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HomeMy Public PortalAbout5357 MCCULLOCH AVE_Electrical__ 7IiA683,C- csleoeB,2/:p APPLICATION FOR ELECTRICAL PERMIT A.. BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN JOB Fill New Residential Bldgs.&Pools EACH NO. CJ FEE ADDRESS93 Q r✓ � A&C. 1 &2 Finally Sq. Ft. $ — $ LOCALITY M r Multi-family Sq. Ft. — NEAREST Residential Swimming Pools CROSS ST. P RM NAME Ye �✓% Outlets: Light,Switch&Receptacle -0 d MAIL �//O` First 20 `�� ADDRESS E3 n Additibnal CITY !e W" /(a Ci Tel. NO. PLAN CHECK Lighting FixturesAPPLICANT First 20 - 57 b z_ ADDRESS Additional CITY Tel, No.PER pp Fixed Appliances Not Over 1 HP APPLIC NTO C,- Gee w/ Range_ Heater_ D.W. OADDRESS �c✓f'/OG Oven _ Dryer _ W.M. � ✓� Top — FAU _ W.H. — CITY7-e Tel.No.ly q2.9A/4�{ Hood Fan LICENSE OR d Disp. A.C. .5 V REG.NUMBER Class. p V 1 HEREBY ACKNOWLEDGE THAT 1'HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY .0 Power Apparatus&Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. Size&Type.HP, KW,KVA,or KVAR LU Up.to 1 Incl. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR Over 1 to 10 Incl. LICENSED AS REQUIRED BY LOS NGBLE9 O,UNTY AND STATE OF CALIFORNIA OR THAT. 1 AM LEGA OWNER OF THE ABOVE Over 10 to 50 Incl. DESCRIBED RESIDENTIAL PR RTY. Over 50 to 100 Incl. PERMITEE Over 100 SIGNATURE DISTRIC > OCES BY Services •0-200 Amp. Under 600 V 201 -1000 Am,p.Under 600 VAPPROVALS TE INSPECTOR'S 'Over 1000 Amp,or-Over 600 V' SIGNATURE TEMP.POWER POLE Temp.Power Pole&Appurtenances UNDERSLAB WORK Sign with One Branch Circuit ROUGH CONDUIT Additional Sign Branch Circuits (Other) WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (Sub-Total) UTILITY CO.NOTIFIED PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL PERMIT ISSUING FEE NOTES ' TOTAL FEE /II . -0 PLAN CHECK VALIDATION CK. M.O. (�CASH `' E IIA T VALIDATION CK: M.O. CASH 4 2 7 FSB 2D 1 0.5 0 ago 7GA889-CE908 9-88 APPLICATION FOR ELtCTRICAf PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING ,C' �o BUILDING AND SAFETY DIVISION ADDRESS a J JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. RECEPT. TOTAL NO. I EACH Fee 1 OUTLETS FIRST 20 8.20 S OWNER LIGHT Jt MAIL SWITCHAOD'L 10 ADDRESS OVER 20 TOTAL FIRST 20 .20 CITY TEL.NO. LIGHTING FIXTURES FIXTURES ADD'L 10 CONTRACTOR _ OVER 20 RANGES RYE WTR.HTRS. 1.00 OIU' ADDRESS Q ..Qil2 GARB.DIBP. STA.COOK oor CITY o.�,�j- TEL.N DISHWASH. AUTO.-WASH. STATE SPACE HTRS. BTA. ADPL. ,gp LICENSE NO. MOTORSI OVER NOT OVER H.P. DIS'TRIc IG77PI Z D O 1 1.00 / Q ��, 1 a 1.50 INSPECTION R CORD s s 2.00 8 15 2.50 1 s so 3.00 d 50 100 5.00. 0 SIGNS, NO.TRANS. NO.LAMPS O ri SERVICE O-SOOV-NoT OVER 200A ! 1:00 go d SERVICE O-SOOV-OVER 200 A. 2.00 U) SERVICE OVER SOOV 5.00 OTHER (SEE COMPLETE FEE SCHEDULE) PERMIT ISSUING FEE 2.00 041 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 APPROVALS DATE INSPECTOR'S SIGNATURE TOTAL FEE 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION UNDERSLAB WORK AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY ROUGH CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES - CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO POWER RESIDE IN,THE ABOVE DESC ED E ENTIAL PROPERTY. SIGNATURE UTILITY CO.NOTIFIED ✓� OF PERMITTEE 4s FINAL ( LK MO CASH ION JOSEPH C. ROOHAN SUPERVISING ELECTRICAL ENGINEER CK MO 863 ?iZ HU 19 2 B 5.00- 140 WORKERS'COMPENSATIONDECLARATION i CE-806G (2-801 APPLICATION FOR ELECTRICAL PERMIT � CE-806 I hereby affirm that I have a certificate. of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure;'or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3806,Lab.C.) I. FOR APPLICANT TO FILL IN cc /�/� /' Policy No. 'Company JOB ADDRESSDS'? M �Vv• /,v 44 T• New Residential Bldgs.&Pools EACH NO. FEE Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ 1I LOCALITY y is filed with the count building inspection -CROSS Sq. Ft. — NEAREST Certified copy y gins actionResidential Swimming Pools i CROSS ST to department. FIRM NAME Ot irVil Date - Applicant Outlets: Rec.—Light Sw. ADDR First 20 ESS M c 6/ OCA CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY 'reel No. COMPENSATION INSURANCE PLAN CHECK Ci _ © ®L o}. APPLICANT `- O (This section need not be completed if the work involved Lighting Fixtures First 20 Q by the permit is for one hundred dollars ($100) or less.) ADDRESS Total No. Additional W I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. H permit is issued,'I shall not employ any person in any mannerPERMIT a so as to become subject to the.Workers'Compensation Laws. Range_HeaterD.W.._ APP.LICANT Oven _- Dryer_W.M._ ADDRESS to Date Applicant Top _ FAU _W.H.•_ Z Hood _ Fan _Other._ - CITY Tel NOTICE TO APPLICANT: If, after making this Certificate of Disp. _Room.Air Cond-_ ILICENSE 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. DISTRICT y -� _/ PCE 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. • * FINAL Incl. Over 1 to 10 . DATE / LICENSED CONTRACTORS DECLARATION ( ��� VALIDATION OJer 10 to 5b Incl. I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL ; BY. 9 (commencing with Section 7000)of Division 3 of the Busi- Over 100 ness and Professions.Code, and my license is in full force and _ effect. Services License Number Lic.Class 0-200 Amp.Under 600 V 201-1000 Amp:Under 600 V Contractor Date Over 1000 Amp.or Over 600 V ' HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances I hereb affirm that Iain exempt from the Contractor's Sign with One Branch Circuit Additional Sign Branch Circuits Lfcens Law for the•following reason (Section 7031.5, Busi- I ness d Professions Code): Misc.Conduits&Conductors s 2 4 9.2 A •I, 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 # 0'0 0 0 0 2 7044,Business and Professions Code). CONSTRUCTIONLENDING AGENCY •/ 2 0'c 2 3 5 O I hereby affirm that there is a construction lendingagency for the performance-of the work for which this permit is E / 6 0 o 2' 5 Q PER FE (Sub-Total) u issued(Sec.309'1,civ:C.). ' '- Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) ► 2.3 1 Lender's/Address PERMIT ISSUING FEE " 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 an tate laws regulating Electrical wiring, and hereby sutho ere entatives of this County to enter upon . , theabove- tion roperty for inspection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE tla#t�r� Permittee Date v � .