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Home My Public Portal About6164 SULTANA AVE_Electrical__ 7GA663-CE6061-67 APPLICATION FOR. E.LECTRI AL PERMI COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS (p JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING• LOCALITY ,. NEAREST FOR APPLICANT TO FILL IN CROSS ST. RECEPT. 1 OUTLETS TOTAL NO. EACH FEE I FIRST 20 8.20 S OWNER LIGHT J} MAIL SWITCHADD-L 10 ADDRES OVER 20 TOTAL FIRST 20 .20 CITY TEL.NO. LIGHTING FIXTURES FIXTURES ADD•L CONTRACTOR OVIER 20 10 RANGES DRYERS WTR.HTRS. 1.00 ADDRESS S O a GARB.DISP. STA.COOK CITY f TEL.NO. DISHWASH. AUTO.-WASH. STATE Il SPACE HTRS. STA. APPL. .50 LICENSE NO. MOTORS: OVER NOT OVER H.P. DISTRICT IMP P Z P O_____ B O 1 1.00 �- 1 9 ` 1.50 INSPECTION RECORD s 6 2.00 S is 2.50 15 50 3.00 so 100 5.00 0 SIGNS: NO.TRANS. of NO.LAMPS bSERVICE 0.600V-NOT OVER 200A 1.00 U Q W SERVICE 0.60OV.OVER 200 A: 2.00 y SERVICE OVER 600V 5.00 ? OTHER (SEE COMPLETE FEE SCHEDULE) PERMIT ISSUING FEE 2.00 (}Q L� SUPPLEMENTARY PERMIT ISSUING FEE 1.00 APPROVALS DATE INSPECTOR'S SIGNATURE TOTAL FEE 8 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION UNDERSEAS WORK AND STATE THAT THE ABOVE 11 CORRECT AND AGREE TO COMPLY ROUGH CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING - ELECTRICAL WIRING. WIRING r 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT1 LEGA OWN ,AND INTEND TO POWER RESIDE IN.THE ABO D R ED SID ROPERTY. SIGNATURE e ` UTILITY CO.NOTIFIED OF PERMITTEE - FINAL LIDATION JOSEPH C. ROOHAN SUPERVISING ELECTRICAL ENGINEER K MO CASH 0463 SEP 6 2 D 4..50 4 1 ', y�4CORKERS'COMPENSATION DECLARATION 76A663 10/81 nn O pp pp�� [[�� q�® C AA ` ! Hereby affirm that I have a certificate of consent to self CE-806G E�PPLOCATI®II��,1 FOR ELECTRICAL RICAL PERMIT insure, or a certificate of Worker-#Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3600, Lab. C.) Policy No. s Cc-npony FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS ❑ Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ _ $ LOCALITY tion department. Multi-family Sq. Ft. NEAREST CROSS ST. Residential Swimming Pools Date Applicant OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec� Light Sw./ AMAIL DDRESS COMPENSATION INSURANCE First 20 (This section need not be completed if the work involvod by Total No. Additional CITY T Tel. No. 774/ the permit is for one hundred dollars(5.100)or less.) PLAN CHECK Jr I certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ any person in any manner so as to become subject to the Worke Co en ion S. Lighting Fixtures First 20 ADDRESS Total No. Additional CITY Tel. No. Date lica Fixed Appliances Not Over 1 HP PERMIT r NOTICE TO APPLICANT: I , er 's C making rfificate of APPLICANT Exemption, you should ecome 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. — deemed revoked. CITY el. IVo. �7-^ o Hood _ Fan —Other_ LICENSED CONTRACTORS DECLARATION 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 Business DISTRICT NO. PROCESSED BY and Professions Code and my lcse is in full force and effect. Power Apparatus&Large Appliances y. Size&Type HP, KW, KVA, or KVAR 510 ;Iam e Numb Lic. Class. Up to 1 Incl. FINAL /i Over 1 to 10 Incl. DATE �� f� VA IDATION ct 74347 Over 10 to 50 Incl. FIN l/9 � exempt under Sec. Over 50 to 100 Inc. B Over 100 B.&P.C. for this reason Date: Services, Swbd., MCC&Ponelboords =- 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ c n Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V # 0 6 SINGLE FAMILY Temp. Power Pole&Appurtenances o o 5 0 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 1 hereby affirm that I am exempt from the Contractor's License o o o l 3 5 C Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): 013-87 7 ❑ 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 t✓ Lender's Address I certify that I have read this application and state that the TOTAL FEE above information is correct. I agree to comply with all County ordinances nd State laws regulating Electrical wiring, and hereby a oriz repre ative f this County to enter upon the ob -ment ned r perfy spection purposes. 4 SEE REVERSE FOR EXPLANATORY LANGUAGE J ignafure of Per tee Date WORKERS'COMPENSATION DECLARATION, 76A663 10/81 CE-8d6G - APPLICATION FOR Ed CTRICAL PERMIT hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES l BUILDING AND SAFETY or a certified copy thereof(Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB / �( Certified co is hereby furnished. EACH NO. FEE ADDRESS fo [ 1 PY Y New Residential Bldgs. &Pools _ ❑ 1 &2-Family, S Ft. $ — $ LOCALITY Certified copy is filed with the county building inspec- Y. q' N tion department. Multi-family Sq. Ft. EAREST Residential Swimming Pools CROSS ST. Date Applicant OWNER OR r FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Li _MAIL COMPENSATION INSURANCE Outlets: Rec Light S w. 715 _ ADDRESS First 204 -� �S r17 (This section nood not be completed If tho work involvod by Total No. Additional CITY Tel. No. 861 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 Date�- 15 - �A/ Applicant y, Q CITY Tel o. Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after makinb 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 _ FAUW.H. — CITY Tel. No.deemed revoked. IHood _ Fan Other_ LICENSED CONTRACTORS DECLARATION [CENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room it Cand. < REG.NUMBER Class. (commencing with Section 7000)of Division 3 of the Business DISTRICT NO. PROCES BY �. and Professions Code,and my license is in full force and effect. Power Apparatus 8 Large Appliances Size&Type HP, KW, KVA, or KVAR /d O �s License Number Lic. Class Up to 1 Incl. FINALcccc F� Contractor Date Over 1 to 10 Incl. DAT VALIDATION Over 10 to 50 Incl. FINAL ❑ I am exempt under Sec. Over 50 to 100 Inc. BY d Over 100 B.&P.C. for this reason J Date: Services, Swbd., MCC&Panelboards 110, 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 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 7031.5, Business and Pro ssions 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 TOTAL 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-mention d property for inspection purrp�posses.QQ(�� SEE REVERSE FOR EXPLANATORY LANGUAGE Z5L Signature f Permitfee- Date WORKER'S COMPENSATION DECLARATION DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT 76A663 I hereby affirm that I have a certificate of consent to self insure, 7BA663 or a certifipate of WErker's Compensation Insurance,or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN DB ADDRESS Certified copy is hereby furnished ❑ NO. EACH FEE . New Residential Bldgs.&Pools _ $ $ LOCALITY ❑ Certified copy is filed with the county building inspection 1&2-Family,Sq.Ft. NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE I PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec.—,a-Light_L S. F RM NAMOR f COMPENSATION INSURANCE Q (This section need not be completed If the work Involved by the First o MAIL 64 permit Is for one hundred dollars(13100)or less.) Total No. Additional ADDRESS W I certify that in the performance of the work for which this permit CITY "'� Tel.No. 4 is issued, I shall not employ anyNn n in any m ner so as to become subject to the Workers'Co on Laws. Lighting Fixtures First 20 APPLICANTKtTotal No.�_ AdditionalADDRESS Date ` Applicant d T( ESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after makin this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code,you must forthwith comply with such PERMIT p p y provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000)of Division 3 of the Business and CITY Tel.No. .Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR Over 50 to 100 Incl. REO.NUMBER Class' d Over 100 DISTRICT NO. P SED BY V License Number Lie.Class Services,Swbd.,MCC&Panelboards Contractor Date 0-399 Amp.Under 600 V DATE O F1I am exempt under Sec. 400-1000 Amp.Under 600 V �� VALIDATION W Over 1000 Amp.or Over 600 V FINAL 0., B.&P.C.for this reason BRANCH CIRCUIT FEES BY r Z Date: 15A,or220A,120V,Lighting or Recept. �' — a$yam 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ Al Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances E:{^" L HOME OWNER-BUILDER DECLARATION rti•.•1 o iT it —ch Ci B with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law Sign w for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits Code I,as owner of thero ert ,will do the work and the structure Misc.Conduits&Conductors P P Y � 55 o. is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). ® CHECK CONSTRUCTION LENDING AGENCY CHANGE .0-1 I hereby affirm that there is a construction lending agency for the �f performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) oc q Civ.C.) _ PLAN CHECKING FEE Lender's Name / 6451 + AM ILC;56 PERMIT ISSUING FEE (p Lender's Address TOTAL FEE I certify that I have read this application and under penalty of purjury state that the above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring,and hereby authorize ,111nCtIton s of this County to enter upon the above-mentioned property purpo es. SEE REVERSE FOR EXPLANATORY LANGUAGE IIT ERMITtEE DATE