HomeMy Public PortalAbout6358 SULTANA AVE_Electrical__ DBS-5A 9.58 APPLICATION FOR ELECTRIC PERMIT 1
DBS-5A
DIVISION OF BUILDING AND'SAFETY
Deportment of County Engineer BU
/ / ,p�
County of Los Angeles i4DDRE155 S 1/1
WM.J.FOX,COUNTY ENGINEER
CASSATT D.GRIFFIN.SUPT OF BUILDING (1 ��
LOCALITY J
FOR APPLICANT TO FILL IN NEAREST / J1
PERMIT FEES cRos;ST. ,h
NUMBER EACH FEE
LIGHT OUTLETS OWNER O -P t7
RECEPTACLES MAIL
ADDRESS
WALL SWITCHES
TOTALOUTLETS 5¢ S CITY TEL.NO.
ELEC.RANGES 25 ELECTRICIAN b dV Al
ELEC. HEATERS 25 ADDRESS
KW EA CITY TEL.NO.
FIXTURES _ "S 5 LICENSE NO.
NUMBER OF LIGHT CIRCUITS
DISTRICT NO. I C7ROUP I Z �I READY FOR INSPEC710N
NUMBER OF RECEPTACLE CIRCUITS
MOTORS
NUMBER HORSEPOWER FEE INSPECTION RECORD
NEW MVD. HP OVER INC. EACH
lh&LESS S .25
Ih 2 .50
2 5 1.00
5 15 1.50
15 50 2.50
50 200 5.00.
Alan r-io
MISIK
- a- r
NO.SIGNS NO.TRANS. r
NO.SIGNS NO.LAMPS T d
FOR EACH PERMIT: &A' �UP• IS
WIRING $1.00 U ,v
FIXTURES $1.00 b(S \ r �z?ZM'7 �f-t-7
SUPPLEMENTARY .50 APPROVALS Q*-i
TOTAL FEE g .ft 3.,,/ DATE INSPECTOR'S SIGNATURE
AHEREBY ACKNOWLEDGE THAT I HAVE ROAD THIS APPLICATION CONDUIT
,HEREBY
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ',WIRING
ELECTRICAL WIRING.
1 HEREBY CERTIFY THA �1 A PROPERLY REGISTER D A /OR FIXTURES
LICENSED AS REQUIRED 8. LO ANGELES LINTY A STA OF
CALIFORNIA OR THAT AM E L9tiAL NER 0 HE OVE POWER
DESCRIBED RESIDENTIA RO RTY 1 ��rr
SIGNATURE 1 ;, ��� , UTILITY CO.NOTIFIED - Z#A• 1r ! l/�•!7P/a'
OF PERMITTEE r 1�•'� .FINAL
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION A.C.VEIT.CHIEF ELECT.INSPECTOR
JACO 6 4 4 9 5 AUG 9 2 2.3 5
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7,6A668-CESO6-11-57
APPLICATION FOR E.L E C T RIC-'PERMIT' 4•:
COUNTY OF LOS ANGELES
DEPARTMNT OF COUNTY ENGINEER eukLrw 161
BUILDING AND SAFETY DIVISION JADDRESS '
" JOHN A.LAMBIL Co—ty weer
GASSATr D.'GEIFFM Slip t of 8iiildia9 CnCALISY v
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
'PERNIIT FEES l
•
'OWNERNUMR1TEM. BEEACH FE
OUTLETS.� � $ $ 1 MAIL•? '
LIGHTS M.sRECEPT. SW. - .10 ADDRESS
s
LIGHTING FIXTURES 10 pe . CITY ,''T L.�IVO.
ELEC.RANGES CLO._DRYERS •ELECTRICIAN� �" Ll
WATER HEATERS .5.0
ELEC.SPACE HTRS. DISHWASHERS ADDRESS de"
I - CITY. _ -'TEL.NO.
GARBAGE DISPOSERS AUTO.-
5
�, S STATE' _ '
WASHERS STA.COOKING UNITS .2LICENSE NO:
MOTORS: OVER INC. H.P. '
o — +/z 2g DIST RI.C. •IVO: GROUP ZONE READY FOR INSPECTION
1/2 — .2 - .50
2 — 5 1.00' - '��''�C RECORD
5 15 1.50
18 — 50 2.50' ' 1
SCI— 200 5.00 -
SIGNS: NO:TRANS.
NO.LAMPS
SERVICE 0-800V 1.00
SERVICE OVER 600V 5..00 ,
MISC: 1'
I WIRING PERMIT .1.00
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT 50' _ 'd ^• - _ `
TOTAL FEE $ :13 ' "-APPROVALS
I HEREBY ACKNOWLEDGE THAT I,HAVE• READ THIS APPLICATION DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CO 1. '
WITH. ALL COUNTY ORDINANCES AND STATE LAWS REGULATING . ..
ELECTRICAL WIRING. ;i VVIRING'.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES• F
LICENSED AS AEQU1RED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGA OWNER'OF THE ABOVE .POWER- • i
DESCRIBED RESIDENTIAL.PROPERTY,, +
SIGNATURE (�--�� SLA UTILITY,CO.NOTIFIED
OF PERM)TTE
FINAL
VAuDA. Old 'ARTHUR C.1[EIT.
1 SUPERVISING LECTRICAL ENGINEER
CK MO'I CAbH:
•• �• {„ ?
RD
VGASe8_CESOO-IT-WAPPLIC.ATION FOR ELECTRIC PERM T 1
10OUNTY OF LOS XWELES
DEPARTMENT OF COUNTY ENGINEER �HUILDING
8U>d.DING AND SAFETY DIVISION DDRESS
rrOF>iN A.LADQ M Coes -LOCAL!---
8W
CASSAYT D.GBitFFlci, m e 1
NEAREST 7
FOR APPPLET TSS LL IN Ro s sT.
,.—ITEM NUMBER EACH FEE OWNER
OUTLETS: $ $ MAIL
LIGHTS RECEPT. SW. ,101111DRESS.
LIGHTING FIXTURES .10 CITY V T N0. .
ELE.C.RANGES 'CLO.DRYERS .ELECTRI AN
WATER HEATERS .50 ADDRESS �
ELEC.SPACE HTRS. DISHWASHERS
GARBAGE DISPOSERS AUTO.- (TTY TEL.NO. ..
TI
WASHERS STA.COOKING UNITS ;2S STATE �.
LICENSE NO.
MOTORS- OVER INC. H.P.
O— I/z 2S -DISTR C GR ZONE. READY FOR INSPECTION
Vi — 2 .50 Pig
2 — S 1:00
INSPECTION RECORD
5 — 15 1.S0
Is — SO 2.90
SO— 200 $.00
SIGNS: NO.TRANS.
NO.LAMPS
SERVICE 0.600V 1.00
SERVICE OVER•600V 5.00
MISC.
WIRING PERMIT Loo
FIXTURE PERMIT 1.:00
SUPPLEMENTARY PERMIT ,SO' a
TOTAL FEE g t APPROVALS
I HEREBY ACKNOWLEDGE THAT I .HAVE READ MIIS APPLICATION DATE INSPECTOR'S SIGNATURE
AND STATE. THAT THE ABOVE IS.CORRECT AND AGREE.TO COMPLY CONDUIT dJ, t,
WITH ALL COUNTY ORDINANCES AND STATE LAWS 'REGULATING ..
.ELECTRICAL WIRING. WIRING v
I HEREBY CERTIFY THAT I AM PROPE Y REGISTERED AND/OR '
LICENSED AS REOUIRED BY LOS ANGELPffiCOUNTY AND STATE OF " FIXTURES'
CALIFORNIA OR THAT 1 AN THE LE OWNER OF THE ABOVE POWER .
DESCRIBED RESIDENTIAL R PERTY. 0 `
SIGNATURE UTILITY CO.NOTIFIED.
MOFPERMi r FINAL _ I .� r fill;iLl.%iv
/�ATION ARTHUR'C. EIT.
Mo CASH SUPERVISING ELECTRICAL EN(UMM
+ ' q • " film that
I COMPENSATION DECLARATION 76-663 10/81 APPLICATION FOR ELECTRICAL PERMIT
�`�ieeebq.e�ff'i6rm that I have a certificate of consent to self insure, CE-8o6G
or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec.3800,Lab.C.)
Policy No.LO—O&II&CL Company ZWM FLJJFOR APPLICANT 70 FILL IN JOB
❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ADDRESS (J ,
1 &2-Family,Sq.Ft. $ — $ LOCALITY rQm �e
Certified copy is filed wit county buil in ion NEAREST
department. Multi-family Sq.Ft. CROSS ST.
Date Applica Residential Swimming Pools OWNER
OR
FIRM'NAME (j
CERTIFICATE OF EXEMPTION FROM WORKERS' 6�- MAIL
Outlets:Rao Light t 2 —
COMPENSATION INSURANCE U'; ADDRESS
This section need not be completed if the work Involved b the First 20
( P Y Total No.�— Additional �} CITY Tel.No. $ _
permit is for one hundred dollars($100)or less.) y
I certifythat in the performance of the work for which this permit PLAN CHECK
P P APPLICANT 4
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
Additional
Total No. CITY Tel.No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT ,
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT
Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. _
provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS '
provisions or this permit shall be deemed revoked. Top — FAU W.H.
CITY No 7
LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_
1 hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR
(commencing with Section 7000)of Division 3 of the Business and REG.NUMBER �� � Class/
Professions Code,and my license is in full force and effect. DISTRICT NO. PROLE ED BY
Power Apparatus&Large Appliances �,;
.^ /
Size&Type HP,KW,KVA,or KVAR C Y O
License Numgbrer, 6 Lic.Class � Up to 1 Incl. FINAL 7 ACC- �, C.1
fflI%SOyI/70/�S/1Z Date p r' Over 1 to 10 Incl.
DATE ,`3
Contractor �l Over 10 to 50 Incl. /�
❑ 1 am exempt under Sec. Over 50 to 100 Inc. BY FINA j ��� i j El(E W
Over 100r'_ I L�_
B.&P.C.for this reason (~ 4 -e
Services,Swbd.,MCC&Panelboards ~ .a.
Date: 0-200 Amp.Under 600 V f.t'lLi:.' .:►o t,
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 ricli —01--1,1141 "' `
I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits
for the following reason(Section 7031.5,Business and Professions
Code):
❑ 1,as owner of the property,will do the work and the structure Misc.Conduits&Conductors
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
I certify that I have read D applicatio nd state that the above TOTAL FEE y
information is correct. I agree to com ith all County ordinances
d to laws re ulatin lectric ring, and hereby authorize
eprese tatives i nt�to nter upon the above-mentioned
ropart for i pection SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permit ee Date