HomeMy Public PortalAbout5917 MUSCATEL AVE_Electrical__ 76AS63-CESOG 12/75 APPLICAT10FOR ECTRI9CAL PERM
.r COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER JOB �� �l
BUILDING AND SAFETY DIVISION ADDRESS
F P F IN LOCALITY
New Residential Bldgs& Pools EACH NO. FEE NEAREST I '
1 & 2-Family,Sq. Ft. $ .025 — $ CROSS ST. 14AX MN41.s
Multi-familyS Ft. 02 — OWNER OR
q FIRM NAME ,d
Residential Swimming Pools 20.00 a� ADDRESS O&C f/ 6
Outlets: Light,Switch& ReceptacleCITY Tel.No.2 8g 9 Z
First 20 •50 PLAN CHECK
Additional .30 APPLICANT
ADDRESS
Lighting Fixtures �~
First 20 .50 CITY Tel.No.
Additional .30PERMIT
APPLICANT _VC,
Fixed Appliances Not Over 1 HP ADDRESS 6'
_Heater D.W.
Oven_Dryer_W.M.�_ CITY � v! Tel.No.�' $ ,��-/
OvenLICENSE OR [r
Top_ FAU _W.H. '56 REG.NUMBER - Class. 6_10
Hood_ Fan i__ Q
2.00 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
Djg
P_A•C• J AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
Power A ELECTRICAL WIRING.
Apparatus& Age Appliances / -Yy
Size&T�Pe HP,", KVA,or KVAR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF 'e
Up to 1 Incl. 2.00 / CALIFORNIA OR THAI I A THE LEGAL OWNER OF THE ABOVE
5.00 DESCR IDED RESIDENTIAL R RT Y.
Over 1 to 10 Incl. `
Over 10 to 50 Incl. 10.00 PERMITEE
20.00 SIGNATURE
Over 50 to 100 1 ncl.
Over 100 30.00 DISTRICT NO. P ED BY
Services ® C✓ U
0- 200 Amp. Under 600 V 12.50 INSPEC R 0.
r 201.1000 Amp. Under 600 V 25.00 APPROVALS, DATE SIGNATURE IA
Over 1000 Amp. or Over 600 V 50.00 TEMP.POWER POLE
Temp. Power Pole&Appurtenances 10.00 UNDERSLAB WORK
Sign with One Branch Circuit 10.00 ROUGH CONDUIT
Additional Sign Branch Circuits 2.00 WIRING
(Other)
FIXTURES
POWER AUTHORIZED
UTILITY CO.NOTIFIED
FINAL `� �� �✓r"�=t
PERMIT FEE (Sub-Total) NOTES
PLAN CHECKING FEE (One-Fourth Permit Fee)
PERMIT ISSUING FEE $6.00
TOTAL FEE a O�
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. MO. CASH
8 D Oco-CEC l 0 2 0 2 3.0 0 a;,d
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE ^ '
RKERIS#
TION
WOrr#thatI have
a cera DECLARATION CE80�¢G 10/81 APPLICATION FOR ELECTRICAL PERMIT
I hereby,j�,ffirri?'that I have a certificate of consent to self
insure,�gfa cFertificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or'a►cifFfified copy thereof(Sec. 3800, Lab. C.) I
Policy No. Company I FOR APPLICANT TO FILL IN JOB
DR ESS f o
Certified copy is hereby furnished. Jffild AA
New Residential Bldgs. &Pools EACH NO. FEE
❑ LOCALI
Certified copy is filed with the county building inspec- I 1 8 2-Family, Sq. Ft. $ — $ r
AV
tion department. I Multi-family Sq. Ft. — NEAREST
Residential Swimming Pools CROSS ST.
Date Applicant OWNER OR
FIRM NAMEAf
CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL -
COMPENSATION INSURANCE I Outlets: RecL'ight Sw. gDDRES
tThis section need not be completed if the work involved b First ti 7! A
he permit Is for one hundred dollars($100)or less.) Y Total No. Additional CIT Tel. N ¢
PLAN CHECK
I certify that in the performance of the work for which this APPLICANT'
permit is issued, I hall not employ any person in any manner95
so as to becom ubj t to the Work s'Compensation Laws. Lighting Fixtures First 20 ADDRESS
Additional .v
Total No. CITY Tel. No.
Date / pelican Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO AP I T.: .if, aft making this Certificate of
Exemption, you should become subject to the Workers' Range_ Heater_D.W. _ APPLICANT
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. No.
LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other— ----
Disp. _ Room Air Cond. S LICENSE
I hereby affirm that I am licensed under provisions of Chapter 9 REG.NUMBER
(commencing with Section 7000)of Division 3 of the Business power Apparatus 8 Large Appliances DISTRICT NO.. PROC Y
and Professions Code,and my license is in full force and effect.
Size&Type HP, KW, KVA, or KVAR'
License Number Lic. Class Up to 1 Incl. -U6 FINAL Lle
Over 1 to 10 Incl. ?pD DATEO
Contractor Date VA TION_
❑ Over 10 to 50 Incl. FIN W
m
I aexempt under Sec. Over 50 to 100 Inc. B n,
B.&P.C. for this reason
Over 100 Z
ate: Services, Swbd., MCC&Ponelboards -226 1 2 3 A
0 -200 Amp. Under 600.V '� # o o o o o2
Signature £- 201 -1000 Amp. Under 600 V
❑ Over 1000 Amp. or Over 600 V
I o - 21,00
Exemption for Reg. Maint. lett. 0 0 o 2 1,0 0
SINGLE FAMILY Temp. Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 121 7 i`$6
-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&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 const r ction lending agency for
the performance of the work for hick this permit is issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE
Lenders Address el
I certify that I have read this application and state that the TOTAL FEE / O
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 above-mentioned property for inspection purposes. .i SEE REVERSE FOR EXPLANATORY LANGUAGE
I
Signature of Per_i e Date