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Home My Public Portal About6036 KAUFFMAN AVE_Electrical__ 76A683 �E eo 10,77 APPLICATION FOR ELECTRICAL PERMIT - COUNTY OF LOS ANGELES DEPARTMENT,OF COUNTY ENGINEER JOB ADDRESS BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN i LOCALITY -r New Residential Bldgs &Pools EACH NO FEE NEAREST , $. 025 — $ ClOSSST K► AL C 1 &2-Family,Sq Ft. OWNER OR Multi.famllyScl Ft '02 — FIRM NAME Residential Swimming Pools 25.00 MAIL ADDRESS Outlets: Rec Llght_Sw. CITY Tel No O�Z First 20 50 PLAN CHECK Total No Additional .30 APPLICANT ADDRESS' Lighting Fixtures First 20 .50 CITY Tel:No. IT Total No Additional 30 APPLICANT Fixed Appliances Not Over 1 HP ADDRESS Range—Heater,D W CITY Tel No Oven —Dryer_W M I LICENSE OR Top —FAU —W H REG NUMBER Class. Hood_Fan _Other— I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION-AND STATE Disp Room Air COnd 2'50 THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDIN- ANCES AND STATE LAWS REGULATING ELECTRICAL WIRING , Power Apporatus&Large Appliances Size&Type HP, KW, KVA,or KVAR I HEREBY CERTIFY THAT 1•AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED B OS ANGELES COUNTY AND STATE OF CALIF RNIA OR THAT I-AM Up to 1 Incl 2'50 THE LEGAL ER OF THE ABOVE D ED RESIDENTIAL OPERTY d b C Over 1 to 101ncl 5.00 U Over 10 to SO Incl 12.50•; tPEE 25.00 RE Over 50 to 1,00'Inc Over 100 40'00 T N SS NServices " G d7 0-200 Amp Under 600 V 12 5C IN ECTOR S 201-1000 Amp Under 600 V25.00 PPROVALS DATE GNATURE Over 1000 Amp or Over 600 V 5000 OWER POLE UNDERSLAB WORK Temp Power Pole&Appurtenances 1000 Sign with One Branch Circuit' 10.00. ROUGH CONDUIT Add lNonol,Sign Branch G 2.00 WIRINGrcurts o -Mist Conduits&Conductors 100 FIXTURES 0. Other(See Complete Fee Schedule) POWERAUTHORIZED UTILITY CO.NOTIFIED FINAL PERMIT FEE (Sub-Total) NOTES ' PLAN CHECKING FEE (One-Fourth Permit Feel PERMIT,ISSUING.FEE $7.00 7 TOTAL FEE PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION CK- M.0 CASH=-' 1 3 1 95 0 SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE '6a�63`E-806(41 X78)_ APPLICATION, FOR-ELECTRIC ER : COUNTY OF LOS ANGELES BUILDINGAND SAFETY FOR APPLICANT-TO FILL IN JOB, New Residential Bldgs'&Paoli - -EACH• -NO -• FEE ADDRESS D .. 1 &2-Family,Sq 'Ft ' $ 025 , — $ LOCALITY Multi'family.Sq Ft 02 — NEARESTCROSS ST Residential Swimming Poo s 2500 OWNER O --- - -- — - FIRM NAME Outlets Re c L(ght- Sw • MAIL _ _ First 20 . 50 ( ADDRESS' y�' .a Totol:No moi-- Additional. 30 CITY ^Tel No _ PLAN CHECK ' .APPLICANT Lighting Fixtures First 20 .50 ADDRESS , rt Total No Additional '30 CITY Tel No. Fixed.Appli'ances,Not Over-1.HP PERMIT ' APPLICANT Range_Heater_ D W 'r _ r-ADDRESS --Oven_Dryer_W.'M—_. Top =FA W H CITY T61 No,l �J _ •. i �0/ ' Hood_Fan --,'--'Other LICENS OR Disp _Room Air Co2 50 Classnd ._ _ - REG NUMBER '. ,• _ _ .__- _ - . _•,, ,,- ', r, I HEREBY ACKNOWLEDGE THAT I HAVE,READ THIS APPLICA- Power'Apparatus&Large Appliances: TION AND'STATE THAT THE ABOVE IS CORRECT AND AGREE TO , Size&T COMPLY WITH 'ALL'COUNTY-ORDINANCES,AND-STATE"LAWS• ``"3* ype HP, KW, KVA,or KVAR REGULATING ELECTRICAL WIRINGdf ' Up to 1 In ' 2.50 cl HEREBY-CERTIFY THAT I AM PROPERLY,REGISTEREDAND/OR" '+ (®,� Over l't6 1'0 Incl. 5 00 LICENSED AS REQUIRED BY LOS ANGELES COUTY AND STATE OF 43 Over-10-to 50 Incl 12 50 CALIFORNIA OR THAT I M THE LEGAJ. R.OF.THE_ABOVE- 0 25 00 DESCRIBED RESIDENTIA ROPERTY Over SO to 100 Inc ' 40 00 PERMITEE. ,_ Over,-]00 .. SIGNATURE Services _ _ DISTRICT P 0,--200 Amp Under 600 V•. 12 50 20;1':'1000 Amp Under 600 V 25 00 i -- -- - --- Over 1000 Amp••or Over 600 V' 5000 Z Temp Power Pole&Appurtenances 10 00 j .•`.•- Q »A\'`\ O�', Sign'wrth One Branch Circuit 1000 Additional Sign Branch Circuits2.00 �\ a IN ; > . '•' ' - � Misc Conduits&Conductors' _ 10 INFOSPECTIONRMATION'00 + ' Other(See Com lete'Fee ScKedulel• ON REVERSE-k"""= �•O p. ,R SIDE Z -o'2 II 2'0,6 PERMIT_FEESub-Totall _ • _ .. „-'' r c o.5,2 81-.8,0• Z c PLAN CHECKING FEE (One-Fourth Permit Feel _' O PERMIT ISSUING FEE $7 00 TOTAL FEE. - > .INSPECTION FINALED W • date ,By d Obs t 4 - .,, WORKERS'COMPENSATIONDECLARATION CE866G (2-80) APPLICATION FOR ELECTRICAL PERMIT a I�hereby affirm that I have a certificate of consent to self -COUNTY OF LOS ANGELES I DING A ET insuii,'.or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800, Lab.C.) FOR APPLICANT TO FILL IN JOB I Policy No. Company EACH NO. FEE A D D R E S� New Residential Bldgs.&Pools Certified copy is-hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY r' Multi-family Sq. Ft. NEAREST Certified copy is filed with the county building inspection, CROSS ST {_ T #_Zdepartment.. Residential Swimming P ols OWNER OR FIRM NAME '' zi Date Applicant Outlets Rec. Light' Sw 6� MAIL S First 20 CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY ( L•7r Tel No. COMPENSATION INSURANCE PLAN CHECK \ �z a APPLICANT 0 (This section need not be completed if,the work involved U Lighting Fixtures First 20 by the permit is for ,one hundred' dollars ($100) or less.) � ADDRESS , Additional Total No. 0 I certify that in the performance of the work for which this CITY Tel No. Fixed Appliances Not Over 1 HP II— permit is issued', I shall not employ any person in any manner, PERMIT V so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT W n. Oven. Dryer_W.M. ADDRESS ce Z Date Applicant Top FAU _W.H. r t Hood Fan _Other_ CITY Tel No. NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond. LICENSE OR Exemption, you should become subject to the Workers' REG. NUMBER '" Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO PR S 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,1,0 Incl. DATE. •- LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl / • VALIDATION I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 BY, � ness and Professions Code, and my license is in full force and {!J� effect. Services License Number Lic.Class 0-200 Amp. UrSder 600 V 201-1000 Amp.Under 600 V Contractor Date, Over 1000 Amp.or Over 600 V TI �` ; HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances r^\ I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit License'Law for the following reason (Section 7031:5, Busi= Additional Sign Branch Circuits ness and Professions Code):" Misc.Conduits&Conductors I, as owner of the property, will do the work and the i Other (See Complete Fee Schedule)— ructure is not intended or offered for sale (Section 7044, Business and Professions Code). i r - CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency �• for the performance of the work for which this permit is o issued(Sec. 3097,Civ. PERMIT FEE (Sub-Total) Lender's Name_sE l�� aR 2 ?r r _ PLAN CHECKING FEE � (One-Fourth Permit Fee) ,. � / ... Lender's Addreso! �i� J 1`> �� /✓ PERMIT ISSUING FEE / o 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 f this County to enter upon t --the above-menti� pro rty f inspection pur see. SEE'REVERSE FOR EXPLANATORY LANGUAGE mgnature o Permittee / Date