Loading...
HomeMy Public PortalAbout10236 DAINES DR_Electrical__ 76A663 OBS SA 3-513APPLICATION FOR PERMIT" DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. - GROUP 'ZONE PERMIT NO. ELECTRICIAN �/ ADDRESS � R �.E ED 8Y FIRST INSPECTION DY FOR DATE�J18/BUE'20 (�7 CITY w.v /J' �U .WL.. NO. C , COUNTY LICEN8E/NIp _ XPIRES BUILDING Q PERMIT FEES FEE ADDRESS D � S NUMBER EACH LOCALITY LIGHT OUTLETS ZA NEAREST CROSS 81; 20, 'RECEPTACLES �zS � WALL SWITCHES OWNER _ TOTAL OUTLETS Aw a, Sc $ MAIL (/J} ELEC. RANGESd' 25 ADDRESS ELEC. HEATERS 25 ( / CITY TEL..• NO. ® Y FIXTURES l 5 1 HEREBY ACKNOWLEDG THAT 1 HAVE READ THIS MISC. APPLICATION AND STATE HAT THE ABOVE IS_ CORRECT NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. MOTORS I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS NUMBER HORSEPOWERFEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER EACH OF THE RESIDE IAL PROPERTY DESCRIBED ABOVE. NEW MVD. HP OVER INC. ' 1/ S LEHB $ .25 SIGNATURE RTTEr d8���"�" /2 2 .50 -1 2 5 1.00 INSPECTION RECORD 5 15 1.50 is 50 2.5❑ 50 200 5.00 c./dP,O fJ/VD 200 500 10.00 4$v; 7y 4m , ,/I G s0o 1000 15.00 OCA Nu r eCl*Q �/V .Tc�iel/ Z OVER 1000 20.00 13 M.G. BET/FREQ. CHANGER-HP '� �/ d� It WELDERS: AC-KVA 3 LiCaN 1� /�EV�' tJ.0 /� Tp C//N O ' GENERATORS - KW vy I Irly v' ���+ �-���9 tgyyd TRANSFORMERS - KVA ' y Q �O W TEMP. MOTORS (75% OF ORIG-)• G�I MOVED MOTORS (75% OF ORIG.) Mlec. �v3 -�✓K � 2 3' c.� Fi.✓�.Ftc SIGNS NO. NO.TRANS. APPROVALS NO. NO. LAMPS FOR EACH PERMIT: DATE INSPECTOR'S NAME WIRING $1,00 CONDUIT FIXTURES $1,00 WIRING SUPPLEMENTARY .50 FIXTURES POWER - TOTAL FEE >�� f 'UTILITY CO.NOTIFIED ( FINAL WORKER'S COMPENSATION DECLARATION 26-0019 DPW(12-91) 76A663 APPLICATION FOR ELECTRICAL PERMIT a I hely affirm that I have a certificate of consent to self Insure, 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) JOB Policy No- Company FOR'APPLICANT TO FILL IN /Ne C ADDRESS , ✓ ❑ Certified copy Is hereby furnished New Residential Bldgs &Pools NO EACH FEE $ $ LOCALITY , — ❑,,^ ,Certified copy,is filed with the county building &2-Family,Sq Ft lding inspection _ NEAREST j� department Multi-family Sq Ft CROSS ST Date Applicant Residential Swimming Pools ASSESSOOR K MAP BO PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER OR �J� �+ pp S COMPENSATION INSURANCE Outlets Rae _Light Sw FIRM NAME 0�/V(Z 0� C. /��Pr First 20 MAIL (This section need not be completed if the work Involved by the Total No Additional ADDRESS l permit is for"one hundred dollars($100)or less) ; C I certify that in-the performance of the work for which this permit -CITY C�19%� Tel No Is Issued, I shall not employ-any person in any manner so as to PLAN CHECK become subject to the Workers' Compens on aws Lighting Fixtures First 20 APPLICANT Total No Additional "ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP " NOTICE,TO APPLICANT If, after making this Certificate of CITY Tel No " Exemption,you-should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP rovisions of the Labor Code, ou must forthwith comply with such PERMIT /► a7lVC / r�gl�C�L� P y P y APPLICANT ��/ (,, v! � provisions or this permit shall be deemed revoked Power Apparatus&Large Appliances �, LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS 612i? ` C jLjj4L vg I hereby affiFm that I am licensed under provisions'of Chapter 9 Over 3 to 10 Incl p (commencing with Section 7000) of Divlslon'31of the Business and CITYJA )t C� Tel Nog`Y 3sk. 2a Professions Code, and my license is In full force and effect "Over 10 to 50 Incl LICENSE OR //'� Clas�/�f C" Over 50 t0 100 IRCI REG NUMBER & (p ©7� "�" (/�� ,9 O Cy O Over 100 DISTRICT NO PROC SED BY O CL License Number `r t/ Llc Class n 0 Sen�jVA s,S w b d,/t� C$�P/aynIb/Dardsv Contractor i�Y ate 10 0-39 S pJUifder 600/V DATE ❑ 1 am•exempt under Sec 400-1000 Amp Under 600 V 1� // a61r Over 1000 Amp or Over 600 V �+ VALIDATION LU FINAL d B&P C for this-reasonBRANCH CIRCUIT FEES By 0- 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 Mamt Elect 15A,20A,208V To 277V Lighting Br Circuits Lyp 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 for the following reason (Section 7031 5, Business and Professions_ Additional Sign Branch Circuits Code) ❑ I, as owner of the property,will do the work and the structure Mlsc Conduits&Conductors isnot intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code) CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Sec 3097,. PERMIT.FEE (Sub-Total) Civ C) PLAN CHECKING FEE Lender's Name Y PERMIT ISSUING FEE ,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 Inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF PERMITTEE DATE , • 'v CGUNTY OF LOS ANGELES T =c G;ff G5v8 zLECTRICAL PERMIT LEPARTMENT OF PUBLIC WORKS 9lb1 LAS -.-,IN.S EL 6508 0410210009 BUILDING ACED SAFETY / LAND DEVELOPMENT F rf-Y CA 91780 �6) 285-0488 E"-. LEGAL ID: FEES PAID — BUILDINU ADDRESS: TR: 15862 LT: 7 102"-', :;AINE3 DR _ FEE DESCRIPTrrs: QUANTITY: UC,;4 AMOUNT: TEMP 1'A '`17902707 ASSESSOR INFORMA'ION N0,11BER: NEAREST CRJSS STREET: 8586-027-007 Al PERMIT ISSUANCE cFE 27.75 THOMAS GAGE: 597 GRID: B3 u;C�j !T`i: TEMPLE CITY, CI F1 120V, 15/20. GR .KTS 2.00`BR 34.50 TENANT: G1 OUTLETS-LGT,SV REf-P 25.00 OUT 45.75 I ON: PRCCESSED BY: P LAT-W: EXPIRES ON: G2 LIGHTING �: UkE� 8.00 LCT 15.60 10/21/04 Ja 04/1105 JB AC UNITS 3-10HP 1.00 AC 19.65 OWNER: TEL. NO: TOTAL FEES 143.25 FINAL DA—it----FINAL BY: —Ci?