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HomeMy Public PortalAbout5940 PRIMROSE AVE_Electrical__ 76A863-CE806 9-64 OR EC APPLICATION F 1TRICAL RMIT L COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS, SUPT. OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. I RECEPT. TOTAL NO. EACH FEE OUTLETS FIRST 20 $.20 $ OWNER LIGHT MAIL ADD'L 10 ADDRESS SWITCH. OVER 20 TOTAL CITY EL. LIGHTING 1 I FtiRsr 20 .20 FIXTURES 1 /�_ ADD'L �O ELECTRICIAN OVER 20 RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS GARB.DISP. STA.COOK CITY TEL.NO. DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.(.Ys H.P.MAX.) .50 LICENSE NO. MOTORS: OVER NOT OVER H.P. DISTRICT NO. GROUP N P SSED BY O 1 1.00 3 J(1 t s 1.50 INSPECTION REC .RD s S 2.00 Z O B is 2.50 1s so 3.00 �! 7e O -, so too 15.00 NO.TRANS. - UJ SIGNS: NO.LAMPS y Z SERVICE O-SOOV-Nor OVER 200A 1.00 SERVICE 0-000V-OVER 200 A. 2.00 SERVICE OVER SOOV 5.00 MISC.. ' r PERMIT ISSUING FEE 2.00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 Thi L FEE $ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL-COUNTY CONDUIT A/ ORDINANCES AND STATE LAWS REGULATING p ELECTRICAL WIRING. WIRING �A u-' 1 HEREBY.CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND.STATE 01' CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND I TEND TO RESIDE IN. THE ABOVE DESCRIBED RESIDENTIAL P PERTY _ POWER. / SIGNATURE UTILITY CO NOTIFIED OF PERMITTEE FINAL JRG nnHAR C? �J ION 119ETPA SI G ELECTRICAL C? rqamLwo CASH SUPERVISING ELECTRICAL ENGINEER E� V j _1 9 3 1 G IMAY 21 4 1 D , 76A663-CE808 4-68 P� CATION FOR ELECTRICAL PERMIT COUNTY F L a ANGELES DEPARTMEN OF C NTY ENGINEER BUILDING BUILDING AND SA ETY DIVISION ADDRESS © 4.11-01�d� JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDINGLOCALITY FOR APPLICANT TO FILL IN NEAREST NO. AC FEE CROSS ST. 5 $ OWNER �� MA e4 RECEPT._ MS-4IL LIGHT TOTAL FIRST 20 .20 ADDRESS ' SWITCH_ o OVER 20 .10 CITY TEL. NO. PLAN CHECK LIGHTING 1 TOTAL FIRST 20 .20 APPLICANT FIXTURES T OVER 20 .10 ADDRESS RANGE—DRYER—WTR.HTR._ CITY TEL.. NO. STA.COOK_DISP._F.A.U.— CONTRACTOR � C., SPACE SPACE HTR. AIR COND. ADDRESS / ry� CLOTHES WASH._DISHWASH._ CITY TEL. NO. FAN—OTHER 1.00 LICENSE IJO.g Z CLASS. MOTORS,TRANSFORMERS RATING IND. HEATERS, ETC. HP. KW. KVA. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APFLICATION SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 0 - 1 1.00 ELECTRICAL WIRING. ' I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 1 - 10 3.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE Or CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO 10 - 50 5.00 RESIDE IN, THE ABOVE DESCRIBED ESIDE I PROPERTY. 50 - 10010.00 SIGNATURE d OF PERMITTEE V too - Soo 15.00 DI RIC P N PRO EB"E3Y o SIGN,GAS SIGN AND ONE CIRCUIT 3.00 „V' TUBE, OR /j MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES: J (� ' y Z SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 SERVICE OVER 600 VOLTS OR 200 AMP 5.00 hl' TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPRofALS DATE INSPECTOR'S SIGNATURE QQ TEMP. POWER POLE UNDERSLAB WORK ROUGH CONDUIT PERMIT FEE (SUB TOTAL) WIRING FIXTURES PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED PERMIT ISSUING FEE 2.00 UTILITY CO.NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL '? TOTAL FEE JOS PH C. ROOH N SUPERVISING ELEC CAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE Ya�I��iI/l9t/ i WORKER'S COMPENSATION DECLARATION zp0B83 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that..!have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified TCOUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 11.+C.) ` [�9 O . O +) 1 Policy No.135 Company�T• �`, y I FOR APPLICANT TO FILL IN JOB j Certified copy is hereby furnished. I New Residential Bldgs.&Pools NO.1 EACH FEE E4 N4 fQ64=5 LOCALITY� L �J f. ❑ 1&2-Family,Sq.Ft. — $ $ Certified copy is filed with the4ounl, spection NEAREST lepartment. Multi-family Sq.IL — CROSS ST. J PJA Date Applicant Residential Swimming Pools ASSESSOR 1 'MAP BOOK PAGE PARCEL 1 CERTIFICATE OF EXEMPT . KERS' I OWNER OR COMPENSATION INSURANCE Outlets:Rec._Light Sw.'. FIRM NAME First 20 (This section need not be completed if the work Involved by the Total No. Additional ti ADDRESS f f Oo O i permit is for one hundred dollars(8100)or less.) I certify that in the performance of the work for which this permit j CITY I.No: Zi is issued,.I shall:not employ any person in any manner so as to PLAN CHECK become subject to the Workers'Compensation taws. (Lighting,Fixtures First 20 APPLICANT j Total No. Additional • ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. t" f NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers'Compensation I OTHER APPLIANCES NOT-OVER 3 HP. provisions of the Labor Code,you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked. i Power Apparatus&Large Appliances APPLICAN I 1 LICENSED CONTRACTORS DECLARATION # Size&Type HP,KW,KVA,or WAR ADDRESS tit. 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 I CITYT .•612 Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. I 19T t LICENSE Over 50 to 100 Incl. REG.NUMBER `T/� �I • O- G- f c> j Over 100 DISTRICT NO. PR E BY License Number Lic.Class. 0 C Q jServices,Swbd.,MCC&Panelboards. Contract Date -v r 0-399 Amp.Under 600 V DATE U ❑ I 400-1000 Amp.Under 600 V ����� VALIDATION I am' tempt er Sec. I Over 1000 Amp,or Over 600 V FINAL 11 B.&P.C.for this reason (BRANCH CIRCUIT FEES BY co Date: I 15A,or 20A,12OV,Lighting or Recept. _ 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V lighting Br.Circuits SINGLE FAMILY Tem er Pole&Appurtenances ` HOME OWNER-BUILDER DECLARATION Sign with One ranch Circuit ACC r I hereby affirm that.I am exempt from the Contractor's.License Law CC t.e Z for the following reason(Section.7031.5, Business and Professions Additional Sign Branch Circuits :-r -, r ' Code): s..Fv� t•I Liza it ' ❑ I,as owner of the property,will'do the work and the structure 'Mist..Conduits&Conductors I ITEMS E:.MS is not intended or offered for sale(Section 7044, Business 'Other(See Complete Fee Schedule) polo. s T 101AL 67 m 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(Sec. 3097, PERMIT FEE (Sub-Total)' CHANGE Civ.C.) PLAN CHECKING FEE 2�j 0010n. 101 7j Df = Lender's Name PERMIT ISSUING FEE ;r Fs0 1 tij I i 10 15 Lender's Address I certify that'(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 andaws regulating Electrical wiring,and hereby authorize represent sof this, unty to enter upon the above-mentioned property for iris coon purpose 'SEE REVERSE FOR EXPLANATORY LANGUAGE SIG. REO ER EE DATE i