HomeMy Public PortalAbout5749 ROWLAND AVE_Electrical__ 76A663-CE&06 9-17 APPLICATION FOR ELECTRICAL PERMIT
a " 43OUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS Ow frNrJ
JOHN A. LAMBIE, COUNTY ENGINEER �J
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.. L-o IS G,
NO. EACH FEE
RECEPT..#- $ $ OWNER r
MAIL
LIGHT 1 TOTAL FIRST 20 .20 O ADDRESS ,VA.
SWITCH OVER 20 .10 CITY G EL. NO.
LIGHTING �.TOTAL FIRST 20 .20 CONTRACTORFIXTURES ' OVER 20 .10 ADDRESS A
RANGE—DRYER—WTR.HTR.— CITY 'oTEL//NO. `I1 .'j'5�VIP
STA.COOK_OISP.—F.A.U.._ LICENSE NO. yd 17
SPACE HTR. AIR CO'ND. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
ANO STATE THAT THE ABOVE IS. CORRECT AND AGREE TO COMPLY
CLOTHES WASH._DISHWASH._ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING.
FAN-OTHER 1.00I-HEREBY CERTIFY THAT I AM PROPERLY REGISTERED'AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
MOTORS,TRANSFORMERS RATING CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO
IND. HEATERS, ETC. HP. KW. KVA. RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY.
SIZE & TYPE OVER TO SIGNATURE.
0 - 1 1.00 OF PERMITTEE
0
1 - 10 3.00 DISTRICT NO. G P ZO P D U
10 - 50 5.00 Q O
50 - 100 10.00 NOTES: b
W
100 - 500 15.00 nN'
SIGN,GAS SIGN AND ONE CIRCUIT 3.00
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 ov
SERVICE OVER 600 VOLTS OR.200 AMP 5.00
TEMP SERVICE, POLE, &APPURTENANCES 3.00
APPROVALS DATE INSPECTOR'S SIGNATURE
TEMP. POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT y✓
WIRING 21 ,Q(. A
ISSUING FEE 2.00
FIXTURES
SUPPLEMENTARY ISSUING FEE 1.00 POWER AUTHORIZED
PERMIT FEE UTILITY CO.NOTIFIED !94 Em
PLAN CHECK FEE (50% PERMIT FEE) FINAL ��' n.� _g/ '
TOTAL FEE f JOSEPH C. ROOHAN
SUPERVISING ELEC ICAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK M.O. CASH
1 9 3 liz NOV 29 2 D 5.8 0-
EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE Ck�.//jn� I����NI+'�/!/Vi•L/
WORKERS'COMPENSATION DECLARATION 76-663 10/81
CE-60eG APPLICATION FOR ELECTRICAL PERMIT -
I,,bereby affirm that I have a certificate of 4consent to self insure,
or a certificate of Workers' Compensation Igsurance,or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
cop*th�redF(Sep.3800,Lab.C.) �y /
PolicyliNo. Company FOR APPLICANT TO FILL IN JOB
❑ EACH NO. FEE ADDRESS �f
Certified copy is hereby furnished. New Residential Bldgs.&Pools
❑ Certified copy is filed with the county building inspection !1 &2-Family,Sq.Ft. $ _ $ LOCALITY 7eR'�jr
��♦ ��� a ,
department. IMulti-family Sq.Ft. NEAREST
CROss ST. �y l� /✓
Date Applicant Residential Swimming Pools OWNER OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec Light SW.-� L MAIL COMPENSATION INSURANCE 5 ADDRESS 6740 /r 0604.¢i,/9>
(This section need not be completed if the work involved by the First 20
permit is for one hundred dollars($100)or less.) Total No. Additional CITYr7�j �1��5/ Tel.No.������
1 certify that.in the performance of the work for which this permit PLAN CHECK
APPLICANT
is issued, I shall not employ any person in any manner so as to
become subject to the Workers'Compens tion Laws. Lighting Fixtures First 20 ADDRESS
Total No.
Additional
�J � CITY Tel.No.
X Date r �a Applican A Fixed Appliances Not Over 1 HP
'`NOTICE TO APPLICANT: If, after making this Certificate of PERMIT
Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. _ APPLICANT
provisions of 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 Tei.No.
LICENSED CONTRACTORS DECLARATION Hood— Fan Other-L-
I
therLI hereby affirm that I am licensed under provisions of Chapter 9LICENSE OR
(commencing with Section 7000)of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER Class.
Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO.
ESS Y ,
W
Size&Type HP,KW,KVA,or KVAR 45 t O
License Number Lic.Class Up to 1 Incl. FINALQc,, Q
Contractor Date Over 1 to 10 Incl. DATE VALIDATION O
Over 10 to 50 Incl. FINAL
❑ I am exempt under Sec. Over 50 to 100 Inc. BY W
Over 100 n'
B.&P.C.for this reason / Z
Services,Swbd.,MCC&Panelboards
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
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuita
I hereby affirm that I am exempt from the Contractor's License Law ACCTA
for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits
Code): 3307 45.25
X I,as owner of the property,will do the work and the structure
® Misc.Conduits&Conductors 1 ITEMS
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule)
TOTAL 4F5 o 25
and Professions Code).
25
CONSTRUCTION LENDING AGENCY
CHECK °
I hereby affirm that there is a construction lending agency for the CHANGE 00
performance of the Work for which this permit is issued(Sec.3097, PERMIT FEE: (Sub-Total)
Civ.C.).
PLAN CHECKING FEE
Lender's Name 1
QQQtI-0101 9/13/89
PERMIT ISSUING FEE 5572 1 AM 8!46
Lender's Address
1 certify that I have read this application and state that.the above TOTAL FEE
information is correct.I agree to comply with all County ordinances
and State laws regulating Electrical wiring, and hereby authorize
representatives of this County to enter upon the above-mentioned
grope for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
XSignature of Permittee Date