HomeMy Public PortalAbout10414 DAINES DR_Electrical__ 76A663 985,"': 7-51 APPLICATION FOR PERMIT.
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR-APPLICANT TO FILL NDISTRIC O. GROUP ZONE PERMIT NO.
I� �_ �
ELECTRICIAN IVED BY READY'FOR DATE.198666
ADDRESS I,, ,,"�,,__)meq �j , �Ij ,��_!'� '> FIRST I $PECTI N ' W � 3 _
CITY 0/"Di whit'-'// /lam TE11 L. NO': /1_3
COUNTY LICENSE NO. //j EXPIRES / , BUILDING
ADDRESS
PERMIT FEES �/1/LI /Z�„•1 yA� yt�
FEE ,� �
NUMBER EACH LOCALITY �yV Al ,
LIGHT OUTLETS NEAREST
CRO88 ST L
RECEPTACLES
WALL SWITCHES Y ❑WNI R
TOTAL OUTLETS Sc $ 2— 0 MAIL
ELEC RANGES 25 ADDRESS
ELEC. HEATERS 25 CITY TEL. NO.
FIXTURES --,� s 1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MISC APPLICATION AND STATE THAT THC 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 1 CERTIFY THAT 1 POSSESS THEABOVE VALID LOS
FEE
NUMBER HORSEPOWER ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
NEw Mvo. HP OVER INC., EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
V2 & LESS $ .25 SIGNATURE OF J`/�
I/2 2 .50 PERMITTEE
2 B 1.00INSPECTION RECORD
S 15 1.50
is 50 2.50
50 200 Boo
200 500 10.00 J
500 1 000 15.00 Q
OVER 1000 20 OO Lo
MG. SET/FREQ. CHANGER-HP - Q
WELDERS: AC-KVA - O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF ORIG)
MOVED MOTORS (75% OF ORIG) _
MISC.
SIGNS
NO. NO.TRAN8
� - APPROVALS �
NO NO LAMPS
FOR EACH PERMIT: DA INSPECTOR'S NAME
WIRING $1,00 (� CONDUITS p
FIXTURES $1.00 Q d WIRING
SUPPLEMENTARY ,50 FIXTURES
POWER
TOTAL FEE, 9+ LITILIT-/CO.NOTIFIED
FINAL Z
•} ?WORKER'S COMPENSATION DECLARATION 20 0019 DPW(12-91)
76A663 APPLICATION FOR ELECTRICAL PERMIT �J
I hereby 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) ,
P❑OI Cy NO Company FOR APPLICANT TO FILL IN JOB tO/f t 11 5 k v i S f
ADDRESS T'\`-�-
Certified copy Is hereby furnished New Residential Bldgs &Pools NO EACH FEE❑
$ $ LOCALITY
Certified 1 &2-Family,Sq Ft copy is filed with the county building Inspection _ NEAREST
department Multi-family Sq Ft CROSS ST e ` h
Residential Swimming Pools ASSESSOR
Date Applicant MAP OK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' NER OR 11
I COMPENSATION INSURANCE Outlets Re Light If Sw ��� FIRM NAME1 �} U
( P y /J / FIfSt 20 �� AMAIL
DDRESS 0 I �.� S �J 1
This section need not be completed If the work Involved b the O�'�C p
permit Is for one hundred dollars($100)or less)' f Total N Additional d�^
I certify that in the performance of the work for which this permit CITY C� Tel NoS&L O`/`'
is Issued, I shall not employ any person in any manner so as to PLAN CHECK
become subject to the Workers'Compensation Laws Lighting Fixtures First 20 APPLICANT
Total No Ad Itional
' ADDRESS '
Date Applicant 7l —N—i
NOTICE TO APPLICANT If, after making this Certificate of IAN S OVER 3HP CITY Tel No
Exemption, you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP
provisions of'the Labor Code,'you must fo-rrthwith comply with such PERMIT
provisions or this permit shall-be deemed revoked Power Apparatus&Large Appliances APPLICANT
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESSI&A
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 InclQ
(commencing with Section 7000) of Division 3 of the Business and CITY ��,(� Y Tel No N, �gZ 4
Professions Code,and my license is in full force and effect Over 10 to 50 Incl
LICENSEClass tl
' Over 50 t0 100 Incl REG NUMBER O
Over 100 DISTRICT NO PROCESSED BY U
License Number LIc Class
Services,Swbd,MCC&Panelboards - ccO
Contractor Date 0-399 Amp Under 600 V FINAL DATE F—
❑ I am exempt under Sec 400-1000 Amp Under 600 V A VALIDATION W
Over 1000 Amp or Over 600 V FINAL / ! CL
BRANCH CIRCUIT FEES
B&P C for this reason BY ' W
Date 15A,or 20A, 120V,Lighting or Recept _
Z
z 1 To 10 Branch Circuits
Signature _ 11 To 40 Branch Circuits
❑ 41 Or More Branch Circuits
Exemption for Reg Maint Elect 15A,20A,208V To 277V Lighting Br Circuits
SINGLE FAMILY Temp Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
T°$
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) t_
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) -106 = 50
0
and Professions Code) _
CONSTRUCTION LENDING AGENCY _c
V 16C.51-1
1 hereby affirm that there Is a construction lending agency for theiilrs��C
performance of the work for which this permit Is issued (Sec 3097, PERMIT FEE (Sub-Total) O
Civ C)
}
Lender's Name PLAN CHECKING FEE � 00C10-1-1013 i ,.7�I_rC-}
PERMIT ISSUING FEE pp is J Ar. jn0—
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 ent on the above-mentioned property
�nspect n pu� SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNATURE OF PERMITTEE S— \ DATE