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Home My Public Portal About5612 MCCULLOCH AVE_Electrical__ -c r SA663-CES06 5-62 APPLICATION FOR UCTRIC L PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING �- BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN I CROSS ST. RECEPT: TOTAL NO. EACH FEE LIGHT OUTLETS FIRST 20 $20 >$ OWNER �D AOO'L d ADDRESS SWITCH./ OVER 20 .10 fc TOTAL O CITY TEL.NO. LIGHTING F1asT 20 .20 FIXTURES AOD'LIp ELECTRICIAN OV R 20 RANGES CLO.DRYERS WTR.HTRB. 11.00 ADDRESS / RB.DISP. BTA.COOK CITY TEL NO. DISHWASH. AUTO.-WASH. STATE / .. D SPACE HTRB. .(+/aH.P.MAX. l"P .50 LICENSE NO. MOTORS( OVER NOTOVER H.P. DISTRICT NO. GROUP ZONE P ESSED BY O 1 1.00 7 s ISO - INSPECTION RECORD .2 12,00 B is "0 a IB 50 . s.00 OV BO i00 5.00 O 81GN6+ NO.TRANS. V NO.LAMPS W D. SERVICE O.SOOV.NOT OVER 200A 1.00 N Z SERVICE O.SOOV.OVER 200 A. 2.00 SERVICE OVER 600V 5.00 MISC. PERMIT ISSUING FEE 2.00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE 1 HEREBY ACKNOWLEDGE THAT 1 14AVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY CONDUIT n � WITH ALL•COUNTY ORDINANCES AND STATE LAWS REGULATING _ ELECTRICAL WIRING. WIRING �f'` fslTN. a►.n-" �(�/ 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR V r LICENSED A8 REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES _ Z91 I.' i•d4"C/f %l CALIFORNIA OR THAT 1 AM THE WAL OWNER OF 7HE ABCV f DESCRIBED RESIDENTI7ElFp0., POWER SIGNATUREUTILITY CO.NOTIFIED OF PERMITTEE r FINAL 4 /'b (DATION ARTHUR C. VEIT ' CK MO CASH SUPERVISING ELECTRICAL ENGINEER LAU0 8 7 3 4 DEC 21 2 D 13.60- • ` WORKERS'COMPENSATION DECLARATION 20AUI9DPW 3/87 60 APPLICATION FOR' ELECTRICAL PERMIT O I hereby offir�lhat I have a certificate of consent to self C�g insure,,pr a certificate of Workers'Compensation��7_ , COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a cern. c9p thereof(Sec. 3800 Policy No. ��r Company FOR APPLICANT TO FILL IN JOB ❑Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS J rP (;'Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ _ $ LOCALITY � lion department. Multi-family Sq. Ft. NEAREST Date Applicant Residential Swimming Pools CROSS ST. OWNER OR, FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE ADDRESS ]l - thhis section need not be completed If the work lnvolved b First 20 CITY Tel. No. ,y W�379 e permit is for one hundred dollars($100)or less.) Y Total No. Additional lPs� PLAN 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 become subject to the Workers Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional Total No. CITY Tel. No. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range— Heater—D.W. APPLICATION 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 J—W.H. — deemed revoked. Hood — Fan —Other— CITY Tel. No. ��Z� LICENSED CONTRACTORS DECLARATION LICENSE I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. — REG. NUMBER `F-9-- 74P Class. ►Z-0 (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PROCESSED d and Professions Code,and my license is in full force and effect. ��`_''��a Size&Type HP, KW, KVA, or KVAR (� O License Numbe 70 Lic. Classes Up to 1 Incl. FINAL U Over 1 to 10 Incl. DATE �� /�� VALIDATION 0 Contractor Date O Over 10 to 50 Incl. FI ❑ I am exempt under Sec. Over 50 to 100 Inc. U B.&P.C. for this reason Over 100 21 d U) Services, Swbd.,MCC&Ponelboards Z Date: 0-200 Amp. Under 600 V — Signature 201 - 1000 Amp. Under 600 V A201 01.9A ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V #•o o o,o 0 2 SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ° -21. 00 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits o 6 02 1. 0 0 c=., Professions Code): ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors ( 0,27-88 structure is not intended or offered for sale(Section 7044, Other(See Complete Fee Schedule)_ , 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 0 Is-0 Lender's Address 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 eby a thori a presentatives of this County to enter upon the b e men i�properttion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE D- 16&b i oture o ermittee Date ®s .k , I W04 kEthat I have cerci DECLARATION 76A66CE-806 1081 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-806G insure, br Q certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof(Sec. 3800, Lab. C.) a cy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ❑ 1 8 2-Family, S Ft. $ _ $ LOCALITY Certified copy is filed with the county building inspec- y q NEAREST tion department. Multi-family Sq. Ft. CROSS ST. Residential Swimming Pools O MNER OR Date Applicant FIRNAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec�Light Sw._ MAIL COMPENSATION INSURANCE 20 ADDRESS (This section need not be completed if the work involved by First the permit is for one hundred dollars(:100)or less.) Total No. Additional CITY Tel. NI �p PLAN 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 become subject to the Workers Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional CITY It Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of AP Exemption, you should become subject to the Workers' Range— Heater_D.W. 1 pl 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. — deemed revoked. CITY Tel. ._ O Hood — Fan Other— po LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. REG.NUMBER b Class. (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCESS D X' and Professions Code,and my license is in full force and effect. Power Apparatus 8 Large Appliances 5 't 0. _! Size 8 Type HP, KW, KVA, or KVAR (j License Nu ber 1,4,4�7 c. Class C—rdFINAL 1J Up to 1 Incl. /� 3 641?S Over 1 to 10 Incl. DATE /L 3/ VALI ION Contra ateOver 10 to 50 Incl. ❑ FINAL � I.am exempt under Sec. Over 50 to 100 Inc. BY 8d Over 100 ?L N � 1 B.BP.C. for this reason � Services, Swbd., MCC 8 Panelboards p Date' 0 -200 Amp. Under 600 V r Signature 201 - 1000 Amp. Under 600 V 2$ 0 0 A 0 0 0 0 0 2 ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V � ° ° 3$,2 5 SINGLE FAMILY Temp. Power Pole 8 Appurtenances ° ° ° 3 Et2 5 c=i HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit O 8.2 9_8 5 I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and Professions Code): ❑ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY :4- Ihereby affirm that there is a construction lending agency for 7 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 /O PERMIT ISSUING FEE Lender's Address 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 and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon kthe abo �edoperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE i;ig�natur�e of Permittee Date