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HomeMy Public PortalAbout5037 KAUFFMAN AVE_Electrical__ 76A663 C$-806(6/78) (rY P U C!/"UTM V'll ©R ELECIrMCALs PISIIOWr - COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT ' TO FILL IN JOB New Residential Bldgs:&Pools EACH NO. FEE ADDRESS Al eq--A ' 1 &2-FpmilY,S Q Ft. $ .025 — $ LOCALITY. L� — - . Multi-family Sq. Ft. 02 — NEAREST CROSS ST. Residential Swimming Pools 25.00 OWNER.OR ,r► FIR M.NAME Outlets: Rec./—.!7—Light_. Sw.J2, MAIL r First 20 .50 Q ADDRESS ' D0Z M .30 ,� (7 CITY Tel. No. Total No. Additional - _ PLAN CHECK APPLICANT Lighting Fixtures First 20 .50 ADDRESS /0 Additional 30 Total No.— CITY Tel. No. Fixed Appliances Not Over 1.HP PERMIT _ Range_Heater_D.W. _.. APPLICANT, f Oven—Dryer_W.M.— ADDRESS' Top _FAU W.H. No q Hobd_Fan _Other_ �4 LICENSE:•OR• +I- Disp.—Room,Air Cond. 2'50 REG. NUMBER �fQ Class I HEREBY ACKNOWLEDGE THAT I HAVE READ,THIS APPLICA- Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS'CORRECT'AND AGREE TO COMPLY WITH ALL;COUNTY-ORDINANCES AND STATE LAWS Size&Type HP, KW, KVA,or KVAR 2.50 REGULATING ELECTRICAL WIRING. r Up to 1 Ind HEREBYCERTIFYTHAT 1 AM PROPERLY REGISTERED AND/OR• 0 Over 1 to 10 Incl. 5.00 LICENSED AS REQUIRED BY'LOS ANGELES COUNTY'AND-STATE OF Over l0jo 50.Incl. 12.50' CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE 2500 DESCRIBED RESIDENTIAL,PROPERTY . Over 50 to 100 Inc. '` ' 40.00. PERMITEE Over 100 SIGNATURE= . Services DISTRICT NO -R PROLES ED BY 0-200 Amp.Under 600 V 1 2'50 Z t 201-1.000 Amp. Under 600 V 25.00 _ Over 1000 Amp:or Over 600 V 50.00 Z _. p . Temp"Power Pole&,Appurtenances 0:00 Q Sign with One Branch Circuit 10.00 Additional Sign Branch Circuits 2.00 INSPECTION > INFORMATION- U' Misc.Conduits'&Conductors 10.00 ON REVERSE LU Other(See Complete Fee Schedule) SIDE u Q ;2214.8 A • d goo,0002 PERMIT FEE (Sub-Total) o X, 0 4 Q 8 Z4Q80v PLAN CHECKING FEE (One-,Fourth Permit Fee) O 0 o�0 PERMIT ISSUING FEE $7.00 01-1.0 o`/'9 j TOTAL FEE INSPECTION FINALED n``,, W date:G/Zq'!]l` By OM61 Q� ©S 6. WORKERS'COMPENSATION DECLARATION CE-806G (2-80) hr DCteN FOR E EC C ! LPER G ` ' I hereby affirm that I have a" certificate of consent to self COUNTY OF LOS ANGELES. BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or, t a certified,copy thereof(Sec. 3800,Lab.C.) a1 L. FOR APPLICANT TO FILL IN JOB Policy No.1 5 46 A Company & t'f&t4K0 r`►l 'ts�v New Residential Bldgs.&_ Pools EACH NO. FEE ADDRESSd 7 %G /Yrs h3 ❑ Certified copy is hereby.furnished. 1 &2-Family,Sq. Ft. $ — $ I LOCALITY rV ® Multi-family Sq. Ft. — NEAREST Certified copy is filed with the county building inspection CROSS ST department. Residential Swimming Pools OWNER OR 'FIRM NAME S�4Gi< O /�-V%C--✓� Date' A:pplicantt'. -10F C CII 44V C,Oer•Pr"(- Outlets: Rec._Light_Sw, MAIL First 20 ADDRESS le' . ,_P" +A) CERTdFICATE OF EXEMPTION FROM WORKERS' Total No. Additional ' CITY � Tel No. � COMPENSATIONINSURANCE " PLAN CHECK 0 APPLICANT • (This section. need not be completed if the',work involved Lighting Fixtures First 20 U ,by the permit is for one hundred dollars ($100) or less.)' ADDRESS Additional Total NO.— ' I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. Q ' 0 permit.is issued, I shall not employ any•person in any manner' PERMIT W so as to.become subject to the Workers' Compensation Laws. -;Range_ Heater_D.W. _ APPLICANT. G-% t-Gtr» 4.00+re0 n: Oven _ Dryer_W.M. ADDRESS' �2 6 SPA LT. Top _ FAU ✓W.H.._ Date/d'"y4 Applicant e_A4 f t IC GLI r►t�1� GG�tss?t1L — Hood'_ Fan _Other_ CITYN, �s��' Tel No.q�o tl'33� NOTICE TO APPLICANT: If, after'making this Certificate of Disp. Room Air Cond.— r 5b., LICENSE OR Exemption, .you should become subject to the Workers' REG.NUMBER 3 c// wjp Class Compensation provisions of the Labor Code; you must•forth- Power Apparatus& Large Appliances DISTRICT NO., rO��B with comply with such provisions or this permit shall be Size, Type HP,KW,KVA,or KVAR deemed revoked. - H-:II1P.Upto 1 Incl. 2. U I FINAL- 0 ver INAL:Over 1 to'10 Incl. DATE s VALID ON LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl, a � I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL ` BY �. 9 (commencing with Section 7000)of Division 3 of the Busi- Over 100 r ness and Professions.Code, and my license is in full force andfr : -_'.. . effect. Services v 0 200°Amp.Under 600 V oil License Number 3 � 6%O a bass . eAr t t A 201-1000 Amp.Under 600 V Contractor C-Lt h-147-E. Date lb_t[,• Over 1000 Anip.o'r Over.600 V C o c�•r2 u� - , HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits ness and Professions Code): Misc.'Conduits&Conductors = ❑ I, as owner of the property, will do the work and the Other (See Complete'Fee Schedule)— - structure is not intended or offered for sale (Section 7044, Business'and Professions Code).. 2 b A CONSTRUCTION LENDING AGENCY I hereby' affirm that there is a construction'lending agency for the performance of the 'work for which this permit is # 0 0 0 0.o 2 PERMIT FEE (Sub-Total) �b „ issued (Sec. 3097,Civ.C.). 2..-,o '2 0 0 Le'nder's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's1 20.05Address PERMIT ISSUING FEE � f717 I certify that I have read this application and state that the TOTAL FEE; l Z b0 I �' �'" 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 Signature of Permittee Date