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HomeMy Public PortalAbout6120 LOMA AVE_Electrical__ r 76A663 CE-806(6/78) APPLICATION FOR ELECT R ICAL PERMIT COUNTY OF LOS ANGELES BUILDING AND FET FOR APPLICANT TO FILL IN JOB -V-S2 ADDRESS ()YV�. New Residential Bldgs.&Pools EACH NO. FEE 1 &2-Family,.Sq. Ft. $ .025 — is LOCALITY --r M I?�E rT� Multi-family Sq. Ft. .02 — NEAREST Residential SwimmingPools 25.00 CROSS ST. �, IQ I J, cJ r OWNER OR / FIRM NAME P. �• l� 1�U, d Outlets:Ree Light Sw. MAIL ) �f First 20 .50 ADDRESS /oL D �.O Total No. Additional .30 CITY TL Nyl J C ;,I-/ Tel. No. :2 9,SS-7116 PLAN CHECK APPLICANT Lighting Fixtures First 20 .50 1 ADDRESS Additional 30 Total No. CITY Tel. No, Fixed Appliances Not Over 1 HP PERMIT APPLICANT Range_Heater_D.W. — Oven—Dryer_W,M. ADDRESS Top _FAU Z W.H. _ CITY Tel. No. Hood_Fan —Other 1 LICENSE OR Disp._Room Air Cond. 2.50 REG. NUMBER Class. IHEREBY 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 YPe HP, KW, KVA,or KVAR Up to 1 Incl. 2.50 REGULATING ELECTRICAL WIRING. Q ©O I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR Over 1 to 10 Incl. 5.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF Over 10 to 50 Incl. 12.50 CALIFORNIA OR THAT I AM THE LEGAL WNER OF THE ABOVE 25.00 DESCRIBED RESIDEN L PROPERTY Over 50 to 100 Inc. PERMIT EE 40.00 Over 100 SIGNATURE .i Services DISTRICT NO. OCESSE Y 0-200 Amp.Under 600 V 12.50 201-1000 Amp. Under 600 V 25.00 Over 1000 Amp.or Over 600 V 50.00 Z O Temp. Power Pole&Appurtenances 10.00 Q Sign with One Branch Circuit 10.00 G �2 2 7 3 7 A J Additional Sign Branch Circuits 2'00 INSPECTION > 0 0 0 0 0 2 INFORMATION Misc.Conduits&Conductors 10.00 ON REVERSE i 2 o a ' &50 Other(See Complete Fee Schedule) SIDE v Q o:o 0 1 l�,5�. 021a-79 PERMIT FEE (Sub-Total) Z PLAN CHECKING FEE (One-Fourth Permit Feel O Q PERMIT ISSUING FEE 7.00 c J Q TOTAL FEE , > INSPECTION F NALED rx W date: By I ©s 77 76A 663-C E806 3-69 APPLICATION FOR ELECTIZICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING / BUILDING AND SAFETY DIVISION gODRESS �/�4 L014.} JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING FOR APPLICANT TO FILL IN NEAREST CROSS ST. NO, EACH FEE RECEIPT. $ $ OWNER /C J7 bilJ^ A_ b MAIL LIGHT TOTAL FIRST 20 ,20 ADDRESS �p L SWITCH OVER 20 .10 CITY T� le- TEL.NO. PLAN CHECK LIGHTING TOTAL FIRST 20 ,20 APPLICANT FIXTURES } OVER 20 ,10 ADDRESS RANGE DRYER_WTR. HTR. CITY TEL.NO. STA. COOK DISP. F.A.U. CONTRACTOR IQ SPACE HTR. AIR COND. ADDRESS CLOTHES WASH._DISHWASH. CITY E N0. FAN_OTHER 1.00 LICENSE NO. CLASS. MOTORS,TRANSFORMERS RATING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION IND, HEATERS, ETC, HP. KW. KVA. AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY SIZE & TYPE OVER TD WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. O - 1 1.00 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATEOF } 1 - 10 3.00 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. O 10 - 50 5.00 S_ V SIGNATURE /��� y/n 50 - 100 10A0 OF PERMITTEE li(/� „1daaz.- 0 Q H 100 - 500 15.00 1 DISTRICT NOGROUP ZONE SED BY V W SIGN,GAS SIGN AND ONE CIRCUIT 3.00 TUBE, OR L Z MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES: SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 SERVICE OVER 600 VOLTS OR 200 AMP 5.00 TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE TEMP. POWER POLE UNDERSLAB WORK ROUGH CONDUIT WIRING PERMIT FEE. (SUB TOTAL) FIXTURES PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED PERMIT ISSUING FEE 2.00 iZ E90 UTILITY CO.NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL .r TOTAL FEE JOSEPH C. ROOHAN t D SUPERVISING ELCCK�J-) M.O. NGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CASH { Ai'_ `7f Ott` DEC 4 2 "D 6.0 0 c SEE SACK OF APPLICATION FOP COMPLETE FEE Sf.H FOULF. ^�� _ WORKERS'COMPENSATIONDECLARATION CE-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT ' CE-806 I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGEL B IL ND SAFETY f insure, or a certificate of Workers'Compensation Insurance,or (\ a certified copy thereof(Sec. 3800,Lab.C.) FOR APPLICANT TO FILL IN ,JOB Policy No. Company N ❑ New Residential Bldgs.&Pools EACH FEE ADD Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY"Tyh1VL C ❑ Multi-family Sq. Ft. NEAREST Certified copy is filed with the county building inspection CROSS ST department. Residential Swimming Pools OWNER OR eft,_'�� q� j FIRM NAME eft Y[k'd Date Applicant Outlets: Rec/®Light__!�_Sw.!!;( ��� f� DDRESS IL "First 20 CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY Tel No. ���- COMPENSATION INSURANCE N PLAN CHECK & �� CL (This section need not be completed if the work involved (/ APPLICANT O by the permit is for one hundred dollars ($100) or less.) Lighting Fixtur First 20 ADDRESS Additional Total No. O Fixed Appli I certify that in the performance of the work for which this CITY Tel No. F— aes Not Over 1 HP permit.is issued, I shall not employ any person in any manner PERMIT ...,,,�,,�®A �.�,.. W so as to become subject to the Workers' Compensation Laws. Range Heater_,D-W. APPLICANT 64 4- k(.li d Oven �- Dryer_W.M.— ADDRESS Date Applicant Top _ FAU _W.H.,— 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 DISTR NO. Me S D BY with comply with such provisions or this permit shall be /��� deemed revoked. Size&Type HP,KW, KVA,or KVAR Up to 1 Incl. t� FINAL Over 1 to 10 Incl. DATE / LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. G `2-Z��CS VALIDAT- N 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 effect. Services 0-200 Amp. Under 600 V License Number Lic..Class 201-1000 Amp. Under 600 V Contractor Date Over 1000 Amp.or Over 600 V HOMEOWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances 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 VI, as owner of the property, will do the'work and the Other (See Complete Fee Schedule) — ✓ structure is not intended or offered for sale (Section �` 4 b A 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency 0 0 0 0 o 2 for the performance of the work for which this permit is PERMIT FEE (Sub-Total) issued'(Sec. 3097,Civ.C.). I 2 0 o 2 1,0 0 Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) .0 0 021,001- Lender's Address PERMIT ISSUING FEE 0 7,30-80 30°80 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 of this County to enter upon the above-mentioned property�or inspection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE Agnature'of Permittee Date