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Home My Public Portal About5120 KAUFFMAN AVE_Electrical__ �.-rs � {� 76OA663-CE'06,,,%7D APPUC AUPOO N Pon RECT RUCAL PRA _ LJ' COUNTY-OF LOS ANGELES" DEPARTMENT.OF COUNTY ENGINEER BUILDING. * BUILDING AND SAFETY DIVISION ADDRESS VFF COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST, NO. EACH - FEE TS OWNER � � RECEPT. $ $ MAIL - FIRST 20 25, ADDRESS LIGHT TOTAL ' kir OVER 20 CITY TEL. NO. SWITCH_ .10 PLAN CHECK LIGHTINGTOTAL FIRST 20 25 APPLICANT FIXT � OVER 20 .10 ADDRESS URES APPLIANCES CITY TEL. NO. PERMIT RANGE DRYER WTR. HTR._ ®0 APPLICANT STA. COOK DISP. •F.A.U. ADDRESS SPACE HTR. AIR COND. CIT TEL. N0. -:5�r CLOTHES WASH. DISHWASH. LICENSE N0. CLASS. `�ajQ FAN OTHER 1.00 - 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. SIZE & TYPE OVER TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 - 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR. THAT I AM THE LEGAL OWNER OF, AND INTEND TO } 1 - 10 -3.00 RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. a SIGNATURE - �/� O 10 - SO 5.00 OF PERMITTEE d' 50 - 100 10.00O DISTRICT NO. LASS ZON PR C SE Y 100 - S00 ts.00 2 SIGN, GAS SIGN AND ONE CIRCUIT 5.00 NOTES: f h TUBE, OR zz/7 CA"v •z,-,- MARQUEE ADDITIONAL CIRCUITS . 1.00 AJ � SERVICE NOTOVER600VOLTS OR200AMP / 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE SERVI CE OVER,600 VOLTS OR 200 AM P 10.00 - - TEMP.POWER POLE - TEMP.SERVI CE,POLE, &APPURTENANCES 5.00 UNDERSLAB WORK TEMP LIGHT OR RECEIPT. SYSTEM 3.00 - ROUGH CONDIUT WIRING .1 FIXTURES POWER AUTHORIZED PERMIT FEE (SUB TOTAL) UTILITY CO. NOTIFIED PLAN CHECK FEE FINAL PERMIT ISSUING FEE 3:00 O D JOSEPH C. HAN TOTAL FEE o SUPERVISI RI CAL ENGINEER, PLAN CHECK VALIDATION CK. X.O. CASH PERMIT VALIDATI CK: M.O. CASH 5 Lli O MAR f3 2 4 ? D 9.2 X SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE } }' /per _ ` �• a+% WORKERS'COMPENSATION DECLARATION 76A66310/81 oo no 3/ �n 2 5� on p n0 n0 (�/� I Tiereby a?firm that I have a certificate of consent-to self CE-8066 G=�11f"I�L4�CA �Ol1V FOR 9L E ll ll��AL� h'Ell�llV T unsure, or•a certificat6 of Workers' Compensa+Iion Insuisjnce, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof,(Sec. 3800, Lab. C.)I .��,, ' Policy No� t�i�IO�Company6x 41ws —I S FOR APPLICANT TO FILCIN JOB QCertified copy is hereby furnished. New Residential Bldgs.-& Pools EACH• NO. FEE ADDRESS Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY, tion department:. Multi-family Sq. Ft. — NEAREST, ' Residential,Swimming Pools CROSS SL =Date Applicant1�OR) T�+ � 1 OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL COMPENSATION INSURANCE - Outlets: Rec LightSw.3 ADDRESS S ` This section need not be completed if the work involved b first 20 ( p Y Total No. CITY Tel. No.. the permit is for one hundred dollars ($100)or less.) - Additional I certifythat in the performance of the work for which this PLAN CHECK p APPLICANT. permit is issued, I shall not employ any person in any manner so as to become subject to the Wo o pensation Laws. Lighting Fixtures First 20 ADDRESS Additional Total No. CITY Tel: No. Date $0A Applicant �— Fixed.Appliances Not Over 1 HP PERMIT NOTIPLICANT: If, after mq ing this ertificate of APPLICANT Exemption, you should become subject V the Workers' Range_ Heater_D.W. Compensation provisions of the Labor Code,-you must forth- Oven _ Dryer — W.M. ADDRESS 4-96/ with comply with such provisions or this ,permit shall be Top FAU —W.H. — + deemed revoked. CITY' �J Tel.'No9�� LICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other_ Disp. _,Room Air Cond. 3• LICENSE OR Class. I hereby affirm that I.am licensed under provision's of Chapter 9 REG. NUMBER !' L (commencing with Section 7000) of Division•3 of the Business DISTRICT NO. P E ED BY and Professions Code,and my license is in.full force and effect. Power Apparatus & Large Appliances > Size &Type HP, KW, KVA,or KV,ARQ. License Number /�� Z� Lic. Class Up to 1 Incl. FINAL V Contractor 1QDate /!� Over l to 10-Incl. DATE. VALIDATION o Over.10 to 50 Incl. FINA V I am exempt under Sec. Over 50 to 100 Inc. BIY LU B.&P.C. for this reason Over 100 _ H Services, Swbd'., MCC & Panelboards Date: 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V. ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power.Pole & Appurtenances - HOMEOWNER-BUILDER DECLARATION. Sign with One Branch Circuit 1 hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits 1 Law for the following reason (Section 7031.5, Business and , Professions Code): I, as owner of the property, will do Misc.the work and the Conduits& Conductors _ .structure is not intended or offered for sale (Section Other (See Complete.Fee Schedule)— D -26-0 5 4 A 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY o o ° o 0 2 I hereby affirm that there is a construction lending agency for ( ° ° 2 3.25 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total), (Sec. 3097, Civ. C.). f£•@ 2.3 8 5 PLAN CHECKING FEE Lender's Name -2—_ 34, 6 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 representatives of this County to enter upon the ab 1tioned property for inspection purposes. t SEE REVERSE FOR EXPLANATORY LANGUAGE Signatu o Per ittee Date WORKERS'COMPENSATION DECLARATION CE 8066 (2-80) G=am P UCAMN FOR EL E-C IJ I(UCAL :P-ERN11 I,hereby affirm,•.that I Have a certificate of consent to self COUNTY OF-LOS ANGELES -" BUILDING AND SAFETY insure, or acertificate of Workers,'Compensation Insurance,or a certified copy thereof'(Sec. 3800,Lab. C.)' '�✓ FOR APPLICANT TO F1L_L7N 30g Policy No. Company CD -EACH NO. EE, ADDRESS � �f� . �v'��I _ New Residential Bldgs.&Pools Certified copy is'hereby.furnished. 1 &2-Family,Sq.Ft, $ $ LOCALITY J Multi-family Sq. Ft. — NEAREST Certified copy is filed with.the county building inspection CROSS ST department. Residential Swimming Pools OWNER OR _ FIRM NAME � ) � P Date I Applicant: `�7 � ° Outlets: Rec.LLight�Sw. �i ADDRESS 3 First 20 . CERTI KATE OF EXEMPTION FROM WORKERS' Total No: Additional CITY % Tel No. 3-624q�, - } COMPENSATION INSURANCE PLAN CHECK a APPLICANT .. (This `section need not be completed if.the work involved by the permit is for, one hundred dollars ($100) or less.) Lighting Fixtures First o Additional l ADDRESS - cr_ Total No. O 1 certify that in the performance of the_work for which this Fixed Appliances Not Over 1'HP CITY Tel No. �. permif'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 ��\- 0- Oven Dryer-W.M. r Top . ; FAU —W.H.. ADDRESS' >�Ce. �• l Z Date Applicant CITY `.(��t, TeI No. ��j �' Hood Fan _Other_' ' NOTICE TO APPLICANT: If, after making this Certificate of Disp. Room Air Cond.— LICENSE OR �`1 Z� �d Exemption, you should become subject to the Workers' REG. NUMBER ��"! Class i Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROC SED BY .with comply with such provisions or this permit shall be deemed revoked. Size&Type HP,KW, KVA,or KVAR Up to 1 Incl. - ' ®' FINAL Over 1 to'.10 Incl. DATE 3 VALI DATION LICENSED CONTRACTORS DECLARATION % Over 10 to 50 Incl. FINAL I hereby affirm That I am licensed under provisions of Chapter Over 50,•to 100 Inc. BY 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 . ness and-•Professions.Code, and my license is-in full force and effect. Services 1 a Z1 0-200 Amp.Under.600 V License Number Class Lia 201-1000 Amp. Under 600 V Contractor " ice• 'Date ( Over 1000 Amp.or Over 600 V HOMEOWNER-BUILDER DECLARAT ON Temp. Power Pole&Appurtenances. I hereby affirm 4hat I am 'exempt from the Contractor's Sign with One Branch Circuit .(� p License Law for the following-reason ,(Section 7031,5,Busi- Additional Sign Branch Circuits ness and Pr,ofessions Code): C..o ,0 0 0.'� Misc.Conduits& Conductors - � �' I, as owner of. the property, will do the work and the 2.0.0 Jr`l,7 Other (See Complete Fee Schedule)— ! 5 structure, is not intended or offeredl.for sale (Section 7044, Business and Professions Code). )0 0 0,4 n 7 j? CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is PERMIT FEE (Sub Total) issued(Sec. 3097,Civ.C.). Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Y Lender's Address PERMIT ISSUING FEE I certify t. at I have read this application and state that the TOTAL FEE above i ormation is correct.I'agree to comply with all County ordinan a4s and State laws regulating Electrical wiring, and hereby authorizer sentatives of this County to enter upon -th e.-mention property for inspection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE Signature of P rmittee D to