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HomeMy Public PortalAbout5808 ROSEMEAD BLVD_Electrical__ DOS-5A 12.54 APPLICATION ® LICATION FOR ELECTRIC PERMIT oqMIT DIVISION OF BUILDING AND SAFETY Department of County Engineer County of LosAngeles BUILDING q •,g�D � , WM.J. FOX. COUNTY ENGINEER ADDRESS CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY' �� FOR APPLICANT TO FILL IN PERMIT FEES' NEAREST CROSS ST. FEE �j p /�/� NUMBER EACH OWNER /a! I� a �" 660�I,) FEC."RA TLETSCLES MAILADDRESS ITCHES L OUTLETS 5d S CITYTEL. NO. NGES 25 ELECTRICIAN G /e G r/��dL UATERS 25 ADDRESS O.0 / & ! / I KW EA CITY �(}�G 7Yii TEL. NO. y ��J �® FIXTURES 5 LICENSE NO. IO NUMBER OF LIGHT CIRCUITS NUMBER OF RECEPTACLE CIRCUITS 5 "DISTRICT NO. GROUP' ZONE READY FOR INSPECTION MOTORS I f I I rNUMBE HORSEPOWER FEE INSPECTION RECORD VD. HPOVER INC. EACH &LESS $ .25 r 1 2 .50 _ 2 5 1.00 & fr S 15 1.50 // /, /� 1�ti�xr/!l 15 50 2.50 i L '411-A-7' 614R 144 50 200 5.00 MISC. NO. SIGNS NO.TRANS. NO. SIGNS NO.LAMPS FOR EACH PERMIT: WIRING $1.00 FIXTURES $1.00 SUPPLEMENTARY ,50 / r APPROVALS TOTAL FEE $ ! d DATE INSPECTORS SIGNATURE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING. 1 HEREBY CERTIFY TFI 1'AM PROPERLY RE. TERED AND/OR FIXTURES LICENSED AS REQUIRE. LO ANGELE COU AND STATE OF = POWER CALIFORNIA OR THA M1E LE 0 OF THE ABOVE r DESCRIBED RESIDEN� QE&TY. UTILITY CO.NOTIFIED SIGNATURE OF PERMITTE FINAL WILLIAM J.FOX,COUNTY ENGIN ER VALIDATION e tCo 5.1 4 3' im 2 8 2 1 .25 BY ® DEPUTY WORKE�RS'COMPENSATIONDECLARATION CE-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT CE-806 L hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELESBUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or cli a certified copy thereof(Sec. 3800,Lab.C.) Z1 FOR APPLICANT TO FILL IN SOB Policy No. Company New Residential Bldgs.&Pools EACH NO. FEE ADDRESS v� Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY s Multi-family Sq. Ft. NEAREST Certified copy is filed with the county building inspection CROSS ST Residential Swimming Pools department. , OWNER OR IJ Date /�~6" Applicant [ �,/ �, f�/71 FIRM NAME D2 y' LuS Outlets: Rec.—Light—Sw. MAIL First 20 ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY Tel No. } COMPENSATION INSURANCE PLAN CHECK 0- APPLICANT O (This section need not be completed if the work involved Lighting Fixtures First 200 by the permit is for one hundred dollars ($100) or less.) Additional ADDRESS W Total No. I certify that in the performance of the work for which thisCITY Tel No. � Fixed Appliances Not Over 1 HP U II— permit is issued, I shall not employ any person in any manner PERMIT W so as to become subject to the Workers' Compensation Laws. Range_ Heater D.W. APPLICANT ,6/ /SPA-A GL Oven _ Dryer_W.M._ ADDRESS - Iq D Z Date Applicant Top _ FAU _W.H. Hood — Fan _Other_ CITY 0 Tel No. NOTICE TO APPLICANT: If, after making this Certificate of Disp. — Room Air Cond._ LICENSE OR B Exemption, you should become subject to the Workers' REG. NUMBER 3 © lf Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCE SED BY with comply with such provisions or this permit shall be deemed revoked. Size&Type HP,KW,KVA,or KVARxk Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE LICENSED CONTRACTORS DECLARATION VALIDATION Over 10 to 50 Incl. y I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL 9 (commencing with Section 7000)of Division 3 of the Busi- Over 100 BY ness and Professions Code, and my license is in full force and effect. Services License Number,360 I—A L Lic.Class C/y 0-200 Amp. Under 600 V 7 / 201-1000 Amp.Under 600 V Contracto 7 Tf A6.1 Date / Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances I hereby affirm that I am exempt from the Contractor's Sign with One,Branch Circuit License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits ness and Professions Code): Misc.Conduits&Conductors ❑ 1, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— structure is not intended or offered for sale (Section 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 PERMIT FEE (Sub-Total) issued(Sec. 3097,Civ.C.). G� Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE 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 State laws re ting Electrical wiring, and hereby aut o ize rep resentativ f this County to enter upon the abov ntioned property n ection purposes. GGnn SEE REVERSE FOR EXPLANATORY LANGUAGE ` �I a—,h2 ature of Permittee Date