HomeMy Public PortalAbout4934 ARDSLEY DR_Electrical__ 76A653-CE8 06.,&-64 UPPCAIN FOR E7CTM L PERM//7
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COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING n // „/ /�, ` l.
BUILDING AND SAFETY DIVISION ADDRESS J 7+ G/ -Di,
JOHN A. LAMBIE. COUNTY ENGINEER /^ ?! ,� l /
COLEMAN W. JENKINS, SUP'T. OF BUILDING LOCALITY /•_f" 7 j
NEAREST .. . /� !. t / I d
FOR APPLICANT TO FILL IN CROSS Sr. :'
REC EPT, TOTAL NO, EACH FEE -
OUTLETS FIRST 20 $20 $ _ •� OWNER /+I�' ,e
LIGHT _+ 4 MAIL ;;��
ADD'L f0 ADDRESS �`�S /� _DA/,Y'1?
SWITCH. OVER 20 �—
LIGHTING TOTAL i FIRST 20 ,20 CITY leJ' , TEL. NO.
FIXTURES3 jADD'L 10ELECTRICIAN G+}
OVFR 20
RANGES CLO.DRYERS WTR.HTRS, 1.00 ADDRESS
GARB.DISP.. STA.COOK '+ +
CITY TEL.NO. A. �°
DISHWASH. AUTO.-WASH. STATE _
SPACE HTRS. STA.APP.(y¢H.P.MAX.) .50 LICENSE NO. -�
MOTORS: OVER NOT OVER H.P. DISTRICT G 'Z E PR,( D
O 1 1.00
1 s 1.50 INSPECTION RECORD -
3 8 2.00 a
O
8 15 2.50 V
15 50 3.00
50 100 5.00
l yj s / ✓s' IU
NO.TRANS - - �' I
SIGNS: NO.LAMPS , +-�""" N.
SERVICE 0.600V-Nor OVER 200A 1.00
SERVICE 0.60OV-OVER 200 A. 2.00
SERVICE OVER 600V 5.00 -
MISC.
e PERMIT ISSUINGFEE2.00
SUPPL'EMENTA13Y PERMIT ISSUING FEE 1.00
TOTAL FEE $
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APR'(CATION 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 a
I HEREBY -CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSEDAS REQUIRED BY L05 ANGELES COUNTY AND STATE OF -
CALIFORNIA OR THAT I AM THE LEGAL-OWNER OF; AND INTEND TO
RESIDE IN, THE ABOVE DESC IBED RESIDE TIAL PROP Tv. POWER
1 _
SIGNATURE ..j 144
UTILITY CO.NOTIFIED
OF PERMITTEE
-- - - FINAL
VALIDATI N JOSEPH C. ROOHAN
CK MO
SUPERVISING ELECTRICAL ENGINEER
CASH
t
yrr�-•�y
E i c C 0's UL29 2 D 7.0.0 z*
1
WORKER'S COMPENSATION DECLARATION 20-0019 DPW 9/89 ���n �����®n n ®� ���������� ����8�
76A663 � �I
I herelfy affirm that f have a certificate of consent to self insure, L
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(Sea.3800 Lab. C.)
Policy No. Company. - FOR APPLICANT TO FILL IN JOB
ADDRESS
❑ ���
Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE
❑ $ — $ LOCALITY
Certified copy is filed with the county building inspection 1&2-Family,Sq.Ft.
department. Multi-family Sq.Ft. CROSS ST. Q,t.V t�,
Date Applicant Residential Swimming Pools ASSESSOR
MAP BOOK PAGE PARCEL '
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec. Liht�Sw.— OWNER OR
g , /� FIRM NAME (�n
COMPENSATION INSURANCE. ., (X/�/j� First 20
(This section need not be completed if the work involved by.the MAIL
permit is for one hundred dollars($100)or less.) Total No. Additional ) ADDRESS._
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
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 /� PLAN CHECK
J p 9 v APPLICANT
Total No. Additional
ADDRESS
Date Applicant' 15 OR 20A120V BRANCH CIRCUITS
NOTICE TO`APPLICANT: If; after making this Certificate ,of CITY Tei.No—,
Exemption,you should become'subject to the Workers'Compensation 1 TO 10 INCLUSIVE EACH
provisions of the Labor Code, you must•forthwith comply with such 11 TO 40 INCLUSIVE EACH PERMIT
APPLICANT -
provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH
LICENSED CONTRACTORS DECLARATION - ADDRESS
I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH CIL
(commencing with Section 7000) of Division 3 of the Business and _ CITY Tel.No. �_ U
Professions Code, and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR
_ Power Apparatus&.Large Appliances - -- _ REG.NUMBER Class,' 0
License Number Lic.Class Size&Type HP,KW,KVA,Or KVAR DISTRICT NO. • �� PR ED BY
Up to 3 Incll LU
Contractor -Date Over 3 to 10 Incl. PANTE'_ C/)Over 10 to 50 Incl. c
I am exempt under Sec. Over 50 to 100 Incl. —� ) ' VALIDATION
ET
Over 100 - ' FINAL
B.&P.C.for this reason" BY
Services,Swbd.,MCC&Panelboards.
Date:
0-200 Amp.Under 600 V
Signature - 201 1000 Amp.Under 600 V
❑ Over 1000 Amp.or Over 600 V
Exemption for Reg.Maint.Electr,
a SINGLE FAMILY Temp.Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION "
I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit
for the to
reason (Section 7031.5, Business and Professions Additional Sign Branch.Circuits .. r.
Code):
VNI 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) 5
and Professions Code). - -
CONSTRUCTION LENDING AGENCY 0:
I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit isissued (Sec. 3097, PERMIT FEE (Sub-Total)-
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 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 inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
rd
SIGNATU E OF'ZYLICANT OR AGENT DATE - -