HomeMy Public PortalAbout5133 PAL MAL AVE_Electrical__ 76AGGS-CE806 21-0APPLICATION FOR ELECTRIC PERMIT i
COUNTY OF LOS )INGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING Ay
BUILDING AND SAFETY
pp DIVISION ADDRESS
CASSATT D.GHII'FIL LAIllDT?=Of � LOCALITY �
NEAREST
FOR APP.PLLICA TTOFILLIN CROSS 917.WT FM
T,
-ITEM NUMBER EACH PER. OWNER
OUTLETS: . _/25 $ $ MAIL /
LIGHTS .RECEPT. SW. ,.tG ADDRESS 1 (/
LIGHTING FIXTURES .i0 CITY EL.
ELEC.RANGES CLO.DRYERS ELECTRICIAN
WATER H E'A T'E-R S .50 ADDRESS
ELEC.SPACE HTRS. DISHWASHERS -
GARBAGE DISPOSERS AUTO.- CITY TEL.NO.
WASHERS STA.COOKING.UNITS .25 STATE
LICENSE NO.
MOTORS: OVER INC. H.P.
O— �/a 28 DIS R7INSPECTI
P ZONEREADY FOR INSPECTION
1/2— 22 — 5 1.00 - ON EMORD
a — 18 1.80 i
18 80 2.80
50— 200 5.00
SIGNS: NO.TRANS.
NO.LAMPS ,
SERVICE 0-600V 1..00
SERVICE OVER 600V S.00
MISC.
WIRING PERMIT 1.00 +�
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .50"
TOTAL FEE _ g APPROVALS
I HEREBY ACKNOWLEDGE THAT I :HAVE READ THIS'APPUCATI ON DATE INSPECTOR'SSIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING. f' :r
ELECTRICAL WIRING. WIRING J/I7lt �Li' i !`i'.•:-=t�i•i.J.4
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR "•. FIXTURES LT S� r
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM' THE LEGAL OWNER OF THE #BOVE POWER
DESCRIBED RESIDENTIAL P OPERTY.
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTE 1
FINAL
CKMG I ARTHUR C.VETT.
ctc Mo (�H SUPERVISING ELECTRICAL ENGINEER
«�o& 2 9 9 OR NOV 3 2 A 3.4 0
I I
WORKERS'COMPENSATIONDECLARATION ! CE-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT
CE-806
I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY
insure,or a certificate of Workers Compensation Insurance,or i
a certified copy thereof(Sec.3800,Lab.C.)
• � FOR APPLICANT TO FILL IN JOB
Policy No. Company. New Residential Bldgs.&Pools EACH NO. FEE ADDRESS S
E] Certified copy is hereby furnished. I 1 &2-Family,Sq. Ft. $ — $ LOCALITY
❑ Multi-family Sq. Ft. NEAREST
Certified copy is filed with the county building inspection CROSS ST
department. Residential Swimming Pools OWNER OR
FIRM NAME
Date Applicant I Outlets: Rec.—Light Sw. MAIL ,�+ �(� Q�p
First 20 ADDRESS J 13 A O I t0.
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY�fl Tel No. —93E
}
COMPENSATION INSURANCE PLAN CHECK _E CM a
APPLICANT O
(This section need not be completed if the work involved V
Lighting Fixtures First 20
by the permit is for one hundred dollars ($100) or less.) Additional ADDRESS It
Total No.
I certify that in the performance of the work for which this CITY Tel No.
permit is issued, I shall not employ any person in any manner Fixed Appliances Not Over 1 HP V
PERMIT !JJ
so as to become subject to the. orkers'Co pensation Laws. Range_Heater D.W._ APPLICANT O.
r r Oven — Dryer_W.M._ ADDRESS Z
Date ! r G O Applica i // / Top _ FAU _W.H.,_ CITY Tel No.
Hood — Fan _Other_
NOTICE TO APPLICANT: If, after making this Certificate. Disp. _Room Air Condom 01
LICENSE OR
Exemption, you should become subject to the Worl s' REG.NUMBER Class
Compensation provisions of the Labor Code, you must rth- Power Apparatus&Large Appliances DISTRICT NO. PROLE�'ED BY
with comply with such provisions or this permits all bedeemed revoked. Size&Type HP,KW,KVA,or KVAR �
Up to 1 Incl.
FINAL
LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATE VALIDATION
Over 10 to 50 Incl.
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
ness and Professions Code, and my license is in full force and
effect. Services
License Number Lic.Class 0-200 Amp.Under 600 V
201-1000 Amp.Under 600 V
Contractor Date Over 1000 Amp.or Over 600 V
HOME OWNER-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
ness and Professions Code): 7 E'( Q PMisc.Conduits&Conductors
I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)— ± 0 0 0 0 0 ?
structure is not intended or offered for sale (Section
7044,Business and Professions Code). [ 0 0 2
CONSTRUCTION LENDING AGENCY
350
I hereby affirm that there is a construction lending agegcy 00 o G s
for the performance of the work for which this permit is C u
PERMIT FEE (Sub-Total)
issued(Sec.3097,Civ.C.). Q ), 7 7t-8 2-
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee)
Lender's Address
PERMIT ISSUING FEE
I certify that I have read this application and state that the TOTAL FEE !T� 0
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
e above-mention pr erty for inspection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE
.l
Sig�ture of P'ermt to Date