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Home My Public Portal About5521 WELLAND AVE_Electrical__ 6A668-CE606,5-62 APPLICATION FOR ELECTRICAL PEMIT - COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN'A. LAMBIE, COUNTY ENGINEER ` WILLIAM A.JENSEN.SUPT OF BUILDING LOCALITY NEAREST FOR APPLICANT TOr FILL IN CROSS ST. RECEPT. ,j TOTAL NO. 'EACH' Ffifi — OUTLETS FIRST 20 $'2O $ OWNER LIGHT ADO'L • AIL SWITCH. --�OJ— OVER 20 .10 ADDRESS. �t CITY, TEL.NO. LIGHTING TOTAL i FIRST 20 .80 V FIXTURES1 1.3 ADD'L OV R 20 10 ELECTRICIAN RANGES CLO.DRYERS WT.R.HTRS- 1.00 ADDRESS J( GARB.'DIBP: STA.COOK CITY TEL.NO. 0I8HWASH. AUTO.-WASH. STATE / G, SPACE HTRS. A.APP-IV,H.P.MAX. �+� .50 LICENSE'NO. /) MOTORSI OVER NOT OVER H.P. DIS_TR AAT O. GIff ZONE PJROCESSEDBY O 1 1.00 N 1 s1.80 ,t INSPECTION RECORD 8 8 2.00 F/i� '� 'Y''n-Cy`'>�:�+ ;��9a^-7?1'•��+.:n' -'.A`::' 8 15 2.50 !� fb6 =:�/-a± -e Y �" %;cPJ,da 1' v Tll, a 15 SO 8.00 O 50 100 5.00 ,r 7 /1" ' Ad O SIGNBs mo.TRANS. / `/ ✓ V NO.LAMPS f ' ILI d SERVICE O-SOOV-NOT OVER 200A 1.00 irlv, Z SERVICE 0-600V-OVER 200 A. 2.00 SERVICE'OVER SOOV 5.00 MISC.' PERMIT ISSUING FEE 12.00 SUPPLEMENTARY PERMIT ISSUING FEB 1.00 TOTAL FEE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ TH18 APPLICATI N APPROVALS 'DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY CONDU.IT WITH,ALL-COUNTY ORDINANCES-AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES •/ CALIFORNIA OR THAT I AM THE�LEGAI. OWNER OF THE ABOVE DESCRIBED RESIDENTIAL"OPE Y. POWER SIGNATURE UTILITY.CO.NOTIFIED �A :7 i'�f/l�✓.`� a�r ; _ l� OFPERMITTEE ! FINAL �J3Jid.S/1+�'i ! .: G/ LIDATION ARTHUR C. VEIT v _ CK MO CASH SUPERVISING ELECTRICAL ENGINEER Lr1 o 2 4 5 OG W%R�.5 2 D 1- 4.20- cl i�/ WORKERS'COMPENSATIONDECLARATION CE-806G (2.80) APPLICATION FOR ELECTRICAL PERMIT CE-806G • I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES T C% BUILDING AND SAFETY.. insure, or a certificate of Workers'-Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) FOR APPLICANT TO FILL IN JOB Policy No. Company New Residential Bldgs.&Pools EACH NO. FEE ADDRESS 5521 Wel d Ve. E] Certified copy is hereby furnished. 1 &2-Family.Sq. Ft. $ — $ LOCALITY Temple Cit ❑ Multi-family Sq. Ft. NEAREST Certified copy is filed with the county building inspection CROSS ST department. Residential Swimming Pools OWNER OR FIRM NAME Date Applicant Outlets: Rec.blLight S Sw. Y SU ADDRESS First 20 5591 We"I'lalad Ave CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. 4!!? Additional CITY Tel No. 443 5045COMPENSATION INSURANCE Tem le Cit } PLAN CHECK C (This section need not be completed if'the work involved APPLICANT V Fixtures First 20 by the permit is for one hundred dollars ($100) or less.) Lighting ' ADDRESS , Total No. J Additional OC I certify that in the,performance of the work for which thisCITY Tel No. 0 permit is issued I shall not employ an Fixed Appliances Not Over 1 HP P p y y person in any manner PERMIT U so as to become subject to the Workers' r LU Compensation Laws. Range_Heater D.W._ ' APPLICANT d Oven _ Dryer_W.M._. ADDRESS (Date F-14 Applicant Top _FAU _W.H.._ CITY Tel No. Hood = Fan —Other— Temple City 443 5045 NOTICE TO APPLICANT: If, after m Ing this Certificate of Disp. _Room Air Condom LICENSE OR Exemption, you should become subject to the Workers' REG.NUMBER Class Compensation'provisions of the Labor Code, you must forth- Power Apparatus&Large Appliances DISTRICT NO. PROCES ED BY with comply with such provisions or this permit shall be deemed revoked. Size&Type HP,KW,KVA,or KVAR �` O Up to 1 Incl. FINAL ' Over 1 to 10 Incl. DATE i E ,. VALIDATION LICENSED CONTRACTORS DECLARATION 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' ness and Professions.Code, and my license is in full force and effect. Services 0-200 Amp.Under 600 V• Ax- License Number Lic.Class 201-1000 Amp.Under 600 V Contractor Date 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 License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits ness and Professions Code): ' Misc.Conduits&Conductors .? 1 1 8 7 . I. as owner of the property,will do the work and the Other(See Complete Fee Schedule)— o 0 0 0 0 2 structure is not intended or offered for sale (Section, ft 7044,Business and Professions Code). 2 3 0 5 0 CONSTRUCTION LENDING AGENCY o u 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 e 3 Q S C.CE issued(Sec.3097,Civ.C.). Lender's Name 0 9. 1 6-61 _ PLAN CHECKING FEE (One-Fourth Permit Feel Lender's Address PERMIT ISSUING FEE I certify that I have read this application and state that the TOTAL FEE c [) X- 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 a Q-i6-Pi Signatu 19' Permittee Date WORKERS'COMPENSATION DECLARATION 20-0019 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self cE-80 G insure, or 6 certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified co y�thereof(Sec. 3800, mob. C L e FOR APPLICANT TO FILL IN JOB �' Policy No. Company ' ADDRESS�r '/ ❑Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE $ _ $ LOCALITY .�ertified copy is filed with ounty buildin inspec- 1 &2-Family, Sq. Ft. L' tion department. Multi-family Sq. Ft. — NEAREST t� Residential Swimming Pools 5W R CROSS OR Date f Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light N Sw. MAIL ,7o I ID ADDRESS COMPENSATION INSURANCE moo) -S First 20 (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 D0 so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional • Date Applicant - 'Total No. _ CITY Tel. No. NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT 6 Exemption, you should become subject to the Workers' Range— Heater—D.W. APPLICATION �'• $ Compensation provisions of the Labor Code, you must forth- Oven L- Dryer —W.M.— ADDRESS C'ir with comply with such provisions or this permit shall be Top � FAU W.H. — deemed revoked. Hood Fan �° Other— CITY /- •a Tel. No; dP LICENSED CONTRACTORS DECLARATION .�j� LICENS 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 Power Apparatus&Large Appliances I DISTRICT NO. PROC SSED BY d and Professions Code,and my license is in full force and effect. Size'&Type HP, KW, KVA, or KVAR G+fG ��'p/ O License Number 4j C3� LiLic. Class Up to 1 Incl. FINAL U Contract ' 'f Date Over 1 to 10 Incl. DATE —Z .-lei z VALIDATION �O ❑ Over 10 to 50 Incl. FINAL F- I am exempt under Sec. Over 50 to 100 Inc. BY Q� U 8.8P.C. for this reason Over 100 v f d Services, Swbd., MCC&Ponelboards Z ' Date: 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 Temp. Power Pole&Appurtenances - HOME OWNER-BUILDER DECLARATION _;,.•.r I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Law for the following reason Section 7031.5, Business and Additional Sign Branch Circuits A Professions 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 7044, Ot6r (See Complete Fee Schedule)— ;'..I'1 vi --,?,— -v.. r a . Business and Professions Code). � .v. . • � CONSTRUCTION LENDING AGENCY l+-?e:r I hereby affirm that there is a construction lending agency for ;j!1 the performance of the work.for which this permit is Issued PERMIT FEE (Sub-Total) °`=- (Sec. 3097, Civ. C.). PLAN CHECKING FEE 1.1_I_ l_;� Lender's Name PERMIT ISSUING FEE O?�J� Lender's Address C 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 06ove-mentio ed property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE gnature of rermittee to ®s