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Home My Public Portal About6155 SULTANA AVE_Electrical__ 76A663-CE8061-68 APPLICATION FOR ELECTRIC L PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING /__, �.JL7/}"�� BUILDING AND SAFETY DIVISION ADDRESS (� JOHN A. LAMBIE, COUNTY ENGINEER _- COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST d ,n CROSS ST. I[7LvJ I NO.. EACH FEE RECEPT. $ $ OWNER �, Wi LL L'� T 7' MAIL LIGHT TOTAL FIRST 20 .20 ADDRESS SWITCH __r' OVER.20 .10 CITY TEL. NO.G%P J 6 . PLAN CHECK LIGHTING }TOTAL FIRST 20 2001. .20 ` // APPLICANT FIXTURES 1y OVER 20 .10 ADDRESS RANGE=DRYER—WTR.HTR.— CITY TEL. NO.• STA.COOK_DISP.—F.A.U,_ CONTRACTOR � aP SPACE HTR. AIR COND. ADDRESSM"3 CLOTHES WASH.+ DISHWASH._ CITY TEL. NO. FAN—OTHER 1.00 �® LICENSE NO. .1 O- V CLASS. el–/® MOTORS,TRANSFORMERS RATING IND. HEATERS, ETC. HP. KW. KVA. I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. 0 - 1 1.00 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 1 - 10 3.00 LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF } CALIFORNIA OR THAT I AM GAL OWNER AND INTEND TO D. 10 - 50' 5.00 RESIDE IN, THE ABO DES IBED REST NTIAL PROPERTY. O SIGNATURE V 50 - 100 10.00 OF PERMITTE 100 - 500 15.00 DISTRICT N R Z ESIGN GAS P E TUBE, OR SIGN AND ONE CIRCUIT 3.00 Lu MARQUIL EE ADDITIONAL CIRCUITS 1.00h NOTES: Z SERVICE NOT.OVER 600 VOLTS OR 200 AMP 2:00 Q SERVICE OVER 600 VOLTS OR 200 AMP 5.00 TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVAL'S DATE INSPECTOR'S SIGNATURE TEMP. POWER POLE UNDERSLAB WORK ROUGH CONDUIT PERMIT FEE (SUB TOTAL) WIRING FIXTURES PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED PERMIT ISSUING FEE 2.:OOl 1400 UTILITY CO.NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1.00 I FINAL g �� TOTAL FEE ®G JO C. ROOHAN SUPERVISING ELECTRICAL ENGIN PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH LffiLe 5 7 9 6 AUG 7 ? a 7.0 0- a :E BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE WORKERS'COMPENSATION DECLARATION 161 DPW 3/87 I hereby affirm that I have a certificate of consent to self CEE3 APPLICATION FOR ELECTRICAL PERMIT O insure, or a certificate of Workers'Compensation Insurance, I COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a.certified copy thereof (Sec. 3800, Lob. C.) I Pblicy No. Company j FOR APPLICANT TO FILL IN JOB 6`� ❑ ertified copy is hereby furnished. Nei Residential Bldgs. &Pools EACH NO. FEE ADDRESS l • CCCertified co is filed with the count building inspec- I A 2-Family, S Ft. $ — $ LOCALITY PY � Y 9 � P Y� q• tion department. I ulti-family Sq. Ft. — NEAREST I Residential Swimming Pools CROSS ST. OWNER OR Date Applicant I I FIRM NAME Lc�A�Lt CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec�Light Sw._ t MAIL I COMPENSATION INSURANCE ADDRESS (� A3ttiA tThis section need not be completed If the work Involved b First 20 he permit Is for one hundred dollars($100)or less.) Y Total No. Additional CITY / Tel. No.3�(��y,� I ertify that in the performance of the work for which this A PLICANTPLANCHECK P mit is issued, I shall not employ any person in any manner so s to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional Dae U0 Applicant i Tofal No. CITY Tel. No. NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exdmption, you should become subject to the Workers' Range— Heater—D.W. _ APPLICATION 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. — deemed revoked. Hood — Fan —Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. — REG. NUMBER Class. (coTmencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PROCESBY d and,Professions Code,and my license is in full force and effect. O Size,&Type HP, KW, KVA, or KVAR License Number Lic. Class Up to 1 Incl. FIJ) U Over 1 to 10 Incl. D VA TION Contractor Date Over 10 to 50 Incl. FINAL O ❑ ' I am exempt under Sec. Over 50 to 100 Inc. BY ..9 8 7J,E A W B.&P.C. for this reason Over 100 1ft 0 0 0 0 0 2 Date. Services, Swbd., MCC&Ponelboards ® Z 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 o 0 0 1 �j ,ti 0 � SINGLE FAMILY Appurtenances Temp. Power Pole 8 App HOME OWNER-BUILDER DECLARATION O b.V 9 '.8 H 1 hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Prof ssions Code): as owner of the property, will do the work and the Misc. Conduits 8 Conductors structure is not intended or offered for sale(Section 7044, Other(tee Complete Fee Schedule)_ 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 ISUING FEE Lender's Address TOTAL FEE 3 Sv I certify that I have read this application and state that the 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-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ®a Signature of Permittee L, IDdite I