HomeMy Public PortalAbout5947 MUSCATEL AVE_Electrical__ 78hA883-cEjS 9-69 APPLICATION FOR ELECTRICAL PRMIT l.J
T COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER ] Lr.7 ` n
BUILDING AND SAFETY DIVISION BUILDING " ' / fL
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. Yv Jam+
+ NO. AC FEE
RECEPI. S $ OWNER
LIGHT /� -WTAL FIRST 20 .20 L ADDRESS L
c
1")�7 OVER 20 .10 CITY
SWITCHLLL' -e—e TEL. NO.
LIGHTING TOT L FIRST 20 L • .20 iso-- �C3 CONTRACTOR at.f-,tP(,,..
FIXTURES , OVER 20 .10 ADDRESS RO, 1313
RANGE—DRYER—WTR.HTR.—
CITY �-�.✓11-9Z TEL.�NO.
STA.COOK_DISP.I F.A.U� LICENSE NO. �`
SPACE HTR. AIR COND. 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
CLOTHES WASH-w"'
` WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING.
FAN-OTHER 1.00 ( 4: �
/ '�'y 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED Y LOS ANGELES COUNTY AND STATE OF
MOTORS,TRANSFORMERS RATING CALIFORNIA OR THAT I A THE LEGAL O ER OF, AND INTEND TO
IND. HEATERS, ETC. HP. KW. KVA. RESIDE IN, THE AS E DESCRIBED SIDE NTIAL PROPERTY.
SIZE & TYPE OVER TO SIGNATURE ,• P �/.,t;}
0 - 1 1.00 OIF PERMITTEE O.
O
1 - 10 3.00 DISTRICT O. GROUP NE P CESSED Y V
10 - 50 5.00 z ' 0
50 - 100 10.00 NOTES: 1:d I!% .[P(� G.4,'B ►.0 rj
e
W
100 - 500 15.00 If �. c P� 'P '•3 :i�".� tt'..ii:^ I.`^i' y
SIGN,GAS Z
TUBE, OR SIGN AND ONE CIRCUIT 3.00
MARQUEE ADDITIONAL CIRCUITS 1.00
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 2 t V
SERVICE OVER 600 VOLTS OR 200 AMP 5.00
TEMP SERVICE, POLE, &APPURTENANCES 3.00
APPROVALS DATE INSPECTOR'S SIGNATURE
TEMP. POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
ISSUING FEE 2.00 � � WIRING
� ,
FIXTURES
SUPPLEMENTARY ISSUING FEE 1.00
POWER AUTHORIZED
PERMIT FEE UTILITYCO.NOTIFIED
PLAN CHECK FEE (50% PERMIT FEE) FINAL
TOTAL FEE JOSEPH C. ROOHAN
SUPERVISING ELECTRICALZNGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION M. CASH
y AC,5 2, 0.'.5992 JLN 3 ,: 2 •u 18.4 pN V
EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
WORKERS'COMPENSATION DECLARATION 78- 10/81 APPLICATION FOR ELECTRICAL PERMIT
'
I hereby affirm 6* I have a certificate of consent to self insure, CE-808806G
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. 3170D2 Company STATE COMP FOR APPLICANT TO FILL IN JOB
❑ Certified copy is hereby furnished. EACH NO. FEE ADDRESS 5947 Muscatel
New Residential Bldgs.•&Pools
Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft. $ _ $ LOCALITY San Gabriel, CA 91775
department. Multi-family Sq.Ft. NEAREST
CROSS ST.
Date Applicant Residential Swimming Pools OWNER OR
FIRM NAME MI & MIS Brown
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec—Light�-Sw.— MAIL
COMPENSATION INSURANCE ADDRESS same as above
(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 CITY Tel.No.
I certify that in the performance of the work for which this permit PLAN CHECK
APPLICANT
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
Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. APPLICANT Gibbs Bros.
provisions of the Labor Code,you must forthwith comply with such Oven — Dryer_ W.M._ ADDRESS 1751 N. Main St.
provisions or this permit shall be deemed revoked. Top — FAU _ W.H. _ CITY LA. CA Tel.No213)225-59 5
LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_
1 hereby affirm that I am licensed under provisions of Chapter 9. LICENSE OR C-10
(commencing with Section 7000)of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER 169324 Class.
Professions Code,and my license is in full force and effect. DISTRICT OCESSE BY
Power Apparatus&Large Appliances
Size&Type HP,KW„KVA,or KVAR I 0
License Number 169324 Lic.Class C–lU Up to 1 Incl. FINAL Viol V
�77��i Over 1 to 10 Incl. no
DATE rf–/ VALIDATION
Contrac , s Cate Over 10 to 50 Incl L/
FIN , '
❑ I am exempt under Sec. Over 50 to 100 Inc:
CE
BAP.C.for this reason Over 100
Services,Swbd.,MCC&Panelboards Z�
Date 0-200 Amp.Under 600 V
Signature 201 - 1000 Amp.Under 600 V
❑ Exemption for Reg.Maint.Elect. Over 1000 Amp.or Over 600 V
SINGLE FAMILY Temp.Power Pole&Appurtenances i
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuita
I hereby affirm that'I am exempt from the Contractor's License Law A%-.0 T o v
for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits
Code): ��j r 21.00
El 1,as owner of the property,will do the workMisc.Conduits&Conductors 1 ITEMS.and the structure Other(See Complete Fee Schedule)
is not intended or offered for sale (Section 7044, Business ��
polTOTAL2�], CPO
�
and Professions Code).
CHECK 21o00
CONSTRUCTION LENDING AGENCY CHANGE e)]0
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) 10. 50
Civ.C.).
PLAN CHECKING FEE, 00011-0001 10/16/V
Lender's Name -2*8 1 PM 7 g 2r
PERMIT ISSUING FEE
Lender's Address TOTAL FEE 21.00
I certify that I have read this application and state that the above
information is correct.I agree to comply with all County ordinances
and State laws regulating Electrical w' , and hereby authorize
representatives of this Count oto e upon t above-mentioned
pry r insp tion ur e
� SEE REVERSE FOR EXPLANATORY LANGUAGEI all 01R9
�
I9,n re. f Permitte Date