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HomeMy Public PortalAbout4940 ARDSLEY DR_Electrical__ 76A663-CE806 10/72 APPUC Alcor O�NOR Etd v�°30C Qd PONT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER aooREss �> d BUILDING AND SAFETY DIVISION z' LOCALITY FOR APPLICANT .TO FILL IN NEAREST //1 CROSS ST. �_ � _��b�� �'� T—' .. OUTLETS N0. EACH FEE OWNER OR $ $ FIRM RECEPT._ - MAIL LIGHT TOTAL FIRST 20 25 ADDRESS CITY TEL. NO. • SWITCH._ OVER 20 jp PLAN CHECK FIRST 20 25 APPLICANT r�f� LIGHTING. TOTAL FIXTURES - OVER•20 ADDRESS � � .10 RESIDENTIAL APPLIANCES clTv`' TEL. NO. PERRANGE DRYER WTR. HTR._ APPLIIICANT `,d Lg STA. COOK DISP. - F.A.U. - ADDRESS r. "� • 'v 'c• ._S,iO -'4 SPACE HTR. AIR COND. CITY' _ ly�- TEL. N0:' � LICENSE OR CLASS. �('.G CLOTHES WASH. - DISHWASH. REG. NUMBER •' FAN - OTHER 1.00 I HEREBY ACKNOWLEDGE TH ^ P. <ryTHIS�3AT I�HA VE READ 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 0 -`1 100 LICENSED AS REQUIRED BY'LOS ANGELES COUNTY AND STATE OF CAiIFORNIA •OR THAI ,I AM THE LEGAL OWNER OF THE ABOVE r i 10 3.00 . DESCRIFED RESI'DE,NTIAL PRO RTY. CL PERMITEE / ///J� - V 10 - 50 5.00, 'SI,GNATURE -��t � ��' / ll�J..>• O 50 -100 10.00 F-- DISTRICT NO. ED BY '- W 100 - S00 15.00 � Z SIGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE INSPECTOR' SIGNATURE TUBE, OR MARQUEE ADDITIONAL'CIRC UITS 1.00. TEMP. POWER POLE- - SERVICENOTOVER600VOLTS OR200AMP 3.00 UNDERSLAB WORK SERVICE OVER 600 VOLTS'OR 200 AMP, 10.00 ROUGH CONDUIT' TEMPSERVICE,POLE, &APPURTENANCES. -5.00 WIRING �� i TEMP.LIGHT OR RECEPT:,SYSTEM 3.00 _ FIXTURES - POWER AUTHORIZED 'UTILITY CO. NOTIFIED I FINAL O d 75-1-�7, ` PERMIT FEE (SUB TOTAL) NOTES: 1, PLAN CHECK FEE - PERMIT ISSUING FEE 3.00 TOTAL FEE �_- PLAN CHECK VALIDATION CK. M.Q. CASH PERMI ALIDATION CK. M.O. CASH SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 76A663-CE806 10/72 (x1111 U UC[rUVO V FOR ElECIMUCAL Il LSUU❑ T COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER JOB BUILDING AND SAFETY DIVISION ADDRESS LOCALITY - NEAREST p>.� FOR APPLICANT TO FILL IN CROSS ST. OUTLETS NO. EACH FEE OWNER NAME RECEPT.� S $ MAILADDRESS LIGHT,_ TOTAL FIRST 20 � .25 ~ (J ('� _ CITY TEL. NO.2 ".2 SWITCH 2, OVER 20 .10 0 - PLAN CHECK FIRST 20 APPLICANT LIGHTING .25 G:3 to TOTAL FIXTURES OVER 20 .10 ..ADDRESS - RESIDENTIAL APPLIANCES „ CITY ii' TEL. NO. RANGE DRYER_WTR. HTR.= APPLICANT STA. COOK DISP. F.A.U: ` 5 ~ ADDRESS SPACES HTR. AIR COND. CITY TEL. N0, CLOTHES WASH. DISHWASH. REG.LICENSE NUMBEROR , CLASS. I ' FAM / OTHER / 1.00 J �r v I D HEREBI' ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION- r ANSTATE 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, 0 - 1 - 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL'OWNER OF THE ABOVE 1 - tO 3.00 OESCRI-F:ED R,E SI DENTIAL PROPERTY. i O 10 - 501 5.00 PERMITEE, , � B U SIGNATURE i CCG���Il r �.:"v- �. O 50 - 100 10.00 DISTRICT NO. PROCESSED BY V Lu 100 500 15.00 �1 Gl ` N CO a A g SIGN, GAS SIGN AND ONE_CIRCUIT 5.00 APPROVALS DATE INSP TOR'S SIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS •.1.00 TEMP. POWER POLE SERVI CENOT OVER 600 VOLTS OR 200 AMP ' 3.00 UNDERSLAB WORK SERVI CEOVER 600 VOLTS OR 200 AMP 10.00 ROUGH CONDUIT TEMP SERVICE,POLE, &,APPURTENANCE S 5.00 WIRING ` TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES {_ Q-7 POWER AUTHORIZED ' ,UTILITY CO. NOTIFIED FINAL PERMIT FEE (SUB TOTAL) o NOTES: PLAN CHECK FEE PERMIT ISSUING FEE 3.00 - `3 dv `- TOTAL FEE �_( S_ PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 7. 3 FEB i 3 2 © 1 1.8 t? SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE pp, .. �. 768663-CE806 10/72 APPMC�f���O,1 1 FOR �d�'._ 7MC AL PERNU COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER AooREss = C BUILDING AND SAFETY DIVISION ' - LOCALITY A NEAREST FOR APPLICANT TO FILL IN CROSS ST. OUTLETS NO. EACH I FEE OWNER OR $ FIRM NAME RECEPT ` n MAIL ` FIRST 20 / G 25 'V ADDRESS LIGHT TOTAL CITY TEL. NO. SWITCH OVER 20 .10 PLAN CHECK FIRST 20 25 APPLICANT LIGHTING. TOTAL OVER 20 ADDRESS FIXTURES .1p RESIDENTIAL APPLIANCES CITY TEL. No. PERMIT -RANGE DRYER_WTR. HTR. APPLICANT STA. COOK DISP. I F.A.U. ADDRESS SPACE HTR. AIR COND. CITY TEL. NO. J1 . ,ry, CLOTHES WASH: DISHWASH.� LIC SENUMBER OR / CLASS. LI . J v f FAN OTHER 1.00 O1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 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 0 - 1 1.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAI I AM THE LEGAL OWNER OF THE ABOVE 1 - 10 3.00 DESCRIBED RES". NTIAL PROPERTY. o PERMITEE U 10 - 50 5.00 SIGNATURE I= 50 - 100 --10.00 D I S T R I Tb. PROC• ED BY ly 0- 100 100 - 500 15.00 SIGN, GAS TUBE, OR SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE INSPECTOR'S SIGNATURE MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE SERVI CENOTOVER 600 VOLTS OR 200 AMP / 3.00 UNDERSLAB WORK SERVI CE OVER 600 VOLTS OR 200 AMP 10.00 ROUGH CONDUIT TEMPSERVICE,POLE, &APPURTENANCES 5.00 WIRING TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED FINAL a'��de PERMIT FEE (SUB TOTAL) NOTES; CF _ PLAN CHECK FEE PERMIT ISSUING FEE 3.00 Q TOTAL FEE PLAN CHECK VALIDATION CK. M.D. CASH PERMIT VALIDATION CK.' M.O. CASH 77 3 SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE _ WORKERS'COMPENSATION DECLARATION 76A669oPw3 W APPUCAMH FOR ELEC�TUCAd PERNT T erEb affirm that I have a certificate of consent to self 7E_806 y j.CE-f306G � insure;,or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS ona certifiedI'TSec. 3800, Lab. C.) • Polity No ompany FOR APPLICANT TO FILL IN JOB /� �+ fJ ❑Certified copy is hereby furnished. / -/-f/ New Residential,Bldgs. & Pools EACH NO. FEE ADDRESS D t .5 `-' ❑Certified co is filed with the count buildinginspec- 1 &2-Famil S Ft. $ — $ LOCALITY t copy y p y q NEAREST tion department. Multi-family Sq. Ft. CROSS ST. J//"q"y/,�/� Residential Swimming Pools OWNER OR Date - Applicant-�� V FIRM NAME �_- h CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light�Sw. MAIL COMPENSATION INSURANCE First 20 j D Gj ADDRESS (This section need not be completed if the work involved by Total No.� CITY Te. No. the.permit is for one hundred dollais ($100)or less.) Additional - C PLAN CHECK I certify that in the performance of the work for which this � ; APPLICANT 6�6j-wa4 Li IA permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation taws. Lighting Fixtures First 20 ADDRESS �� rl Additional Total No. CITY Date Applicant � - NOTICE TO APPLICANT: If,' after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range— Heater—D.W. — APPLICATION Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS with comply with such provisions or. this`,permit shall be Top — FAU —W.H. — deemed revoked.. CITY if e1, � LICENSED CONTRACTORS'DECLARATION Hood — Fan —Other— Dis _.Room Air Corid. — LICENSE ORM I hereby affirm that I am licensed under provisions of Chapter 9 p� REG. NUMBER � � Classes.( (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. P O SED BY and Professions Code,and my license is in full force and effect, t1 Size&;T ype HP, KW, KVA, or KVAR HP, KW, KVA, or KVARd �' Q Classy- Up to 1 Incl. FINAL U FTP 7 Over 1 to 10 Incl �� j Contractor (7�1��n ..Lt o afe - - DATE 3-� VALIDATION O Over 10 to 50 Inc[. FINAL ❑ I am exempt under Sec. �� Over 50 to 100 Inc. BY /} � W B.&P.C. for this reason Over 100 3 0- Date: Services, Swbd., MCC& Panelboards D Z . 0-200 Amp; Under 600 V — Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000.Amp. or.Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp. Power Pole 8 Appurtenances Si n with One Branch Circuit A"f'" I hereby affirm that'I am exempt from the Contractor's License g Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): , ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors structure is not intended or offered for sale Section 7044, Other (See Complete Fee Schedule)_ D -7 Business and Professions Code). CONSTRUCTION LENDING AGENCY i I hereby affirm that there�is a construction lending agency for >.b�f?j'ti�� the performance of the,work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE 3 Lender's Name � --' _ _. _.si`3 PERMIT ISSUING FEE -a Lender's Address `I)'I 7.50 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 r resent five§of this County to enter upon the above-mentio ed pro rty for i pection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ©s Signature o erti4ittee Date