HomeMy Public PortalAbout6218 KAUFFMAN AVE_Electrical__ B®_A 10_41 23M t APPLICATION FOR rriElM,
DEPARTMENT OF BUILDING AND SAFE_ IT
COUNTY OF LOS ANGELES ELECTRIC
WM. J. FOX CHIEF ENGINEER
a NAME DISTlVO„ GRO ZONE PERMIT .�
ADDRES ,r
U CITY TEL. im
NO. 07/1 y9 REC VED4" FIRSREADY ISPECTION �U r
CobwTy
CERT.NO. EXPIRES cS
✓r 0
��APTPLICANL�T FILLJK Y OUTLINED PORTION ONLYI JOB
DE,SQ`,RI aION OF, WORK ADDRESS
NUMBER OF OUTLETS ON CIRCUITS LOCALITY/
LOCATION BY ROOMS NEAREST
LIGHT OUTLETS SW. PLUGS FIXT CROSS ST.
-CIRCUIT A B C D E F G H W NAME i
Z MAIL
lo:
ADDRESS
CITY Q/ '6'1'EL.NO:
1 AM THE LEGAL POSSE�TOF
OF TTHHEPABOVE LOS
ANGk3JW COUNT.x CERTIFICQUAUFICATION.;
_ I in--;RIC1AN.
ABO 8 THE LEGAL:OWNER OF TH �OPERTY DESCRIBED
OWNER.
CORREC�.`IONS
1
�.
. I I
0
OTA
No. of OUTLETS
APPROVALS
NO. OF FIXTURES 3 l DATE INSPECTOR'S NAME
NO. OF MOTORS H.P. ffi CONDUIT
NO. OF SIGNS TRANS., WIRING
NO. OF RANGES OR HEATERS FIXTURES
MISCELLANEOUS 6 POWER
O'
PERMIT FEE c� UTILITY CO.NOTIFIED
TOTAL IFER FINA
DB 5-A 12-43 25M I I APPLICATION FOR nT,ey�Y/S�f� ~
DEPARTMENT OF BUILDING AM SAFETY Lll�t111 �'�1'lJj�r1CJ1L1�1Y
COUNTY OF LOS ANGELES ELECTRIC
�tIC
WM. J. FOX CHIEF ENGINEER,,
Z G��/`�� .� �"LT�f1'e
DISTRICT NO. GROUP ZONE PERMIT NO.
Q NAME / /f p)� (�/
11 ADDRESS �d�.L�• l i'�/f • ��f'j 1 / - /
TEL.NOf7 CI'�7 RECEIVED BY READY FOR DATE ISSUED
�I
COUNTY �7 ,+ CCI+YY'-�)�y �` i` FIRST INSPECTIONCERT.NO. EXPIRES� � v'-' � a
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
DESCRIPTION Off' WORK � t : :.
JOB
l �• �t��m�Y!
NUMBER OF OUTLETS ON CIRCUITS - LOCXLITY
LOCATION BY ROOMS
NEAREST /
LIGHT OUTLETS SW. PLUGS RIRT CROSS ST. ���9 C-.,7
CIRCUIT A B C D E F G H X NAME T 7`e2/ -
fj Z MAIL C
�( { 3 ADDRESS V Q y�
j 1 O
f4 cln TEL.NO.
IMAM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFI AT6 OF QU•ALIFICATION4.
T
1 ELECTRICIAN.
1;AM THE LEGAL OWNER OFjTH9 PROPF,RTY DESCRIBED
AEOV6
OWNER.
CORRECTIONS
J
Q
' O
rNO.
A i
OF OUTLETS. $ .� APPROVALS
OF FIXTURES $ DATE INSPECTOR'S NAME
OF MOTORS H.P. CONDUIT (; /1 ,A/V
K all nw
OF SIGNS TRANS. WIRING y�✓�j1/
NO. OF RANGES OR HEATERS t$ FIXTURES
MISCELLANEOUS $ / POWER
PERMIT FEE s ! UTILITY CO.NOTIFIED J
TOTAL FEE FINAL its
WORKERS' COMPENSATION DECLARATQN
consent
CE-806 10/81 •\ , APPLICATION FOR ELECTRICAL PERMIT
I, hereby affirm that I have a certificate of consent to self CE-8066
insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES / , C, BUILDING AND SAFETY
or a certified copy thereof (Sec 3800, Lob C.) Vx1Jo�
Poli No/�i4F3o`�?rfSpany C7O/yJ,O'fcRc�/�L FOR APPLICANT TO FILL IN JOB' �,Q J��U ��
Pal
co is hereb furnished p� EACH, NO FEE ADDRESS ® If
PY Y New Residential Bldgs-& Pool 'P
❑ 1 8 2-Family, S Ft. 5 — LOCALITY l �,L;
Certified copy is filed with the county building inspec- Y- q•
tion 2�)ent Multi-family Sq. FT. i D- O p 'NEAREST
r/ licant ��CL+JL �
Residential I Swimming Pools OWNER OR
Date pp
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets• Rec Light Sw._ MAIL
COMPENSATION INSURANCE ADDRESS - G V
First 20 p
(This section need not be completed if the work Involved by Total No. Additional CITYP1�t Tel No.
the permit is for one hundred dollars ($100)or less:) '7�PLAN CHECK
I certify that in The performance of the work for which this / APPLICANT -
permit is issued, I shall not employ any person in any manner
so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
Total No. Additional -
CITY Tel No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT- If, after making this Certificate of APPLICANT �G
Exemption, you should become subject to the Workers' Range_ Heater_D.W
Compensation provisions of the-Labor Code, you must forth- Oven _ Dryer _1W M._ ADDRESS
with comply with such provisions or this permit shall be
P Y P P Top EAU —W.H.
deemed revoked i , Hood Fan ,Other CITY C! CkeI. No.
LICENSED CONTRACTORS'DECL•ARATION j -LICENSE OR C71,,t Disp. _ Room Air Cond. REG NUMBER Class C71,,
I hereby affirm that I am Licensed under provisions of Chapter 9 _
(commencing with Section 7000) of Division'3 of the Business DISTRICT NO PROCES ED BY
and Professions Code,and,m license is in full force and effect Power Apparatus 8 Large Appliances CL
0
�23Z�tZ Size&Type HP, KW,,KVA, or-KVAR i�i�� O
License Number Lic Class C�� Up to 1 Incl. FINAL U
AV �G� Over 1 to 10 Incl. DATE VALIDATION , O
Contractor Date Over 10 to 50 Incl FINAL L� V
❑ I am exempt under Sec. Over 50 to 100 Inc. BY
B.&P.C. for this reason Over 100 to
Date
Services, Swbd , MCC& Panelboards ► P4
0 -200 Amp Under 600 V'
Signature 201 - 1000 Amp. Under 600 V
Over 1000 Amp. or Over 600 V
❑ 'Exemption for Reg. Maint. Eject ooO
SINGLE FAMILY Temp.,Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits t '
Low or the following'reason (Section 7031 5, Business and 7 b 6,2'A
Professions Code): ,
❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors # o 0 o eio 2
structure is not intended or offered.for sale (Section Other (See Complete Fee Schedule)_
7044, Business and Professions Code) Pilo2'--'l 1560
CONSTRUCTION LENDING AGENCY o-fo 1 1.5'6 0
j 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) ; ro �, ) 1, 1 7.--8-2
(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 S �v
above information is correct. I agree to comply with all County
ordinances and State jaws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
the a ove-mentioned pro rty for inspection purposes.
/D - SEE REVERSE FOR EXPLANATORY LANGUAGE' . . ,
Signature of Permittee Date