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HomeMy Public PortalAbout5403 WELLAND AVE_Electrical__ 5A669-CE606 5-62 APPLICATION FOR ELECTRI R IT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESGL JOHN A. LAMBIE. COUNTY ENGINEER WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY NEAREST +� FOR APPLICANT TO FILL IN CROSS sT. RECEPT. TOTAL 1__Np._l EACH FEE OUTLETS FIRST 20 $20 $ OWNER LIGHT AA ADD'L ADDRESS SWITCH. OVER 20 .10 TOTAL CITY ���lO TEL.NO. - 1 LIGHTING FF1RST20 .20 FIXTURES 1 ADD'L 10 ELECTRICIAN /9 OVKR 20 RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS GARB.DISP. STA.COOK CITY / G TEL.NO v DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.(Va H.P.MAX.) .50 LICENSE NO. MOTORS: OVER NOT OVER x.P. DIST T NGROUP ZONE P OCE ED BY O 1 1.00 INSPECTION RECORD S 9 2.00 h V 8 is 2.80 IL 15s0 s.00 0 50 100 5.00 O SIGNS: NO.TRANS- 1^. NO.LAMPS - u a SERVICE O.600V-PLOT OVER 200A 1.00 Z SERVICE 0.60OV-0VER 200 A. 2.00 — SERVICE OVER 600V 5.00 MISC.i PERMIT ISSUING FEE 2.00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION - PPROVALS. DATE INSPECrOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT A WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 14 ELECTRICAL WIRING. .WIRING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL P OVER". POWER UTILITY CO.NOTIFIED /! �a SIGNATURE OF PERMIT=£ FINAL G M VALMo SU R C. VETT -CK MO �C�ASH/) SUPERVISING ELECTRICAL ENGINEER 6 2 2 71 Gcr30 2 0 5.20- q WORKERS'COMPENSATION DECLARATIONCE-806G 10/81 - APPLICATION FOR ELECTRICAL-PERMIT I h"Ity affirm that I have a certificate of consent to self insure, or a'certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof,(Sec.3800,Lab_G.) i FOR APPLICANT TO FILL IN ;AOS /,�/J J Policy N®��'�" mpany � !Jf✓LS ❑ ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE . • $ _ $ LOCALITY ppGerWl copy isfiled with the county building inspection 1 &2-Family,Sq.Ft. — e f�� Multi-family Sq.Ft. CRROOSSE ST Date8 Applicant ►�C� Residential Swimming Pools OWNER OR FIRM NAMEATE OF EXEMPTION FROM WORKERS' MAIL COMPENSATION INSURANCE Outlets:Rec—Light—Sw.— ADDRESS (This section need not be completed if the work involved by the First 20 Tel.No permit is for one hundred dollars($100)or less.) Total No. Additional CITY (� ✓� I certify that in the performance of the work for which this permit AP NUP CANT K �•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 NOTICE TO APPLICANT: If; after making this Certificate of PERMIT Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APPLICA 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. LICENSED CONTRACTORS DECLARATION Hood._ Fan _ Other_ CITY Tel.N LICENSE I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REG.NUNU ORMBER (� Class. (commencing with Section 7000)of Division 3 of the Business and REG. d Professions Code,and my license is in full force and effect. power Apparatus&Large Appliances ; DISTRICT NO.n g PR D BY ' Size&Type HP,.KW,KVA,or KVAR License Number Lic.Class Up to 1 Incl. FINAL V Date Over 1 to 10 Incl. ! DATE 2/► (� _/V �. � ) • /// � VALIDATION C Contractor Over 10 to 50 Incl. NAL ❑ I am exempt'under Sec. • Over 50 to 100 Inc. FBY INAL B.&P.C.for this reason Over 100 Date: Services,Swbd.,MCC&Panelboards ® Z 0-200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V Over 1000 Amp.or Over 600 V _ ❑ Exemption for Reg.Maint..Elect. SINGLE FAMILY emp.Power Pole&Appurteh e., s HOME OWNER-BUILDER DECLARATION Ign wI ne Branch Circuit 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): ❑ Mise.Conduits& tore I,as owner of the property,will do the work•and the structure I " is not intended or offered for sale (Section 7044, Business I Other(See Complleteets Fee Schedule) and Professions Code). #fig? 2 CONSTRUCTION LENDING AGENCY " I hereby affirm that there is a construction lending agency for the ° ° 4 Q 5 0 performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub Total) Civ.c.).. - o - 4(15030: PLAN CHECKING FEE 0 3,2 9—8 8 Lender's Name PERMIT ISSUING FEE (, yinformati as is I have read this application and state that the above TOTAL FEE correct. ree to comply with all County ordinances ws re a Electrical wiring, and hereby authorize s th'. my to enter upon the ab -menti ed e n rposes. ^�/ SEE REVERSE FOR EXPLANATORY LANGUAGE nature of rmittee Date WORKERS'COMPENSATION DECLARATION 20.0019 DPW 3/87 ����[�1LI ����li �1��0� FOR ���C� nAa PERMIT O ~'"+I.•hereby affirm that I have a certificate of consent to self cE-806G inswre, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certifi d thereof(Sec. 3800, Lab. C.) Policy No.i�ompany .57-ArGil'25�_fo-40 FOR APPLICANT TO FILL IN JOB d -^ ❑Certified copy is hereby furnished. New Residential Bldgs. Pools EACH NO. FEE ADDRESS ® 4*4 Certified co is filed with the co t buildih inspec- 1 &2-Family,S Ft. $ — $ LOCALITY �+ copy y g p y. q NEAREST tion.department. Multi-family Sq. Ft, ❑ CROSS ST. V D Date ^U Applicant Residential Swimming PoolsOWNER OR FIRM NAME ©� CERTIFICATE OF EXEMPTION FROM WCFRKERS Outlets: Rec Light Sw._ t MAIL COMPENSATION INSURANCE First 20 ADDRESS� ' ,'�''-"' (This section need not be completed if the work involved by Total No. Additional CITY Tel. No. the permit is for one hundred dollars($100)or less.) PLAN CHECK 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 Lighting Fixtures First 20 ADDRESS so as to become subject to the Worker 'Compensation Laws. Additional Date Applicant Total No. CITY Tel. No. NOTICE TO APPLICANT: If, after aking this Certificate of Fixed Appliances Not Over 1 HP PERMIT 0.0 Ace CL— Exemption, you should become subject to the Workers' Range— Heater—D.W. — APPLICATION CI Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS I s" a� with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. Hood — Fan —Other— CITY L Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR Disp. — Room Air Cond. Class. I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER O ,lr (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. �. PROCESSED BY d and Professions Code,and my license is in full force and effect. Size&Type HP, KW, KVA, or KVAR �[ O License N_uMbe_r • O ic. Class C ^�y U ��/Ov Up to 1 Incl. FINAL "��s� Over 1 to 10 Incl. DATE. �r /X)IDATION Contractor Date Over 10 to 50 Incl. FI U ❑ I am exempt under Sec. Over 50 to 100 Inc. g LU B.&P.C. for this reason Over 100 LAIa Services, Swbd., MCC&Panelboards Z te. 0-200 Amp. Under 600 V Signature niel 201 - 1000 Amp. Under 600 V ID 1000 Amp, or Over 600 V z 0.1 5 b A Exemption for Reg. Moint. Elect. SINGLE FAMILY Temp. Power Pole&Appurtenances #:0 0 0 0 0'2 HOME OWNER-BU I LDER,DECLARATION I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit I 0 - 7a82 7382 Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): 0 0 - 73,825 Ell, as owner of the property, will do the work and the Mise. Conduits&Conductors structure is not intended or offered for sale(Section 7044, Other(See Complete Fee Schedule)_ D 0 7. 1 3 8 8 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 abov entioned proper or inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ®.— Si nature of P mitt ate ®' 'J'. WORKERS'COMPENSATION DECLARATION 7&AA63 DPW 3/87 APPU UOON FOR EL EC UROC AL PERMIT 0 Phe*&&by affirm that I have a certificate of consent to self CE-806G insure, or a.certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS �/�/_p or a certifi.�d�o�y thereof (Sec. 3800, L . C.) oo ,0 AV&— r Policy No.6bV g"x 2company7r1#/4r/__4440 FOR APPLICANT TO FILL IN JOB e ❑Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS J $ $ LOCALITY c�4. $A ❑Certified co4-T #4 904MONOwd py is filed :with the county building inspec 1 &2-Family, Sq. Ft._ ._ -:4 'NEAREST tion departm�ento, Multi-family Sq. Ft. CROSS ST. V Date . ® � ®� Applicant Residential Swimming Pools OWNER OR w FIRM NAME CERTIFICATE OF EXEMPTION FROM ORKERS.' Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE kADDRESS (This section need not be completed if the work involved by First 20 CITY Tel. No. the permit is for one hundred dollars($100)or less.) Total No. Additional.i PLAN CHECK I certify that in the performance of the work for which thisAPPLICANT permit is issued, I shall not employ any person in any manner Lighting Fixtures First 20 4 ADDRESS so as to become subject to the Workers'Compensation Laws. Additional Date Applicant Total No. CITY Tel. No. NOTICE TO APPLICANT: If, after makingthis Certificate of Fixed Appliances Not Over 1 HP PERMIT APPLICATION' M. 44 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 — FAU —W.H. — CITY Tel. No. g �' // deemed revoked. Hood — Fan —Other_ LICENSED CONTRACTORS DECLARATION LICENSE OR D.isp. — Room Air Cond. LI Class. I hereby affirm that lam Licensed under provisions of Chapter 9 REG. NUMBER �/®� C®` (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PROCESSED BY d and Professions Code,and my license is in full force and effect. ®�� G Size&Type HP, KW, KVA, or KVAR �( U License Number Lic. Class. Up to 1 Incl. FINAL �y Over 1 to 10 Incl. DATE e VA TION 'O Contra to. y. Date Over 10 to 50 Incl. FIN U ❑ I am exempt under Sec. Over 50 to 100 Inc. B W Over 100 B.&P.C. .for this reason d Services, Swbd., MCC&Panelboards 1 D � Z Date: 0-200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V Over 1000 Amp. or Over 600 VQ 1 5.3 A ❑ Exemption for Reg. Moint. Eject. SINGLE FAMILY Temp. Power F z Joe4 r # 0 0 0 0'0 2 HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit o ® 2 Jr 5 Q Law for the following reason (Section 7031.5, Business and Additional Sign Brdnch Circuits Professions Code): o o•0,2 5 50 5 ❑ I, as owner of theproperty, will do the work and the Misc. Conduits&Conductors Other See Complete Fee Schedule)— Business chedule D 07.13?-88 structure is not intended or offered for sale(Section 7044, ( P )— 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 0 Lender's Address �-- I certify that I have read this application and state that the TOTAL FEED(a above information is correct. I agree to comply with all County ordinances,and State laws regulating Electrical wiring, and hereby authorize representatives of this Courity to enter upon the e-mentioned pr erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 7-143 ignature/d Per ittee Date