HomeMy Public PortalAbout8743 BURGHARDT RD_Electrical__ 76Ae63-CERO¢3-84 APPLICATION FOR ELECTRICAL PERMIT
' COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION fADDRESS O
JOHN A. LAMBIE. COUNTY ENGINEER
WILLIAM A. JENSEN. SUPT OF BUILDING
NEAREST
FOR APPLICANT TO FILL IN I CROSS ST.
RECEPT26 TOTAL NO. EACH FEE
OUTLETS (FIRST 20r a 8.20 8 OWNER
LIGHT ` C` MAIL
ADD'L ;} 10 o ADDRESS
SWITCH./' OVER 20 d�
TOTAL CITY TE;PROCESISEDSY
LIGHTING l l/ FIRST 20I l[. .20 Zb0
FIXTURES fl /7 AOD�L
OVER 20 AO ELECTRICIAN
RANGES CLO.DRYERS WTI.HTRS. 1.00 ADDRESS O15
GARB.DISP. y BTA.COOK CITY TEDISHWASH. AUTO.-WASH. STATEJ'�SPACE HTRS. STA.APP.0I HA.MAX. .50 V LICENSE NO. 46MOTORS: OVER HOT OVER H.P. DISTRICT NO. GROUP Z
O t 1.00 _
1 3 1.50 INSPECTION RECORD i
s — e 2.00 O
V
6 15 2.50 m
O
15 SO 3.00 V
50 — 100 5.00 UJ
N
SIGNS: NO.TRANS- _Z
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 6 (p U'
1 HEREBY ACKNOWLEDGE THAT I 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
ELECTRICAL WIRING. WIRING
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR /• y
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. �1 POWER
SIGNATURE �ti UTILITY CO.NOTIFIED
OF PERMITTEE 111!!!""" iiY" V
FINAL
VALIDATION ARTHUR C. VEIT
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
Lto 6 3 0 64 DEC 2 4 2 A 16.00-
d
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WORKERS' COMPENSATION DECLARATION 63 10/81 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate
8ficate of consent to self CE06G
insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof (Sec. 3800, Lab. C.) 5
Policy No. Company FOR APPLICANT TO FILL IN JOB
Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS
Certified copy is filed with the county building inspec- 1 8 2-Fomily, Sq. FL E — 8 LOCALITY
tion department. Multi-family Sq. Ft. — NEAREST
Residential Swimming Pools CROSS ST.
Date Applicant OWNER OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec_Light5w._ MAIL
COMPENSATION INSURANCE First 20 ADDRESS
(This section need not be completed if the work involved by Total No. CITY Tel. No.
the permit is for one hundred dollars ($100)or less.) Additional
I certify that in the performance of the work for which this PLAN CHECKAPPLICANT
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. Additional
CITY Tel, No.
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. _ APPLICANT
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. CITY Tel. No.
deemed revoked. Hood _ Fan _Other_
LICENSED CONTRACTORS DECLARATION LICENSE OR -
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REG. NUMBER - Class.
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO, PROCESSED BY }
and Professions Code, and my license is in full force and effect. Power Apparatus 8 Large Appliances 0
Size 8 Type HP, KW, KVA, or KVAR - V
License Number Lic. Class- FINALU to 1 Incl. W
Over 1 to 10 Incl. DATE LL
VALIDATION
Contractor Date
Over 10 to 50 Incl.
FINAL y
I am exempt under Sec. Over 50 to 100 Inc BY Q
B.BP.C. for this reason Over 100 tY
Date: Services, Swbd., MCC 8 Panelboards ►
0 -200 Amp. Under 600 V
W
Signature 201 - 1000 Amp. Under 600 V �
❑ Over 1000 Amp. or Over 600 V
Exemption for Reg. Mainz. Elect.
SINGLE FAMILY Temp. Power Pole 8 Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits
Professions Code): 9 ♦ is is
I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ , ,n, .y
7044, Business and Professions Code). .' -e
CONSTRUCTION LENDING AGENCY a�'is
hereby affirm that there is a construction lending agency for
the performance o4 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
the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date