HomeMy Public PortalAbout5554 PAL MAL AVE_Electrical__ 76A963-CE806 5.62 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING _ p/1
BUILDING AND SAFETY DIVISION ADDRESS ✓�- (, y
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN I CROSS ST.
REC EPT. TOTAL NO. EACH FEE
LIGHT � OUTLETS FIRST 20 `if) .20 S ,) OWNER
SWITCH. �J �f AIL
ADD'L 10 ADDRESS
�;}- OVER 20 2-
TOTAL O CITY TEL. NO.
LIGHTING FIRST 20 .20
FIXTURES t
OVER
10 ELECTRICIAN
R 20 2
RANGES CLO.DRYERS WTR.WHO. 1.00 ADDRESS 1.
GARB.DIEP. / STA.COOK
CITY EL. NO.
DISHWASH. AUTO.-WASH. STATE ) C / C
SPACE HTRS. STA.APP.(/H.P.MAX.) .00 6 LICENSE NO. I v O U
MOTORS: OVER NOT OVER N.P. DISTR CT N G OUP 2 N PR SSED By
0 1 1.00 ^L�
1 s 1.so INSPECTION RECORD
s — 6 2.00
s 1s 2.60
16 — 60 3.00 r.• ', i O
50 100 S.00
O
SIGNS: NO.TRANS- F-
NO.LAMPS W
n
SERVICE O-600V-NOT OVER 200A 1.00
Z
SERVICE 0-600V•OVEn 200 A. 2.00
SERVICE OVER 600V 6.00
MISC.
PERMIT ISSUING FEE 2.00 0
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE • 13 3
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR /
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. POWER
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTEE
FINAL ��^ F. .
LIDATION ARTHUR'C.nVEIT
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
0745m7
FEBFE3 8 2 D 1 3.-�0
L
SO FVR C
7en6e3-cee0e Sues APPLICATIO ELE RICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER6u1%N611
BUILDING AND SAFETY DIVISION AODRESe 1 el�/JrTd_
JOHN A LAMBIE COUNTY ENGINEER
WILLIAM A JENSEN SDP Tor fDI ILOING LOCALITY
NEAREST
C ANT TO FILLCROSS ST
RECEPT TOTAL NO
OUTLETS FIRST 20 S 1O e 0 OWNER
LIGHT ADD-L ADORE"
MAI
■WITCH DYER 20 10
TOTAL GTY To- NO Ofy
LIGHTING [FIRST 10
FIXTURES DV Dri 20 1O ELECTRI (N
RAMQ1 CLO OHYERS WTR HTRS too ADDRESS Q
OAISI DIV GTA COOT(
CITYTEL NO 7
DIWWADI AUTO WASH STATE
VACa HTRS W&APP (W HJ 1 301 LICENSE NO
MOTORS. ovum MCTOVEII MP DISTRICT NO GROUP ; NE Pq�gnDBY
o — 1 100 S. O Z — Cz
I — s 130 INSPECTION RECORD
a e 100 _ ti ' 1 2, C-0'j D c T1 e 1e :eo IN 4 Zro
10 SO 300 , O '
so 100 Soo
SIGNS, No TNAHS p_
NO LAbS Z
SHRVICH0 GOOV NOT OVER aOOA 100
SERVICE O SOOV Ova 100 A too
SERVICE OVER SOOV Soo
MIeC
PERMIT ISSUING PER too 6
SUPPLILMHNTARY PERMIT ISSUING FEE 100
TOTAL FEE •
1 HERERY AalwoWlmGE THAT I HAVm READ THIS AALICATION APPROVALSDATE IN
AND MAT[THAT THE ANDYE IS COm11fCf AND AGIIQ TO COMPLY CONDUIT
WITH ALL CODHTY 01031 NCE, MD RE ATLAWS WGULATINo
SLECTIIGL WINING WIRING
1 NERERY CRATIFY THAT 1 AM PROPERLY IRGISTEIRD "Dion
UCEN® N IQGUIIIED NY PDS ANOELER COGMTT AMD STATE OF FIXTURES
CALIPONNIA OR THAT 1 AM THE LEGAL OWMER OF THE ASOVE
OESCIUGSD IG[SIOOITIAL % POWER
SIGNATURE UTILITY ILITY 00 D
OF P[RMITTG
FINAL
(DATION ARTHUR C VER
CK MO CASH BUP[RVI[ING ELECTRICAL ENGIN[Qtl
UjCq3 4 1 8 Z SEP 1 2 D 3,70IN
-
WORKERS COMPENSATION DECLARATION 8APPLICATION FOR ELECTRICAL PERMITC
CE-806G S3
(2 801 - �l
1 hereby affirm that I have a certificate of consent to s COUNTY OF LOS ANGELES BUILDING AND SAFETY
Insure,or a certificate of Workers'Compensation In e,or
e certified copy thereof(Sec 3800,Lab C)
FOR APPLICANT TO FILL IN JOB
Policy No ComDanY EACH NO FEE ADDRESS
New Residential Bldgs &Pools
❑ Certified copy is he urnished 1 &2 Family,Sq Ft S — S LOCALITYC
❑ Certified co filed with the county building inspection Multi-family Sq Ft — CROSS ST
depart Residential Svwmming Pools OWNER OR
FIRM NAME
Date Applicant Outlets Rec_Light Sw MAIL _
—dust ADDRESS �C
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No Additional
COMPENSATION INSURANCE CITY Tel No }
PLAN CHECK n
APPLICANT UUUV
(Thu section need not be hndredcompleted if the work or lewd Lighting Fixtures First 20
by the permit ss for one hundred tlo0an (5100) m less) Additional ADDRESS cc
Total No 0
1 certify that In the ll not performance of the work for any
ma this Fixed Appliances Not Over 1 HP CITU Tel No
permit n issued 1 shall not employ any person in any manner PERMIT W
w as to become subject to the Workers' Compensation Laws Range_Heater_D W APPLICANT D.
Oven _ Dryer_W M ADDRESS L ILA 2 pphcan t. Top _ Fan —WH — _
Hood _ Fan _Other_ CITU ���.�� Tel No 5/Lh� f
NICE TIf after making this Certificate of Dnp _ Room Air Cond` C N
Exemption you should become subject to the WorkersRE NUMBE _Clap
Compensation Provisions of the Labor Code, you must forth Power Apperaws& Large Appliances DISTRICT NO PROCESSE Y
with comply with such provisions or this permit shall be 51 r1
deemed revoked Size&Type HP,KW,KVA,or KVA (1
Up to 1 Incl
FINAL
LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl OATS VALID ON
Over 10 to 60 Incl
1 hereby affirm that 1 am licensed under provisions of Chapter Over SO to 100 Inc FINAL
9 (commencing with Section 7000)of Division 3 of the Busi Over 100 By
nese and Professions Code and my Incense Is in full force and
effect /• -\ Services
License Num bajZ_ Lk C -G� J 0.200 Amp Under 800 V
�) 201-1 ODD Amp Under 600 V �j
Contract Date ver Over 1000 Amp or O 800 V J 16 9 23 is 3 2 3
HOME OWNER BUILDER ULAZRATIONTannin Power Pole&Appurtenances i
Sign with One Branch Circuit • • • 3 2 5 0 5
1 hereby affirm that I em exempt from the 031 5, ton's
License Law for the following reason (Sectn_7031 s, BmAdditional Sign Branch Circuits
l Q Q 2 7-8 7
nese and Professions Co:0-nPdP.td
)
Msc Conduits&Conductors
❑ 1, as owner of thprty, wBl do the work and the Other (See Complete Fee Schedulel—
structure h not or offered for sale (Section
7044 Busing d Rofeadone Code)
C RUCTION LENDING AOENCY
1 hereby rm that there u e construction lending agency
for t performance of the work for which this permit s PERMIT FEE (Sub-Total)
On
(Sec 3097 Civ C)
ender s Mama PLAN CHECKING FEE (One-Fourth Permit Fes)
Lender's Address PERMIT ISSUING FEE
1 certify that I have read this application and stale that the TOTAL FEE i
above information Is correct 1 agree to comply with all County
ordmances and State lawn regulating Electrical "ring, and
hereby authorise mpresentati a of this County to enter upon
the a ove mentioned p ops for Inspection purposfses SEE REVERSE FOR EXPLANATORY LANGUAGE
the
of Perm tt e Date/