HomeMy Public PortalAbout5714 PRIMROSE AVE_Electrical__ 76A.863-CES06 6%63 -APPLICATION FOR ELECTRI ALP RMIT .'
COUNTY OF LOS ANGELES
'DEPARTMENT OF COUNTY ENGINEER ,1 BUILDING g/� /��
BUILDING AND SAFETY DIVISION ADDRESS 5714 /Y(/i lK.�� L� '
•° .�11;-':_J.OHN A.�L•AMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY. CITY
NEAREST 1 +, /V ��jK
FOR APPLICANT TO FILL IN, CROSS ST. . )J V '
RECEPT. TOTAL NO. CH FEE ?
OUTLE .S FIRST 20. $2O•$ �1 OWNER EAN � TiGlN '
LIGHT' MAIL �/ ,�J/� `nom �q
ADD'L ..10 ADDRESS' /4 IVO' f FCJ14'&6E /"1'
SWITCH. '� .OVER.20 Cl+�. L
LIGHTING. TOTAL FIRST 20 .20 O CITY F VI �&L:.NO.
FIXTURES } 3 AOD'L .10 ELECTRICIAN
OV R 20 ` .
i
RANGES CLO-DRYERS NRR.HTRS. 1.00 ADDRESS
GARB.DIeP. I GTA.COOK CITY TEL NO.
D18HWASH. AUTO.-WASH. STATE j
SPACE XTRB. BTA.APP.(ys X.P.MAX.) � .50-
T:ICENSE NO..
MOTORS: -OVER NOT OVER H.P. DIST T GRO ZO. PR E D BY
O 1 1.00
1 a ' 1.50 INSPECTION RECORD s
s s 2.00 i /� C3r p:°•' .�_' ;tr'��I s�` Q
s Is 2.50
18 s0 ti: 5.00 �,✓f gay` "'
'50 100. 5.00
SIGNS:
NO.TRANS. ° _ -� ''�'lie H
NO.LAMPS d
SERVICE 0.000V-NOT OVER 20OA 1.00
SERVICE O-SOOV-OVER 200 A. 2.00
SERVICE OVER SOON I 5.00
MISC.
PERMIT ISSUING REE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE 8
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATBINBP.BCTOR'B SIGNATURE
AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY CONDUIT , 1 .� Aw -
WITH ALL-COUNTY ORDINANCES AND STATE LAWS REGULATING. �••-;
ELECTRICAL WIRING. WIRING A
A 21
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED A QU)RED BY LOS ANGEL ES'COUNTY AND STATE OF FIXTURES
CALIFORNIA R TH AM .THE :LEGAL W OF THE ABOVE '
DEBCpIBED SIDE L .R.P.. POWER -
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTE FINAL 9rtfi""1 �1e°' B`i
Y-ALIDAPOR ARTH R C.VEI
CK MO ( CASH SUPERVISING ELECTRICAL.ENGINEER
V�:�ri
6- 71 5 MAR 18 2 D 520- 14
r ._!'z;fgPLfia ct tl la •_ " IL
-
.SAe@3-C3M?.to-er 'APPLICATION FdR -' J'E ltlCAL 'PERMIT :
1COUNI*\OF'LOS ANGEI W
MPARTMEN�'` it MUNTY BNGIN.EER ■urLD
f ESUILDINO•"D SAFETY DMSION DRsf*
JOHIN A. L•AMBILrt Courmr EkcuNmdEk
WILLLAN A .hLksmt'NUr`7T P bUiL4ING LOCALITY
Ck�Oaf)t tl7'
4
'ANTLjrml '(Pimr 30)it No • tl OWNER
uorrs star. sr. '2 NAIL I • n'
(ADD'Lwet), 'lo
jowl ear, sw,cC
LIGHTING IrMTUROi (Ffmw RD) ,=O 1 CITY Tet.N
LIGIRTIN3 FDn-URX@. (AnprhbiAL): .10 ELECT91CIAN
RANs�i CLO.Dwyms 1fem Mid 1.00 ADD 1W f ti
+�o[r. aA cook 2 C17Y T'tl4 N6.
DURWASH. AqM.-WAS*L _.
aPXCK HTML STA.APP.d; T .00 ��3s O�
NOTORm ; Ovia mmova M.P.. -OMTRICrr G1 NE P AP15ESSED
A 7 f.b0 r
�I ECTI'N RKORD'
a e s.00 ! _ T .0
QQis 60 3.00
8O . 100
6.00 i W
31GPlq� NO
Ny r ,
�c
smR%FI¢q Q--abOV•-Nm OVOt 200A 1.00 {l
ICt 0-600V-00M ibO A.-
313MICU OVER a¢os► 5.00 -�+�•.
riamrr mullia I= X.=
•URL WITAQ1f PICAMT IMUING FIQ 1.00 !' f_
TOUT— F91K. f # { • �/
1'H 7Y ACKKCVr XDM THAI 1 HAYtt tetll►4 TH;w APM&&YMN Is 4110"Tum_
_AND STA'1'L THAT TM ASOYtt eS CORF=T AM AGMX TO COMPLY /
WITH ALL.COUNTY OROFNANGO j%ND•STAR L.%Ws "UL/1TTNS _
1 twtoiY cxxmrY THAI I AN rmorAILY mmwrxmn AN-Qi OI!
W1 Mg
[JC " eUMM MY LOS Am.
COUNTY AND hw'�AR�Qf' RIX1yJ - -
rCALIFOtMIA OR•'CHAT 1,AN THZ L ECULL Owlet.OF TM ASOVt
DtSCSi2t� R�QlMtTT. � TdYV�t - _ ^
81Q
INRs I iTIL.)1Y GAO NOTI
i `
FINAL
VALIDATI . ARTHUR'C:. VET_
YGY StiFtl: MING I.RCTRICAL ENGINKM
3-1 9 5 Qi MAY-2 8.,
� :
„+ ,�W('9RKERS'COMPENSATION DECLARATION CE-803 10/81 APPLICATION FOR ELECTRICAL PERMITgel
I hereby.,affirm that I have a certificate of consent to self CE e06G
rnsure, or a certificate of Workers'Compensation Insurance., COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof(Sec. 3800, Lab. C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB
❑ Certified copy is hereby furnished. New Residential Bldgs..&Pools EACH NO. FEE ADDRESS 7�
1 &2-Family, $ — $ LOCALITY
Certified'copy is filed with the county building inspec- y, Sq. Ft. 'NEAREST
tion department. Multi-family Sq. Ft. —
Residential Swimming Pools CROSS ST.
Date Applicant OWNER OR
FIRM NAME Das
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RecLight Sw.� IL
COMPENSATION INSURANCE I ADDRESS .S7/
First 20
(This section need not be completed if the work involved by Total No. Additional' ti4 CITY C Tel. No.�
the permit is for one hundred dollars($100)or less.)
that in the performance of the work for which this PLAN CHECK
I certify p. APPLICANT
permit i's issued, I shall not employ any person in any manner
so as to become subject to the Worker 'Compensation L s. Lighting Fixtures First 20 ADDRESS.
Additional
Date �� Applicant Total No.�_ CITY Tel. No.
NOTICE'TO APPLICANT: If, of er making th' Certificate of Fixed Appliances Not.Over 1. HP PERMIT
Exemption, you should- become subject . o the Workers' Range_ Heater—D.W. _ APPLICANT
Compensation provisions of the Labor C e, you must forth- Oven —Dryer _W.M.— ADDRESS
with comply with such- provisions or this permit shall be Top _ FAU —W.H. —
deemed revoked. Hood _ Fan —Other— CITY Tel. No�3'SJrd,
LICENSED CONTRACTORS DECLARATION 'LICENSE-OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REG.NUMBER Class.
(commencing with Section 7000)of Division 3 of the Business Power Apparatus&Lare Appliances DISTRICT NO. PR SED BY
and Professions Code,and m license is in full force and effect. gpp �(`p IL
y Size&Type HP, KW, KVA,.or KVAR �� V Q
License Number Lic. Class Up to 1 Incl. FINAL
Contractor Date Over 1 to 10 Incl. DATE -- "'gg V DATION
❑ , Over 10 to 50 Incl. FI I°
I am exempt under Sec. Over 50 to 100'Inc. B U4
B.&P.C. for this reason Over 100 r
Date: Services, Swbd.,MCC&Ponelboards
0 -200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600.V
Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V _ :222 1.7 A
SINGLE FAMILY Temp. Power Pole&Appurtenances # a o 0 0 0 2
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 ° ° 19.50
Law for the following reason (Section 7031.5,. Business and
Professions Code):
M Misc. Conduits&•Conductors 0 0 0 1 9 5 00
I, as owner of the.-property, will do.the work and the
structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ ® 0 607-85
7044, Business and Professions Code):
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is.a construction lending agency for
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE ,
Lender's Name
PERMIT ISSUING FEE
Lender's Address S,
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 aut orize representatives of this County to enter upon
the abo -mentioned proper r 11spection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
1gnaf f Permittee D