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Home My Public Portal About10154 DAINES DR_Electrical__ 7GA6d'3.CfBO6 10.58 APPLICATION FOR ELECTRIC PERMIT 1 BUILDING AND SAFETY DMSION Department of County Engineer 7DR County of Los Angeles JOHN A. LAMBIE. COUNTY ENGINEER CASSATT D. GRIFFIN. SUPT OF BUILDING FOR APPLICANT TO FILL IN CROSS.5T. PERM FEES OWNER LIGHTS RECEPTACLES SWITCHES NUMBER 1 T E MEACH FEE MAIL 7r TOTAL OUTLETS $ 10 S ADDRESS / ELEC RANGES, WATER HEATERS, CITY TEL. NO. CLOTHES DRYERS 50 ELEC SPACE HEATERS. STAT'Y' COOK. ELECTRICIAN ING UNITS, GARBAGE DISPOSERS, ADDRESS 0 — ' VVV AUTO WASHERS, DISHWASHER .25 LIGHTING FIXTURES 10 O CITY TEL. N MOTORS - STATE LICENSE NO. HORSEPOWER H.P OVER INC. _ DISTRICT NO. GROUP ONE I READY FOR INSPECTION 1/2 e LESS .25 ,� - 2 .50 INSPECTION RECORD 2 — 5 1.00 5 15 1 50 15 50 250 50 200 5.00 M ISC. SIGNS NO TRANS NO LAMPS SERVICE O-600V too SERVICE OVER 600V 5.00 WIRING PERMIT - 1.00 0 FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT •50 APPROVALS TOTAL FEE S DATE INSPECTOR'S SIGNATURE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS A PLICAT ON, AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING �i� d4F n, 7�iJt 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES b- LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THEL LEGAL WN OF THE ABOVE POWER DESCRIBED RESIDENTIAL P PER . I A SIGNATURE UTILITY CO. NOTIFIED OF PERMITTEE FINAL JOHN A. LAMBIE. VALID ARTHUR C.VETT. COUNTY ENGINEER cK M H SUPERVISING ELECTRICAL ENGINEER ACO a 8 1 2 L JULI1 2 -1 3.9 5 In WORKERS' COMPENSATION DECLARATION 20-0019 DPW 3/87 1 affirm that I have a certificate of consent,to self CE"� APPLICATION FOR ELECTRICAL PERMIT O ins r a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or„ ified copy thereof (Sec 3800, Lab C ) Policy NQ/!2 4X Company 4?V�` ��tit� FOR APPLICANT TO FILL IN JOB ❑Certified copy i ereby furnished ��'�-�� New Residential Bldgs & Pools EACH NO FEE ADDRESS /��-5 DE- Certified copy is filed with the county building inspec- 1 & 2-Family, Sci Ft $ _ $ LOCALITY fJ� tion department Multi-family Sci Ft NEAREST Residential Swimming Pools OWNERCROSS S Date AOR � o� l -s ppicant FIRM NAME CERTIFI ATE OF EXEMPTION FROM WORKERS' Outlets Rec_/ Light -�- Sw MAID COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work involved by First ti CITY Tel No the permit is for one hundred dollars ($100)or less.) Total No r.� AdditionalcB �� ub PLAN CHECK I certify that in the performance of the work for which this 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 Additional Total No -S.— CITY Tel No Date Applicant NOTICE TO APPLICANT If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMITAPPLICATION73;Z_ 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//03 ^-i_ 54,y/eWA6;6 15�L1 7 with comply with such provisions or this permit shall be Top — FAU —W H — deemed revoked Hood — Fan -Other— CITaCt/ / laG Tel No�-y LICENSED CONTRACTORS DECLARATION LICENSE OR Disp _ Room Air CondREG NUMBER Class I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO P SSED BY a and Professions Code,and my license is in full force and effecto ,,cc Size &Type HP, KW, KVA, or KVAR 6-11-1e a O License Number1 ' � Lic Class_ Up to 1 Incl FINAL a U Contractor- �'� lj y Date �� 3 v Over 1 to 10 Incl DATE �' 7�// VALIDATION 0 ❑ Over 10 to 50 Incl FINAL / O I am exempt under Sec ' Over 50 to 100 Inc BY U B&P C for this reason Over 100 a Services, Swbd , MCC& Panelboards U) Date Z 0-200 Amp Under 600 V -` Signature 201 - 1000 Amp Under 600 V El Over 1000 Amp or Over 600 V,, Exemption for Reg Maint Elect SINGLE FAMILY Temp Power Pole&Appurtenances - HOME OWNER-BUILDER DECLARATION - Sign with One Branch Circuit s Sig I hereby affirm that I am exempt from the Contractor's License =1 Law for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits -'7-. Professions Code) -- ❑ I, as owner of the property, will do the work and the Misc Conduits&Conductors i j j E.1_, structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)— , 'tlFAL a" 403 Business and Professions Code) - i CONSTRUCTION LENDING AGENCY CHECK I hereby affirm that there is a construction lending agency for = Ni�E is the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) °= (Sec 3097, Civ C ) PLAN CHECKING FEE _ Lender's NameiI O i- PERMIT ISSUING FEE Lender's Address ='I - A0 k 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 Dote @)sSignature of Permit ee