HomeMy Public PortalAbout9427 OLEMA ST_Electrical__ 76A869-CE60611/70 APPLICATION FOR ELECTRICAL PERMIT LJ
COUNTY OF LOS ANGELES
DEPARTMENT COUNTY ENGINEER DDE ���SS17
BUILDNG AND SAFE DIV SION . A
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEARESTCROSS ST.
OUTLETS N0. EACH FEE e9 aye
�g� OWNER L
RECEPT/1�7V $ S MAIL
LIGHT JJ TOTAL FIRST 20 2c) .25, (!-� ADORES
OVER 20 3 CITY TEL. N0.
SWITCffy .10. PLAN CHECK
FIRST 2025 APPLICANT
LIGHTING T TAL
.
OVER 20 ' ADDRESS
FIXTURES ,10
APPLIANCES CITY TEL. NO.
PERMIT
RANGE-DRYER- HTR. APPLICANT
STA. COOK DISP. I,F/F.A.U. ADDRESS
SPACE HTR.
�� IR COND._� CITY �!' TEL. N0. tlQ O
CLOTHES�`SHA- DISHWASH." � LICENSE NO. O-5 ,f$ SL CLASS.a`�J
FAN ` OTHER 1.00 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
_5 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 & TYPE OVER TO
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 - 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO }
1 - 1 O 9.00 RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. D_
0
SIGNATU10 - 50 5.00 OF PERMRITTEE '
1 11 Ed
50 - 100 10.00 �
DIST TNO ASS ZO POC &
100 - 500 15.00 ,
SIGN, GAS SIGN AND ONE CIRCUIT 5.00 NOTES: h
Z
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00
SERVI CENOT OVER 600 VOLTS OR 200 AMP 3.00 (j
APPROVALS DATE INSPECTOR'S SIGNATURE
SERVICEOVER600 VOLTS OR200AMP 10.00
TEMP.POWER POLE
TEMP SERVICE,POLE,&APPURTENANCES 5.00
UNDERSLAB WORK
TEMP LIGHT OR RECEPT. SYSTEM 3.00
ROUGH CONDI UT
WIRING
FIXTUR"
PERMIT FEE (SUB TOTAL) POWER AUTHORIZED
UTILITY CO. NOTIFIED
PLAN CHECK FEE
FINAL
PERMIT ISSUING FEE 3.00 ,3 �� JOSEPH C. ROOHAN
TOTAL FEE 45' SUPERVISIN ELECTRICAL ENGINEER.
PLAN CHECK VALIDATION CI(. M.O. CASH PERMIT VALIDATIO CK. M.O. CASH
in c 7 s a SEP 27 2 0 2 2..15^'
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
WORKERS'COMPENSATIONDECLARATION I
CE-806G (2.80) APPLICATION FOR ELECTRICAL. PERMIT
CE-806G
I hereby affirm that I have a certificate of consent to self I COUNTY OF LOS ANGE ES G AND SAFETY ,
insure,or acertificate of Workers'Compensation Insurance,.or
a ce fied c'py_th�repf 3 00,L b.C.)
77 W r��l/ FOR APPLICANT TO FILL IN JOB
Pot C rC�a�y New Residential Bldgs.&Pools EACH NO. FEE. ADDRE
Certified copy is hereby furnishe _r 1 &2-Family,Sq. Ft. $ — $ LOCALITY
'PIR Multi-family Sq. Ft. — NEAREST
Certified copy is filed with the county building inspection CROSS ST
4de artment. Residential Swimming Pools
OWNER OR -
OWN NAME
Date Applican Outlets: Rec.^Light Sw. MAIL
First 20 ADDRESS
C TIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY C , Tel No. r�
COMPENSATION INSURANCE PLAN CHECK p,
(This section need not be completed if the work involved i APPLICANT p
First 20 Fixtures i
htng xtures U
by the permit is for one hundred dollars ($100) or less:) LigAdditional � ADDRESS _
Total No.
I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No: O
permit is issued, I shall not employ any person in any manner PERMIT ()
so as to become subject to the Workers'Compensation Laws. Range_Heater D.W. _ APPLICANT W
Oven _ Dryer_W.M._� ADDRES
Date Applicant Top _ FAU _W.H. .
Hood _ Fan —Othec. CITY ie 0. ..
NOTICE TO APPLICANT: If, after making this Certificate of Disp. _Room Air Co
O LI SE OR Z-5
,r. 2
Exemption, you should bebo.rne subject to the Workers' REG.,NUMBE s J
Compensation provisions of the Labor Code, you must forth- Power Apparatus&Large Appliances DISTRICT NO. ��ic
with comply with such provisions or this permit-.shall be
Size&Type HP,KW,KVA,or KVAR
deemed revoked. ,,
� Up to 1 Incl. FINAL
l Over 1 to 10 Incf: DATE te'-'' •+
LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. �6( V'ALID'ATION
i I hereby affirm that I am licensed'under provisions of Chapter Over 50 to 100 Inc. FINAL
9 (commencing with Section 7000)of Division 3 of the Busi- - Over 100 BY ( E 4-kvt
ness and Professions.Code, and my license is in full force and
effect. Services '
License Number ic:Class 0-200 Amp.-Under 600 V f
201-1000 Amp.Under 600 V.
Contractor. Date 2 Over 1000 Amp.or Over 600 V
HOME NER-BUILDER DECLARATION Temp.Power Pole&Appurtenances
I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit
License Law for the following reason .(Section 7031.5., Busi- Additional Sign Branch Circuits f
ness and Professions Code):
Misc.Conduits&Conductors
Ell, 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
7044.,Business and Professions Code). -9-4 9 a 0 A ,
CONSTRUCTION LENDING AGENCY °
I hereby affirm that there is a construction.lending agency # 00 0 o a 2
for the performance of the work for which this permit is 'PERMIT FEE (Sub-Total)
issued(Sec.3097,Civ.C.). 1
Z o o 09.50
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) 0 0 0 0 9 5 0 1
Lender's Address iPERMIT ISSUING FEE 04,27-81 a 27_8
I certify that I have read this application and state that the !TOTAL FEE
above information is correct.I agree to comply with all Count$+
ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
the abo ned property for inspection purposes I SE.E'REVERSE FOR EXPLANATORY LANGUAGE
Si re Permittee f9fite