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Home My Public Portal About5027 ARDEN DR_Electrical__ TENUPLE CITY 76A663.CE80610-61 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS C4,� p {. JOHN A. LAMBIE, COUNTY ENGINEER WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. 1 T E M _ NO. EACH FEE OUTLETS• (FIRST 20) g 20 $ OWNER� �! LIGHTS RECEPT. SW. MAIL OUTLETS: (ADD'L UNITS) 1O ADDRESS LIGHTS RECEPT. SW. - _ LIGHTING FIXTURES: (FIRST 20) 20 CITY TEL. NO_' - w � If LIGHTING FIXTURES: (ADDITIONAL) ,10 v ELECTRICIAN RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS GARB.DISP. STA.COOK CITY _ TEL. NO. DISHWASH. AUTO.-WASH. �- STATE PACE HTR ' STA.APP.(I/z H.P.MAX.) .50 `) LICENSE NO. MOTORS: OVER NOT OVER H.P. DISTRICT I GR04" Z NE PR .G ED B O 1 1.00 1 3 1.50 INSPECTION RECORD 3 8 2.00 _ I-e 8 15 2.50 " ISI 15 50 3.00 ' I._ 50 100 5.00 (-) L1 SIGNS: NO.TRANS. NO.LAMPS 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 $ IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY .. ` WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. / POWER SIGNATURE _ fly UTILITY CO.NOTIFIED w''f OF PERMITTEE FINAL LIDATION ARTHUR C. VEIT MO CASH SUPERVISING ELECTRICAL ENGINEER uk�0553b X21 2 D 8."70~ IN _/ J 76A663-CE80610/72 PPLIC TI 'FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER 7ADDRESS BUILDING AND SAFETY DIVISION r!p(4a1.jj'c (,iYr FOR APPLICANT TO FILL IN rty��t yyfq't,(y�.a, OUTLETS N0. EACH FEE RM NAME,3oX lU Y7�+� 4'� ='I6.'+.4d� .LV Y 'G 0 OWNER OR �b Is I RECEPT._ MAIL FIRST 20 .25 ADDRESS isyT� r,`i Av'+fl _..Y'a LIGHT- TOTAL '" CI TY:1e..y� ' �'i t"r3".. F, ,TEL. NO;lii.pi 72>7F. ~ SWITCH OVER 20 .,10 PLAN CHECK LIGHTING FIRST 20" �} "€ .*APPLICANT TOTAL 25 °€ FIXTURES OVER 20 .10 .ADDRESS RESIDENTIAL APPLIANCES CITY TEL. NO. PERRANGE-DRYER WTR, HTR._ gPPL111CANT l2�iCi r`>� yy�r�� y { .STA, COOK DISP. 0 F.A.U. ADDRESS 402 �'oSazn GQ�l,:.,icl .�'. vd SPACE'HTR.• AIR ICOND. CITY 5,7 + _ •� TEL, NO�id-.� r "' CLOTHES WASH.' DISHWASH. LICENSE OR REG. NUMBER CLASS." FAN OTHER . 1.00 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING ' WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. . SIZE & TYPE OVER TO . I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR � f /; ' LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF 0 - 1 I'pp r #r' CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE CD DESCRIP,ED' RESTIDENTIA,• PROPERTY. �r U or i P G 1 - 1 0 3.00 _ rt F W PERMITEE J/r --I 10.- 50� 5.00 SIGNATURE �_r 50 - 100 10.00 DISTRICT NO. PROCESSED BY "I ,•" 100 - 500 15.00 .A oa .� SIGN. GAS SIGN AND ONE CIRCUIT 5.00 _ APPROVALS ' 'DATE INSPECTOR'S SIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE SERVICENOTOVER 600VOLTS OR200AMP 3.00 UNDERSLAB WORK SERVICE-OVER 600 VOLTSOR200AMP 10.00 ROUGH CONDUIT - TEMP SERVICE, POLE, &APPU RTENANCES 5.00 WIRING TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES POWER AUTHORIZED - UTILITY CO. NOTIFIED FINAL PERMIT FEE (SUB TOTAL) NOTES: " PLAN CHECK FEE - PERMIT ISSUING FEE 3.00 TOTAL FEE PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. ? M.O. CASH SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE WORKER'S COMPENSATION DECLARATION 9DPW(t2-91) 76A663 APPLICATION FOR ELECTRICAL PERMIT 76A66 he,r&b�,affirm that I have a certificate of consent to self insure, .'or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec. 3800 Lab. C.) a Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS Certified co is hereby furnished. NO. EACH FEE LOCALITY PY Y New Residential Bldgs.&Pools — $ $ ❑ Certified copy is filed with the county building inspection 1 &2-Family,Sq. Ft. NEAREST department. Multi-family Sq.Ft. — CROSS ST. Date Applicant Residential Swimming Pool ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' OF OR Outlets:Rec. Light Sw. FIRM NAME COMPENSATION INSURANCE �O First 20 MAIL (This section need not be completed if the work involved by the ADDRESS � permit is for one hundred dollars($100)or less.) Total No.� Additional � >r I certify that in the performance of the work for which this permit CITY-4 Tel.N0 8-727S— is 72S— is issued, I shall not employ any person in any manner so as to PLAN become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANTK Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT O'�6 LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000) of Division 3 of the Business and CITY Tel.No. Professions Code, and my license is in full force and effect. Over 10 to 50 Incl. >_Over 50 t0 100 Incl. LICENSE Class. REG.NUMBB ER f1 License Number Lic.Class Over 100 DISTRICT NO. P SED BY 0 Secc rvices,Swbd.,MCC&Panelboards (f O Contractor Date 0-399 Amp.Under 600 V FINAL DATE O El I am exempt under Sec. 400-1000 Amp. Under 600 V �— U Over 1000 Amp.or Over 600 V FINAL D✓ VALIDATION � B.&P.C.for this reason BRANCH CIRCUIT FEES BY W Date: 15A,or 20A, 120V,Lighting or Recept. _ 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits 2 _ s. SINGLE FAMILY Temp.Power Pole&Appurtenances ACCT.g HOME OWNER-BUILDER DECLARATION a I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit t� for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits 3303 63.30 Code): 1 ITEMS I,as owner of the property, will do the work and the structure Misc.Conduits&Conductors TOTAL S o � is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , and Professions Code), CHECK 63.30 CONSTRUCTION LENDING AGENCY CHANGE 000 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) Aokv Civ.C.) PLAN CHECKING FEE 0000-000. 4/19/96 Lender's Name PERMIT ISSUING FEE �� Q x977 1 AM10a s5 Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE that the above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring,and hereby authorize 4,. A a� representatives of this County to enter upon the above-mentioned property for i tion urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �IGNATURE OF PERMITTEE DATE