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Home My Public Portal About5741 ROWLAND AVE_Electrical__ FSAGGS.CBBQB,.BB APPLICATION FOR LECTRIC PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER ;: I BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER CASSATT 0. GRIFFIN,SUPT OF BUILDING LOCALITY r FGARBAGEDISPOSERS OR APPLICANT TO FILL IN (NEAREST PERM FEES CROSS 1 T E M NUMBER EACH FEE OWNER S: $ $ (MAIL RECEPT. SW. .10 ADDRESS G FIXTURES .10 (CITY TEL. NO. NGES CLO. DRYERS - +ELECTRICIANATER H EATERS 's0 (ADDRESSACE HTRS. DISHWASHERS CITY TEL. NO. DISPOSERS AUTO.- STATE S STA. COOKING UNITS .2s (LICENSE NO. FJS: OVER INC. H.P. 1 DISTRICT NO. GR UP EJE CESSED Y O— 1/2 .25 i 12— 2 .50 DIRMCnON RECORD 2— 5 1.00 5— 1s 1.50 is— so 2.50 50-200 5.00 SIGNS: NO. TRANS. NO. LAMPS i SERVICE 0-600V 1.00 SERVICE OVER 600V 5.00 . I I MISC. WIRING PERMIT 1.00 FIXTURE PERMIT 1.00 h. lWIRN SUPPLEMENTARY PERMIT .50 TOTAL FEE $ AMOVAbS1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION DATE INSPE, QR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ./ 1:- _►%tk�WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. Yiy%i':V,L/I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND�ORLICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFCALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVEDESCRIBED RESIDENTIA PROPERTY.SIGNATURE OTIFIEDOF PERM WE FINAL r-- ZDATION ARTHUR C. VETT, cic o CASH SUPERVISING ELECTRICAL ENGINEER 5 5 7 2 n n?R 2 3 2 A 2.50 I ' HRS'COMPENSATION DECLARATION CE_80 G IO/BI APPLICATION FOR ELECTRICAL PERMIT I herS�by ; m that I have a certificate of consent to self y ina4fe„or 4A.certificote of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or p certif'�a copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. EACH NO. FEE ADDRESS .741 New Residential Bldgs. 8 Pools Certified copy is filed with the county building inspec- 18 2-Family, Sq. Ft. $ — $ LOCALITY �'� tion department. Multi-family Sq.-Ft. — NEAREST Residential Swimming Pools CROSS ST. Date Applicant OWNER OR FIRM NAME CERTIFICATE.OF EXEMPTION FROM WORKERS' 1 s, '' f MAIL Outlets: Rec Light�Sw. COMPENSATION INSURANCE First 20 7 Q /' � ADDRESS (This section need not be completed if the work involved by Total No. Additional 5 vZ � O CITY Tel. No. the permit is for one hundred dollars($100)or less.) PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ ny person in any manner so as to become subject to the Wo ers'Compens tion Laws. Lighting Fixtures First 20 S i ADDRESS Additional Q Q0 Total No. CITY Tel. No. Ddte !w t/ pplicantFixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, or� m.klii' ng this Certifi a of APPLICANT Exemption, you should becect to the Workers' Range_ Heater_D.W. —Compensation provisions of tCode, you must forth- Oven —Dryer —W.M.— ADDRESS with comply with such provisions or this permit shall be Top _ FAU W.H. — deemed revoked. CITY Tel, No. LICENSED CONTRACTORS DECLARATION Hood _ Fan �Other_ Dis _ Room Air Cond. •JPO Z (� LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 p' REG.NUMBER Class. (commencing with Section 7000)of Division 3 of the Business DISTRICT NO. PR ES ED BY a and Professions Code,and my license is in full force and effect. Power Apparatus 8 Large Appliances O Size 8 Type HP, KW, KVA, or KVAR c t!! License Number Lic. Class Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE VALIDATION Contractor Date❑ Over 10 to 50 Incl. W FINA I am exempt under Sec. Over 50 to 100 Inc. BY Q: B.BP.C. for this reason Over 100 Date: Services, Swbd., MCC 8 Panelboords 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V � Over 1000 Amp. or Over 600 Vxempfion for Reg. Maint. Elect, i SINGLE FAMILY Temp. Power Pole 8 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 5 2 9.3 A Law for the following reason (Section 7031.5, Business and Professions Code): # 0000 0 '2 I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ ► )' o 0 6 a 5 0 7044, Business and Professions Code). o 0 o 6 a 5 0 5 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for 0 a2 —$6 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 I` Lender's Address PERMIT ISSUING FEE U54 1 certify that I have read this application and state that the TOTAL FEE b above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and her by authorize representatives of this County to enter upon I above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permit ee Date