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HomeMy Public PortalAbout6323 SULTANA AVE_Electrical__ 76A663-CE80611/70 APPLICATION FOR ELEC ICAC P RE MI�T LI .' COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER FAUDDRE Zy Al. Sgcz&-rAt4 BUILDING AND SAFETY DIVISION COLEMAN W. JENKINS. SUPERINTENDENT OF BUILDING TY ! /•C i T FOR APPLICANT TO FILL IN ST. DG FRECEPT. TS NO. EACH FEE OWNER a •� S 7`12u��P/ SSMAIL TO AL FIRST 20ADDRESS OVER 20 CITY lit6^ TEL. N0.t0 PLAN CHECK LIGHTING1 FIRST 20 .Z A APPLICANT )} TOTAL V OVER 20 FIXTURES !L •10 ADDRESS APPLIANCES CITY TEL. NO. PER 'RANGE DRYER_WTR. HTR. APPLICANT STA. COOK DISP. F.A.U. ADDRESS4!!6 5P SPACE HTR, AIR COND.�_ CITY C TEL. NO-af 7 CLOTHES WASH. DISHWASH. LICENSE NO. 7_12_ ?y4c CLASS. e 1 Q FAN OTHER 1.00 /5 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION VV ANO STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND, HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. SIZE IN TYPE OVER TO I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR 0 — 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AN THE LEGAL OWNER OF, AND INTEND TO } 1 — 10 3.00 RESIDE IN, THE AS DESCRIBED F451DENTIAL PROPERTY. Q 10 - 50 5.00 1 OF PERMRITTE a, 50 - 100 10.00 O DISTRI Nt CLASS Z SED BY G 100 - 500 15.00 CL SIGN, GAS SIGN AND ONE CIRCUIT 5.00 NOTES: z Z TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 SERVI CENOTOVER 600 VOLTS OR 200 AMP &0 O© APPROVALS DATE INSPECTOR'S SIGNATURE SERVI CEOVER 600 VOLTS OR 200AMP 10.00 TEMP.POWER POLE TEMP SERVICE,POLE,&APPURTENANCES 5.00 UNDERSLAB WORK TEMP LIGHT OR RECEPT. SYSTEM 3.00 ROUGH CONDIUT / WIRING FIXTURE% POWER AUTHORIZED PERMIT FEE (SUB TOTAL) UTILITY CO. NOTIFIED PLAN CHECK FEE FINAL PERMIT ISSUING FEE 00 �`� JOF9EPH C. ROOHAN TOTAL FEE leo SUPERVISING ELECTRICAL ENGINEER, PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 4r„9 9 5 3 A?R 2 7 2 D. 7.2 O N SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE WOAKERS'COMPENSATIONDECLARATION CE-7sA663 6G (2-80) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self i COUNTY OF LOS ANGELES r- BUILDING AND SAFETY insure,or a certificate of Workers'Compensation Insurance,or / j a !�i�py thereof(Sec.3800,Lab. .) "'''�� FOR APPLICANT TO FILL IN JOB o y R Company EACH NO. FEE ADDRESS ew Residential Bldgs.&Pools - Certified copy�is.hereby furnished, 1 &2-Family,Sq. Ft. $ — $ LOCALITY ` Certified co Multi-family Sq. Ft. NEAREST copy is filed with the county buil spection Residential Swimmin Pools CROSS ST department. (� �, g OWNER OR FIRM NAME Da Zb I lh�plicant Outlets: Rec.---_Light Sw. MAIL First 20 ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY T COMPENSATION INSURANCE PLAN CHECK p}, (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 U Total No. Additional � I certify that in the performance of the work for which this CITY el No. O permit is issued, I shall not employ any'person in any manner Fixed Appliances Not Over 1 HP PERMIT so as to become subject to the Workers'Compensation Laws. I Range_Heater D.W. _ APPLICANT +� W Oven — Dryer_W.M._ ADDRES tall Top _FAU _W. .._ D Applicant �-y ' � HCITY Tel N Hood _ Fan _Other— ' NOTICE TO APPLICANT: If, after making this Certificate of Hoo _Room Air Con r LICENSE OR Exemption, you should become subject *to the Workers' REG.NUMBER lass Compensation provisions of the Labor Code,you must forth- Power Apparatus&Large Appliances DISTRICT NO. PROCES D BY with comply with such provisions or this permit shall be Size&Type HP,KW,KVA,or KVAR �— p deemed revoked. L.1 r(Jd Up•to 1 Incl. Over 1 to 10 Incl. FINAL • LICENSED CONTRACTORS DECLARATION DATE —( VALIDATION Over 10 to 50 Incl. I hereby affirm that I am licensed under provisions of Chapter Over-50 to 100 Inc. FINAL 9 (commencing with Section 7000)of Division 3 of the Busi- Over 100 BY �r ness and Professions:Code, and my license is in full force and effect. r— Services �� License NCl0-200 Amp.Under 600 V u r ic. a s ) 201-1000 Amp.Under 600 V Contracto to 1 Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances - I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit Additional Sign Branch Circuits License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): Misc.Conduits&Conductors L!0 0 g 7 A I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)— structure is pot intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY `l o - 3200 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) C o.o ?i ,Q issued(Sec.3097,Civ.C.). 20 Lender's Name PLAN CHECKING FEE- (One-Fourth Permit Fee) 1 0 6 2'5-8 1 Lender's Address PERMIT ISSUING FEE I certify that I have read this application and state that the TOTAL FEE 3A 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-rpee4ie property for inspection. urposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE ture o r Date WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) 76A663 APPLICATION FOR ELECTRICAL PERMIT ,I hereby affirm that I have a certificate of consent to self insure, br a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab.C.) No. Company FOR APPLICANT TO FILL IN 6's23 . Policy p Y ADDRESS 16VTA&)A' ❑ Certified copy is hereby furnished. NO. EACH FEE � J0J New Residential Bldgs.&Pools LOCALITY �0 ❑ 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 ryory MAP BOOK �✓�d a/- PAGE PARCEL dt�:W�9 CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER OR + COMPENSATION INSURANCE Outlets:Rec. Light Sw. q FIRM NAME \ {f}r �C1� //,,�� First 20 ' !C MAIL (This section need not be completed 0 the work Involved'by the Total No.�. Additional ADDRESS fp� permit Is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITY �+�Vh� II�Li'` Tel.No.ZVI� p 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 7 ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. 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. rovis.ions of the Labor Code, ou must forthwith comply with such PERMIT p Y 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 d Over 50 to 100 Ind. REG.NUMBER Class. Over 100 DISTRICT NO. P CESSED BY V License Number Lic.Class Services,Swbd.,MCC&Panelboards , 0 e L/J �J Ir 0 0-399 Amp.Under 600 V FINAL Contractor Date DATE .fit V ❑ I am exempt under Sec. 400-1000 Amp.Under B00 V Z, --{ VALIDATION LLI Over 1000 Amp.or Over 600 V FINAL a- l1 B.&P.C.for this reasonBRANCH CIRCUIT FEES BY Cl) Date: 15A,or 20A,120V,Lighting or Recept. 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits 41 Or More Branch Circuits ❑ Exemption for Reg.Maint.Elect. 15A,20A,2DSV To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION _ I hereby affirm that I am exempt from'the CoSign with One Branch Circuit Contractor's License Law a •--- �,�,_�_� for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): 04 _y- I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors S. Is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) ry i-`=f;� S. `a:5 and Professions Code). 4 =. - -18._-r 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 _ •-r. -�r. Lender's Name - PERMIT ISSUING FEE a Cs��' AN Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE g� 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 of,,- 4& S GNATUft OF PERMITTEE DATE