HomeMy Public PortalAbout5937 KAUFFMAN AVE_Electrical__ DOS S-A 2-46
DEPARTMENT OF BUILDING AND SAFEW APPLICATION FOR PERMIT
COUNTY OFLOS ANGELES ELECTRIC
W J. FOX,TCH1EF ENGINEER
Z
FFUeA DISTRICT. - GROUP ZONE PERMIT NO.
< NAME
DRESS ��. s +
TYTEL.NO. ` / t��yREC LVED BY FIRST INSPECTIONREADY FOR DATE.,IS(S�UED
UNTY � ./ EXPIRES ,/ �-+'RT.NO. �p
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
JOB
DESCRIPTION OF WORD ADDRESS /.G /fo r
NUMBER OF OUTLETS ON CIRCUITSLsf�nFJ
LOCALITY
LOCATION BY ROOMS
NEAREST
LIGHT OUTLET lsw.I UGS I FI]LT CROSS ST.
'CIRCUIT -' A-- B- -Ctr _D E_ F G H K NAME
Z MAIL- - - -
3 ADDRESS -- - - - -
O
CITY TEL.NO.
1 AM THE LEGAL POSSES q O�F LOS
ANGELES COUNTY CERTIFICEO ..
ELECTRICIAN. _
I AM THE LEGAL OWNER 0 HE PROPERTY DESCRIBED
ABOVE
OWNER.
CORRECTIONS
J
Q
Z
L7
O
TOTAL S
NO. OF OUTLETS OI D $ 0 O APPROVALS
NO. OF FIXTURES �~ $ 25' DATE INSPECTOR'S NAME
NO. OF MOTORS H.P. $ CONDUIT
NO. OF SIGNS TRANS. $ WIRING
NO. OF RANGES OR HEATERS $ FIXTURES
MISCELLANEOUS $ S POWER
PERMIT FEE $ UTILITY CO.NOTIFIED
TOTAL FEE S'� S FINA Z
• WORKERS'COMPENSATION DECLARATION 96-863 ,DAB, APPLICATION *FOR ELECTRICAL PERMIT
CE-806G
I hereby affirm that•L•have a-certificate of consent to•self lnsu�e, a
or a certificate of Workdr`s' Compensation Insurance, or a certified COUNTY,OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Ser,:-3800.Lab.C) �•,
Policy No:, �'n (_,Company • - _ - _ FOR APPLICANT TO FILL IN JOB
ADDRESS
❑ Certified copy is'hereby furnished. New Residential.Bldgs & Pools EACH NO.... FEE
";❑ •certified copy is filed with'the county building.inspection 1 8 2-FamdY, Ft
- LOCALITY
�S q• $ — $
department •'N ,+•' Multi-family Sq.FtNEARESST--' ^
Residential Swimming Pools. OWNER O
-•�
Date` ry Applicant R„
'�, , .�:.•• G FIRM NAME'-" / - •-
CERTIFICATE OF EXEMPTION FROM,WGRKERS'j: MAIL • �" �
Outlets,Rec Light — Sw. — t
' COMPENSATION,INSURANCE r r � ADDRESS "
f(This section-need not be completed if the work involved-by the First 20a .
permit Is'for one hundred dollars,($100):or less.) Total No Additional CITY , l• ', eI N 'j-�-
PLAN CHECK
8 I certify that,in%the performance-of•the,work for which this permit - - + APPLICANT
is issued, I shall.not employ, any person in an manner,so,as'to
�- ybecome-subject,tonthe-Workers'Compe w Lightmg Fixtures First 20 ADDRESS
Abditional" a.�..F��
Total No CITY, Tel.No
Date Applicant - `• Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO, APPLICANT If,.after -making this Certificate of APPLICANT eS'�� S O'� '
~•Exemption,you should become sublectito the.Workers'Compensation, ,A Range_ Heater_ DW _
provisions of,tlie'L'abor,Code,•you must•forthwith comply with such Oven _ Dryer W M ADDRESS
provisions orchis permit shall`be.deemed_revoked ,Top _ — FAU. WH
LICENSED CONTRACTORS,DECLARATION. CIT �' L��JZS Te17N6 ,
Hood Fa i Other_
I hereby,aft rm`that I am licensed'under provisions-of Chapter 9 LICENSEOR
(commencing with Section 7000) of Division 3 of the Business and Disp- _ Room-Air Cond= -7z i , ClassG/d
REG NUMBER
Professions Gode,:and my license is'in,full force'and effect DISTRICT NO. PROCESSED BY
Power Apparatus'& Large Appliances
q Size& Type HP,KW,KVA,or KVAR f
License Number J 2�� ' Lic Class / Up to 1 Incl FINAL
/ I Over 1•to 10 Incl. DATE
Contractor C� Date Over 10 to 50 Incl
❑ FINAL
I am exempt under Sec Over 50 to 100 Inc BY a
B&P.Cf for this reason' JL�S ` Over•100
O` Services,Swbd„•MCC& Panelboards Z -
te 0- 200 Amp Under 600-V "
Signature 201 1000"Amp.Under 600 V
Over 1000 Amp or Over 600 V "{
Exemption for Reg.Matnt Elect
SINGLE FAMILY •Temp',Power Pole&A ppurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ;
I hereby affirm that I am exempt from the Contractor's License Law'
for the following reason (Section 7,031 5, Business and Professions, Adddiorial-Sign Branch Circudsp
Code). _ # /�
❑ Misc'Conduits-&'Conductors:'.
I,as owner of the property,will do the work and the structure •�' o o 2•'] 0,Q
•is,not intended or offered for sale (Section,7044, Business Other(See Complete Fee Schedule) _
and Professions Code) "'" 'a
0 0 02760=:
CONSTRUCTION LENDING AGENCY
,•1•-1 reby'affirrrthat there is a construction lending agency;for the
performance of the work for which this permit is issued(Sec 3097, PERMIT FEE (Sub-Total)
Civ, C) ;
` PLAN CHECKING FEE 71
Lender's Name
PERMIT ISSUING FEE
Lender's Address
1 certify that,I have read,this application and state that the above TOTAL FEE -
information is•correct I agree to corrply,:with all County ordinances r
and State'laws regulating Electrical wiring; and*,hereby authorize
repre ives of this un o enter upon the-above-,mentioned
prop or inspec' r SEE REVERSE FOR,EXPLANATORY LANGUAGE
Signature o i tee. Date