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Home My Public Portal About5117 ARDEN DR_Electrical__ 76A663-CE806 3-64 APPLICATION FOR ELECTRIC PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING �- ,? /9$vzul V� BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER WILLIAM A. JENSEN,SUPT OF BUILDING LOCALITY Tj��4 li—r- Lt. 7' NEAREST FOR APPLICANT TO FILL IN CROSS ST. RECEPT, TOTAL CH FEE OUTLETS FIRST 20 $20 $ �� OWNER �L`� 6E! LIGHT gDD'L MAIL ADDRESS tJ r� -7 v - -4 I?PE-L �r SWITCH. y __ OVER 20 .10 . LIGHTING TOTAL FIRST 20 3 ,20 /_6 CITY � �L �t7� TEL. NO. FIXTURES } 3 ADD'L 10 co ELECTRICIAN C OVFR 20 RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS 13 GARB.DISP. STA.COOK CITY TEL.NO.. DISHWASH. AUTO.-WASH. STATE SPACE HTRB. BTA.APP.(yy H.P.MAX.) .50 LICENSE NO. 9l! MOTORS. OVER NOT OVER H.P. DISTRICT N GR P Z P E O 1 1.00 1 3 1.50 INSPECTION RECORD CL 3 S 2.00 O V 8 18 2.80 18 SO 3.00 0 V 80 100 5.00 uJ a N SIGNSt NO.TRANS Z NO.LAMPS SERVICE 0-600V-NOT OVER 200A 1.00 SERVICE 0-600V-OVER 200 A. 200 SERVICE OVER SOOV 8.00 MISC. PERMIT ISSUING FEE 2.00 60 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE III 3D 1HEREBY ACKNOWLEDGE THAT 1 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 /1 7 ELECTRICAL WIRING. WIRING 4�Z '�oA 1HEREBY 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 ROPERTY. POWER SIGNATURE - � UTILITY CO.NOTIFIED OF PERMITTEE FINAL LIDATION ARTHUR C. VEIT CKMO CASH SUPERVISING ELECTRICAL ENGINEER o APP,2 2 = D 5.31�� -f;, 0 ` WORKER'S COMPENSATION DECLARATION 20-0019 DPW(t2-9t) 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 y dK ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY t ❑ 1 &2-Family,Sq.Ft. $ $ vr�� Certified copy is filed with the county building inspection _ NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools v y `_ MAP BOOK PAGE PARCEL ASSESSOR CERTIFICATE OF EXEMPTION FROM WORKERS' / I p OWNER OR First 20 IBJ/C°f�E COMPENSATION INSURANCE Outlets:Rec. Light Sov. , l7 G O FIRM NAME rLG 17� O� �y (This section need not be completed if the work involved by the Total No.t� MAIL ADDRESS Additional J�"� ADDRESS J�� permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITY &NPI C C j �( Tel.N flo(J I�S 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 n ADDRESS \ Date ApplicantD NTIA P CES NO OVER 3 HP. s 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 complywith such PERMIT p provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Ty�K ,KVAir KVAR / j� ADDRESS W I hereby affirm that I am licensed under provisions of Chapter 9 ver 0 10 Incl. JAM (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. LICE } SE OR Over 50 to 100 Incl. REGNNUM ER Class. IZ Over 100 DISTRICT NO. PROCESSED BY 0 License Number Lic.Class p Services,Swbd.,MCC&Panelboards cc 0-399 Amp.Under 600 V FINAL O Contractor Date DATE 400-1000 Amp.Under 600 V � U El am exempt under Sec. VALIDATION U.11Over 1000 Amp.or Over 600 V FINAL a B.&P.C.for this reason BRANCH CIRCUIT FEES BY Date: 15A,or 20A,120V,Lighting or Recept. z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits _- j Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits — SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION with One Branch Circuit n sp : I hereby affirm that I am exempt from the Contractor's License Law Sign DOTAL 1 �=._ for.the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits C ): f'�lu,v: I, as owner of the property, will do the work and the structure Misc.Conduits&Conductors ;_s Mt;i_l_ ,%,art is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). CONSTRUCTION LENDING AGENCY r} i�111i 1-` r'—'- I hereby affirm that there is a construction lending agency for the 't y: L• 1 `4�I performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) "! `= AIN �� Civ. C.) PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE VOW that the above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring,and hereby authorize p� representatives of this County to enter upon the above-mentioned property for in e ' n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE t/ Ile/ i _ SIGNATU F ERMITTEE A 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 ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY f ❑ 1 &2-Family,Sq. Ft. $ $ ' Certified copy is filed with the county building inspection NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR p MAP BOOK �Q PAGE QD(O/ PARCEL�v CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec. Light Sw. .OWNER OR COMPENSATION INSURANCE aFIRM First 20 MAIL ME (This section need not be completed it the work involved by the Total No. Additional ADDRESS permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITY Tel.No. is issued, I shall not employ any person in any manner so as to 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 02Z-47LGr/ 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. LICESE OR >_ Over 50 to 100 Incl. REGNNUM ER Class. Over 100 DISTRICT NO. P SSED BY O License Number Lic.Class y U Services,Swbd.,M C&Pan boar�{�yz"} Do FINAL Contractor Date - mp.Un er 00 V DATE �. O ❑ I am exempt under Sec. 400-1000 Amp.Under 600 V VALIDATION W Over 1000 Amp.or Over 600 V FINAL B.&P.C.for this reason BRANCH CIRCUIT FEES BY d Date: 15A,or 20A, 120V,Lighting or Recept. z 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 SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit = �' I hereby affirm that I am exempt from the Contractor's License Law fo the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits - ti ia; t I, as owner of the property,will do the work and the structure Misc.Conduits&Conductors is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) } 0! and Professions Code). 3 I u _ CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the n '_•?'iii-?'•3z performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Il Civ. C.) PLAN CHECKING FEE rjIF L-_I `Ix) _ +7= Lender's Name PERMIT ISSUING FEE1 tEj__±n 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 representatives of this County to enter upon the above-mentioned property for ins ction Pur SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF WTIMMEE L DATE