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HomeMy Public PortalAbout6240 SULTANA AVE_Electrical__ 16A663 CE-9106(0/7131 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANTTO FILL IN JOB / '� New Residential Bldgs.&Pools EACH NO. FEE ADDRESS N 1 &2-Family,Sq.Ft. $ .025 — $ LOCALITY Multi-family Sq.Ft. .02 — NEAREST PF 25.00 CROSS ST. :6f Residential Swimming.Pools OWNER OR FIRM NAME Outlets:Rec�Light Sw. .AIL ' ` ^1 First 20 .50 DDRESS N ' u 19I�itJ.� Total No.. Additional .30 CIT aaf6el.No. PLAN CHECK APPLICANT L(ghting.Fixtures First 20 •50 ADDRESS Additional .30 Total No. CITY Tel.No. Fixed Appliances Not Over 1 HP PERMIT Range—Heater—D.W._ APPLICANT Oven_Dryer_W.M. ADDRESS F� C7®-�A%• `i�d r� P Top _FAU _W.H._ CITY s'. Tel.N63y" D Hood_Fan —Other LICENSE OR Disp:_Room.Air Cond. 2.50 REG:NUMBER Class- ID I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA.. Power Apparatus&Large Appliances 'TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO Siie&Type HP,KW.,KVA,or KVAR' COMPLY WITH ALL COUNTY-ORDINANCES AND STATE LAWS 2.50 REGULATING ELECTRICAL WIRING. Up to 1 Incl I HEREBY. TIFY THAT I AM PROPERLY REGISTERED AND/OR 0 Over 1 to 10 Incl. 5.00 .LICENSED RE ED BY LOS ANGELES COUNTY AND STATE OF V Over 10 to 50 Incl. 12.50 CALIFORNIA RT I AM THE LEGAL:OWNER.OF E VVL 25.00 DESCRIBED RE ROP Over 50 to 100 Inc. r 40.00 PERMIT EE Over 100 SIGNATURE Services DISTRICT NO. PR SED 0.200 Amp.Under 600 V 12.50 201.1000 Amp. Under 600 V 25.00 S Q Over 1000 Amp.or Over 600 V 50.00 A Temp.Power Pole&Appurtenances 10.00 Sign with One Branch Circuit 10.00 0 Additional Sign Branch Circuits 2•00 INSPECTION > Mist.Conduits&Conductors 10:00 INFORMATIONON REVERSE _ Other)See Complete Fee Schedule).- Z SIDE u 548IL3,A # 000002 PERMIT FEE )Sub-Totol) , 1250 0 PLAN CHECKING FEE (One-Fourth Permit Fee) O 2 0 5 PERMIT ISSUING FEE $7.00 711 2 TOTAL FEE %�M.� > 6 8 7 9 INSPECTION FINALED date: 4,e a—e 6 By �.� s ®s WORKER S'COMPENSATION DECLARATION ICE-806 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to. self COUNTY OF LOS ANGELES , BUILDING AND SAFETY insure,or a certificate of Workers'Compensation Insurance,or j a certified copy thereof(Sec.3800,Lab.C.) ,, j Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS -410 c�u L 14A)New Residential Bldgs.&Pools EACH NO. FEE fi Certified copy is hereby furnished. 1 &2-Family,Sq.Ft. $ —' $ LOCALITY '7 M [F_ Certified co Multi-family Sq. Ft. — NEAREST Certi copy is filed with the county building inspection CROSS ST h AJ department. Residential Swimming Pools OWNER OR FIRM NAME Date Applicant I Outlets: Rec.—Light Sw. MAIL COs�i First 20 ADDRESS d (5UL7 CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY `�t t Tel No. >_COMPENSATION INSURANCE PLAN CHECK a (This section need not be completed if the work involved APPLICANT V 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 /D V so as to become subject to the Workers' Co sation Laws. Range_Heater D.W._ APPLICANT /4 2- �� S + �-© . a Oven _ Dryer_W.M._ ADDRESS&C9,2&' /v t eo2 ipn!ed s &5— Z, Date%' ��. �Applica —� Top _ FAU _W.H._Hood Fan —Other CITY7�� j� ()/?-,/Tel N _ _ g-6 NOTICE TO APPLICANT: If after making this Certificate of Disp. —Room Air Condom LICENSE OR �y Exemption, you should become subject to the Workers' REG.NUMBER 0 �� Class ' Compensation provisions of the Labor Code, you must forth- Power Apparatus&Large Appliances DISTRICT NO. PROCESSED BY with comply with such provisions or this permit shall be deemed revoked. Size&Type HP,KW,KVA,or KVAR Up to 1 Lncl. FINAL 7 �/ f!� Over 1 to 10 Inc]. DATE y'r ' LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. VALIDATION r (w� I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINALBY d� 9 (commencing with Section 7000)of Division 3 of the Busi- Over 100 S ^ ness and Professions Code, and my license is in.full force and effect. 0-200 Amp.Under 600 V License Number �� B Lic.Class 16 201-1000 Amp.Under 600 V ontracto Date Over 1000 Amp.or Over 600 V HO OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits ness and Professions Code): Mise.Conduits&Conductors 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). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is PERMIT FEE (Sub-Total) issued(Sec.3097,Civ.C.). Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE /D 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 re ntatives of this County to enter upon the abo e o d operty for inspection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE � � /6 Sigj ture o ermittee Date WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT lJ I hergby,affirm that I have a certificate of consent to self insure, 76A663 or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT,OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(SBc.3800 Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE MAPA-kJ PA �r _ $ $ LOCALITY1,9 ❑ Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. department. Multi-family Sq.Ft. CROSS S. Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._v"_Light �/ Sw. OWNER OR COMPENSATION INSURANCE r First 20 - p d FIRM NAME MAIL (This section need not be completed If the work Involved by the /���y� permit is for one hundred dollars($100)or less.) Total No.� Additional" ADDRESS GAO AlL I certify that in the performance of the work for which this permit . �7 Tel Noge-, is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional Q ADDRESS Date Applicant 10-1 RESIDENTIAL PLIANCES OT ER 3 HP. / �o✓ �� NOTICE TO APPLICANT: If, after making 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 ,,,,, 7 provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT Citi R��rc� LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions df 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 ORCl Over 50 t0 100 Incl. REG.NUMBB Class. � License Number Lic.Class Over 100 DISTRICT NO. P SED BY V 1/900, p Servic wbd�CC P elb ar �A cJ Contractor Date 0-3 A p. r 0 DATE O ❑ 400-1000 Amp.Under 600 V ' AI­_I am exempt under Sec. VALIDATION V Over 1000 Amp.or Over 600 V FINAL LJ I B.&P.C.for this reasonBRANCH CIRCUIT FEES BY a) Date: 15A,or 20A,120V,Lighting or Recept. Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits -.• _- -_ SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit {r( ja.,6q,�• i _�'O I hereby affirm that I am exempt from the Contractor's License Law __ for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits Code• ^��'' I,as owner of theproperty,will do the work and the structure Misc.Conduits&Conductors 'y _7 `3"' u ,.+i d M_ 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 TOTAL FEE I certify that I have read this application and under penalty of purjury state , that the above information is correct. 1 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 SIGNATURE OF PERMIrrEE DATE