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HomeMy Public PortalAbout5927 ROWLAND AVE_Electrical__ BA888-C@808 f0-88 APPLICATION FOR E LE TRIC PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT AND SAFETY UNTYENGINEER ADDRESSRow land JOHN A. LAMBIE. COUNTY ENGINEER 5927 N. WILLIAM A.JENSEN.SUPT OF BUILDING LOCALITY Temple Citi FOR APPLICANT TO FILL IN NEAREST PERM FEES CROSS ST. Las Tunas Dr* ITEM NUMBER OWNER d�.EACH FEE MAIL OUTLE $ $ ADDRESS LIGHTSG RECEPP.�7 1 SW. 13 .10 3-130 LIGHTING FIXTURES 2 2 10 20+ CITY TEL.NO. ELEC.RANGES CLO.DRYERS ELECTRICIAN C•0p�111®8 & son 6C r C 1V WATER HEATERS .50 ADDRESS-1. O N. Gran V' ®W AVeo @LEC.SPACE HTRS. DISHWASHERS GARBAGE DISPOSERsl AUTO.- v STATE CITY S©• S n Gabr 8 L. N • WASHERS STA.COOKING UNITS .2S 2 LICENSE NO. 1 6 C-10 MOTORS: OVER INC. H.P. DISTRICT O. GROUP ' ZZONI_Ij P ESS W BY Pano— 1/z 1 .2s , O Z I�� I/a— 2 .so INSPECTION RECORD 2— s 1.00 s— its 1.50 is— s0 2.50 / 50-200 s.00 7 6 0 e9k NO.TRANS. �� �D �� '�. •7 SIGNS: NO.LAMPS f SA,/ 7AW s Q SERVICED-600V ] 1.00 Q0 R/F F_l.ECT a' Y SERVICE OVER 600V 5.00 Misc: OT 26�l1F Bh' WIRING PERMIT 1.00 31.00 oT m,9. c YET FIXTURE PERMIT 1.00 .00 ` J1=/t,RL SUPPLEMENTARY PERMIT SO TOTAL FEE S s 1 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 ORDINANCES AND STATE LAWS REGULATING CONDUIT. / /�aLC ELECTRICAL WIRING. WIRING "ZZ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR / LICENSED :AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES - ,t�r•�d�f/.L��'�J('p CALIFORNIA OR THAT B THE LEGAL OWNER OF THE AOVE DESCRIBED RESIDENTIPR ER POWER f,�} SIGNATURE 0UTILITY CO.NOTIFIED '�'" OF PERM I"' 7��F31 ATION ARTHUR C.VEIT, SUPERVI MO CASH SING ELECTRICAL ENGINEER CK � ��`9 2 4 4 9 % JUN 2 0 2 D 5.� � 0 WORKERS'COMPENSATION DECLARATION 7 663 10/81 APPLICATION,ION, FOR ELECTRICAL PERMIT I hereby affirm that I have a Certificate of consent to self CEI • insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy there f SjeFOR AP c. 3800...(Lab. Policy No. �C.) O�S Camp n�TLti �0�1 APPLICANT TO FILL IN JOB! R r Certified copy is hereby furnished. Ipts J=ulvo New Residential Bldgs. & Pools EACH NO. FEE ADDRESS 1 &2-Family, 1�^Q $ — $ LOCALITY Certified copy is filed with the county building inspee- y, Sq. Ft. .� tion department. �i f, _ Multi-family Sq. Ft. — NEAREST Date q —10 -`u HALAEL .�Uz f Residential Swimming Pools OWNER OR T Applicant FIRM NAME L CERTIFICATE OF EXEMPTION FROM WORKERS' p2O MAfL COMPENSATION INSURANCE Outlets: Rec Light Sw. Cd ADDRESS AG)i,iJ L-1140 U This section need not be completed if the work Involved b A df ti , ( p Y Total No. Additional CITY I•�YZ'vQ C Tel. No. the permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this PLAN CHECKAPPLICANT permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional CITY Te. Date ApplicantFixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: I.f, after making this.Certificate of APPLICANT Exemption, you should become subject to the Workers' Range_ Heater—D.W. Compensation provisions of the Labor Code, you must forth- Oven —Dryer W.M.— ADDRESS with comply with such provisions or this permit shall be Top _ FAU —W.H. — CITY Tel. No. deemed revoked. Hood Fan _Other_ LICENSED CONTRACTORS DECLARATION 10S6 LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. REG..NUMBER Class. (commencing with Section 7000.)of Division 3 of the BusinessDISTRICT NO: PROCESSED BY and Professions Code,and my license.is'in-full force.and effect. Power Apparatus&Large Appliances � V/I�( Size&Type HP; KW, KVA, or KVAR• L ( U License Number Lic. Class Up to 1 Incl. FINAL .. Over 1 to 10 Incl. DATE � VAL ATION Contractor Date Over 10 to 50 Incl. FIN V ❑ I am exempt under Sec. Over 50 to 100 Inc. BY 8 3 2 9 A U11 BAP.C. for this reason Over 100 # o a o o,c 2 #A Date: Services, Swbd., MCC&Panelboards 0 -200 Amp. Under 600 V I - - 49.25 Signature 201 - 1000 Amp. Under 600 V o 0 0 4 9.2 5 5 Over 1000 Amp. or Over 600 V ❑ Exemption for Reg. Maint. Elect. 0-87 SINGLE FAMILY Temp. Power Pole&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 Law for the following reason (Section 7931.5, Business and rofessions Code): I, as owner of the property, will-do the work and the Misc. Conduits&Conductors structure is not intended or offered for sale (Section, Other(See Complete Fee Schedule)_ 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 issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.).. PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE _ Lender's Address I certify that I have read this application and state that the I TOTAL FEE t above.information is correct. I agree to comply with all County ordinances and'State laws regulating Electrical wiring, and hereby authorize repre atives of this County to enter upon t above-mention,jd'proVerty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Pere Date , R _s-✓ "RKERS'COMPENSATION DECLARATION ) 78A663 1081 APPLICATION FOR ELECTRICAL PERMIT I herby affirm that I have a certificate of consent to self Insure, CE-8086 or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab.C.) Policy No. Company I FOR APPLICANT TO FILL IN Job ❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ADDRESS `J _ $ LOCALITY ���Ol� &; .. Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. $ department. Multi-family Sq.Ft. NEAREST V. OSS ST11%2,1 ol Date Applicant Residential Swimming Pools _LOSS OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec—Light—Sw.— MAIL COMPENSATION INSURANCEADDRESS I(� 5 C,7 to r (This section need not be completed If the work Involved by the First 20 CITY permit is for one hundred dollars($100)or less.) Total No. Additional PLAN CHECK' I certify that in the performance of the work for which this permit APPLICANT is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS J_2I,? A q Additional d Total No. CITY T . Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making thi ert' ate of APPLICANT Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. 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 Tel.No. LICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other_ I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR Class. (commencing with Section 7000)of Division 3 of the Business and REG.NUMBER Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT ] PROCESSED e Size&Type HP,KW,KVA,or KVAR ✓l L Q License Number Lic.Class Up to 1 Incl. ' FINAL V Over 1 to 10 Incl. DATE Z�� VAL ION 0 Contractor Date Over 10 to 50 Incl. FI I--- ❑ I am exempt under Sec. Over 50 to 100 Inc. B LLLI 1. B.&P.C.for this reason Over 100 Z Date: Services,Swbd.,MCC&Panelboards , 0-200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V ❑ Exemption for Reg.Maint.Elect, Over 1000 Amp.or Over 600 V 9 21.5 A SINGLE FAMILY Temp.Power Pole&Appurtenances #,! 0 0 0 0 0 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits I' ­ 2S50 for the following reason(Section 7031.5,Business and Professions Code): '0 a - 25,500 I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors 0 319-88 \ is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) 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) Civ.C.): PLAN CHECKING FEE Lender's Name ' PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the above TOTAL FEE �r 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 p7&.&44 rty for inspection poses. I SEE REVERSE FOR EXPLANATORY LANGUAGE I - 31-.-L I J,98 Sig ature of Permit Dat