HomeMy WebLinkAbout1100 (15)ELECTRICAL PERMIT APPLICATION
City of Hermosa Beach - Community Development Department
5201
NEW BRANCH CIRCUITS - LIGHTING OR
GENERAL USE AND DWELLING APPLIANCES
QTY
Amount
JOB ADDRESS:
1100 Pacific Coast Highway
Hermosa Beach, CA 90254
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
$ 87
$130
$ 22 each
$ 22 each
JOB DESCRIPTION:
Install a 20A/120V general purpos€
electrical outlet
ADDED OUTLETS (TO EXISTING CIRCUITS),
LAMPHOLDERS OR TEMPORARY LIGHTS AND
YARD LIGHTING
PROPERTY OWNER(S) NAME:
Roger Eldon Bacon
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 $65 added to the $98 above)
$22
$33
$33+$20
and up
$65
$98
$98+$65
and up
___L__
S)---2-Redondo
ADDRESS:
P.O. Box 282
CITY, STATE, ZIP:
Beach, CA 90277
PHONE:
(310) 374-8991
ELECTRICAL CONTRACTOR:
Berg Electric
MOTORS, TRANSFORMERS, HEATING
APPLIANCES & MISC. EQUIP. OR APPLIANCES
EMAIL ADDRESS:
Iwood@bergelectric.com
(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
$ 65 each
$ 65 each
$ 65 each
$ 65 each
$ 65 each
ADDRESS:
11333 Sunrise Park Dr
CITY, STATE, ZIP:
Rancho Cordova, CA 95742
REQUIRED FIRE WARNING, COMMUNICATIONS
AND EMERGENCY CONTROL SYSTEMS
PHONE:
(916) 636-1880
1. a. Up to 50 Devices, Total Fee
b. 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
$ 35
$ 63
$ 98
$131
$164
$194
$ 35 each
BUSINESS LICENSE NO.:
STATE LICENSE NO.:
85046
TYPE OF BUILDING:
Commercial
SERVICE PANELS/SUBPANELS (INCLUDING
BREAKERS)
NO. OF STORIES:
AMP. and Voltage Ratings of Service Entrance
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
$ 54
$ 54
$ 54
$ 54
$ 43
NO. OF METERS:
NO. OF FAMILIES:
DATE ISSUED:
11-2q-13
ISSUED BY:
�,j,i
I
MISCELLANEOUS
$ 33
SUPPLEMENTAL PERMIT FEE
$ 17
PERMIT NO.:
( _
L 13 - I iQ Y
1
ISSUANCE FEE
$ 59
(%5
TOTAL FEE
M
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
Sectio 7031.5 of the State License Business and Professional Code (or claim exemption under Section 7044).
X11 l.i' l/rd
Signature of Contractor - `
— Signatureof Owner.(If-Owner/Builder)
F:b95/cd/forms-handouts/application/electric 9/1/11 revised 2-1-12