HomeMy Public PortalAbout5760 OAK AVE_Electrical__ 76A663 CE806 10/72 APPLICATI E {CAL PERMIT
A
COUNTY OF LOS ANGELES
t`DEPARTMENT OF COUNTY ENGINEER FNEAREST
5 to O .tJ
BUILDING AND SAFETY DIVISION
Y
^
FOR APPLICANT TO FILL IN T
OUTLETS NO EACH FEE OWNER OR4-1
$ $ FIRM NAME
L GHTT TOTAL FIRST 20 25 Q� ADDRESS D N
SWITCH OVER 20 CITY TEL NO J86 T —00
f0 PLAN CHECK
LIGHTING TOTAL FIRST 20 25 APPLICANT
FIXTURES OVER 20 f0
ADDRESS
RESIDENTIAL APPLIANCES CITY TEL NO
PERMIT
RANGE DRYER_WTR HTR APPLICANT
STA COOK DISP F A U ADDRESS JJO )I► , �¢
SPACE HTR AIR COND CITY TEL NO / f75J'
CLOTHES WASH _L DISHWASH REG NNUMBER CLASS Cr-ID
FAN OTHER100 /J I HEREBI ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
Y AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IND HEATERS ETC HP KW KVA ELECTRICAL WIRING
SIZE S TYPE OVER TO
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 — 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAI I AM THE LEGAL OWNER OF THE ABOVE
1 — 10 900 DESCRIFED RESIDEI AL PRO Y '
EE 19
10 — 50 500 PERMITSIGNATURE pm
O
50 — 100 1000 DISTRICT NO ROCE SED BY W
coli
SIGN
100 — S00 to00
Z
SIGN GASSIGN AND ONE CIRCUIT 500 APPROVALS DATE INSPEc S310NATURE
TUBE OR
MARQUEE ADDITIONAL CIRCUITS 100 TEMP POWER POLE
SERVI CENOTOVER 600 VOLTS OR 200 AMP 300 Q UNDERSLAB WORK
SERVI CE OVER 600 VOLTS OR200AMP 1000 ROUGH CONDUIT
TEMPSERVICE POLE &APPURTENANCES 500 WIRING
y 2;*z
TEMP LIGHT OR RECEPT SYSTEM 300 FIXTURES �! v
f POWER AUTHORIZED
UTILITY CO NOTIFIED r
FINAL
PERMIT FEE (SUB TOTAL) NOTES f
PLAN CHECK FEE I
PERMIT ISSUING FEE I 300 6
TOTAL FEE
r
PLAN CHECK VALIDATION I CK M 0 CASH PERMIT VALIDATION cK IM O CASH
I
1 5 6L-ZJUL 23 2 0 5 7 5 ®�,
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
WORKERS COMPENSATION DECLARATION CES0601 . APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY
insure or a certificate of Workers Compensation Insurance or
a certified copy thereof(Sec 3800 Lab C)
FOR APPLICANT TO FILL IN JOB
Policy No Company ADDRESS�/
New Residential Bldgs &Pools EACH NO FEE
Certified copy is hereby furnished 1&2 Family Scl Ft $ — $ LOCALITY
Multi family Scl Ft NEAREST
0 Certified copy is filed with the county building inspection I CROSS ST
department Residential Swimming Pools OWNER ORrr
FIRM NAME G��6 ELOE�
Date Applicant Outlets Rec ALighti—Sw-v 2First ADDRESS J,//v t
� 222222000000��-��-
CERTIFICATE OF EXEMPTION FROM WORKERS Total No --,�+Z Additional CITY Tel No
COMPENSATION INSURANCE PLAN CHECK
(This section need not be completed if the work mvohed APPLICANT 0
Additional
by the permit is for one hundred dollars ($100) or less) Lighting Fixtures First ADDRESS
Additional cc
I certify that in the performance of the work for which this Total No Fixed Appliances Not Over 1 HP CITY Tel No 0
permit is issued I shall not employ any person in any manner PERMIT /�yy LU
so as to become subject to the Workers Compensation Laws Range_Heater DW APPLICANT f6 .'0 ,sr Cd O.
Oven _ Dryer_W M ADDRESS r V nX pZs; s , Z
Date Applicant Top _FAU _W H
Hood — Fan a.Other_ CITY f Tel No&r r,/('o
NOTICE TO APPLICANT If after making this Certificate of Disp _Room Air Cond_ LICENSE OR /S-Zlass
Exemption you should become subject to the Workers REG NUMBER
Compensation provisions of the Labor Code you must forth Power Apparatus&Large Appliances I DISTRICT NO PROCESSED BY
with comply with such provisions or this permit shall be Size&Type HP KW KVA or KVA /-�
deemed revoked Up to 1 Incl 0 a
Over 1 to 10 Incl FINAL
LICENSED CONTRACTORS DECLARATION DATE lO—yS'' VALIDATION
Over 10 to 50 Incl
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc FINAL ��J
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
0 200 Amp Under 600 V
License Number Lic Class 201 1000 Amp Under 600 V
Contractor Date Over 1000 Amp or Over 600 V
HOME OWNER BUILDER DECLARATION Temp Power Pole&Appurtenances
I hereby affirm that I am exempt from the Contractors Sign with One Branch Circuit
License Law for the following reason (Section 7031 5 Busi Additional Sign Branch Circuits 2'5 6 a 4 A
ness and Professions Code)
Misc Conduits&Conductors
I as owner of the
property will do the work and the Other(See Complete Fee Schedule)—
structure is not intended or offered for sale (Section 2 • 4270
7044 Business and Professions Code)
CONSTRUCTION LENDING AGENCY • •t• 4 2 7 O v
I hereby affirm that there is a construction lending agency i
for the performance of the work for which this permit is PERMIT FEE (Sub Total) S 7-82
issued(Sec 3097 Civ C)
Lender s Name PLAN CHECKING FEE (One Fourth Permit Fee)
Lender s Address PERMIT ISSUING FEE
I certify that I have read this application and state that the TOTAL FEE Z
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 SEE REVERSE FOR EXPLANATORY LANGUAGE
� ,,f— — a2
Signature of Permittee Date