HomeMy WebLinkAbout1015 (3)ELECTRICAL PERMIT APPLICATION
City of Hermosa Beach - Community Development Department
NEW BRANCH CIRCUITS — LIGHTING OR
GENERAL USE AND DWELLING APPLIANCES
QTY
Amount
JOB ADDRESS:
1015 15TH PLACE
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:
TEMP POWER POLE 100 AMP FOR
SFD
ADDED OUTLETS (TO EXISTING CIRCUITS),
LAMPHOLDERS OR TEMPORARY LIGHTS AND
YARD LIGHTING
PROPERTY OWNER(S) NAME:
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
ADDRESS:
CITY, STATE, ZIP:
PHONE:
ELECTRICAL CONTRACTOR:
S&S PORTABLE SERVICES
MOTORS, TRANSFORMERS, HEATING
APPLIANCES & MISC. EQUIP. OR APPLIANCES
EMAIL ADDRESS:
(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:
19034 E. ARROW HIGHWAY
CITY, STATE, ZIP:
COVINA, CA 91722
REQUIRED FIRE WARNING, COMMUNICATIONS
AND EMERGENCY CONTROL SYSTEMS
PHONE:
800622-2244
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 LICEN O.: ,l 3
*96200- 6/1
STATE LIC NSE NO.:
974149
TYPE OF BUILDING:
SFD
SERVICE PANELS/SUBPANELS (INCLUDING
BREAKERS)
O. 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:
7�%v%
ISSUED BY:
1
MISCELLANEOUS
$ 33
SUPPLEMENTAL PERMIT FEE
$ 17
PERMIT NO.:
/,f �D /��
eq- [
ISSUANCE FEE
$ 59
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 goveming 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 Califomia. 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 Owner (If Owner/Builder)
F:b95/cd/forms-handouts/application/electric 9/1/11 revised 2-1-12