HomeMy Public PortalAbout5341 SANTA ANITA AVE_Electrical__ 76Fi669•CESOB 4•65 APPLICATION FOR E.LECTRICAL9ERMIT•
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE,.COUNTY ENGINEER
COLEMAN•W. JENKINS. SUPT. OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
RECEPTACLE TOTAL No. EACH FEE
j LIGHT OUTLETS FIRST 20 $.20 $ 92 OWNER
f MAIL
AOD'L 1C ADDRESS
SWITCH
OVER 20
TOTAL FIRST 20 .20 CITY TE;NE
LIGHTING 1 FIXTURES _
FIXTURES J( VER 2 ,10 CONTRACTOR T ,o
OVER 20
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS GARB.DISP. STA.COOK CITY TEDISHWASH. AUTO.-WASH. STATE
SPACE HTRS. STA.APP.(V$H.P.MAX.) ,SQ LICENSE NO.
MOTORS: OVER NOT OVER H.P. •DISTRICT NO. GROUP ZPROC SSED BY
O 1 1.00 !0
t s 1.50 INSPECTION RECORD
s s 2.00
s 1s 2.50
15 so 3.00 so too 5.00
V
SIGNSNO.TRANS. Q
rI
NO.LAMPS V
' W
SERVICE 0.600V-NOT OVER 200A 1.00 to
SERVICE O-SOOV-OVER 200 A. 2.00
SERVICE OVER 600V S.00
OTHER (SEE COMPLETE FEE SCHEDULE)
PERMIT ISSUING FEE 2.00 dov
8UPPLEMENTA13Y PERMIT ISSUING FEE 1.00
TOTAL FEE $ APPROVALS DATE INSPE oR'9 61GNwTUR6
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPL ATI ON UNDERSLAS WORK t 41 Lc
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO POWER
_ RESIDE IN,THE ABOV:FSCR:ll RESIDENTIAL PROPERTY.
SIGNATURE UTILITY CO.NOTIFIED
OF PERMIT-E
FINAL s
VALIDA JOSEPH C. N
EASH
CK MO ( ASHH SUPERVISINGG ELECTRICAL ENGINEER
LACI 3'2 2 8.p JUL 1 2 D 4.8 O N
kr COUNTY OF LOS ANGE M APPLICATION FOR PERMT
DEPARTMENT OF COUNTY ENGINEER
DIMION OF BUILDING&SAFEff ELECTRIC 1
WILLIAM 1. FOX COUNTY ENGIId M
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO,
ELECTRICIAN /11;42 '� 'r 1 �4- a 1 r
ADDRESS ,Jr ® M r ` R CEIVED READY FOR DATE ISSUED
CITY rCJ9 TEL. NO. FIRST INSPECTION
COUNTY LICENSE NO. l i EXPIRES .?O -545 BUILDING
P �.�. . ADDRESS !� �� 10111,
FEE / a
NUMBER EACH LOCALITY
LIGHT OUTLETS NEAREST
RECEPTACLES CROSS sT.
WALL SWITCHES OWNER
TOTAL OUTLETS 5C $ MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 25
5 CITY TEL. NO.
FIXTURES
MISC. 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
NUMBER OF LIGHT CIRCUITS APPLICATION AND STATE THAT THE ABOVE 16 CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBS OF RECEPTACLE CIRCUITS I AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NuMHER HORSEPOWER FEE ANGELES COUNTY LICENSE. OR I AM THE LEGAL OWNER
NEW MVD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
9 LESS $ .25 /
• SIGNATURE OF
V2 2 .50 PERMITTEE
2 5 1.00 INSPECTION RECORD
5 is 1.50
Is so 2.50
so 200 5.00 �
200 goo 10.00 / J
Boo R000 Is.00 Z 1
OVER IOOO 20.00
M.G. SET/FREQ. CHANGER-HP O
WELDERS: AC-KVA
GENERATORS-KW
TRANSFORMERS-KVA
TEMP. MOTORS 70% of oRIG.)
MOVED MOTORS (75% OF OHIO.)
MISC.
SIGNS
NO. NO.TRANS. APPROVALS
NO. NO. LAMPS
FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING $1.00 CONDUIT
FIXTURES $1.00 WIRINGvw-
SUPPLEMENTARY .50 FIXTURES
POWER
TOTAL FEE UTILITY CO. NOTIFIED !'
79A 988 008# 9A. 4-52
I /A //
WORKEr�11S'COMPENSATION DECLARATION 1:76A663 LE
APPLICATION FOR ECTRICAL PERMIT
ICE 808G (2-80)_ !�
I hereby affirm that'( have a. certificate of consent to self I: COUNTY OF LOS ANGELES BUILDING AND SAFETY
Insure,or a certificate of Workers'Compensation Insurance,or
a certified copy thereof(Sec.3900,Lab.C.) • `
�(�,�J � FOR APPLICANT TO FILL IN JOB
Policy N 1� � ompany �i New Residential Bldgs.&Pools -EACH . .NO. FEE ADDRESS 3
`.❑ Certified copy is hereby furnished. 40- 1 &'2-Family,Sq.F.t. $ — $ LOCALITY
Certified co Multi-family Sq.Ft. — NEAREST
�`d copy is filed with the county buildin inspection Residential Swimming Pools CROSS ST
apartment. OWNER OR �)
-21 FIRM NAME i C/
Da'teApplicant -Outlets: Rec..—Light Sw. ADDRESS J
First 20
CE_ RTIFICATE.OF EXEMPTION-FROM WORKERS' Total No. Additional CITY Tel No.
COMPENSATION INSURANCE
PLAWCHECW d
(This section need not be completed if the work involved APPLICANT 0.
by the permit is for one hundred dollars ($100) or less:) Lighting Fixtures First 20 ADDRESS
Total No. Additional O
I certify that in the performance of the work for which this Fixed Appliances.Not Over 1 HP CITY Tel No.
permit is issued, I shall not employ any person in any manner PERMIT
so.as to become subject to the Workers'Compensation Laws. Range_Heater D.W. _ APPLI.CANT
Oven _ Dryer_W.M.._ ADD ' N
Date Applicant Top _ FAU _W.H.,— ��
Hood _ Fan _Other_ CITY o. J
NOTJCE TO APPLICANT:If, after making this Certificate of Disp. _Room Air Cond— LICE SE O. 7�
Exemption, you should become subject to the Workers' REG.NUMBER . �r
.Compensation provisions of the Labor Code,you must forth- Power Apparatus&Large Appliances DISTRICT NO. PR ES D BY
with comply with such provisions or this permit shall be ze&,Typ HP,KIN,KVA,or KVAR
deemed revoked.
Up to 1 Incl. FINAL
LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATE 1 F/ VALIDATION
Over 10 to 50 Incl. (�
I hereby affirm that I am licensed'under,provisions of Chapter ,• Over 50 to 1.00 Inc. FINAL
9 (coinmencing with?Section 7000)of Division 3 of the Busi- I Over 100 BY s
ness and Professions.Code,and my license is in full force and
effect. / �+ �•/ Services
License Numb e ` Lic.Class ` `U C' Y 0-200 Amp.Under 600 V '
201-1000 Amp.Under 600 V
ContractorDate "' /acs'/l' Over 1000 Amp.or Over 600 V
HO. DER DECLARATION, Temp.Power Pole&Appurtenances
I hereby affirm that I am exempt from the Contractor'sSign.with One Branch Circuit .
License Law for the following reason .(Section 7031.5, Busi- Additional Sign Branch Circuits 5 2' 6 A
ness'and Professions Code): - 1 o
Misc.Conduits&Conductors # 0 0 0 0 0 2
El I, 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). 1. 2 0 o 1 200
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction Lending agency o'o o 2 0 O'cxr
for the performance of the work for which this permit is
issued(Sec.3097,Civ.C.). PERMIT FEE (Sub-Total) 0 S 1 '5_8 1
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 TQTAL FEE'
above 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-mentione ro.perty for inspection purposes.
SEE'REVERSE FOR EXPLANATORY LANGUAGE
�S eS .J'�
ignature of Permi a Date
- I