HomeMy Public PortalAbout5636 SULTANA AVE_Electrical__ 'fiA8fi3-CER06 5-82 AP,P�ICATIOIV R ELECT ICAL PERMIT
1 COUNTY OF LOS ANGELES
DEBUILDI�NG AND SAFETY DIVISIONENT OF COUNTY wUDGRE'ss 636 3u1
JOHN A LAMBIE COUNTY ENGINEER
WILLIAM A JENSEN SUP T OF BUILDING LOCALITY
NEAREST
q
FOR A PLIC NT TO FILL IN CROSS ST Las Tunas
RECEPT (• TOTAL 1—No EACH F[[
1.2 OUTLETS FIRST 201 20 S 4 OQ OWNER stiogg
LISHT
�I� ADWL29 �y� ADDRESS
SWITDH 14 --�J—. OVER 20 to 2 90
CITY TEL NO
LIGHTING TOTAL FIRST 20 1 20 2 40
FIXTURES 12 ADD L 10 ELECTRICIAN Mansfield Eleetri
DV R 20
RANGES l CLO DRY] l WTR HTRe f DD - ADDRESS 89W E. Valle B Vd
GARB DISP l BTA COOK
CITY Rosemead TEL NO
DIGHWKSH AUTO WASH 50 STATE
SPACE HTRS Rw APP (WHIP MAX ) So fLICENSE NO
MOTORS OVER NOT OVER H P DISTRICT GROUP NE PRD SEED BY
O 1 100
1 a t so INSPECTION RECORD
B 15 2 80 \ d
O
IS SO• soo , V
50 too 5001
O
SIGNS NO TRANS ()
NO LAMPS
d
SERVICE O ROOV NOT OVER 200A 100 l 00 Z
SERVICE O BOOV OVER 200 A 200
SERVICE OVER SOOV 500
MISE
PERMIT ISSUING FEE - 2001 0
SUPPLEMENTARY PERMIT ISSUING FEE 100
TOTAL FEE S 14 8
1 H[R[RY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONAPPROVALS DAT[ INMN
ECTOR R SIGIATI
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT ///I
WITH ALL COU HTY ORDINANCES AND STATE LAWS REGULATING ) J'1 {jl�,�
ELECTRICAL WIRING WIRING Y //1�vOMl
I HERESY CERTIF
LICENSED AY THAT I AM PROPERLY REGISTERSO ANOIOR I / • ,
E REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I M TH[ LEGAL OWNER THE ABOVE
DESCRIBED REBIDENTIA _! _.RT,
POWER
SIGNATURE UTILITY CO NOTIFICD �n
OF PERMITT
FINAL a I I /� -'e9l/✓•N/
a`hI VALIDATION ARTHUR C VEIT '
K MO CASH SUPERVISING ELECTRICAL ENGINEER
LAAO 3 2 9 2 G WR 12 2 D 1 4.80-
a
ION
WORKERS have
a certificate
of consent to 7BAB06 ,DrB, APPLICATION FOR ELECTRICAL PERMIT {�
hhejeby affirm that I have a certificate of consent to self insure �eoBc �f
pe
or a certificate of Workers Cdr neaten Insurance or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof
(Sec 3800 Lab C) 'AQJ 1�`F
policy �i3 C rrpany v FOR APPLICANT TO FILL IN ADDRJOB ESS
E] Certified copy is hereby furnished r New Residents]Bldgs & ols EACH NO FEE
Certified
r — $ LOCALITY
Certified copy is bled with lite county huiaing inspection 14& 2-Family Sq Ft $
ST
p nt Multi family Sq Ft — CROSS `._ W
Date 1 � Applicant ��� i Resxlential Swimming Pools OWNER OR M� „` It. .`
FIRM NAME t 4 )
CERTIFICATE OF EXEMPTION FROM WORKERS pullets Rec Light $w LLNL /
COMPENSATION INSURANCE ADDRESS fj lr ✓C.L.d-G.(ill�!
(This section need not be completed d the work involved 20volvetl by the Total No AtltlRanal CITY � � C No -�
permit is for one hundred dollars ($100) or less)
FLAN 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 Lighhrki Fixtures First 20 ADDRESS -
Total No Additional. CITY,- Tel No
Date ,Applicant
NOTICE TO APPLICANT If after making this Certificate of Fixed Appliances Not Over 1 HP P�FRM�T CC Q�
Exemption you should become subject to the Workers Compensation Range— Heater_ DW
proviaons of the Labor Code you must forthwith campy with such Oven _ Dryer _ WM — ADDRESS Yo 70 e r t
prwisionsior this permit shall be deemed revokeda l `_Top — EAU _ WH v
LICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other_ CITY Tel No �
I thereby affirm that I am licensed under provisions of Chapter 9LICENSE OR 11^^
(commencing with Sector 7000) of Drvison 3 of the Busineas and Cop — Room Air Coed REG NUMBER Z Z? ctaa'
Professions Code and my license is in full force and effect Power,Apparatus& Large Appliances _ DISTRCT NO PROCESSED BY
-?
Size& Type HP KW KVA or KVAR L� A
License Number �J` Lo Class C
Up tollnG` ' FINAL
�uL'� \ \ 1 -'� Over 1 to 10 Incl DATE i�(� d'
Contractor Date� ! 2 , VALIDATION
❑ 'Over 10 to 50 Incl FlNA / U
I am exempt under Sec Over 50 to 100 Inc BV�T W
Over 100 l��Jll d
S&PC for this reason N
Servaes'Swbd MCC & Panelboards -' Z
Date 0- 200 Amp Under 600 V
Signature 201 - 1000 Amp Under 600 V
❑
Exemption for Reg MaOver 1000 Amp or Over 600 V _
mt Elect
2
SINGLE FAMILY Temp Power Pole 8 Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ACCT.i
I Hereby affirm that I am exempt from the Contractors License Law Additional Sign Branch Qralns ;�17 L).130
for the following reason(Section 7031 5 Business and Professions
Code) '
❑ I as owner of the property will do the work and the structure Misc Conduits 8 Conductors 1 ITEh�;
is not intended or offered for sale (Section 7044 Business other(See Complete Fee Schedule) TOTAL
22 - 00
and Professions Code) i
CWK 22.00
CONSTRUCTION LENDING AGENCY LU.`ur
I hereby affirm that there is a construction lending agency for the CHANE .OI]
performance of the work for which this permit is Issued(Sec 3087 PERMIT FEE - (Sub Total) -
Cry C)
PLAN CHECKING FEE 0CIGO-0001 10/ 4I fl
Lenders Name PERMIT ISSUING FEE QM 11]:int
Lenders Address
I 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 authonze
representatives of the County to enter upon the above-mentioned
property for lnspectin purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
X'l l4 fan
SigneSgne r a Date