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HomeMy Public PortalAbout6390 OAK AVE_Electrical__ 76A663C. CE:806812/76 APPLICATION FOR ELECTRICAL PERMIT ALS � BUILDING AND SAFETY DIVISIONL7S7o FOR APPLICANT TO FILL IN ' New Residential Bldgs.&Pools EACH NO. 'FEE ADDRESS 1 &2 FRlally Sq. Ft. J03% $ — $ LOCALITY7rgane � Multi-family Sq.Ft. — NEAREST CROSS ST. p / Residential Swimming Pools OWNER OR FIRM NAME Outlets: Light,Switch&Receptacle MAI L / o ADDRESS b3� First 20 Additibnal + N1 0 Ac IGO CITY e'F,1 G C-= TeI.No. �pagy PLAN CHEC Lighting Fixtures APPLICANT First 20 O ADDRESS Additional CITY ' Tel.No. PERMIT Fixed Appliances Not Over 1 HP APPLICANT Range Heater— D.W. Oven Dryer — W.M. ADDRESS 1b0 .{ ` Ave Top FAU W.H. CITY AS r¢ Tel.No._7914­4601C' Hood �— Fan � LICENSE NE Disp. A.C. �. �47 S® GNUMBR C - � 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION Power A AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY Q Apparatus&Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING I.. Size&Type HP,KW,KVA,or KVAR ELECTRICAL WIRING. Up to 1 Incl. 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR COD Over 1 to 10 Incl. ��® LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE Over 10 to 50 Incl. .DESCRIBED RESIDENTIAL PROPERTY. Over 50 to 1.00 Incl. PERMITEE Over 100 SIGNATURSEE E DISTRICT NO. PROgE PSED BY' Services �� �ti 0-200 Amp. Under 600 V 201 -1000 Amp.Under 600 VAPPROVALS DATE INSPECTOR'S SIGNATURE Over 1000 Amp.or Over 600 V TEMP.POWER POLE Temp.Power,Pole&Appurtenances UND.ERSLAB WOR16 Q `a °` Sign with One Branch Circuit ROUGH CONDUIT ll Additional Sign Branch Circuits r/ 7 (Other) WIRING Z'-Z •-/ FIXTURES POWER AUTHORIZED PERMIT FEE (Sub-Total) UTILITY CO:NOTIFIED PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL o PERMIT ISSUING FEE ® NOTES TOTAL FEE PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALID M.O. CASH 111 749�se .12 -2 © 31.33 WORKER'S COMPENSATION. DECLARATION � 61�9 DPW.(12-87) & APPLICATION FOR ELECTRICAL PERMIT :I y affirm that I have a bertificate of consent to self Insure; I orrtificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS.ANGELES DEPT.OF PUBLIC WORKS UILDING AN AFETY D!Y. copy thereof•.(Sec.3800 Lab.C.) Policy No. Company FOR.APPLICANT TO FILL IN JOB ❑ .ADDRESS Certified copy Is hereby furnished. New Residential Bidgs.&Pools NO. EACH FEE LOCALITY ❑ 1&2-Family,Sq.Ft. — $ $ Certified copy is filed with the county building inspection _ NEAREST toe department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw.. FFIIRM NAOR ME COMPENSATION INSURANCE First 20 MAIL J� (This section need not be completed it the work involved by the Total No. Additional ADDRESS permit Is for one hundred dollars(5100)or less.) I certify.that in the performance of the work for which this permit CITY I.No. is issued, I shall not employ any per9'on in any manner so as to PLAN CHECK become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT.OVER 3 HP. NOTICE TO.APPLICANT: If.; after making this Certificate of CITY Tel.No. Exemption,you should become subject,to the Workers'Compensation• OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with.such. PERMICANT +%� provisl'bns or this permit shall be deemed revoked. Power Apparatus.&Large Appliances LICENSED.CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl (commencing with Section 7000).of Division .3 of the Business and CITY Tel.No. Over 10 to @O:lncl. Professions Code,and my license is in full force.and effect. } LICENSE B Class, d Over 50 to 100 Incl. REG.NUMBER O Over 100 DISTRICT NO. 7PORMSBEDBY License Number Lic.Class � ' Services,Swbd.,MCC&Panelboards O 0-399 Amp.Under Boo V FINAL Contractor Date DATE f' ❑ I am exempt under Sec. 400-1000 Amp.Under 600 V VALIDATION IVy( Over 1000 Amp.or Over 600 V FINAL d B.&P.C.for this reason C C FEES BY Z Date: V,Lighting or Recept: 2 _ Signature. 1 To 10 Branch Circuits �• A"-(%�z 11 To 40 Branch Circuits E-141 Or More Branch Circuits 33133 43.95 Exemption for Reg.Maint.Elect. 15A;20A,208V To 277V lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances i � W HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ' 43. 65 I hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 7031.5, Business and Professions Additionai.Sign Branch Circuits Code): V� kC4,ia4� I,as owner of the property,will do"the work and the structure Misc.Conduits&Conductors CHANGE .00 is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) . and Professions.Code). CONSTRUCTION LENDING AGENCY (I �—�' ( �.4'195 1 hereby affirm that there is a construction lending agency for the , # 7 ; ;;� performance of the work for which this permit is issued(Sec.309.7, PERMIT FEE (Sub-Total) Civ.C.) PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE. Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE �•lo� that the above information Is correct. I agree to comply with all County r ordinances and State laws regulating Electrical wiring,and hereby authorize, representatt of this Countyto ant the above-mentioned property for 1 p as. SEE REVERSE FOR EXPLANATORY LANGUAGE i i E O ERMITr *I—AT ' WORKER'S COMPENSATION DECLARATION 20.0018 DPW(12-97) APPLICATION FOR ELECTRICAL PERMIT Ll I hereby affirm that I have a certificate of consent to self insure, 76A663 or 4 certificate of Worker`s Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab.C.) POIICy NO. Company FOR APPLICANT TO FILL.IN JOB /1 Q Polis ADDRESS (J Cer(ified copy is hereby furnished. NO. EACH FEE Y New Residential Bldgs.&Pools G �C El Certified &2-Family,Sq.Ft. — $ LOCALITY$ Certified copy is filed with the county building inspection _ NEAREST department. Multi-family Sq.Ft.. CRoss ST. O rtJ Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER OR COMPENSATION INSURANCE Outlets:Rec. Light Sw. /�0 FIRM NAME �}- /� w " L V%- �d (This section need not be completed if the work involved by the MAIL First 20 ' 1 . 1 / permit is for one hundred dollars($100)or less.) Total No. Additional ADDRESS 4 50 d o L C I I certify that in the performance of the work for which this permit CI Ir1..e-,�-(Lc. Tel.No. Vi S3 is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers'Comp on Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Dater exp Applicant �" ;5 NOTICE TO APPLICANT: If, after making this Certificate of RESIDENTIAL APPLIANCES NOT OVER 3HP. CITY Tel. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. rovisions of the Labor Code,you must forthwith comply with such PERMIT p p y GL provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000)of Division 3 of the Business and CITY Tel.No. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. 17 } LICENSE _ /_ / Over 50 t0 100 Incl. REG.NUMBER W O License Number v LIC.Class��� Over 100 DISTRICT NO. `O� P O SSED BY 0 Services,Swbd.,MCC&Panelboards C �� Contractor a/ r t\iDate �/ f o -!r 7 0-399 Amp.Under 600 V DATE O F1 I am exempt under Sec. 400-1000 Amp.Under 600 V FINAL .r�o ASALIDATION d BRANCH CIRCUIT FEES Over 1000 Amp..or Over 600 V B.&P.C.for this reason BY fn Date: 15A,or 20A,120V,Lighting or Recept. Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits F-141 Or More Branch Circuits Exemption for Reg.Ma)nt.Elect. 16A,20A,208V To 277V Lighting Br.Circuits _ SINGLE FAMILY Temp.Power Pole&Appurtenances �� I HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit �•=+�; :r., ;I.! for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits , Code): - a I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors i•::RL. ha is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) �` , r•.' ; and Professions Code). ` `1°`'" 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(Sec. 3097, PERMIT FEE (Sub-Total) Civ.C.) PLAN CHECKING FEE ';,'� y I M Lender's Name PERMIT ISSUING FEE OZ Lender's Address TOTAL FEE I certify that I have read this application and under penalty of purjury state that the above information is correct. I agree to comply with all County ordina sand State laws regulating Electrical wiring,and hereby authorize re sent fives of this County to ter u n the above-mentioned property r insp io purp se SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF PERMITTEE DATE