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HomeMy Public PortalAbout5103 KAUFFMAN AVE_Electrical__ Mm 76A663;CE806 4-68 QPPMCAUM FOR Q ELECTMICAL IPER `OU COUNTY OF LOS ANGELES DEPARTMENT B4,JIBUILDING LDING AND SAFETY DIV DIVISION ADDRESS 59.03 Kauffman Jo1HN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. NO. EACH FEE _ $ $' OWNER Estrada ' RECEPT. MAIL 5103 Kauffman LIGHT TOTAL FIRST 20 .20 ADDRESS p� ^ SWITCH_ OVER 20 .10 CITY Temple City TEL. NO. PLAN CHECK LIGHTING 1 TOTAL FIRST 20 .20 APPLICANT FIXTURES T OVER 20 .10 ADDRESS RANGE—DRYER—WTR.HTR._ CITY p� TEL. NO. STA.COOK—DISP. F.A.U. CONITRACTOR ey�pmoff Electric Comp. P' SPACE HTR. AIR COND.-,L— ADDRESS 315 SO San Gabriel Blvd CLOTHES WASH._DISHWASH._ / /,.����/ CIT an io pie TEL. NO. �181 '( '1 FAN OTHER / 1.00 / 651206 LICENSE IJO. CLASS. MOTORS,TRANSFORMERS RATING IND. HEATERS, ETC. HP. KW. KVA. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY SIZE & TYPE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. _ 0 - 1 1.00 I HEREBY CERTIFY H T I AM PROPERLY REGISTERED AND/OR 1 - 10 3.00 LICENSED AS REI ED Y LOS ANGELES COUNTY AND STATE OF _ CALIFORNIA OR TH T I M THE LEG L OWNER OF, AND INTEND TO 10 - 50 5.00 RESIDE IN, TH OVE DESCRIED RESIDENTIAL PERTY. CJ 50 - 700 10.00 SIGNATUREOF PERM! T E 100 - 500 15.00 DISTRICTRO P ZONE P O E D B GOR SIGN AND ONE CIRCUIT 3.00 N TUBE, Z MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES: SERVICE NOT OVER 600 VOLTS OR 200 AMP .00 SERVICE OVER 600 VOLTS OR 200 AMP 5.00 TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE TEMP. POWER POLE UNDERSLAB WORK ROUGH CONDUIT PERMIT FEE (SUB TOTAL) WIRING FIXTURES PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED PERMIT ISSUING FEE .00 ©� UTILITY CO.NOTIFIED SUPPLEMENT4NRY PERMIT ISSUING FEE 1.00 FINAL s 7 TOTAL FEE IaL y JOSEPH C. ROOHAN SUPERVISING ELECTRICAL ENGINEER PLAN CHECK VALIDATION CK. M.0. CASH PERMIT VALIDATI CK. M.O. CASH SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE 4f-0 _WORKERS' COMPENSATION DECLARATION t 76A663 ' '10/81: //�� I�(� �r � CE-806G P`�PIr.L� CAMON FOII ➢ELE-C MICAL -PERNT' re0y,affirm that I have a;certificate,of consent to self insure; or a certificate of.Workers';Compensation'lnsurance, or.a.certified COUNTY''OF LOS ANGELES BUI,LDINGAN•D•SA.FETY , copy thereof(Sec.3800,Lab. C.) " Policy No.._24M? Com an � FOR APPLICANT TO FILL.IN` :JOB ❑. ADDRESS Certified copy is hereby furnished. New Residential Bldgs. &Pools' - 'EACH NO. • - FEE D w��. AVS $ $ LOCALITY. P(.lr CI Certified ,copy, is'filed with the county-building•Inspection 1.,& 2-Family;Sq.Ft / n�, department rr Multi-family.Sq:Ft. — CROSS ST. `A ' iZbSA 10 - _ Residential Swimming Pools'. OWNER OR- Date Applicant • c - 'FIRM;NAME ..M'ILMill S1517 CERTIFICATEOF.EXEMPTION,FROM RKERS Light 3 Sw -: Outlets Rec. First 20 r M1 MAIL Al A YC ,. COMPENSATION INSURANCE CITYESS..,, Scr�►� (This section rieed-not be completed if the work Involved by the Tel:.Na,9$9­151S5 Additional,•. permd.is for one.hundred Total No.dollars($100) or less.) , e PLAN CHECK :I.certify.that in the performance of•thezwork for which:this.permit ; :. puCANT is',issued;'I shall not employ any:person in any,manner,so as.to become subject.to;#Fe Workers'Compensation Laws: Lighting,Fixtures First]2'b ADDRESS Date Applicant Toa o. Additional t I N CITY Tel:No Fined,Appliances Not Over 1 HPPERMIT -. NOTICE TO APPLICANT: If',, after'.'making this Certificate of_ (A✓`1v'. .• � :- ..• •APPLICANTS � •�Jct'. R��1ti1QDE1ERcS .A• • �•Exemption,you ehoald become subject to the Workers;Comvet�satio .OveRann 'HDeaeter _NW ,: ., Provisions`or th s permif shat be deemed evoked you mu4'fortk�Milh comply such' FAU W.H ADDRESSj �' Ly' GYLr. P Top- CITY LICENSED CONTRACTORS DECLARATION' Fan Other— Hood.' I'hereby affirm that I am'licensed 'under provisions of Chapter "9 LICENSE OR Disp. Room,Air Gond. .— REG:NUMBER ,'SO J Class awl (Co,mencing with Section;7000) of Division 3 of the Business_ and : Professions Code,and my license isiin full force•and effect. power Apparatus,& Large Appliances' i� s } /j Size&-Type HP,.KW,KVA,or KVAR Ivv DISTRICTNO. PROCE SEY �f/59License,Number Lie.Class Up to:1 Incl.' FINAL C. - Contractor.'., Date ZO . I T- Over 1 to.1.0 Ihcl DATE � VALIDATION Over 10 to 50 Incl LLL_ ;. FINAL ' ❑ I am exempt u er Sec: Over,.5p to 100 Inc.' BY ' B.&P.C:for this.reason Over, 100 N Services,Swbd:;MCC &•Panelboards Date: 0- 200 Amp. Under.600 V ' Signature --201,- 1000 Amp.Under;600 V. - Over .1000 Amp. or Over 6004 Exemption for Reg,Maint.Elect.: SINGLE FAMILY„ ", Temp.Power Pole&Appurtenances'. HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that Lam exempt frorri•the Contractor's License Law. for the,following'reason.(Section 7031:5„Business and Professions Additional Sign:Branch Circuits Code)' ❑ 1,as owner of the pro ert will do tYe work and the structure, Misc.Conduits& Co ductorsa P P ' v. Other(See Complete Fee Schedule) is not intended or'offered.for sale (Section 7044, Business and Professions"Code). CONSTRUCTION LENDING AGENCY I4 hereby affirm that there is a construction lending agency,;•for the performance of.the work for.which this permit is issue8(Sec 3097, PERMITTEE (Sub Total).. > „ Civ.C.). „ - CJ ^� r _i L+I 'zr h•7 PLAN CHECKING FEE -..:v' J.�F Rei -i L r 1 Lender's Name tr.] rr.,. •--1 f PERMIT-ISSUING•FEE _. a 17111 Lender's Address I certify that I have read this application ands _ tate that the above TOTAL FEE �� ` �,,, T, 01 _ • information is correct. I,agree to comply with all County ordinances F a and State laws regulating Electrical wiring,`and hereby authorize 0.1 representatives of this County to enter upon the above-mentioned �•' IM "` property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Imo, p 6 b,J Sig ture of P mittee Date r'i 10 ) >~i WORKERS' COMPENSATION DECLARATION CE-806G 10'81 /nlll ll UCC U DON FOR ELEC'uU CAL u E�`au�/u� u I hereby affirm.that I have a certificate of consent to self insure, or a certificate of Workers' Compensation In ce, COUNTY OF LOS ANGELES BUILDING AND SAFETY or q certified'copy thereof (Sec. 3800, Lab, Policy No. Compan FOR APPLICANT TO FILL•IN. JOB Certified copy is here urnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS — Certified co filed with the county building inspec- 1 & 2-Famil Y,-Sq. Ft. $ $ LOCALITY tion de menu Multi-family So. Ft. NEAREST Residential Swimming Pools CROSS ST. DatApplicant OWNER OR . FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RecLigh`t SW.'/ MAIL ADDRESS ' COMPENSATION INSURANCE This section need not be completed if the work involved b First ti ( p Y Total No. CITY Tel. o. the permit is for one hundred dollars ($100)or less.) Additional PLAN HECK I certify that in The performance,of the work for which this. � APPLICANT permit is issued, I shall not employ any person in any manner . so as to come su ject to the Workers'Compensation Laws.' Lighting Fixtures �t First 20 ADDRESS Total No. �` Additional Dat Applicnn� CITY Tel. No. Fixed Appliances Not Over 1 HP PERMIT NOTICE O A LICANT. If, after'making'this Certificate of APPLICAN Exemption, you should become subject- to the Workers' Range_ Heater_D.W.,— Compensation provisions of the.Labor Code, you must forth- Oven _ Dryer W.M.— ADDRESS with comply with such provisions or this -permit shall be _Top FAU W.H. deemed revoked: Hood _ Fan _ Other— CITY Tel. No�� LICENSED CONTRACTORS DECLARATION ® )LICENSE OR a -7 I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room'Air Cond. — REG. NUMBER J f �--, Closs.��� (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCESSED BY and Professions Code,and my license is in full force and.effect. Power Apparatus&Large Appliances CL Size &Type HP, KW, KVA, or KVAR' License Numbe,2!?e j � Lic. Clos �` p/Tp��1�Incl. LJ FINAL ` s . �� cc vErc�F to,10 Incl., DATE VALIDATION Contracto Dat j,' Over 10 to 50 Incl, FINAL H ❑ I am exempt under Sec. / Over 50 to 100 Inc. BY d B,&P.C. for this reason_ // `Over 100 Services,'SwtiB.;MCC& Panelboards z 3 9.2 2 A Date: -0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V # *-o o o o2 ❑/OARA Over 1000 Amp. or Over 600 V 2;p - 3 8,2 tJ mption for Reg. Maint. Elect. SINGLE FAMILY o 0 0 3 2 3 L Temp Power Pole&Appurtenances •- + ;i• HOME OWNER-BUILDER D ARATION Sign with One Branch Circuit o 9,'o 1� —Fj 4- I heffirm that I am exempt fr m the Contractor's License Additional Sign Branch Circuits Lawe following reason ection 7031.5, Business and . Pros Code): ❑ s owner of th property, will do the work and the Misc. Conduits&Conductors cture is.no intended' or offered for sale (Section Other (See Complete Fee Schedule)_ D , Busin and Professions Code).STRUCTION LENDING AGENCYI hff' that there is a construction•lending agency for the ance of the work for which This permit is issued PERMIT FEF (Sub-Total) (Se , Civ. C.). PLAN CHECKING FEE- Lename PERMIT ISSUING FEE _Lender's Address I certify that I have read this application and state that the TOTAL FEE above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize re resentatives of this County to enter upon the ove-mentio ed pr erty_for inspect purpose ; SEE REVERSE FOR EXPLANATORY LANGUAGE Signature•o ermittee D e