HomeMy Public PortalAbout5818 KAUFFMAN AVE_Electrical__ 76A683.CE606 4.65 APPLICATION FOR ELECTRIC PERMIT
COUNTY OF LOS ANGELES .
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS'
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS. SUPT OF BUILDING LOCALITY +
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
RECEPTACLE TOTAL NO. EACH FEE
OUTLETS FIRST 20 �20 $ _OWNER
LIGHT MAIL
SWITCH ADD'L 10 ADDRESS
OVER 20
TOTALFIRST 20 ,20 CITY T 1 NO.
LIGHTING FIXTURES
FIXTURES ADD'L t0 CONTRACTOR
OVER 20 /� 1
RANGES CLO DRYERS WTR.HTRS. 1.00 0 'ADDRESS /.
GARB.DISP. STA.COOK
CITY TEL NO.
DISHWASH. AUTO.-WASH. - -STATE
SPACE HTRS. STA.APP.(ys H.P.MAX.) .50
LICENSE NO.
MOTORS: OVER NOT OVER . H.P. DIST ICT�k4G PZ2p.E P E D
O 1 1.00 /
1 3 1.50 INSPECTION RE ORD `
3 S 2.00
8 15 2.50
13 50 3.00 - 0
so too 5.00
V
ce
SIGNS: NO.TRANS O
NO.LAMPS V
�e W
SERVICE 0.600V-Nor OVER 200A 1.00 L a
N
SERVICE 0-60OV•OVER200A. - 2.00 z
SERVICE OVER 600V 5.00
OTHER (SEE COMPLETE FEE SCHEDULE)
PERMIT ISSUING FEE 2.00 \ G Q
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE $ APPROVALS DATE INSPECTOR'8 SIGNATURE
LRESIDE
EBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION UNDERSLAB WORK
TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ,ROUGH CONDUIT r/`
L COUNTY ORDINANCES AND STATE LAWS REGULATING
CAL WIRING. WIRING
EBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
D AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF +�
NIA OR THAT I AM THE LEGAL J�O%JADIJEND TO POWER
IN.THE ABO CR D RESI
URE ` L UTILITY CO.NOTIFIED
MITTEE —
FINAL
LIDATION Jos PH C. •ROOHK
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
LA
Co,l 0 1 21 APR 5 2 D 4.0 0
�'WOrr Eth' COMPENSATION DECLARATION �E-8 G 1
0
/81 APPLICATION FOR ELECTRICAL PER
I�hg,Aby affirm that I have a certificate of consent to self C PERMIT ,
insure, ora certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof 1Sec 3800 Lab C )
Policy No�'.2.Scompany FOR APPLICANT TO FILL IN JOB �-(J /
Certified copy is hereby furnished New Residential•Bldgs & Pools EACH NO. FEE ADDRESS J o r
Certified copy is filed with the county building inspec- 1 & 2-Family, Sq Ft. Q7D $ — $ ' ' LOCALITY [�
;,onclepart ent Multi-family Sq Ft — NEAREST Lit 5
r Residential Swimming Pools CROSS OWN�Li RM.ER T
Date Z¢ ApplicantOR
CERTIFICATE OF EXEMPTION FROM WOR S' MAIL AME
COMPENSATION INSURANCE Outlets Rec Light Sw ADDRESS p r10PjOVe—.
(This section need not be completed if the work involved byFirst 20
the permit is for one hundred dollars ($100)or less.) Total No Additional CITY Tel. No
I certify that in the performance of the work for which this PLAN CHECK APPLICANT .t Lp 5A
permit is issued, I shall not employ any person in any manner V a C
so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
Date .Applicant
Total No Additional
CITY -IN v Tel. No.�,�j�Qg9'
Fixed Appliances Not
NOTICE TO APPLICANT. If, after making ,Over 1 HP PERMIT this Certificate of (
APPLICANT �. ,tl L,D
Exemption, you should become subject to the Workers' Range_ Heater_D W.
rza
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' _ r
deemed revoked Hood _ Fan _OtherCITY /-1 0�2 0 •A, . . Tel. No. 3� �/fi
0 .
LICENSED CONTRACTORS.DECLARATION _ LICENSE OR /� r� q /1
Disp. _ Room Air Cond. / Class. J
(commencing with Section 7000) of Division 3 of the Business
Power ADISTRICT NO _ PROCESS
k CL
and Professions Code,and my license is in full force and effect. Apparatus& Large Appliances !, C)
Size&Type HP, KW, KVA, or KVAR U U
License Number Lic. Class' Up to 1 Incl
FINAL
Contractor Date Af
[, Over 1,to 10 Incl. DATE �'— VALID ION
a Over 10 to 50 Incl. FINA W
1 am exempt under c. Over 50 to 100 Inc. BY LL
B BP.C. for this reason Over 100 Z
Services, Swbd., MCC_& Ponelboords ►
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. 3 9 3 A
SINGLE FAMILY Temp. Power Pole& Appurtenances }f o 0 2 2 A
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit , `� o'o
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
Law for the following reason (Section 7031 5,,Business and ow.- 23255-
Professions Code)
DConduits&,Conductors 0 205786 -
I, as owner of the property, will do the work and the Misc.
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ ,
7044, 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
I certify that I have read this application and state that the TOTAL FEE 3 a 5
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
th abo e-men
a�nede inspects purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date
' - ,',.�: ' :,�'r• `:�'�, vc ,o,u_.�w.iilr?a�+rr"'}i;:tE � ub:+;'u�4z,�fx r�l "�_� +� r ':•r i}.... ,`'�
lLplA; T r �•
p Fb� FL
Irpo
DSP A_RTMENT OF EIII[�DING':,_A�'YD' SAFETY �y
CUUlv-W `OZr,LOS: ANGELES '
' r
Yom` m J. IEox, CHIEF ENGINEER. ..
NATIJ E F IN3TALLA N DISTRICT No: , GROUP.. RMiT.:•No.
.10
WIRING FIXTUREStERVIC2 d
RIiCE1VRD by - READY F DA7R.ISSU D 'rr
RANGE HEATER !`OWER t '' ItIR>iT 1lSSPlCTION f i 1 f
SIGNS MtSCELLANEOUts ', ' r 41�
APPLICANT FILL.:IN.:HEAVILY, 'OUTLINED PORTION,.Q
4
<. ,. a. : JOB
w NAMES ADDRES>iI?
ADDRESS '�'V�/' LOCALITY r'
i}
NEAREST
tl CI . TEL �. CROSS'ST.
TY .
COUNvlf
CERT. NO.- s' EXPIRES S NAME
DESCRIPTION. Or' WORK
NUMBER.OF OUTLETS ON CIRCUtTB O`
LOCATION BY ROOMSCITY' TEL No. . a°
;+
I ' LIGHT OUTLETS SW.I PLUGS nzT 1 .AM- TAR 'LEGAL POSSESSOR F TH6 .ABOVE
CIRCUIT ANGELES COUNTY CERTIFICAT I
"I A' .B . '.0 D E FQ H i
•,. : air:
LIVING ROOM __ atiCT IGtAN
Yet s
DINING ROOM 'y ' r VE TH6 LIZ 01KN[R OF THE PROPHRTY'D CRIB6D
O
et
BRFST. RM. 1;•i / .��s.
BATH
CfDRREC7CIONS
: l
ENT: HALL
FRO�H I a
A�?'
OUTSIDE
KITCHEN.-I
SERV. PCH.
CL MITT
CLOSQT
I •F
� L
+ v: ' L ,i .. _n�r. Yt'�:%rt,•.,. ':..b rar..n ♦ ::>.'. " - .''k: r r ,
TOTALrL., r AA{/
!YO. OF OUTLETS :�
NO.,'OF•FIXTURES y` �! fi '' (r� •VM 5•, <A` ri AT1R:+ :i`.INt►tG7QR�,MA1f1[
•;,. ,, ., 1.. r. , �, :• q a .�, M"'tJ'� �f}°° �?�.:.4ir rn� i ��k`�j+'y° t,vv� ,rs t7 ' }a S:/'Jh'} '4.
NO. •:OF MOTORS
NO:''OF .S14N8 WIRIAIG a 6r. >•x ;G"
NO. OF?.RANGES
.'OR•HE%1TER8. >/ Xi; FIXTURES'."J:
S
Ii;CELL NEOV fi � � " POW6{t E ^t •� +` re �`
-PER ITFEEid
4 s UTfLfTYCQ I1QY1F1L'D yrs � ,
TOTAL:FE6
- ( v i�r i+{.o,.a .riX� d, �: •�Y .i. kn`�.: t..,+. � 7�i.,. ,i aF�,...r. ,t.l.., ..t ,y v:r r