CITY OF GLENDALE ▬ BUILDING AND SAFETY

633 E. Broadway, Room 101 Glendale, CA 91206

(818) 548-3200, (818)548-4837 (Inspection)

ELECTRICAL PERMIT WORKSHEET

Separate sign permit is required for
Please Type or Print Legibly in Ink any electrical work as part of a sign or billboard. Permit No. BE
Job Addres s ( Include Zip Code )
Work Description ( Fill all that apply and specify quantity )
$33.00 Issuance Fee
Technology Surcharge of 18.38% will Apply to Permit and Plan Check Fees
Perm it I nform a tion
Is this work related to a BuildingHas work started? Yes
$33.00 Supplemental Permit to
Permit Yes No (Double the permit fee will be charged $38.00 Minimum Inspection Fee ( If fees below add up to less than $38.00)
for legalization )  Yes  No 15% Energy surcharge P/C
Describe where the work will be done & fill out the work description on the right
side of this application.
Plan Check ( 50% of Permit Fee, Minimum of $72.00)
Residential
$50.00 Up to 100-Amp Service ( * )
Applicant 's Name Phone $75.00 101 to 200-Amp Service ( * )
( ) G.W. P. Approval Required
$125.00 201 to 400-Amp Service ( * )
Address ( Include City and Zip Code ) $175.00 Over 400-Amp Service ( * )
$94.00 Kitchen, New or Remodeled
E-Mail Address:
$33.00 Bathroom, New or Remodeled
$33.00 Laundry Room, Single Family & Multi Family
$33.00 Landscape Lighting (SFD)
Property Owner's name Phone
Other ( Residential / Commercial )
( )
Address (Include City & Zip Code)
Is this work related to a sign or billboard?  Yes  No
If answer Yes , a separate Sign Permit is required.
$1.40 Outlets, Each, 1-10 (Including low voltage)
E-Mail Address:
$0.60 Outlets, Each, Over 10 (Including low voltage)
$11.00 Branch Circuits, Each, 1-10 ( * ) - First 10
L icens ed des ign profes s iona l or engineer I nform a tion:
Name
$10.00 Branch Circuits, Each, 11-40 ( * ) - Additional up to 30
Phone
( ) $9.00 Branch Circuits, Each, Over 40 ( * ) - Additional up to 40
$114.00 Miscellaneous Other Equipment, Minimum Charge
Address (Include City & Zip Code) License No.
$77.00 Annual Maintenance
$50.00 Temporary Service, Under 600 Volts
CALIFOR N IA LICE N S E D CON TR ACTOR 'S D E CLAR ATION : I herby af f irm
under penalty of perjury that I am lic ens ed under prov is ions of Chapter 9 $333.00 Construction Alternative per unit fee for new units
(c om m enc ing with s ec tion 7000) of D iv is ion 3 of the Bus ines s and P rof es s ions (Including garage and common areas, excludes service)
Code, and m y lic ens e is in f ull f orc e and ef f ec t.
Commercial - G.W.P. Approval Required
Contractor's Name Phone
$50.00 200-Amp Service or less ( * )
( )
$100.00 201 to 600-Amp Service ( * )
Address (Include City & Zip Code)
$150.00 601 to 1200-Amp Service ( * )
$200.00 Over 1200-Amp Service ( * )
E-Mail Address:
$225.00 Over 600-Volt Service ( * )
Other
State License No. Exp. Date City License No. Exp. Date $1.10 Panels other than service, fee based on total number of
overcurrent protection device spaces available.
Contractor's Signature Switchboards
$49.00 600 Volts or less, First Switchboard Section
FOR OFFICE USE ONLY $33.00 601 Volts or less, Additional Switchboard Section
APN Lot $100.00 Over 600 Volts, Each Switchboard Section
Motors,Transformer,Heating Appliance, Welder,X-Ray Machine,Storage Battery
Tract NAICS/Structure Use System, Infrared Appliance, Etc.
$9.00 Up to and Including 1 Hp ( * )
Floor Above Grade Below Grade Mezz Type of $12.00 Over 1 & not over 5 Hp ( * )
Area Const.
$17.00 Over 5 & not over 20 Hp ( * )
Fire Edition of the Code Hp = K.W. or K.V. A.
Sprinkler $28.00 Over 20 & not over 50 Hp ( * )
Comments $56.00 Over 50 & not over 100 Hp ( * )
$83.00 Over 100 Hp ( * )
Low Voltage Installation
G.W.P. Approved By: Date: Receipt No.
$1,599.00 New low voltage installation - per floor up to 10,000 sf/floor
$279.00 New low voltage installation - each additional 10,000 sf/floor
P.C. Processed By: Date: Receipt No. $0.09 Existing low voltage installation - Per square foot/floor
Note: Any item having this mark ( * ) may require plan check for multi-family ( 3 or more units) & commercial
P.C. Approved By: Date:
buildings. (Installation of multiple services equal to 200 amps or greater; 10 branch circuits and above

Processed By Date: Receipt No. 5 HP motors and above; multiple installations of less than 5 HP motors. Also provide Title 24 LTG-1 & LTG-2 if
more than 10% of lighting is changed or 40 fixtures altered).

CPDPSD - 53 (07/15)
ADDRESS: PERMIT NO.

INSPECTIONS APPRVD DATE INSPECTIONS APPRVD DATE

PRESITE
SHORING
SETBACKS AND YARDS
UFER
TRENCH AND FORMS REINFORCING STEEL
SETBACK & ELEVATION SURVEY

OK TO POUR FOOTINGS
DO NOT POUR FOOTINGS UNTIL ABOVE IS APPROVED
OK TO GROUT CMU / P.I.P.
OK REBAR SHOTCRETE WALL
HVAC GROUNDWORK / U.F.
ELECTRICAL GROUNDWORK / U.F.
PLUMBING GROUNDWORK / U.F.
GAS PIPING GROUNDWORK / U.F.
FIRST FLOOR JOISTS
UNDER FLOOR INSULATION
OK TO POUR SLAB FLOOR
DO NOT POUR CONCRETE FLOOR SLAB OR COVER FIRST
FLOOR JOISTS UNTIL ABOVE IS APPROVED
ROUGH ELECTRIC
ROUGH PLUMBING
DUCTS
ROUGH HEATING OR REFRIG.
ROUGH GAS PIPING
ROOF SHEATHING
ROUGH FRAMING AND ROOF
ALARM ROUGH
FLOOR NAILING

T-BAR Mechanical Electrical

INSULATION
OK TO COVER
DO NOT COVER UNTIL ABOVE IS APPROVED
LATHING Interior Exterior

DRYWALL
BROWN COAT Interior Exterior

SEWER - SEPTIC / TANK - CESSPOOL

SERVICE RELEASE
FINAL GAS
FINAL PLUMBING
FINAL ELECTRICAL
FINAL HEATING OR REFRIGERATION
ENERGY FINAL
LANDSCAPE FINAL
GRADING FINAL
ELECTRICAL SERVICE RELEASE
FINAL-ENGINEERING
FINAL SPRINKLER
FINAL CENTRAL STATION
OCCUPANCY OF THIS BUILDING BEFORE ALL
FINAL FIRE ALARM
FINAL INSPECTIONS ARE MADE IS A VIOLATION
FIRE PREVENTION FINAL
OF THE CITY OF GLENDALE MUNICIPAL CODE
FINAL BUILDING INSPECTION

CPDPSD - 53 (07/15)