HomeMy Public PortalAbout5324 MCCULLOCH AVE_Electrical__ f6A663-CE806 8-62 API;LCATION FOR ELSCTRICA 'PERMIT
COUNTY OF LOS ANGELES•.
DEPARTMENT'OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION =ADDRESS
JOHN A. LA,MBIE.., COUNTY'ENGINEER
WILLIAM A4JENSEN,SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS NO. EACH FEE ST.'
"
RECEPT. TOTAL - � -
OUTLETS FIRST 20 yI 4 $ OWNER
LIBHT 'e'/ 4, 2O '� MAIL ov _ -
/'� 'ADD'L ADDRESS
SWITCH. OVER 20 .10
i TOTAL CITY TEL.NO.
LIGHTING FIRST C� .20'
FIXTURES ADD'L
OVER 20 .10 ELECTRICIAN.
RANGES 'CLO.DRYERS NRR.HTRS. 1.00 ADDRESSd t ,
GARB.D18P. STA.COOK CITY TEL.NO.
DISHWASH..
AUTO.-WAS STATE
SPACE HTRB. STA.APP.('A H.P.M ,50 LICENSE NO. O
MOTORE6 OVER NOT OVER H.P. DISWICT N9r GR P NE P SSE BY
O 1 1.00 [6
1 s• 1.so INSPECTION 'RECORD .r
8 S 2.00 711A7
8 18 2.50 l
J .! ✓ni iG�i!�'-r :�� .1�.L.:r was-��.'_r_:+���rl
15 50 3.00
' d
SO 100 5.00 Q
SIGNSI NO.TRANS.
NO.LAMPS .O�...
SERVICE 0-SOOV-NO'r OVER 200A 1.00 (� W
SERVICE O-SOOV-OVER 200 A. 2.00 y_
SERVICE OVER 600V 5.00 Z
MISC.
PERMIT ISSUING FEE 2.00 Q
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 - 1
TOTAL FEE 6
1 HEREBY ACKNOWLEDGE TWIT 1 HAVE.READ THIS APPLICATION APPROVALS DATE INSPECTOR'®SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL-COUNTY ORDINANCES'AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED'AS REQUIRED BY LOS ANGELES COUNTY AND STATE.OF FIXTURES 5 i
CALIFORNIA OR THAT 1 AM At.
NER OF THE ROVE
UTILITY CO.NOTIFIED �
DESCRIBED RESIDENTIAL�P POWER '
SIGNATURE I• 1 wl:Ilyl+:�i /i .../�
OF PERMITTEE FINAL 1 s 7`!"
VALIDATION ARTHUR C. VEIT-#'
MO :CASH SUPERVISING.ELECTRICAL ENGINEER
LACo 6 8 0 u ' JUN 2 8 2 D 1 4.30—
., WORKERS'COMPENSATION DECLARATION 7663 10/61 APPLICATION FOR ELECTRICAL PERMIT
• ' .I hereby affirm that I have a certificate of consent to self Insure, CE-806G
or.a certAcatd•of Workers' OomWnsation Insurance, or a certified BOUNTY OF LOS ANGELES BUILDING AND SAFETY
6opy1heieof(Sec.3800,Lab.d:)
Policf No. Company / FOR APPLICANT TO FILL IN JOB
❑ Certified copy is hereby furnished. EACH NO. FEE ADDRESS s3 2 y Gv t[ock Aze
New Residential Bldgs.&Pools
Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft.
$ —1$ LOCALITY
department. Multi-family Sq.Ft. NEAREST
CROSS
Date. ��—�19 Applicant A���LPt EC e�C'e� Residential Swimming Pools OWNER R /' �
FIRM NAME r-,e—A If N
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec 26 Light L:Sw. MAIL
First 20
COMPENSATION INSURANCE ADDRESS ! Ad
(This section need not be completed if the work involved by the �/ CITY Tel.No.
permit is for one hundred dollars($100)or less.) Total No.Se_7— Additional Ah
I certify that in the performance of the work for which this permit PLA CHECK
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. 13 Additional CITY Tel.No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT. If; after making this Certificate of APPLICANT A,9,CAVkP5 'Z P-�C-
Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. _.
provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS I-ZZ Sr
provisions or this permit shall be deemed revoked. Top — FAU _ W.H. _
LICENSED CONTRACTORS DECLARATION Hood — Fan — Other_ CITY PeAC/AQ I p Tel.No.yr{7$75'6
I hereby affirm that I am licensed under provisions of Chapter 9LICENSE OR
(commencing with Section 7000)of Division 3 of the Business and Disp. Room Air Cond. REG.NUMBER 3zs"C�'8(V Cias& G—(O
Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT V PROC ED BY d
Size&Type HP,KW,KVA,or KVAR O
License Number 3 2 Sl9 6 Lic.Class C Up to 1 Incl. FINAL V
Contractor � /J �
C�OI �G 22'-gate 6—Ss Z Over 1 to 10 Incl. DATE 7� 1� ^� VALIDATION Q
t�
Over 10 to 50 Incl. FINAL J ` U
❑ ' I am exempt under Sec. Over 50 to 100 Inc. BY a
B.&P.C.for this reason Over 100 C/)
Services,Swbd.,MCC&Panelboards Z
Date: 0-200 Amp.Under 600 V f
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 ACCT
I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits
for the following reason(Section 7031.5,Business and Professions `, )�796
,11
Code):
❑ I,as owner of theroe will do the work and the structure Misc.Conduits&Conductors 1 ITEMS
p p
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , TOTAL 96. 10
and Professions Code). CHECK 96.1-
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the CHANGE Xl?
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total)
Civ.C.).
Lender's,Name PLAN CHECKING FEE �(Bi�-[([((l
PERMIT ISSUING FEE ov 1 AN 7:41
Lender's Address
I certify that I have read this application and state that the above TOTAL FEE
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 fo n action p o SEE REVERSE FOR EXPLANATORY LANGUAGE
V-3?0
Signature o Pe mittee Date ,