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HomeMy Public PortalAbout5736 LOMA AVE_Electrical__ `� AL U 76A665-CE806_�1/70 APPLICATION FOR ELECTRIC ERMIT IVI T C`bUNTY-OF LOS ANGELES DEPARTMENT•OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS ,LD�t-Js3 COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY'r�+`� NEAREST FOR APPLICANT'TO FILL'I,N CROSS ST. OU LETS NO. EACH FEE /n OWNER S S RECEP gie MAIL FIRST 20 3 25, ADDRESS, e (p �Or� --9LIGHT TOTAL //�� OVER 20 CITY7�/hP,,� &'/ TEL.'NO. 5 SWITCH_ .10 PLAN CHECK LIGHTING FIRST 20 25. APPLICANT TOTAL FIXTURES OVER 20 .10 ADDRESS - APPLIANCES CITY TEL. N0: PERMIT RANGE-DRYER r WTR. HTR. APPLICANT lTID.e �i�EcT•e/� STA. COOK OISP. •F.A.U. ADDRESS, ``j �p• :�/gtiJ �� 2fEL - SPACE HTR. AIR COND. CITY d�/E`, TEL. NO.,;?,f7 CLOTHES WASH. DISHWASH. LI CENSE NO. .; CLASS. FAN OTHER 1.00 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE 70 COMPLY MOTORS, TRANSFORMERS RATING .. I WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. _ SIZE & TYPE OVER TO 'I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR' 0 - 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I HE LEGAL OWNER OF, AND INTEND TO >- 1 - lO 3,00 RESIDE IN, THE ;B���TI ROPERT O 10 - 50 5.00 SIGNATURE V OF PERMITTEE 50 - 100 10.00 � O DIS TRIC/T�NO. ASS ZON PR C 100 - 500 15.00 ^-V W SIGN, GAS SIGN AND ONE CIRCUIT 5.00 NOTES: �'7 Z TUBE, OR _ MARQUEE ADDITIONAL CIRCUITS 1.00 J� � - SERVI CENOT OVER 600 VOLTS OR 200 AMP 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE S ERVI CE OV ER 600 VOLTS OR 200 AM P 10.00 - TEMP.POWER POLE TEMRSERVI CE,POLE, &APPURTENANCES 5.00 UNDERSLAB WORK' TEMP LIGHT OR RECEPT, SYSTEM 3.00 ROUGH CONDIUT WIRING IFS UTHORIZED PERMIT FEE (SUB TOTAL) CO. NOTIFIED PLAN CHECK FEE PERMIT ISSUING FEE 3.00 - JOS F� C. ROONAN'. TOTAL FEE SUPE 'SI ELECTRICAL ENGINEEP. PLAN CHECK VALIDATION - CK. M.0. CASH PERMIT VAL ON CK.' M:O. CASH Liao.>5 3 9 7 5 2 D 6:55N. . SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 76A663-CE80611/70 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEERBUILDING BUILDING AND SAFETY DIVISION ADDRESS LOCALITY, 9 ��� COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING NEAREST FOR APPLICA'NT'TO FILL�IN GROSS ST. OUTLETS .. NO. EACH FEE - OWNER RECEPT. $ S_ � MAIL ` ADDRESS .,Qp�+ LIGHT TOTAL •FIRST 20 25' CITY Z GF ��T TEL. NO_f7.,l�jQ SWITCH OVER 20 .10 ' PLAN CHECK LIGHTING 1 FIRST 20 25 APPLICANT I FIXTURES TOTAL 10OVER 20 ADDRESS . APPLIANCES CITY TEL. N0. PERMIT RANGE DRYER_WTR. HTR. APPLICANT a STA. COOK DISP. ,F.A.U. ADDRESS SPACE HTR. AIR COND. CIT 1 TEL. NQ. CLOTHES WASH. DISHWASH. LICENS NO.,�?_,5�_/_2 O CLASS. FAN OTHER 1.00 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE,ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING i WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS,. ETC. HP. KW. KVA. ELECTRICAL WIRING. SIZE & TYPE OVER TO 'I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 — 1 1.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR ;THAT I HE LEGAL OWNER OF, AND INTEND TO >- , 1 — 10 3;00 RESIDE IN, THE AB E DESCRIBED RESIDENTIAL PROPERTY O SIGNATURE. U 10 — 50 5.00 OF PERMITTEE 50 — 100 10.00 O DISTRICTNO. CLASS JZONE PR CES ED F- 1 100 — 500 15.00LOU - N SIGN, GAS SIGN AND ONE CIRCUIT 5.00 NOTES: Z TUBE, OR - 'MARQUEE ADDITIONAL CIRCUITS 1.00 SERVICENOTOVER 600 VOLTS OR 200AMP 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE SERVI CEOVER 600 VOLTS OR 200 AMP 10.00 S TEMP.POWER POLE TEMRSERVI CE,POLE, &APPURTENANCES 5.00 UNDERSLAB WORK TEMP LIGHT OR RECEPT. SYSTEM 3.00 ROUGH CONDIUT WIRING FIXTURES POWER AUTHORIZED PERMIT FEE - (SUB TOTAL) , UTILITY CO. NOT..IFIED PLAN CHECK FEE FINAL PERMIT ISSUING FEE3.00 JOSEPH C. ROOHAN . TOTAL FEE SUPERVISING ELECTRICAL ENGINEER, PLAN CHECKNALIDATION cK. M.cf. cnsH PERMIT VALIDATION 0 , .O. CASH 65 - .,u 1.5 2 0 400r SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE ' WORKERS' COMPENSATION DECLARATION 76A663 DPW 3 87 APPLICATION FOR ELECTRICAL PERMIT 1_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 DEPT. OF PUBLIC WORKS c+ a certil"ed copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB _� Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS (� L(J I F Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ _ $ LOCALITY�M tion department. Multi-family Sq. Ft. NEAREST CROSS ST. Date Applicant Residential Swimming Pools OWNER OR* A U �j FIRM NAME CERTIFICATE OF EXEMPTION.FROM WORKERS' d�Li ht q' � v�-- MAIL COMPENSATION INSURANCE Outlets: Re g �SLSw. fe � ADDRESS First 20 � JWV (This section need not be.completed if the work involved by Total No. Additional A CITY Tel. No. the permit is for one hundred dollars ($100)or less.) 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 ..__ Additional ' ;�'S" ApplicanD�i!// t�/ Total No. CITY Tel. No. Date Fixed Appliances Not Over 1 HP PERMIT / NOTICE TO APPLICANT: If, after making this. Certificate of APPLICATION ` ,G (C 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.— ADDRESS �v with comply with such,provisions or this permit shall be Top ' — FAU —W.H. — deemed revoked. Hood Fan :—Other— CITY a Tel. No.l�i�! LICENSED CONTRACTORS DECLARATION ' LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. — REG. NUMBER 2&,q-1-3 Class.0 (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY d and Professions Code,and my license is in full force and effect. — / Size &Type HP, KW, KVA, or KVAR b� 'D 0 0 License Number Lh7�L —Lic. Class ilk Up to 1 Incl. FINAL V �S L� C �C. j Over 1 to 10 Incl. DATE I� VALIDATION 0 Contractor/f Date Over 10 to 50 Incl. rJ F- FINAL U FT I am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C. for this reason Over 100 Services, Swbd., MCC & Ponelboards Z Date: _ Z 0-200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V QOver 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION I hereby affirm-that I am exempt from the Contractor's License Sign with One Branch Circuit Z Law for the following reason (Section 703.1.5, Business and Additional Sign Branch Circuits Professions Code): ❑ I, as owner.of the property, will Misc. Conduits&Conductors'do the work and the structure is.not intended or offered for sale(Section 7044; Other (See Complete.Fee Schedule)— Business and Professions Code). M iw;;i_1 CONSTRUCTION LENDING AGENCY I.hereby affirm that there is a construction lending agency for l the performance of the vvork for which this permit is issued PERMIT FEE (Sub-Total) Bfl jy;-sj;� • _ (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name - - PERMITISSUING'FEE ' Lender's Address 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 lows regulating Electrical wiring, and hereby thorize represen aiives of thi County to,enter upon ' the a ve-m tioned pro ty for ins ection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE is Si ture of Pe tte Date ©s