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HomeMy Public PortalAbout5018 PAL MAL AVE_Electrical__ e , C!c 72,-663-CEBO6 11/70 APPLICATION FOR ELECTRICA PERMIT7 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER 7ADDRESS BUILDING AND SAFETY DIVISION (J COLEMAN W. JENKINS. SUPERINTENDENT OF BUILDING FOR APPLICANT TO FILL IN OUTLETS NO. EACH FEE 7 OWNER C a RECEPT. $ $ MAIL LIGHT TOTAL FIRST 20 25 D ADDRESS O 6 CITY C TEL. N0.�e a SWITCH �� OVER 20 .10. PLAN CHECKf LIGHTINGTOTAL FIRST 20 .25 APPLICANT FIXTURES OVER 20 .10 ADDRESS APPLIANCES CITY TEL. NO. PERMIT RANGE DRYER_WTR. HTR. APPLICANT STA. COOK DISP. F.A.U. ADDRESS SPACE HTR. AIR COND. CITY TEL. NO. CLOTHES WASH.-t—DISHWASH. LICENSE NO. CLASS. FAN OTHER1.00 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY OtiDINANCES 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 1.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO �.. 1 - 10 3.00 RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. CL O SIGNATURE V 10 - 50 5.00 OF PERMITTEE ix 50 - 100 10.00 DISTRICTNO. SS ZONE PR C S BY I... 100 - 500 15.00 LU CL a SIGN, GAS ISIGN AND ONE CIRCUIT 5.00 NOTES: Z z TUBE, OR MARQUEE ADDITIONAL CIRCUITS IAO SERVI CENOTOVER 600 VOLTS OR 200 AMP 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE SERVI CE OVER 600 VOLTS OR 200 AMP 10.00 TEMP.POWER POLE TEMP SERVICE,POLE,&APPURTENANCES 5.00 TEMP LIGHT OR RECEPT. SYSTEM 3.00 ROUGH LAB WORK ROUGH CONDIUT WIRIN FIXTURES POWER AUTHORIZED PERMIT FEE (SUB TOTAL) UTILITY CO. NOTIFIED PLAN CHECK FEE FINAL PERMIT ISSUING FEE 3.00 JOSEPH'C. ROOHAN TOTAL FEE SUPERVISING EL ICAL ENGINEER PLAN CHECK VALIDATION CK. M.0. CAS PERMIT VALIDATION CK. M.O. CASH UrGo447, 7v 61!$ 2 D 4.75 SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE "663`E-80e`6"8' APPLICATIO OR ELECTRI L RMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO.FILL IN JOB X711 a4. New Residential Bldgs.&Pools EACH NO. FEE. ADDRESS 1 &2-Family,.Sq.Ft. $- .025 — $ LOCALITY i—c— c Multi-family Sq.Ft.. :02 — NEAREST Residential Swimming Pools 25:00 O OSS ST.R Olt- Outlets:RecLight Sw. FIRM NAME� MAIL First 20 .50 ADDRESS M-A—c._-- Total No. Additional '.30 CIT L Tel.No. PLAN CHECK APPLICANT Lighting Fixtures First 20 •50 ADDRESS Additional .30. Total No. CITY Tel.No. Fixed Appliances Not Over 1 HP PERMIT AI 'PPLIVT �i�4rt Range—Heater_D.W.— AADD CC . Oven_Dryer—W.M.— ' Top _FAU —W.H._ CITY Tel No 3� Hood_Fan —Other LICENSE R 1 /i- Disp._Room Air Cond. 2.50 REG.NUMBER - ` t"c Class. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA- Power Apparat &Large Appliances TION.AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO Size&T ��J+►KW, e p or KVAR COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS YP REGULATING ELECTRICAL WIRING. P 2.50 U to 1 Incl. I HEREBY CERTIFY JAMHE AM PROPERLY REGISTERED AND/OR o Over 1 to 10 Incl. 5.00' LICENSED AS R' Q U IR ANGELES COUNTY AND STATE OF Over 10 to 50 Incl. 12.50 CALIFORNIA ORT ILEGAL O' R THE ABOVEODESCRIBED RF.I. TIAL TY.�Over 50 to 100 Inc. 25.00 pERMITEE ; Over 100 40.00 SIGNATURE Services DISTRICT N P D 0-200 Amp.Under 600 V 12.50 Q� 201-1000 Amp.Under 600 V 25.00. r 0 Over 1000 Amp,or Over 600 V 50.00 Z O Temp.Power Pole&Appurtenances 10.00 Sign with One Branch Circuit 10.00 0 Additional Sign Branch Circuits 2'00 INSPECTION Misc.Conduits&Conductors INFORMATION u l o.00 ON REVERSE M Other(See Complete Fee Schedule) SIDE v. Z �84610A 061 0 0 0.0 0 2 PERMIT FEE (Sub-Total) 2 - 2S50 Z PLAN CHECKING FEE (One-Fourth Permit Feel O PERMIT ISSUING FEE $700 0 0 0 2 5 rj 0;5 TOTAL FEE /� > 01.03-80 INSPECTION FINALED W date: /' 7/%J B ���%� -- ®s 4,yfORKEFi'SOMPENSATION DECLARATION 200019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT L1 76A863 I hereby affirm that I'hade 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.) Q Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS D. Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY 7 ❑ I 1&2-Family,Sq.Ft. _ $ $ Certified copy is filed with the county building inspection NEAREST /) ©LQ /� � 5� department. Multifamily Sq.Ft. CROSS ST: C W Dade Applicant Residential Swimming Pools ASSESSOR �•p� 0M MAP BOOK J OJ PAGE,U�C/ PARCEL D� CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec. Light Sw.3 OWNER OR n A COMPENSATION INSURANCE First 20 U FlRM NAME MAIL y This section need not be completed if the work involved b the permit Is for one hundred dollars($100)or less.) �Total No. �� Additional ADDRESS I certify that in,thii performance of the wor) for which this permit CITY �0�'. I.No.. �s Is issued, I shall not employ any person 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. rovisions of the Labor Code,you must forthwith comply with such PERMIT P Y P Y APPLICANT provisions 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. Professions Code,and my license is in full force-and effect. Over 10 to 50 Incl. LICENSE OR Class. a Over 50 to 100 Incl. REG.NUMBER Over 100DISTRICT NO. P SED BY V License Number Lic.Class Services,Swbd.,MCC&Panelboards %J W - O Contractor Date 0-399 Amp:Under 600 V DATE �l 400-1000❑ Amp.Under 600-V IL•r`� VALIDATION U I am exempt under Sec. Over 1000 Amp.or Over 600 V FINAL d. B.&P.C:for this reasonBRANCH CIRCUIT FEES BY (n 15A,ot-20A,120V,Lighting.or Recept. Z. Date:- - 1 To.10 Branch Circuits Signature 71 To 40 Branch Circuits ❑ 41 Or More Branch Circuits rt Exemption for.Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits +- SINGLE FAMILY Temp.Power Pole&Appurtenances ACC =`a HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit -,Irl- w ?t I hereby.affirm that I am exempt from the Contractor's License,Law 3-3301,r �i. _�ti1, for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits _ Code): .i 6i)L ❑ I,as owner of the property,will do the work and the structure 'Misc.Conduits&Conductors3 TO� L -a� f is not intended or offered for sale(Section 7044, Business - Other(See Complete Fee Schedule) and Professions Code). CHECK CONSTRUCTION LENDING AGENCY CHANGE =ilij 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) a Lender's Name PLAN CHECKING FEE 4470 1 Pri 6.'IT PERMIT ISSUING FEE I. Lender's Address I ro I certify that I have read this application and under penalty of purjury state TOTAL FEE ! that the 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 Ins ction purposes. �® p SEE REVERSE FOR EXPLANATORY LANGUAGE SIGRO>E �E DATE