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Home My Public Portal About5534 MCCULLOCH AVE_Electrical__ 76A669 * �.'• DBS-SA 12-54 APPLICATION FOR ELECTRIC 'PERMIT ]; DIVISION OF BUILDING AND SAFETY Deportment of County Engineer County of Los Angeles c WM.J. FOX, COUNTY ILDING ENGINEER ADDRESS CASSATT D.GRIFFIN.SUPT OF BUILDING may FOR APPLICANT TO FILL IN • LOCALITY �2n / PERMIT FEES NEAREST CROSS ST. NUMBER EACH FEE LIGHT OUTLETS OWNER RECEPTACLES � MAIL �*� " ADDRESS r/ WALL SWITCHES TOTAL OUTLETS 5@ $ CITY TEL.NO. ELEC. RANGES 25 ELECTRICIAN ELEC. HEATERS 25 ADDRESS �,�'LJ !". KW EA CITY __ _ L�L,d TEL. NO.L(rli.JIF FIXTURES S !� - LICENSE NO. - NUMBER OF LIGHT CIRCUITS DISTRICTNO. I GROUP IZ0 I READY FOR INSPECTION NUMBER OF RECEPTACLE CIRCUITS -� +•, MOTORS NUMBER HORSEPOWER FEE ;. �, INSPECTION RECORD NEW MVD. HP OVER INC. EACH &LESS $ .25 2 5 1.00 5 15 1.50#1 Y7 , 15 50 2.50 - - 50 200 5.00 M ISC. NO. SIGNS NO.TRANS. NO.SIGNS NO. LAMPS FOR EACH PERMIT: WIRING $1.00 FIXTURES $1.00 SUPPLEMENTARY .50 APPROVALS TOTAL FEE $ a o DATE INSPECTOR'S SIGNATURE I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION' CONDUIT r AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING V-17 -5s- ELECTRICAL WIRING. 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF POWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. -UTILITY CO.NOTIFIED SIGNATURE OF PERMITTEE FINAL WILLIAM J.FOX.COUNTY ENGINEER VALIrT.�O p o AUG 26 2 4.0 0 BY �/•" DEPUTY 'VbmRhat I have a certificate DECLARATION 76-808 ,D/a, APPLICATION FOR ELECTRICAL PERMIT I hereby affirm.that I have a certificate of consent to self insure, CE-808G ,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 FOR APPLICANT TO FILL IN JOB ❑ Certified copy is hereby furnished. � New Residential Bldgs.&Pools EACH NO. -FEE ADDRESS ❑ 1 &2-Family,Sq.Ft. $ — $ LOCALITY Certified copy is filed with the county building inspection department. Multi-family Sq.Ft. — NEAREST =. Residential Swimming Pools CROSS ST Date Applicant OWNER OR a. FIRM NAME Z S r CERTIFICATE.OF EXEMPTION FROM WORKERS' MAIL Outlets:Rao—Light— t 20 COMPENSATION INSURANCE I" ADD SS 7'�O (This section need not be completed if the work involved by the First 20 permit Is for one hundred dollars($100)or less.). Total No. Additional GIT Tel.No. I certify that in the performance of the work for which this permit PLN CK is issued, I shall not employ any person in any manner so as to APPLICANT become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional Total No. CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT rr 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"*T provisions or this permit shall be deemed revoked. ITop FAU _ W.H. LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ CITY I.No. I hereby affirm that I am licensed under provisions of Chapter 9 LIC S Disp. — Room Air Cond. RE .NUMBER Class. (commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. r9 pp DISTRICT NO. PROCE16r Power Apparatus&La e Appliances Size&Type HP,KW,KVA,or KVAR License Number Lic.Class. Up to 1 Incl. FINAL i7 Over 1 to 10 Incl. DATE f _ VALIDATION Q Contractor Date. Over'10,to 50 Incl. FIN 0 ❑ I am exempt under Sec: Over 50 to 100 Inc. , ;2 81 9.2 A OW. B.&P.C.for this reason I Over 100 i Services,Swbd.,MCC&,Panelboards ' , /� # 0 0 0 0 02 Z Date: 0-200 Amp..Under 600 V f/ Signature ' 201 - 1000 Amp.Under 600 V I o o 2 S 5 0 Over 1000 Amp.or Over 600 V ❑ Exemption for Reg.Maint.Elect. o o o 2 5 5 0 C5 SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 0.26 -87 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 pCode): LJ I,as 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 F Schedule) and Professions Code). j 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.3097, PERMIT FEE (Sub Total) Civ.C.). + PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE 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 ria for�purposes. I �O SEE REVERSE FOR EXPLANATORY LANGUAGE v: Date I /]