HomeMy Public PortalAbout10411 OLIVE ST_Electrical__ 7§yq ,q- g6 9-37 APPLICATION FOR ELECTRICALP MIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDRESS
:-JOHN A. LAMBIE, COUNTY ENGINEER--
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY �/77 0— l'] VNEAREST
FOR APPLICANT TO FILL IN CROSS ST.
NO. EACH FEE
$ $ OWNER
RECEPT._ MAIL
(LIGHT TOTAL FIRST 20 .20 ADDRESS /dn:,4 JI
SWITCH_ OVER 20 .10 CITY Od-tV TEL. NO.
LIGHTING lTOTAL FIRST 20 .20 CONTRACTOR
,FIXTURES 7( OVER 20 .10 ADDRESS
RANGE—DRYER—WTR.HTR._ CITY 1 A TEL. NO.`a d
STA.COOK—DIS P.—F.A.U._
LICENSE' NO. L :39
(SPACE HTR. AIR COND. I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
CLOTHES WASH._DIS FIWAS H._ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING.
FAN-OTHER 1.00 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
MOTORS,TRANSFORMERS RATING LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
IND. HEATERS, ETC. HP. KW. KVA. RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY.
SIZE & TYPE OVER TO SIGNATURE , ~
0 - 1 1.00 OF PERMITTEE d
o O
1 -- 16 / 3.00 DISTgJC -NO. G�jQ"LJP y�ZONE PROCESSED BY U
10 - 50 5.00 ��® u l� 'S-� l c-
50 - 100 10.00 NOTES• r O
ldJ
100 - 500 15.00 ;N
TUBE, OR SIGN AND ONE CIRCUIT 3.00
MARQUEE ADDITIONAL CIRCUITS 1.00
SERVICE NOT OVER 600 VOLTS OR 200 AMP 12.00 Z (50
SERVICE OVER 600 VOLTS OR 200 AMP 5.00
TEMP SERVICE, POLE, &APPURTENANCES 13.00
APPROVALS DATE INSPECTOR'S SIGNATURE
TEMP. POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
ISSUING FEE 2.00 2 OC)
WIRING
FIXTURES
SUPPLEMENTARY ISSUING FEE 1.00
POWER AUTHORIZED
PERMIT FEE UTILITY CO.NOTIFIED
PLAN CHECK FEE (50% PERMIT FEE) FINAL /,-,` =/--/.p n/
JOSEPH C. ROOHAN
TOTAL FEE -z d
SUPERVISING ELECTRICAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
5 1 3' 5k X20 2 D 7.Q0- 17
EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
FOAS63-CESOS-7.56 APPLICATION FOR ELECTRIC PERMIT ],
BUII.DIIYG AND SAFETY DMSION
Deportment of County Engineer BUILDING
County of Los Angeles ADDRESS �.
JOHN A.LAMBIE. COUNTY ENGINEER
CASSATT D.GRIFFIN.SUPT OF BUILDING LOCALITY c e
"gayNEAREST
FOR APPLICANT TO FILL IN CROSS ST.
PERMIT FEES
NUMBER OWNER
LIGHT OUTLETS MAIL
ADDRESS
jtECEPTACLES
WALL SWITCHES FEE CITY TEL.NO.
TOTAL OUTLETS @ s¢ S ELECTRICIAN
ELEC.RANGES 25 ADDRESS
ELEC.HEATERS 25 CITY TEL.NO.
KW EA STATE
FIXTURES 5 rDISTRICTNO.
NO.
MOTORS READY FOR INSPECTION
NUMBER HORSEPOWER FEE IGROUPI..ZONE
�
NEW MVD, HP OVER INC. EACH
Q 16&LESS $ 2s INSPECTION RECORD
I/2 2 .50
2 5 1.00.
5 15 1.50
1s 50 2.s0
i 50 200 5.00
M ISC.
NO.SIGNS NO.TRANS._
NO.SIGNS NO.LAMPS
FOR EACH PERMIT:
WIRING PERMIT $1.00 V d
FIXTURE PERMIT
SUPPLEMENTARY .80 APPROVALS
TOTAL FEE . $ Zp Aq. DATE INSPECTOR'S SIGNATURE
NHEREBY ACKNOWLEDGE THAT I HAVE READ THIS-APPLICATION CONDUIT
AD STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING
ELECTRICAL WIRING. FIXTURES14
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED.AS REQUIRED BY LOS ANGELES COUNTY AND.STATE OF POWER _
CALIFORNIA OR THAT I AM THE GA HER OF THE ABOVE
DESCRIBED RESIDENTIA ERTJ
UTILITY CO.NOTIFIED y'
SIGNATURE
OF PERMITTE FINAL �� �r� '� ✓L ....94s.�Z
JOHN A.LAMBIE. ATION ARTHUR C.VEIT.
..OUNTY ENGINEER SUPERVISING ELECTRICAL ENGINEER
CK MO CASH
!;AC06 2 1 4 Sn- MAR 20 2 6.4 U 11
WORKER'S COMPENSATION DECLARATIONMB69 DPW(12=&1)
7669 APPLICATION FOR ELECTRICAL ,PERMIT
76A
I hesgpy•.affir.tR that I.have a certificate of consent to self insure,
or a 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.)
Policy No.. ompany Pl/'�G`G� FOR APPLICANT TO FILL IN JOB y��
ADDRESS
Certified copy is hereby furnished. New Residential Bldgs.&Pools: NO. EACH FEE
_ $ $ LOCALITY
�( 1 &2-Family,Sq.Ft. _
1--+� Certified copy is filed with the county building inspection NEAREST
department. Multi-family S.q.Ft. CROSS ST. !� IF.�
Date�� ` " Applicant -� "�� Residential'Swimming Pools• ASSESSOR,
MAP BOOK
PAGE: PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' �5O OWAME cT/ 6�Zee �
N N '►Q: >r
COMPENSATION INSURANCE Outlets:Rec. Light SW.
First 20 MAIL
(This section need.not completed the work Involved by the Total No. Additional ADDRESS Oyl1 QLI
permit is for one hundredd dollars.($1000)or less.;) -
I:certify that in.the performance of thework for which this-permit CITY —f".A/fl:L_- Tel;No.cfl /
is issued, I shall not employ,any person in any manner soas to
PLAN CH CK
become subject-to the Workes'Compensation Laws, Lighting Fixtures First 20
APPLICANT
Total No. Additional
ADDRESS
DateApplicant RESIDENTIAL APPLIANCES NOT OVER 3'HP
NOTICE TO APPLICANT:;If; after making this Certificate of CITY •Tei..No.
Exemption,you,should become subject to.the Workers'Compensation OTHER .APPLIANCES NOT OVER 3'HP.
PLICANT
provisions of thePERMIT
.Labor Code,you,must forthwith comply with such - - � QQ 4
provisions or this.permit.shall be deemed:revoked. Power Apparatus&..Large Appliances ,AP-
'' LICENSED CONTRACTORS DECLARATION Size 8i TypeIIII����H,,,,P,KIN,KVA,.or KVAR ADDRESS
I herebq'affirm that I am licensed under provisions of'Chapter 9I — Over 3 to 10'Incl,
(commencing with Section 7000)of Division 3 of the Business and CITY Tel.N. _j Al
Professions Code,and my license.is in full force and effect. Over 10 to 50 Incl.. }
LICENSE OR �+
Over 50 to'100 Incl. REG.:NUMBER 22Z b CIa9e.
License Number Z-12-119 'Lic.Class V Over 1110 DISTRICT NO. PR D BY 0
V
Services,Swbd.,MCO&Panelboards. a.C)15 ,
Jql�e .��o� %,fi G I .0-399 Amp:Under 500 V 0
Contractor Date.J --31..-."�.G .DA`E O
400-1000.Amp.Under 600 V
I am exempt Under Sec. VALIDATION
Over 1000 Amp,of.Over 600 V
FINAL. = a
B.&P:C.for this reason. BRANCH CIRCUIT FEES
(J)
Date: , 15A,or 20A,120V,Lighting or Recept. Z
1 To 10 Branch Circuits.
Signature 11 To 40 Branch Circuits '
_ 4T Or More:Branch Circuits
Ezemptlon for-Reg.Maint.Elect. , 15A,2UA,206V To 277V Lighting Br.Circuits,
SINGLE FAMILY Temp.Power Pole&Appurtenances 2
HOME OWNER-BUILDER DECLARATION
Sidn with One Branch Circuit 8
I hereby affirm that I am exempt from the Contractor's License.Law. accTe�
for.the following reason(Section 703.1:.5,,:Business,and'Professions .Additional Sign Branch Circuits '
Code): 3303 -50.70
0 I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors I ITEMS
is not Intended or offered for sale(Section 7044, Business. Other(See Complete Fee Schedule) ..
and Professions.Code). TOTAL -50 m 70- _ - CHECK 50.70CONSTRUCTION LENDING AGENCY {•�
I hereby affirm that there Is a cohsttuction:fending agency for the .+ .. CHANGE .00
performance of.the work for which this permit is issued(Sec. 3097, I PERMIT FEE (Sub-Total) 2' '
Civ.C..) PLAN CHECKING PEE
Lender's Name IiE0000-0001 1/30/96
PERMIT ISSUING FEE: P2_1 45,95 1 AM 9-0 36
Lender's Address
I certify thai I have read this application and under penalty of purjury state n. TOTAL FEE
that the above'Information'is correct. I agree to comply with all County ;
ordinances and Statelaws regulating Electrical wiring,and hereby authorize
representatives.of this County to enter upon the above-mentioned property
for inspea-It purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNATURE OF PERMITTEE. -- - DATE