE,FAMILY Temp;Power'Pole& Appurtenances ° HOMEOWNER-BUILDER DECLARATION Sign with One Branch Circuit hereby affirm tt at'I am exempt from•the Contractor's License Law ; Additional'Sign,Branch Gircuits. for'the following reasori(Section.7031.5, Business and Professions • ;.. CHANGE" ); ondbitsl& Conductors: F L Code Misc C ' ❑, .I,as owner..of the property,will do thework and,the`structure Other See.COm Iete Fee Schedule 4? isnot intended or offered-for sale (Section 7044; Business• p ) hj3lt" �} ` and'Professions Code). ( .. - f l { I CONSTRUCTION LENDING AGENCY - ` � ri 10 19 hereby affirm that there is a"construction.lending agency for the ' performance of'fhe work,for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) 7S: : Civ.C.).. PLAN.CHECKING,FEE Lender's Name V /r� PERMIT ISSUING FEE. L l./ '• Lender's Address 7 S I certify that I have read this application and state that the above TOTAL FEE [� 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. OY SEE REVERSE FOR EXPLANATORY,LANGUAGE 46 Signature of der tee Date