HomeMy Public PortalAbout5346 MCCULLOCH AVE_Electrical__ SA668.CES0610-61 APPLICATION FOR 'ECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION PIDDRE88
JOHN A. LAMBIE. COUNTY ENGINEER
WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY ei. L�
NEAREST
FOR APPLICANT TO FILL- IN CROSS ST.
1 T E M NO. EACH FEE
OUTLETS: FIRST 20) E.20 E L OWNER
LIGHTS RECEPT. SW. MAIL
OUTL (ADD•L UNITS) ADDRESS
LIGHTS _ RECEPT. SW. •�O v
57
LIGHTING FIXTURES: (FIRST 20) .20 CITY TEL.NO.
LIGHTING FIXTURES: (ADDITIONAL) .10 ELECTRICIAN,
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS
ww"
Re.DI STA.COOK CITY TEL.NO.
DISHWASH. AUTO.-WASH. STAT �+
✓� LICENSE NO.
SPACE HTRS. .APP_.(yy:H.P.M .50
MOTORS: OVER NOT OVER H.P. (DISTRICT.NO. G UZ NE P ESSED BY
0 1 1.00
I a 1.50 INSPECTIO R C RD
S. 62.00 D-
O
8 1s 2.50 } U.
Is' .. so 3.00 ti Q
.50 100 5.00 i G
SIGNS: NO.TRANS.
NO.LAMPS Z
1
SERVICE 0-600V.Nar OVER 200A. 1.00
SERVICE 0.600V-OVER 200 A. 12.60
SERVICE OVER 6001/. 5.00
MISC.
I,
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 .
TOTAL FEE $
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APP I ION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS-*REGULATING -
ELECTRICAL WIRING. WIRING
1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY IAS 6ELES COUNTY AND STATE OF FIXTURES .Et"
CALIFORNIA OR THATI AM FM LEGAL ER HE AB E
DESCRIBED RESIDENT PR RTY. BOWER
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTE (FINAL
25W7
VALIDATION AMUR C. VEIT
CK MO CASH 0 SYERVISING ELECTRICAL ENGINEER
1.�Lal 9 A O� JUL 2.3 2 D 1 2.9 C?� oll
p\ -�o bRKERS'COMPE��JSAT.IONr7ECLARATION CE-806G '°'81 APPLICATION FOR ELECTRICAL PERMIT .
I hereby affirm that.1 have a certificate of consent to self insure,
or a certificate of Workers' Compensation.Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
,copy thereof(Sec.3800,1-ab.C.)
Policy.No. Company FOR APPLICANT TO FILL IN JOB W.
aA
Certified copy is hereby furnished. EACH NO. FEE ADDRESS s T ip AA r. C i
New Residential Bldgs.&Pools LOCALITY
Certified copy is filed with the county building $ — $
'❑.., g inspection 1 &2-Family,Sq:Ft.
department. Multi-family Sq.Ft. NEAREST �y�
CROSS ST. i-Y'� C'�aI
Date Applicant Residential Swimrriin9 Pools OWNER OR
• FIRM NAME.
-CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec
MAIL
Light_Sw.— '
COMPENSATION INSURANCE ADDRESS �� IF_ � . dC '
(This.section need not be completed if the work Involved by the First 20 (1
permit is for one hundred dollars($100)or less.) Total No. Additional CITYpOle
`: Tel.Nos 7 "�y
I certify that in'the performance.of the work for which this permit ALAV��K
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
• z Additional
.—.11— �g' L C' Total No. CITY Tel.No.
Date" Applicant e J�(n�3 �+��. Fixed Appliances Not Over 1 HP •
NOTICE TO APPLICANT: If, after making this Certificate of PERMIT
Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. APPLICANT .s eC, 1 t cr
provisions of the Labor Code,you must forthwith comply with such Oven - Dryer_ W.M._ ADDRESS.
provisions or this permit shall be deemed revoked. Top FAU _ W.H.
,LICENSED CONTRACTORS DECLARATION' Hood.— Fan Other_ CIN Q /Ip 1.. Tel.No&:S' V(
I hereby affirm that I.am licensed under provisions of Chapter 9 LICENSE OR td r /I w
Disp. — Room.Air Coad. REG.NUMBER Cl- ��
"(commencing.with Section 7000)of Division 3.of the Business and
Professions Code;and my license isin full force and effect. DISTRICT NO./ PR CESS
E BY'
Power Apparatus&Large Appliances
Size&Type HP,KW,KVA,or KVAR Q
License Number ,` ` Lic.Class Up to 1 incl. FINAL, `'
�ahJ 6�•ecf/= C /� 17—f, Over 1 to 10 Incl. DATEVALIDATION -0
Contractor Date p Over,10,to 50 Incl.
FINA
El I am exempt under Sec. Over 50 to 100 Inc. gY W
B.&P.C.for-this reason Over}0
Date:
Services_Swbd.,MC C•&-Panelboar da Z
0.r 200 Amp.Under 600 V ,
Signature 201 1000 Amp.Under 600 V '
❑ Over 1000 Amp.or Over 600 V
Exemption.for Reg.Maint.Elect.
SINGLE FAMILY Temp.Power Pole&Appurtenances 2
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm.that I am exempt from the Contractor's License Law ACCT
A?the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits 19441 o V
Code): 3307 B,5I
El1,:as owner of the property,will do the work and the structure Misc.Conduits&Conductor ,
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee s 1 ITES
Schedule) _
and Professions Code). ► TOTAL 25.50
CONSTRUCTION LENDING AGENCY CHECK 25.50
1 hereby affirm that there is a construction lending agency for the
f
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) n
Civ.C.). '
PLAN CHECKING FEE
Lender's Name QItD�QIIi b�1 /3�
•PERMIT ISSUING FEE • a
Lender's Address s � O 3914 1 AH111373
I certify that I have read this application and state that the above TOTAL FEE C]r
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
erty for inspecti n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Sig ture of Permittee Date