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Home My Public Portal About5526 MCCULLOCH AVE_Electrical__ D r 7BA663_C6994 10/74 APPLICATION FO EL`ECTRI AL PERMIT � COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER �DDRESS rdi BUILDING AND SAFETY DIVISION J LOCALI TY NEAREST FOR APPLICANT TO FILL IN CROSS ST. OUTLETS NO. EACH I FEE OWNER OR rl FIRM NAME RECEPT._ S S MAIL LIGHT TOTAL FIRST 20 ZB 1 ADDR S CITYTEL. N0. SWITCH OVER 20 .10 I PLA CHEC Al" LIGHTINGTOTAL .f0FIRST 20 .25 APPLICA FIXTURES NT OVER 20 ADDRESS RESIDENTIAL APPLIANCES CITY TEL. NO. PERMIT RANGE DRYER_WTR. HTR. APPLICANT STA. COOK DISP. F.A.U. ADDRESS SPACE HTR. AIR COND. CITY TEL. NO. CLOTHES WASH. DISHWASH. REGNUMBER V CLASS. FAN OTHER 1.00 ' 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. SIZE & TYPE OVER TO I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR 0 — 1 1.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAI' I AM THE LEGAL OWNER OF THE ABOVE 1 — 10 9.00 DESCRIBEEBID TIAL PR TY. p V 10 — 50 8.00 tPERMITE�EO50 — 100 10.00CT NO. ED BY100 — 500 15.00 8SIGN, GAS SIGN AND ONE CIRCUIT 5.00 PPROVALS ✓ DATE INePECTOR'991GNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 140 TEMP. POWER POLE ERVI CENOT OVER 600 VOLTS OR 200 AMP 5.00 D UNDERSLAS WORK SERVICEOVER600VOLTSOR200AMP 10.00 ROUGH CONDUIT F� TEMPSERVICE,POLE,&APPURTENANCES 5.00 WIRING TEMP LIGHT OR RECEPT. SYSTEM 8.00 FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED FINAL PERMIT FEE (SUB TOTAL) 1 NOTES. PLAN CHECK FEE PERMIT ISSUING FEE 8.00 S 1TOTAL FEE C5 PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.D. eAsn 0 2 0 1RnrT 7 2 D 9.0 0 °-Jd SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE SATION DECLARATION 764663 10/81 ti� �Areb irrrb 1 of I have 6 certificate of consent to self CE-806G 'APPLICATION FOR ELECTRICAL PERMIT sure, b certificate.of Workelsr CompensothOldnsurance, CQU[NTY OF LOS ANGELES BUILDING AND SAFETY -or a certi ied copy thereof(Sec. 3800, Lob. C.) Policy No. Company FOR APPLICANT TO FILL IN. JOB . Certified copy is hereby furnished. 1' New Residential Bldgs. 8,Pools EACH NO. FEE ADDRESS J 1 &2-Family, S Ft. $ = $ LOCALITY Certified copy is filed with the county building 'nspec- y� q• Tion department. Multi-family Sq. Ft. NEAREST / Da Residential Swimming Pools ; CROSS$ / , 1 "OWN O Applicantf FIRM NAME G CERTIFICATE OF'EXE.MPTION FROM WORKERS' Outlets: Rec LightSw MAIL �/� COMPENSATION INSURANCE ADDRES- 70 O I�-� f� ' First 20 (This section need not be completed if the work involved by Total No. Additional CI' �'� Tel. No the permit is for one hundred dollars($100)or less.) R 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 eco, a subject to the Workers'Compensate Laws. Lighting Fixtures First ti ADDRESS Total No. Additional CITY Tel. Dat Applican �� Fixed Appliances Not Over 1 HP PERMIT NO CE TO APPLICANT: If, after making this Certificate of APPLICANT E mption, you should become -subject to the Workers' Range_ Heater—DWAPPLICANT — Compensation provisions of the Labor Code, you must forth- Oven —Dryer —W.M.— ADDRESS with comply with such provisions or this permit shall be Top _ FAU —W.H. — CITY Tel. rVo. deemed revoked. Hood _ Fan _Other— LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am•licensed under provisions of Chapter 9 Disp. Room Air Cond. REG. NUMBER Class. (commencing with Section 7000)of Division 3 of the Business DISTRICT NO. PROCE E BY and Professions Code,and my.license is in full force and effect. Power Apparatus&Large Appliances Size&Type HP,,KVO, KVA, or KVAR' �f (� O License Number Lic. Class Up to 1 Incl. FINAL Over 1 to 10 Incl, DATE VA DATION Contractor Date Over 10 to 50 Incl. I.- FIN n. U ❑. I am,exempt under Sec. Over 50 to 100 Inc. BY B.&P.C. for this reason Over 100 44 Date: Services, Swbd.,,MCC&Panelboards 27611,2A 0 -200 Amp. Under 600 V Signature 201 -1000 Amp. Under 600 V # 0 0 0 0 0 2 Over 1000 Amp. or Over 600 V Exemption for Reg. Maine. Elect. 1 'o o 1200 SINGLE FAMILY Temp. Power Pole&Appurtenances o 0 0 2 Q Q cy. HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I-am exempt from the Contractor's License n Branch.Circuits Low for the following reason. (Section 7031.5, Business and' Additional Sig08,11 8 7 _Professions Code): ® I, as owner of the property, will do the work and the Misc. Conduits&Conductors structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)- 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm.that there is a construction lending agency for the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). - PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address r /t I certify that.I have read this application and state that the TOTAL FEE f/ 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 abo entione ppferty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sig. tur of ermittee d ' aWORKFR$'COMPENSATION DECLARATION CE-806G '°'S1 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate offonaemt•ia self insure, or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab.C.) Policy No. Company I FOR APPLICANT TO FILL IN JOB FEE ADDRESS L eL Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. LOCALIT 1 &2-Family,Sq.Ft. $ _ $ !Z8d44&�Ckt 44 Certified copy is filed with the county building inspection NEAREST � department. Multi-family Sq.Ft: Residential Swimming Pools CROSS ST. �Y Date Applicant OWNER OR J1 FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL First 2 COMPENSATION INSURANCE Outlets:Rec—Light— t 20 w.— ADDRESS ,� 0 (This section need not be completed if the work involved by the CITY � Tel.No. gy permit is for one hundred dollars($100)or less.) Total No. Additional PLAN I certify that in the performance of the work for which this permit APPLICANT 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. Additional CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If; after making this Certificate Of APPLICANT s 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._ ADDRES �� . r- provisions or this permit shall be deemed revoked. Top — FAU _ W.H. Tel. LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ CITY No. I hereby affirm that I am licensed. under provisions of i Chapter gLICE (commencing with Section 7000,)of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER / Gass. Professions Code,and my license.is in full force and effect. DISTRICT.NO. / PROCESS BY Power Apparatus&Large Appliances Size&Type HP,KW,KVA,or KVAR pvv License Number Lic,ClassUp to 1 Incl. FINAL U Over 1 to 10 Incl. DATE / a. Contractor Date ` JLIDATION Over 10 to 50 Incl. FI I--- I am exempt under Sec. Over 50 to 100 Inc. V Over 100 OU! B.&P.C,for this reason9819, U) Date: Services,Swbd. MCC&Panelboards b 1 A 0-200 Amp.Under 600 V # 0 0 0 0 02 Signature 201 - 1000 Amp.Under 600 V I o - 2550 ❑ Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. 0 0 0 2 5 d U SINGLE FAMILY Temp.Power Pole&Appurtenances . HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 1 Q 2 6 s 8 7 1 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 CoKas owner of the property,will do the work and the structure Misc.Conduits&Conductors is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ ION. Professions Code). v 0 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3087, PERMIT FEE (Sub-Total) Civ.C.). PLAN CHECKING FEE o Lender's Name PERMIT ISSUING FEE 69 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_LhACounty to enter upon the above-mentioned pTpert r insp o purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ig to o rmittee Date