HomeMy WebLinkAbout102 (2)ELECTRICAL PERMIT APPLICATION
City of Hermosa Beach - Community Development Department
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NEW BRANCH CIRCUITS - LIGHTING OR GENERAL USE
AND DWELLING APPLIANCES
QTY
Amount
JOB ADDRESS:se
I�
JOZ Lo.a6�- Coy '
1. 15 or 20 AMP., 120V - 240V
a. 1-10 Circuits, Total Fee
b. 11-40 Circuits, Total Fee
c. 41 or More Circuits, Total Fee
2. 15 or 20 AMP. @ 208V to 277V (Commercial)
3. All Other Lighting Circuits 600V or Less
$43
$88
$131
JOB DESCRIPTION:
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$22 each
$22 each
ADDED OUTLETS (TO EXISTING CIRCUITS), LAMPHOLDERS
LIGHTS AND YARD LIGHTING
OR TEMPORARY
PROPERTY OWNER(S) NAME:
i 10„20- % M-at.n`
V�-1 1 I�
1. Receptacles/Outlets
a. 1- 5 Outlets (Inclusive), Total Fee
b. 6 - 10 Outlets (Inclusive), Total Fee
c. Over 10 Outlets (Every 10 outlets or
fraction thereof will be an additional
$20 added to the $33 above)
2. Light Fixtures/Lampholders
a. 50 or Less (Inclusive), Total Fee
b. 51-100 (Inclusive), Total Fee
c. Over 100 (Every 100 or fraction thereof will
be an additional $66 added to the $99 above)
$22
$33
$33 plus`i
$20 & up
ADDRESS:
225� W CGrc&- er.
CITY, STATE, ZIP:
AA
1`�L� PAN—( 01 CI) 3ZO
$66
$99
$99 plus
$66 & up
PHONE: 2
S 3740 ' 0((bi
ELECTRICAL CONTRACTOR:
"a
FG(�)1 L -c f C.Q� t i.t G/�
MOTORS, TRANSFORMERS, HEATING APPLIANCES AND
OR APPLIANCES
MISC. EQUIPMENT
(Rating of Equipment; H.P., K.W., or K.V.A)
1. 3 - 5
2. 6 - 20
3. 21- 50
4. 51- 100
5. Over 100
$66 each
EMAIL ADDRESS: i
f(U 6 rawr,,cati
$66 each
$66 each
ADDRESS:
3-1 5r. f
T� Aoz•
$66 each.
$66 each
REQUIRED FIRE WARNING, COMMUNICATIONS AND
CONTROL SYSTEMS
EMERGENCY
CITY, STATE, ZIP:
Q 1324 -ib.
1. a. Up to 50 Devices, Total Fee
51- 100 Devices, Total Fee
c. 101- 200 Devices, Total Fee
d. 201- 300 Devices, Total Fee
e. 301- 500 Devices, Total Fee
f. Over 500 Devices, Total Fee
2. Each Control Panel, Standby Power Panel,
or Similar Main Piece of Control Equipment
$35nd�r
$99
$132
$166
$196
PHONE: Si.Th�� �z60
BUSINESS LICENSE NO:-J�
STATE LICENSE NO: i , C —1-1,.....,
`7J
$35 each
TYPE OF BUILDING:
SERVICE PANELS/SUBPANELS (INCLUDING BREAKERS
AMP. and Voltage Ratings of Service Entrance
or Conductors, Services Switches or Circuit
Breakers or Switchboard Sections
1. 200 AMP or Less @ 600V or Less
2. 201- 600 AMP @ 600V or Less
3. Over 600 AMP @ 600V or Less
4. Over 600V Rating
5. Temporary Power Pole
$55
NO. OF STORIES:
NO. OF METERS:
$55
f
NO. OF FAMILIES:
$55
$55
DATE ISSUED: �J �I . /
/ (
$43
MISCELLANEOUS
$33
ISSUED BY:
SUPPLEMENTAL PERMIT FEE
$17
ISSUANCE FEE
$60
PERMIT NO: r/5 . Dz /
,�
C� Z_
TOTAL FEE
I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and
ordinances governing this type of work will be complied with whether specified herein or not. No person shall be allowed to perform
work under this permit in violation of the labor code of the State of California. I further state that I am properly licensed as required
by Section 7031.5 of the State License Business and Professional Code (or claim exemption under Section 7044).
Signature. of Contractor —
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Signature of Owner (If Owner/Builder)