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HomeMy Public PortalAbout9539 PENTLAND ST_Electrical__ 76AG63 j?E806 I-68L APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS 7 JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY FOR APPLICANT TO FILL .IN NEAREST d �• CROSS ST. NO. AC' FEE , RECEPT. 00 $ $ OWNER ryry MAIL LIGHT TOTAL FIRST 20 4� .20 10 ADDRESS vvAm --SWITCH OVER 20 .10 120 CITY TEL. NO. �y PLAN CHECK LIGHTING TOTAL FIRST 20 .20 f (/ APPLICANT FIXTURES �� OVER 20 .10 'ADDRESS RANGE/—DRYER—WTR.HTR.— CITY TEL. NO. STA.COOK_DISP.—F.A.U._ CONTRAC'T'OR SPACE HTR.-/—AIR COND. ADDRESS slr 2/C CLOTHES WASH._DISHWAS.H._ ,y CITY TCL. NO. r� FAN—OTHER GG.• 1.00 190 LICENSE 1� CLASS. MOTORS,TRANSFORMERS RATING IND. HEATERS, ETC. HP. KW. KVA. I HEREBY ACKNOWLEDGE THAT 1 HAVE-READ THIS-APPLICATION SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING +ELECTRICAL WIRING. 0 - 1 1.00 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 1 - 10 3:00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER F, AND INTEND TO 10 - 50 '5.00 RESIDE IN, THE ABOV C SIGNATURE .ED R TIAL OPERTY. O V 50 - 100 10.00 OF PERMITTEE dw too — soo 15.00 DIST CT N GROUP ONE P O S,�ED B SIGN,GAS TUBE, OR SIGN AND ONE CIRCUIT 3.00 MARQUEE ADDITIONAL CIRCUITS 1:00 H NOTES Z SERVICE NOT OVER 600 VOLTS OR 200 AMP ♦ 2.00 Q� SERVICE OVER 600 VOLTS OR 200 AMP 5.00 TEMP SERVICE, POLE, &APPURTENANCES 3.00. APPROVALS DATE INSPECTOR'S SIGNATURE TEMP. POWER POLE UNDERSLAB WORK ROUGH CONDUIT WIRING PERMIT FEE _ (SUB TOTAL) FIXTURES PLAN CHECK FEE (SQA.PERMIT FEE) pOWER:AU.THORIZED PERMIT ISSUING FEE 2.00 ®® UTILITYCO.NOTIFIED " SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL TOTAL FEE Ag JOSEPH C. ROOHAN SUPERVISING ELECTRICAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIOCK. M.O. CASH - �, 3 8 4 1 R 2 8 2 D 1 3.( lq :E BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE WORKERS'COMPENSATION DECLARATION 76A66voPlnis/e7 APPLICATION FOR ELECTRICAL PERMIT Q I hereby affirm that I have a certificate of consent to selfMaw insure, or aeertificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS a or a certified cry thereof(Sec. 3800 Lab C.) I Policy No. ompany • FOR APPLICANT TO FILL IN I SOB ❑Certified copy is hereby furnished. New Residential,Bldgs. &Pools EACH NO. FEE ADDRESS ❑Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ — $ LOCALITY C' tion department. Multi-family Sq. Ft. NEAREST 004 CROSS?I Residential Swimming Pools OWNERSOR S Date APPlican // FIRM NAME CERTIFICATE OF EXEMPTION FROM WOR ERS' Outlets:Rec___CLLight�Sw. MAIL Sir COMPENSATION INSURANCE 3 a ADDRESS ed not becompleted leted IF the work Involved b First 20' (This section need P ll Total No. Additional CITY Tel. No. the permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this PLAN CHECK permit is issued;I shall not employ any person-in any manner ? I. APPLICANT so as to.become"subject to the Workers'Compensation Laws: Lighting Fixtures First 20 �J a ADDRESS Total No. Additional i CITY Tel. No. Date Applicant ! ,I Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT:.If, after making this Certificate oaf I APPLICATIO G Exemption, you should become subject to the Workers' Range— Heater—D.W. t.` Compensation provisions of the Labor Code, you must forth Oven — Dryer —W.M.— r� ADDRESS G with comply with such provisions. or, this: permit shall be Top _ FAU W.H. — I deemed revoked.• !I CITY' Tel. No LICENSED CONTRACTORS DECLARATION. i Hood —.Fan —Other_ LICENSE OR 1 hereby affirm that I am licensed under provisions of Chapter 9 Disp. fe. Room Air Cond'. Class. ` REG. NUMBER (commencing with Section.7000)of Div.ision.3 of the Business Power Apparatus rge.Ap I� DISTRICT NO. P SED BY > and Professions Code,and my license is in full force and effect,) 1 'Jr�� a- Size&Type HP, KW, KVA, or KVAR. Licens Nu—b- r9415_11 ic. Class _ Up to 1 Incl. �I. FINAL 5 Vl� GY�vw' G Over 1 to 10 Incl. 11 .DATE �� r(} VALIDATION Contractor date �—�{ � Over 10 to 50lncl. �I FINAL U ❑ I am exempt under Sec. II Over 50 to .100 Inc. BY W B.&P.C. for this reason i{ Over 100 ;I a_ Services,Swbd..,MCC&Panelboards Z Date: . 0200'Amp. Under 600 V ( , — Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V i SINGLE FAMILY 'I HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances Sign with One Branch Circuit II ^n r s 1 hereby affirm that I am exempt from the Contractor's Licens �I �(A t .,; Law for the following reason (Section 7031.5, Business an' Additional Sign Branch Circuits. _ s-� Professions Code): ! A ��(1 rr t F,,:*); Misc. Conduits&.Conductors l ❑ I, as owner of the property, will do the work and the ;i ITEM—' structure is not intended or offered for sale(Section 7044; Other(See Complete Fee Schedule)— =._7 =._•,, p Business and Professions Code). 11 I! !eL -_r CONSTRUCTION LENDING AGENCY !i ;}t 51?,.,_,f' I hereby affirm that there is a construction lending agency forf_ F1k�1G � the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) UU (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name �f[i�J—E PERMIT ISSUING FEE Lender's Address 949 `ITOTAL FEE AM °'yr _ 4 w I certify that I have read this application and state that the . �' above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and I hereby thorize.representatives of this County to enter upon -mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 1D Signature of Per ittee Date ®' W(&KERS'COMPENSATION DECLARATION 76MM.. 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self' CE-9066 insure, or a certificate of Workers'Compensation Insurance,, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof(Sec. 3800, Lab. C..) .r Policy N4,0O Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH- NO: FEE ADDRESS v33 /V /°�`� $ _ S LOCALITY Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. tion de aNEAREST rtment. Multi-family Sq. Ft. pCROSS ST. L D L' y Date + Applicant�aNO� 1'��'�c'tJ Residential Swimming Pools OWNER OR /� FIRM NAME IV d�h CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE ADDRESS 01 Tis section neenot be completed if the work Involved b First 20 ( hd p Y Total No. Additional CITY Tel. No �j. the permit is for one hundred dollars($100)or less.) L I certifythat. in the performance of the work for which this PLAN CHECK p APPLICANT permit 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 /applicant Fixed Appliances Not Over 1 HP PERMIT 6�.�' NOTICE TO APPLICANT: If; after making this Certificate of APPLICANT O A2 4,410 CTI N C, Exemption, you should become subject to the Workers' Range_ Heater_D.W. _ r r Compensation provisions of the Labor Code, you must forth- Oven —Dryer W.M.— I ADDRESS fes✓ !'0O �!':.Lr with comply with such. provisions or this permit shall be Top — FAU W.H. — 3/ Y deemed revoked. CITY ,n'� Tel. IV�,j` Hood =Fan —Other_ D�� �`' � LICENSED CONTRACTORS DECLARATION LICENSE OR 1 hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. Class.�p REG.NUMBER Q� �� (commencing with Section 7000),of Division 3 of the Business DISTRICT NO. PROCES D BY and Professions Code,and.m license.is in full force and effect. Power Apparatus&Large Appliances (� �//s�yr Size&Type HP, KW, KVA, or KVAR• ��� D Q License Number �©Q 7� Lic. Classes V —� Up to 1 Incl. DATE / I/C r ��i r ' 09 MAMA) Date ,tea`e Over 1 to 10 Incl. P If- DATION O Contractor' Over 10 to 50 Incl. FINAL / ��, Q L'//- V ElI am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C.'for this reason Over 100 Z Date: Services, Swbd., MCC&Ponelboards ► 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V Over 1000 Amp. or Over 600 V ❑l Exemption for Reg..Maint. Elect. SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm.that I am exempt from the Contractor's License Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and Professions Code): -a 2 8 9 1 A 1 I,,as owner of the property., will do the work and the Misc. Conduits&Conductors structure is not Intended or offered for sale (Section' Other(See Complete Fee Schedule)_ , # o o o o•o 'Z 7044, Business and Professions Code)'. I o -21.00 CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for o o o 2 1,.0 0LxQ the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (' 09.1 1 —8 5 (Sec. 3097, Civ. C.). PLAN CHECKING FEE , Lender's Name PERMIT ISSUING FEE Lender's Address I, certify.that I have read this application and state that the TOTAL FEE 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 inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Dat Signature of Permi tee — a