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HomeMy Public PortalAbout5756 RIO HONDO AVE_Electrical__ APPLICATION FOR ELECTRICAL PEWMIT L1 76A568-CE805 1/70 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS lD G.#v'6 Q JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY y ,p COLEMAN W. JENKINS SUPERINTENDENT OF BUILDING NEARESTl } OF FOR APPLICANT TO FILL IN CROSS ST. 4-,ILCV N S OUTLETS NO. EACH FEE OWNER $ $ RECEPT._ MAIL LIGHT TOTAL FIRST 20 .20 ADDRESS 10 OVER 20 CITY r TEL. NO. SWITCH_ f0 PLANCHECK TOTAL LIGHTING FIRST 20 .20 APPLICANT OVER 20 ADDRESS FIXTURES .10 APPLIANCES CITY TEL. N0. rPER f RANGE DRYER_WTR. HTR. APPLIICANT �I r 1 STA. COOK DISP. F.A.U. ADDRESS lg Apto SPACE HTR. AIR COND. CITY TEL. NO. SJ CLOTHES WASH. DISHWASH. LICENSE NO. CLASS. a z FAN OTHER 1.00 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION �. AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. SIZE & TYPE OVER TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 - 1 , 100LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO 1 - 10 3.00 RESIDE IN, THE AB E DESCRIBED REST NTIAL PROPERTY SIGNATURE ��II O. 10 - 50 5.00 OF PERMITTBF �c o_��e� 50 - 100 10.00 DISTRICT ICLASS GROUP PRO SEED BY O 100 - 500 15.00 ,©� � �-/ G W SIGN, GASSIGN AND ONE CIRCUIT 3.00 NOTES., h TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 ? SERVI CENOT OVER 600 VOLTS OR 200 AMP 2.00r O SERVICE OVER 600 VOLTS OR 200 AMP 5.00 APPROVALS DATE INSPECTOR'S SIGNATURE TEMP.POWER POLE TEMP SERVICE,POLE,8&APPURTENANCES 8.00 TEMP LIGHT OR RECEPT. SYSTEM 800 UNDERSLAB WORK ROUGH CONDI UT WIRING PERMIT FEE (SUB TOTAL) FIXTURES POWER AUTHORIZED PLAN CHECK FEE (50% PERMIT FEE) UTILITY CO. NOTIFIED / -71 f PERMIT ISSUING FEE 2.00 .� Q SUPPLEMENTARY PERMIT ISSUING FEE 1.00 r -/-3 i JOSEPH C. ROOHAN TOTAL FEE C/o SUPERVISING ELE ICAL ENGINEER. r PLAN CHECK yALIDATION CK. M.O. CASH PERMIT VALIDATIONCK. M.O. CASH . ' 1 t w% 1 :9229 AUS12 2 D 7.0 ON SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE Ic- , -- WORKER'S COMPENSATION DECLARATION 7069 DPW(12-.91) APPLICATION FOR ELECTRICAL PERMIT •I,herebkaaffirm that I have a certificate of consent to self insure, or al!certiF�cate of worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sm.'•38ob'0 b.C.) Policy N _Company FOR APPLICANT TO FILL IN DDRESS Certified copy is herebyfurnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY F11&2-Family,Sq.Ft. — $ $ Certified copy Is filed with the county building.inspection _ NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR 3H- ra.- Co•5 Ce I MAP BOOK PAGE 'PARCE 7 c-I CERTIFICATE OF EXEMPTION FROM WORKERS' ORMENAME COMPENSATION INSURANCE Outlets:Rec. In n C 5 First 20 MAIL (This section need not be completed if the work Involved by the Total No. Additional ADDRESS permit Is for one hundred dollars($1.0.0)or-loss.) C� I certify that in the performance of the.work for which this permit Tel.No. _ U is issued, I shall not employ any person in any manner so as to PLAN HECK become subject to the Workers'Compensation Laws; Llghting,Fixtures First 20 .APPLICANT Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers'+Compensation 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. Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter g... Over 3 to 10 Incl. ,(commencing with Section 7000)of Divisloh 3 of the Business and- CITY Tel.No. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. } LICENSEClew • - - Over 50 to 100 Incl. -. 'REO.NUMBB.ER d Over 10o DISTRICT NO. PR ESSED BY 0 License Number Lic.Class Services,Swbd.,MCC&Panelboards ty' 0-399 Amp.Under 600 V FINAL 0 • Contractor- Date DATE I am exempt under Sec. ❑ 400-1000 Amp.Under 600 V VALIDATION V Over 1000 Amp.or Over 600 V F W wowa B.&P.C.for this reason BRANCH CIRCUIT FEES BY U) Date: 15A,or 20A,12OV,Lighting or Recept. Z 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 2 SINGLE FAMILY Temp.Power Pole&Appurtenances Ativ'{A HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit -� I hereby affirm that I am exempt from the Contractor's License Law eByA 7 + for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits 3 vY 3307 °" Code): VVVV 1 ITEMS �i<s owner of the property,will do,the work and the structure Misc.Conduits&Conductors TOTAL $,�, Is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) , '— ' m 95 and Professions Code.). � CHECK 9 - CONSTRUCTION LENDING AGENCY CHECK ,10 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) /v Q CHANGE a0 Civ.C.) ' PLAN CHECKING FEE Lender's Name ,— 0000-0001 4'/12/?3 PERMIT ISSUING FEE Lender's Address Q 1 1 Aft 811 13 I certify that I have read-this application and under penalty of purjury state TOTAL FEE w that the above information is correct. I agree to comply with all County NI ordinances and State laws regulating Electrical wiring,and hereby authorize representatives of this County to enter ups the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ( �.A .E PI E� DATE WORKERS'COMPENSATION DECLARATION CE 806G 10/81 APPLICATION FOR ELECTRICAL PERMIT I•hereby,affirm that I have aveaa certificate of consent to self insure. , os a�Gelificate of WorJcere' Compensation'Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY u ,.copy a (Spec.38800,Lab.C.) �r -I �, �✓ Zen r1y—7/) �% �✓/�� FOR APPLICANT TO FILL IN JOB �Q �� Polk O. Cotnpa ADDRESS Q Certified copy is hereby furnished. New Residential Bldgs.&P,00ls EACH NO. FEE Certified copy is filed with the county building inspection 1 &2-Famjly,Sq.Ft. $ — $ LOCALITY NEAREST de artment. Multi-family Sq.Ft. CROSS ST. yv 0RF 1i! 1j4A/ 0 � Residential.Swimming Pool$ OWNER OR Date Applicant' FIRM NAME ' CERTIFICATE OF EXEMPTION FROM WORKERS' �Light�Sw.� MAIL, nn ,r COMPENSATION INSURANCE Outlets:Rec -ADDRESS o r o do Aov (Thfs section need.not be completed If the work Inbolved by the First 20 permit is for one hundred dollars($100)or less.) Total No. Additional CITY 1-e- cz tTel.N �5f• I certify that,in the performance of the work,for Which this permit PLAN CHECK to a APPLICANT is issued, I shall not employ y ny person in any manner so 8s to � become subject to•the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS�� ���. / Additional Total No. CITY epl v Tel.No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If.; after making this Certificate of APPLICANT Exemption,you should become subject to the Workers'Compensation Range_ Heater, D.W. provisions bf the Labor Code,you must forthwith comply with.such Oven _ Dryer_ W.M._ ADDRESS provisions or this permit shall be deemed revoked. Top _ FAU _ W.H. _ CITY ��s�� Tel.No. ^. LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ I hereby'affirm that I.amlicensed under provisions of Chapter 9 LICENSE OR `� '` ' Dis _ Room Air Cond.. C.lasa, .(commencing with Section 7000)of Division'3 of the Business and p REG.NUMBER Professions Code,and my license is.in full force and effect. power Apparatus&Large Appliances DISTRICT NO. PSSED BY Size&Type HP;KW,KVA,or KVAR ✓t Q License NumberLic.Class_�_ Up to 1 Incl. FINAL +`� f p Over 1 to 1.0 Incl: DATE ) VALIDATION Contractorl::; j *� �Date !3 -Over 1.0.to 50 Incl. FINAL 77 0 I am exempt under Sec, Over 50 to 100 Inc.. BY W Over 100 10.: B.&P.C.for this reason r� Services,Swbd.,MCC&Panelboards ZZs Date:. 0-200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V ❑ Over 1000•Amp.or Over 600 V Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.'Power Pole&Appurtenances 2 HOME OWNER-BUILDER DECLARATION Sign.with One Branch CircuitQ '`'i' g I hereby affirm that.I am exempt from the Contractor's License Law °8 for the following reason(Section 7031.5,Business and Professions' Additional Sign Branch Circuits Code): 3307 13050 0 1,as owner of the property,will do the work and the structure Misc.Conduits&Conductors 1 ITM is not intended or offered for sale (Section 7044, Business' Other(See Complete Fee Schedule) _ Poo. .r�.r� 13® � and Professions Code j. CONSTRUCTION LENDING AGENCY A G iS°1 Q[I 1 I hereby affirm that there iG �s a Is lending agency for the; , performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub Total) Cly.C.). I PLAN CHECKING FEE' LF7J1i1 g' �, Lender's Name I - r OOD-CUO 89 PERMIT ISSUING'FEE ,, 1 G1af7 Lender's Address 1 certify that I have read this application and state that the above TOTAL FEE information is correct.].agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize represent .Ives of thi .County to enter upon the above-mentioned property f r inspecti urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �✓-S 89 Si nature•of rmittee Date i. .