The URL can be used to link to this page

Home My Public Portal About5028 ARDEN DR_Electrical__776.A-663-CES06 8-62 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITY %TJ NEAREST FOR APPLICANT TO FILL IN CROSS ST. p RECEPT, TOTAL NO. EACH FEE OUTLETS FIRST 20 $20 $ OWNER2c LIGHT .3 a MAIL A DD'L ADDRESS SWITCH. 2 OVER 20 .10 TOTAL CITY TEL. NO. LIGHTING FIRST 201 .20 /Av FIXTURES ( ADD'L 10 ELECTRICIAN OV R 20 RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS fpQ C - E GARB,DISP. STA.COOK CITY eel TEL. NO. DISH WASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.(yz H.P.MAX.) .50LICENSE NO.ohm `1 1 MOTORS: OVER NOT OVER H.P. DISTRICT O. GROUP ZONE �PRQCESSED BY O 1 1.00 I J 1 1 3 1.5o INSPECTION RECORD i 3 6 2.00 8 15 2.50 15 50 3.00 } D_ 50 100 5.00 0 SIGNS: NO.TRANS. C NO,LAMPS O H SERVICE 0.60OV-NOT OVER 200A 1.00 V w C SERVICE 0.60OV-OVER 200 A. 2.00 V) Z SERVICE OVER 600V 5.00 �- MISC. PERMIT ISSUING FEE 2.00 �� SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE $ 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS .PPL ATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO OMPLY CONDUIT 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 OF RESIDENTIAL PROP Y. POWER SIGNATURE UTILITYCO.NOTIFIED OF PERMITTEE FINAL ,�....._. 'L'._r•. .,. 1(ALIDATION A THUR C. VEIT CK MO CASH SUPERVISING ELECTRICAL ENGINEER it WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, 76A663 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.) Policy No. Company FOR APPLICANT TO FILL IN JOB /f �yDRESS F-1 �L. Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE _ $ $ LOCALITY 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 Pools ASSESSOR 0Eap� MAP BOOK lJrl PAGE PARCEL ��C7 CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. RRMNER OR NAME COMPENSATION INSURANCE First 20 MAIL (This section need not be completed if the work involved by the ADDRESS Com` permit is for one hundred dollars($100)or less.) Total No. Additional 1 certify that in the performance of the work for which this permit CITY C � Tel.No. is issued, I shall not employ any person in any manner so as t0 PLAN CHECK become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT 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 Lz, LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS __0? e 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. //J Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. �vT (4�� l/ LICENSE OR Class. Over 50 t0 100 InREG.NUMBER Over 100 DISTRICT NO. SSED BY Wf License Number Lic.Class p V Services,Swbd.,MCC&Panelboards L/ cc Contractor Date 0-399 Amp.Under 600 V FINAL DATE 0 ❑I am exempt under Sec. 400-1000 Amp. Under 600 V 6f�Cq 4 W Over 1000 Am or Over 600 V VALIDATION P FINAL IL B.&P.C.for this reason - BRANCH f// U) BRANCH CIRCUIT FEES Date: 15Aor 20A,120V Li"117ghting or Recept. Z c7? 20 Branch Circuits Signature 1 Vo 40 Branch Circuits 41 Or More Branch Circuits El -+n 44e�0 Exemption for Reg.Maint. Elect. 15A,20A,208V To 277V Lighting Br.Circuits 3303 SINGLE FAMILY Temp.Power Pole&Appurtenances 1 ITEMS HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit r5 I hereby affirm that I am exempt from the Contractor's License Law 9 TOTAL 1 � o"a 0 for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits t n � Code): CHECK `J4 ❑ I, as owner of the property,will do the work and the structure Misc.Conduits&Conductors CHANGE .00 is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , and Professions Code). ttt��t�t �tr�}t 1/11/96 CONSTRUCTION LENDING AGENCY tSVVV—UVV1 I hereby affirm that there is a construction lending agency for the ¢219 1 AM 9:30 performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ. C.) 9 PLAN CHECKING FEE Lender's Name / �j PERMIT ISSUING FEE pc r C Lender's Address �/ 1 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 representatives of this County to enter upon the above-mentioned property for inspection purpo SEE REVERSE FOR EXPLANATORY LANGUAGE /_/( �6 SIGNATURE OF PER TEE DATE WORKERS'COMPENSATION DECLARATION�i�.Q10181 APPLICATION FOR ELECTRICAL PERMIT I•her �fir�fi that CE-806t I have a certificate of consent to self CE-806G • insuree; ora certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) Policy No.60995?2—Company -ry,47E FC"�"-0 FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. & Pools qCHNO FEE ADDRESS SoZ8 /J",gC,/ ® Certified copy is filed with the county building inspec- y, Sq. LOCALITY tion department. �/y Multi-family Sq. Ft. 'NEAREST CROSS ST.'44g4„7.� Residential Swimming Pools OWNER OR LbW�ti 1112-"--;,A- Date Applicant fes`` 7 FIRM NAME LAD \S 119�11— CERTIFICATE OF EXEMPTION FROM WORKERS' (p 3 Outlets: Rec Light � Sw. MAIL _ COMPENSATION INSURANCE First 20 00 ADDRESS C,4/),AE_ (This section need not be completed if the work involved by (Z- o.CITY Tel. N the permit is for one hundred dollars($100)or less.) Total No. Additional 3-3¢!(� 1 certifythat in the performance of the work for which this PLAN CHECK P APPLICANT permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No. 3 Additional CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If,' after making this Certificate of APPLICANT Exemption, you should become subject to the Workers' Range_ Heater_D.W. Compensation provisions of the Labor Code, you must forth- Oven _ Dryer W.M.— ADDRESS �� ¢� �/Z �, OA, ®,E with comply with such provisions or this permit shall be Top _ FAU W.H. — deemed revoked. Room Air Cond. CITY 7�pS Tel. No. LICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other— LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. REG. NUMBER 3>LS-572— br/ �- Class. b (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCESSE BY and Professions Code,and m license is in full force and effect. Power Apparatus& Large Appliances @. y Size &Type HP, KW, KVA, or KVAR' O License Number3e_72-13 y7- Lic. Class e-lj }AP Up to 1 Incl. FINAL Over 1 to 10 Incl. VALID ON Contractor l 2"-3 ��`f7 Date S 1-aJ Over 10 to 50 Incl. FINAL ❑ I am exempt under Sec. Over 50 to 100 Inc. BY LU B.&P.C. for this reason Over 100 X11`9`b 3'A Date: Services, Swbd., MCC& Panelboards ► m 0 -200 Amp. Under 600 V #'ol.o o o o;2 Signature 201 - 1000 Amp. Under 600 V Over 1000 Amp. or Over 600 V I o 4 2 GO ❑ Exemption for Reg. Maint. Elect. SINGLE FAMILYU HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and Professions Code): ❑ 1, as owner of the property, will do the work and the Misc. Conduits & Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ ► 7044, Business 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 PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT.ISSUING FEE Lender's Address I certify that I have read this application and state that the TOTAL FEE above 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 above- mentioned for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE /-6 f Signature of Permittee Date