HomeMy Public PortalAbout10627 OLIVE ST_Electrical__ 1 . . t TEMPLE CULT Y
76A663-CE806 8-62 APPLICATION FOR ELECTRICAL- PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING .
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS.ST.
RECEPTA 3 TOTALNO. EACH FEE
OUTLETS FIRST 20 $. $ OWNER
LIGHT17 - a,C� .20 MAIL
, ���C, ADD'L /'/ 0 ADDRESS
SWITCH.-go � OVER 20 7 0 •10 V
TOTAL
LIGHTING FIRST 20 .20 CITY TEL.NO.
FIXTURES ADO'L 10 ELECTRICIAN
OVOR 20
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS
GARB.DI STA.COOK CITYapatk
TEL.NO.
DISHWASH. AUTO.-WASH. yy n STATE 7�y
rsO
A.APP.(Vs X.P.M _ .50 (/1� LICENSE NO. 6 �/a
N OVER N.P: DISTRI T O. GRQUP Z NE 1 i.00 104 1 8 1.50 _ INSPECTION RECORD
8 8 2.00
a' is 2.50 -
I s 50 3.00_ a
50 100 5.00
SIGNS,
No.TRANS. OC
NO.LAMPS 0
SERVICE 0.600V-NOT OVER 200A 1.00 94b
SERVICE 0.60OV-OvER 200-A. 2.00 h
SERVICE OVER 600V 5.00 Z
MISC.
PERMIT ISSUING FEE 2.00 �}
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE
is TQ
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT: A •}
WITH ALL-COUNTY ORDINANCES AND STATE LAWS REGULATING •y _
ELECTRICAL WIRING. WIRING J �� T
•.R'~��.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANDI�OR C'�"'I
LICENSED AS REQUIRED BY NGELES COUNTY AND STATE OF FIXTURES fig°. el
CALIFORNIA OR THAT I LEG OWNS OF E ABOVE
DESCRIBED RESIDENTIA Y POWER
SIGNATURE UTILITY CO.NOTIFIEDWUWR
OF PERMITTEE INALLIDATION AIT
C MO CASH '" SUPERVISING ELECTRICAL ENGINEER
LACO 2 0 0 IUD OCT 2 9 2 0 1 6.4 0~ q
'firm that I COMPENSATION DECLARATION E-8000 '°'B' APPLICATION FOR ELECTRICAL PERMIT
I herby affirm that I have a certificate of consent to self insure,
! or a certificate of Workers'Compensation Insurance,or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec.3800,Lab.C.)
Pol No. �- Compaq FOR APPLICANT TO FILL IN JOB
L�(j Certified copy is hereby furnished. EACH NO. FEE ADDRESS r
New Residential Bldgs.&Pools $ _ $ LOCALITY
❑ Certified copy is filed with the county building Inspection 1 &2-Family,Sq.Ft. _ C s
department. Multi-family Sq.Ft. NEAREST
Residential Swimming Pools L CROSS Si.
Date Applicant OWNER OR
�'• FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec-Light, SwJ . MAIL �-
COMPENSATION INSURANCE . ADDRESS • o G
(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 C_ Tel.No:
I certify that in the performance of the work for which this permit. „ PLANCHE�CK
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 ApplicFixed Appliances Not:Over 1 HP
NOTICE TO A LICANT: If; PERMIT after making this Certificate of PERMIb ,'��
Exemption,you should become subject to the Workers'Compensation Range_ Heater D:W.
provisions of the'Labor Code,you must forthwith comply with such Oven Dryer W.M._ ADDRESS ,S"� L
provisions or this permit shall be deemed revoked. Top FAU W.H. _
LICENSED CONTRACTORS DECLARATION Hood _ Fan Other_ CITY Tel.No.W -oc-1
I hereby affirm that I am licensed under provisions of Chapter 9LICE..NSE OR /
Disp: Room Air Cond. REG.NUMBER Com! ClasqC
(commencing with Section 7000),of Division 3 of the Business and - '
Professions Code;and my license is in full force and effect. A4Power Apparatus&Large Appliances DISTRICT NO. 'N PROCESSED BY
/ q 4 pSize&Type HP,KW,KVA,or KVAR Q�
License Number pfd-�L / _ Lic.Class^ [ Up to 1 Incl. FINAL `�
�. Over 1 to 1'0Incl. DATE •VALIDATION
Contrac T Date Over 10 to 50 Incl: O
F( C;
❑ I am exempt under Sec. Over 50 to 100 Inc. B ILBAP.C.for this reason Over 100 IL
Services,Swbd.,MCC&Panelboards Z
Date: 0-200 Amp.Under 600 V
Signature 201 1000 Amp.Under 600 V
❑ Elect Exemption for Reg.MainOver 1000 Amp.or Over 600 V
t. t: • - - -••--.-•----•- ••- •.-••••. _ -...:.
SINGLE FAMILY Temp.Power Pole&Appurtenances. 2 ,
04.
.•'••
HOME OWNER-BUILDER DECLARATION Sign..with One Branch Circuit
I hereby affirm.that I am exempt.from the Contractor's.License Law .
for the.following reason(Section.7031.5,BusiAdditional Sign Branch Circuits
ness and Professions � 38,25Code): 3307
❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors 1 ITEMSOther(See Complete Fee Schedule) _
andintended or offered for sale (Section 7044, Business , TOTAL 38 o 25
nd Professions.Code). CHECK 38o2t
CONSTRUCTION LENDING AGENCY ,
I hereby affirm that there is a construction lending agency for the CHANGE Go
' performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub Total)
Civ.C.).
PLAN CHECKING FEE 0MG-0001 7/24/89
Lender's Name PERMIT ISSUING FEE d 4633 1 Ali 9°n 40
Lender's Address
I certify that'I have read this application and state.that,the above TOTAL FEE �!
o.
information is correct.I agree to comply with all County ordinances
and State laws regulating Electrical wiring, and hereby authorize
representatives of this Cou9W to enter upon the above-mentioned i
property inspe ion pugroses., SEE REVERSE FOR EXPLANATORY LANGUAGE
�
7/2
Signature of Permittee I D to i
.� 1