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HomeMy Public PortalAbout5817 KAUFFMAN AVE_Electrical__ 76A663A-CEB06A 4/72 APPLICATION cOOR ELE�RICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER TADID G BUILDING AND SAFETY DIVISION S G �q vrr TY T r FOR APPLICANTTO FILL IN CROSS'ST, OUTLETS NO. EACHI FEE OWNER RECEPT. $ $_ MAIL FIRST 20 ADDRESS I:�g 's.�. LIGHT TOTALt� CITY r C — TEL. N0. SWITCH OVER 20 PLAN HECK LIGHTING TOTAL 1 FIRST 20 APPLICANT I FIXTURES OVER 20 ADDRESS RESIDENTIAL APPLIANCES CITY /� TEL. NO. PERII RANGE DRYER_WTR. HTR. APPLIII ANT CJI/. 14le-1`riG 'I STA. COOK DISP. F.A.U. ADDRESS Cl U SCJ' SPACE HTR. AIR COND. CITY �. �-- TEL. NO. CLOTHES WASH. 01SHWASH. LICENSE NO. 3// S� CLASS6-,/d FAN OTHER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION d AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING C7 IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. SIZE & TYPE OVER TO p I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 _ 1 LICENSED AS REQUIRED BY LOS ANGELES. 000NTY AND STATE OF W CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO O_i - 10 RESIDE IN, THE ABOVE DESCRIPE RESIDENTIAL PROPERTY. y 10 - 50 SIGNATURE OF PERMITTEE 50 - 100 F47e TNO. rl.ASS ZONE PROC SED BY loo _ 500 SIGN, GASB SIGN AND ONE CIRCUIT NOTES: TUBE, OR MARQUEE ADDITIONAL CIRCUITS SERVI CE NOT OVER 600 VOLTS OR 200 AMP APPROVALS DATE INSPECTOR'S SIGNATURE SERVI CE OVER 600 VOLTS OR 200 AMP TEMP.POWER POLE TEMP SERVICE, POLE, &APPURTENANCES UNDERSLAB WORK TEMP LIGHT OR RECEPT, SYSTEM ROUGH CONDIUT WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (SUB TOTAL) UTILITY CO. NOTIFIED PLAN CHECK FEE FINAL PERMIT ISSUING FEE TOTAL FEE PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.D. CASH 4 ,0 3 SFP -28 '2 U 9.00 f '. WCRKERS' COMPENSATION DECLARATION 20-0019 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT O.j hhereoy affirm that 1';have a certificate of consent to self Ce 806G insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a'certified copy thereof (Sec. 3800, Lob. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB 17 j// (// /,�J j/ SS (j / EJ Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRE ❑Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. — NEAREST CROSS ST. Date Applicant Residential Swimming Pools OWNER OR , FIRM NAME C� CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RecALight�Sw:_ ADDIL /-/7 COMPENSATION INSURANCE ^` / First 20- (This sect ed not be completed if the work involved by CITY /C I. No. Total No. Additional 1 the pUue�d, e hundred dollars ($100)or less.) PLAN CHECK 1 cer -performance of the work for which this APPLICANT perall not employ any person in any mannero tbject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional Total No.__sZ_— CITY Tel. No. ateApplicant Fixed Appliances Not Over 1 HP PERMIT OTI APPLICANT: If, after making this Certificate of Range- Heater-D.W. APPLICATION xe on, you should become subject to the Workers' ompensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS th comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. CITY Tel. No. Hood Fan —Other— LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REG. NUMBER Class. (commencing with Section 7000)of Division 3 of the Business Power Apparatus & Large Appliances DISTRICT NO. PRO"��ALIDATION d and Professions Code,and my license is in full force and effect. O Size &Type HP, KW, KVA, or KVAR License Number Lic. Class Up to 1 Incl. FINAL U Over 1 to 10 Incl. DATE --- � Contractor Date 0 Over 10 to 50 Incl. FINAL ~ I am exempt under Sec. Over 50 to 100 Inc. BY U W B.&P.C. for this reason Over 100 n. Services, Swbd., MCC& PonelboordsU Z Date: p- 200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V OExemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V s� SINGLE FAMILY Temp. Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION I y affirm that I am exempt from the Contractor's License Sign with One Branch Circuit for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Pr(rll, Bions Code): ' Z♦ �� asowner of the property, will do the work and the Misc. Conduits &Conductors 7 structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ 3G,ZY Ell Business 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 PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Adds I certify th I ve read this application and state that the TOTAL FEE above 1 a n is correct. I agree to comply with all County ordino a Sta a laws regulating Electrical wiring, and reb o ze representatives of this County to enter upon o e- ntioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE S gry of Permitt a Date ©s OR. K .y off"" that COMPENSATION DECLARATION 76A669DPW3/87 APPLICATION FOR ELECTRICAL PERMIT 76A663 `Ffhereby affirfi that I have.a.certifitate of consent to self CE-806G insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB r, ,/ Certified co is hereby furnished. EACH NO. FEE ADDRESS tT 17 /eAo PY Y New Residential Bldgs. & Pools F 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 ST. Date Applicant FOWNER IRMNAMEa�'C/�/l/j/'f'�}ri 'f's%�`H� CERTIFICATE OF EXEMPTION FROM WORKERS' � ,0 MAIL Outlets: Rec Light Sw._ �y� ADDRESS S �] �i cf COMPENSATION INSURANCE o- W I��1�FMArl // U� First 20 (This sec0on,eed not be completed if thew involved by CITY ��'MfJL� s` Tel. No. 5]L� Total No. Additional t' �� the permor one hundred doll (S rss.) PLAN CHECK I certifin the performance oft /which this APPLICANT r i issued, I shat not employ y on in any manner become su ci to the ompensation Laws. Lighting Fixtures First 20 ADDRESS Additional �.— Total No. CITY Tel. No. App,' t w�t Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: a er making this Certificate of APPLICATION 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 I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REG. NUMBER Class. (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. ^1 PROCESSED BY a and Professions Code,and my license is in full force and effect. Size &Type HP, KW, KVA, or KVAR 0 License Number Lic. Class Up to 1 Incl. FINAL U Over 1 to 10 Incl. DATE s� —� cc Contractor Date C./FINAL VALIQITION 0 Over 10 to 50 Incl. H U I am exempt under Sec. Over 50 to 100 Inc. BY W B for this reaso Over 100 ® Services, Swbd., MCC& Panelboards U)Z 0- 200 Amp. Under 600 V 201 - 1000 Amp. Under 600 V \ Over 1000 Amp. or Over 600 V Exemption for Reg. /�iaint. Elect. SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION ;20 5 3,4 A I her by affirm that I am exempt from the Contractor's License Sign with One Branch Circuit # o o;0 ® 0 2 Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Prof ssions Code): ° -,29..00 I, as owner of the property, will do the work and the Misc. Conduits&Conductors o - 29.006 structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ Business 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 PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address ZZ TOTALFEE I certify th I have read this appl' atio and state that the r above ation is correct. I agF e to all County ordi s and State I s re at' lectrical wiring, and he authorize re r sentat' es of is County to enter pon he ve- e ti prop y nspection pure e . SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permute ate ©s