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Home My Public Portal About10602 KEY WEST ST_Electrical__ DBSg5A\:,5, 1- APPLICATION FOR ELECTRIC PERMIT �. DI;VISION OF BUILDING AND SAFETY Department of County EngineerNG f- County of Los Angelos ADDREBUILDISS I l9 6 O� WM J. FOX. COUNTY ENGINEER CASSATT D.GRIFFIN, SUPT OF BUILDING Tn LOCALITY 1 G FOR APPLICANT TO FILL IN NEAREST i� PERMIT FEES CROSS ST �1 d Y'e� I NUMBER EACH FEE t— S OWNER ti � I CA- LIGHT OUTLETS MAI L } RECEPTACLES AD.RTESS I t��7- ,�Q. W 7 WALL SWITCHES CITY "�-��ti TEL NO �-O q S TOTAL OUTLETS 5¢ $ J ELEC RANGES 25 ELECTRICIA ELFC HEATERS I 25 ADDRESS KW EA CITY TEL NO FIXTURES 5 LICENSE NO NUMBER OF LIGHT CIRCUITS DISTRICT-NO. GROUP I ZO�I JREADY FOR INSPECTION NUMBER OF RECEPTACLE CIRCUITS I II MOTORS NUMBER 'HORSEPOWER FEE INSPECTION RECORD NEW MVD HP OVER I INC EACH _ 112&LESS $ 25 lh 2 5o 2 5 1 00 5 15 1 50 15 50 2 50 50 200 1 Soo MISC NO SIGNS NO TRANS NO SIGNS NO LAMPS FOR EACH PERMIT WIRING $1 00 P J!2& FIXTURES $1 00 SUPPLEMENTARY 50 APPROVALS TOTAL FEE S DATE INSPECTORS SIGNATURE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CONDUIT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ' ELECTRICAL WIRING 1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGE ES COUNTY AND STATE OF CALIFORNIA OR TH T t AM HE LE 'L OW R OF THE ABOVE POWER - DESCRIBED RESIDEN A P OP TY. SIGNATURE UTILITY CO NOTIFIED ' OF PERMITTEE " FINAL f/^ WILLIAM J. FOX. COUNTY ENGINEER VALIDATION A. C.�VEIT.CHIEF ELECT. INSPECTOR 7 3 1 2'r AUG 3 0 2 1 .0 5 �' 76A�43-C E 606 10%74 r APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER JOB BUILDING AND SAFETY DIVISION ADDRESS p p 2 (� LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST OUTLETS No EACH FEE OWNER-OR FIRM NAME V bZ RECEPT.- MAIL LIGHTTOTAL FIRST 20 O 25 �,� ADDRESS (2 CITY TEL NO ^12- SWITCH OVER 20 10 PLAN CHECK FIRST 20 25 2- APPLICANT L- LIGHTING TOTAL FIXTURES OVER 20 10 ADDRESS ` RESIDENTIAL APPLIANCES CITY TEL NO 3 PERMIT / J h�(� RANGE DRYER_WTR HTR APPLICANT �d trL. iC-C C STA COOK DISP F A U ADDRESS SPACE HTR AIR COND I CITY TEL NO /► C, CLOTHES WASH DISHWASH LICENSE OR L' REG NUMBER Z CLASS FAN OTHER / 100 / S_0 O I HEREBY ACKNOWLEDGE THAT I'HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND HEATERS, ETC HP KW KVA ELECTRICAL WIRING 51ZE & TYPE OVER TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 — 1 100 LICENSED AS RED IRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAI I AM THE LEGAL OWNER OF THE ABOVE 0- 1 — 1O 300 DESCRIBED RESIDENTIAL PROPERTY \ U PERMITEE 10 - 50 500c:) SI GNATURE F- U 50 - 100 1000 LLA DISTRICT NO PRO SED a- 100 100 - 500 1500 SIGN, GAS SIGN AND ONE CIRCUIT 500 APPROVALS DATE INSPECTOR'S SIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 100 TEMP POWER POLE SERVICE NOTOVER 600 VOLTS OR 200 AMP 300 UNDERSLAB WORK SERVI CE OVER 600 VOLTS OR 200 AMP 1000 ROUGH CONDUIT TEMPSERVIICE, POLE, &APPURTENANCES 500 WIRING TEMP LIGHT OR RECEPT SYSTEM 300 FIXTURES , POWER AUTHORIZED UTILITY CO NOTIFIED FINAL PERMIT FEE (SUB TOTAL) 00 NOTES - PLAN CHECK FEE PERMIT ISSUING FEE 300 ) ,SO ° TOTAL FEE ' PLAN CHECK VALIDATION CK 0 CASH PERMIT VALIDATION CK M o cases 4 5 QCT 30 2 1) 2 1.5 Q A-3 SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE WORKERS' COMPENSATION DECLARATION CE-806 10i81APPLICATION FOR ELECTRICAL PERMIT e I hereby affirm that I have a certificate of consent to self CE-8000 \ C-1- insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY I or a certified copy thereof (Sec 3800, Lab C ) Policy No Company FOR APPLICANT TO FILL IN JOB If ��(/ � Certified copy is heieby furnished New Residential BldgsOW-II/B& Pools EACH NO FEE ADDRESS 42 G ❑ Certified copy is filed with the county building inspec- 1 & 2-Family, Sq Ft $ — $ LOCALITY tion department Multi-family Sq FtNEOSS ST R Residential Swimming Pools OWNER OR ;�Cy Date Applicant FIRM NAME * CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec Light Sw' �j MAIL COMPENSATION INSURANCE'' First 20 Y 5 -ADDRESS (This section need not be completed if the work involved by Total No Additional CITY Tel No the permit is for one hundred dollars (Slop)or less ) PLAN CHECK 1 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 2. Additional NCOTICE te r� -7 23Applican CITY Tel No xe Appliances Not Over i HP PERMIT TO APPLICANT If, t making this Certificate of APPLICANT Exemption, you should a me subject to the Workers' Range_ Heater_D W — Compensation provisions^ 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 OtherCITY 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 PROCESSED BY >_and Professions Code,and my license is in full force and effect Size &Type HP, KW, KVA, or KVAR V Q/V_Q-A-A O License Number Lic Class Up to 1 InclV FINAL Contractor Date Over 1 to 10 Incl DATE VALIDATION 0 Over 10 to 50 Incl H FINAL I am exempt under Sec Over 50 to 100 Inc BY L B&P C for this reason Over 100 Z Date Services, Swbd , MCC &-Panelboards , 0 -200 Amp Under 600 V Signature 201 - 1000 Amp Under 600 V ❑ Exemption for Reg Maint Elect Over 1000 Amp or Over 600 V SINGLE FAMILY Temp Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION � Sign with One Branch Circuit 2584,6A I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits 0 0 0 0 0 2 Law for the following reason (Section 7031 5, Business and Professions Code) 2 0 0 1 a 7 5 1, as owner of the property, will do the work and the Misc Conduits&Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ , o 0 0 1 57 5 5 7044, Business and Professions Code) ' CONSTRUCTION LENDING AGENCY _ 0,07-83 1 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 1 Lender's Address h L I certify that I have read this application and state that the TOTAL FEE ev [ 7 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 thea ve-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 15�Ile /�- 7 d'_3 pll�Lnature of Permittee ' Date WORKERS'COMPENSATION DECLARATIONS10/B1 APPLICATION FOR ELECTRICAL .PERMIT I hereby affirm that I have a certificate of consent to self 'CE-806G insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY $a certified copy thereof (Sec 3800, b C } _ S- e Poly �Company �// FOR APPLICANT TO FILL IN JOB ❑ Certified copy is hereby furnished ' New Residential Bldgs & Pools EACH NO FEE ADDRESS _ Y 1 & 2-Family, S Ft $ _ $ LOCALITY Certified copy is filed with the county building mY spec- . q SS tion department Multi-family Sq Ft NEST T PAL_ CR ARE / y2 Residential Swimming Pools OWNER OR Date LTJ Applicant �y FIRM NAME E.E J i Q CERTIFICATE OF EXEMPTION FROM WORKERS' AIL Outlets M COMPENSATION INSURANCE Outlets Rec Light�_Sw_ DDRESS First 20 S � f- '� (This section need not be completed if the work involved by Total No Additional CITY--�� }7 �t Tel N the permit is for one hundred dollars ($100)or less) I certifythat in the performance of the work for which this PLAN CHECK P 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 7 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 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 — ADDRESSGt 9 with comply with such provisions or this permit shall be Top — FAU —W H deemed revoked Hood Fan _ Other_ CITY �Cj.��r � Tel No LICENSED CONTRACTORS DECLARATION LICENSE ORq 1 hereby affirm that I am licensed under provisions of Chapter 9 Disp _ Room Air Cond —' REG NUMBER J Class(" ( (� (commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO PRO CES D BY >_ and Professions Code, and my license is in full force and effect d Size& Type HP, KW, KVA, or KVAR �' 0 License Numbcs*—SF32/2Lic Classes, Up to 1 Incl Y FINAL V �C-�—� Date Over 1 to 10 Incl ( DATE 3— Y� VALIDATION ad Cont?actor, 419 � Over 10 To 50 Incl C! 0 ❑ FINAL I am exempt under Sec Over 50 to 100 Inc BY d B&P C for this reason `� Over loo �454,'5A z Date Services, Swbd , MCC& Ponelboards !� 0 -200 Amp Under 600 V ► o 0 0 o o 2 Signature 201 - 1000 Amp Under 600 V �j �� 1 2 0.0 1 3 5 Q F] Exemption 1000 Amp or Over 600 V Exemption for Reg Maint Eject SINGLE FAMILY Temp Power Pole &Appurtenances o 0 0 �j,5 Q 1 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 08 17-83 1 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 Professions Code) ❑ I, as owner of the property, will do the work and the Misc Conduits &Conductors 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) �t (Sec 3097, Civ C ) - PLAN CHECKING FEE Lenders Name - PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the TOTAL FEE 12, Sb 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 above-me tion property for inspection purposes g SEE REVERSE FOR EXPLANATORY LANGUAGE `� gnature of Permittee Date