HomeMy Public PortalAbout4936 ARDEN DR_Electrical__ 76A663-CE806 9-64 APPLICATION FOR ELCTRICA PERMIT �.
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDINGc t,
BUILDING AND SAFETY DIVISION ADDRESS `T Yi
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPT. OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN cRoss sr.
REC EPT. d TOTAL NO. EACH FEE
y OUTLETS FIRST 20 26 $.20 $ OWNER �dU►
LIGHT �7 � MAIL
SWITCH. "'2 j 10 ADDRESS
OVER ZO 1
TOTAL r- CITY TEL.NO.
LIGHTING FIRST 201 /7 20
FIXTURES �3 _ ADO'L to ELECTRICIAN �Y
OVER 20 /
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS (� (O Y e
GARB.DISP. STA.COOK /> "t
CITY s� TEL.NO. `T J
DISHWASH. AUTO.-WASH. STATE
SPACE HTRS. STA.APP.(y H.P.MAX.) .50 LICENSE NO.
MOTORS: OVER NOT OVER H.P. DISTRICT NO. GROUP ZONE P ESSED B
.O 1 1.00
1 3 1.50 INSPECTION RECORD
3 8 2.0064 9Ler-7-A ll,AAAo O
8 15 2.50
15 50 3.00
50 100 5.00
U
SIGNS: NO.TRANS d
NO.LAMPS to
_z
SERVICE 0.60OV-NOT OVER 200A 1.00
SERVICE 0-60OV-OVER 200 A. 2.00
SERVICE OVER 600V 5.00 .�
MISC.
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE $
1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE.
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
I HEREBY .CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE IN, THE ABOV ED RESIDE
LZ: N T L ERTV. POWER
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITT
FINAL
(DATION JOSEPH C. ROOHAN
CK
SUPERVISING ELECTRICAL ENGINEER
MO CASH
1,..!'i C! 2 3 2 2 .I N 4 2 D 1 3.70'
WORKERS'COMPENSATION DECLARATION. - 10/81 APPLICATION FOR ELECTRICAL PERMIT
•�� I her,?ojY affirm that l have a certificate of consent to self insure, CE-806G
e
or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec.3800,Lab.C.)
Policy No.0 8— Z Co 1pany FOR APPLICANT TO FILL IN JOB r
f`f
Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ADDRESS
LOCALITY
Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft.• $ _ $ E
department. Multi-family Sq.Ft. NEAREST 1 -
�� � CROSS ST.
••
Date g/ Applicant/ fes` Residential Swimming Pools OWNER OR
FIRM NAME VVICERTIFICATE OF EXEMPTION FROM WORKERS' J-
Outlets:Rec Light Sw. MAIL
COMPENSATION INSURANCE w ADDRESS
(This section need not be completed if the work involved by the First 20 0.,,
permit is for one hundred dollars($100)or less.)
Total No. Additional CITY Tel.No.
I certify that in the performance of the work for which this permit PLAN CHECK
is issued, I shall not employ any person in any manner so as to PPLICANT
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
Date Applicant
+ of Fixed Appliances Not Over 1 HP Additional PERMIT Total No. CITY Tel.No.
/J y�e .—
NOTICE TO APPLICANT: If, after making this Certificate of VC
Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. APPLICANT
provisions of the Labor Code,you must forthwith comply with'such Oven _ Dryer _ W.M._
ADDRESS ��
provisions or this permit shall be deemed revoked. Top' — FAU — W.H. —
CITY C , Tel.No.
' LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ C
I hereby affirm that I am licensed under provisions of Chapter 9 uCENSE OR.
Disp. — Room Air Cond. REG.NUMBER Class.
(commencing with Section 7000)of Division 3 of the Business and
Professions Code,and my license is in full force and effect.' Power Apparatus& Large Appliances DISTRICT NO.—.—I' / PROCESS BY
Q/- /ry,� Size&Type HP,KW,KVA,or KVAR t
License Number 7 qZ Lie.Class `' Up to 1 Incl. FINAL V
Over 1 to 10 Incl. /
Contractor �yZ�� DateDATE "' % %� VALI ION 0
Over 10 to 50 Incl. FIN
QI am exempt under Sec. Over 50 to 100 Inc. - W
B.&P.C.for this reason Over 100 n-
Services,Swbd.,MCC&,Panelboards Z
Date: 0-200 Amp.Under 600 V
Signature 201 - 1000 Amp.Under 600 V
❑ Over 1000 Amp.or Over 600 V $(� 7 A
Exemption for Reg.Maint.Elect.
SINGLE FAMILY Temp.Power Pole&Appurtenances # 0 0 0 0 0 2
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Law I ° ° 1 5,75
for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits
Code): o ° ° 1 5,755
Conduits
I,as owner of, Misc.the property,will do the work and the structure &Conductors •12 O 1 8 7
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee.Schedule) ►
and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the
'performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total)
Civ.C.).
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE 5
Lender's Address A
I certify that I have read this application and state that the above TOTAL FEE /
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 in ction purpos
SEE REVERSE FOR EXPLANATORY LANGUAGE
..I�9
Signatur of Perm' ee Date