HomeMy Public PortalAbout5608 MCCULLOCH AVE_Electrical__ !A66S-CESO6 5-62 APPLICATION FOR E. ECTRICAL P RMIT�' og'
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN,-SUP'T OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
REcEPT.a7,1 TOTAL NO. EACH FEE
OUTLETS FIRST 20 0 S.20 III OWNER
LIGHT MAIL
ADD'L .10 ADDRESS
TOTAL
SWITCH. AL OVER 20
err CITY TEL.NO.
LIGHTING F1asr20 .20
FIXTURES ADD'L .10 ELECTRICIAN
OVER 20
RANGES CLO.DRYERS WTR.HTR8. 1.00 I ADDRESS /� �j�
G D
STIL eoox CITY TEL.NO.
DIBHWASH. AUTO.-WASH. STATE
SPACE HTR8. A.APP. H.P.MAX. .50 LICENSE NO. d
MOTORS, OVER NOT OVER H.P. DISTRICT NO. GROUP ZONE PESSED BY
0 1 1.00 d _ &--I
1 s 1.50 INSPECTION RECORD
9 B 2.00 i
8 1s 2.50
15 50 5.00
50 100 5.00 De
O
SIGNS, NO.TRANS• V
NO.LAMPS
IL
W
SERVICE O-SOOV-NOT OVER 200A 1.00 N
Z
SERVICE O-BOOV-OVER 200 A. 2.00
SERVICE OVER SOOV 5.00
MISC.
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE 8
EREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'SSIGNATURE
ANDHSTATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL'COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR /lg r ,T •')
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES � R C . . ''�'=`•.'—f�'i .
CALIFORNIA OR THAT I A THE GAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL E POWER /� .�•1
SIGNATURE UTILITY CO.NOTIFIED 4 lv A
OF PERMITTER --
FINAL
IDATION ARTHUR C. VEIT
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
LALOs733\'D-' DEC 21 2 0 13.60N
o7v/�-
WORKER S'COMPENSATION DECLARATION 78A883
iCE•808G (2.80) APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BU NG AND SAFETY
insure,or a certificate of Workers'Compensation Insurance,o; X2. Za
a certified copy thereof(Sec.3800,Lab..C.)
Policy No.
FOR APPLICANT TO FILL IN J Q
Compan New Residential Bldgs.&Pools EACH NO. FEE A DRESS _
0 Card ' d_-aCis hereby furnished. 1 &2-Family,Sq.Ft. $ — $ LOCALITY ,t
Multi-family Sq. Ft. — NEAR ST
Cer ie copy'A filed with building inspection CROSS ST
d !nt. Residential Swimming Pools
OWNER OR
FIRM NAMEelz
Dat cant Outlets: Rec.—Light Sw. MAIL
First 20 ADDRESS
C RTIFICATE OF EXEMPTION FROM WORKERS' Total No.. AdditionalCITY Tel N.,3��Co- '
COMPENS'ATION.INSURANCE }
PLAN CHECK IL
APPLICANT Q
(This section need not be completed .if the work involved ' V
by the permit is for. one hundred dollLighting Fixtures First 20
ars ($100). or less.) ADDRESS '
Total No. -Additional O
I certify that in the performance of the work for which this CITY Tel No. 0
permit is issued, I shall not employ any person ln'any manner Fixed.Appliances Not Over 1 HP
PERMIT tL
so as to become subject to the Workers'Compensation Laws: Range_Heater D.W._ APPLICANT d
Oven _ Dryer_W.M._ ADDRESS Z
Date Applicant, Top- — FAU' _W.H.
Hood'_ Fan _Other CITY 44el No.
NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond— LICENSE OR
Exemption, you should- become subject to the Workers' REG.NUMBER �e� assC./+
Compensation provisions of the.Labor Code,you must forth- Power Apparatus&Large Appliances DISTRICT NO. PROLE ED B)�
with comply with such provisions or this permit shall be
deemed revoked. I Siie&Type HP,.KW,KVA,or KVAR 9;
Up to 1 Incl. )
• FINAL
Over 1 to 10 Inc]. DATE p�-
LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. /r ef® VALIDATION
I
I hereby affirm that I am licensed under provisions of Chapter. Over 50 to 100 Inc. FINAL
9 (commencing with Section 7000)of Division 3 of the:Busi- Over 100 BY
ness and Professions.Code,and my license is in full force and
effect. Services -
License mber �Li .Cl - 0-200 Amp.Under 600 V �„Z2-
201-1000
—
201-1000 Amp.Under 600 V
a Over 1000 Amp.or Over 600 V
HOME OWNER-BUILDER D ARATION Temp.Power Pole&Appurtenances
I hereby affirm that I am exempt from the Contractor's , Sign with.One Branch'Circuit ,
License Law for the following reason (Section 7031..5, Busi- ) Additional Sign Branch Circuits
ness and Professions Code): r.
Misc.Conduits&Conductors E C 8$ 1 A
OI, as owner of the property, will do the work and theI Other(See Complete Fee Schedule)—
structure is not intended or offered fdr sale (Section ± 0 0 0'0 0 r
7044,Business and Professions Code?. i
CONSTRUCTION LENDING AGENCY I '� --t-0 - 24, 50-1
I
24, 5O•'-
I hereby affirm that there is a construction lending agency I
for the performance of the work for which this permit is I PERMIT FEE (Sub-Total) o 0 0,2(l,5 C 5
issued(Sec.3097,Civ.C.).
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) 0 ,F2[l'_P 1
Lender's Address PERMIT ISSUING FEE 700
I
I certify that I have read this:application and state that the TOTAL FEE e
above info i is.correct.I agree to comply with all County
prdi ces and Sta� aws regulating Ele rical wiring, a
he. y authorize represe tives of this unty to enter on
e tinned grope y for' on pur es. SEE'REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date