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Home My Public Portal About10545 DAINES DR_Electrical__ 76A663 DBS SA 11-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES L Cm R I C 1 WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTR�fcT NO. GROUP Z NE PERMIT NO. S ,�' / = C3zx.57 ELECTRICIAN 7 /S � � 4' / ADDRESS f r READY FOR DATE ISSUED FIRST INSPECTION CITY T NOS H'f-(O70 COUNTY LICENSE NO EXPIRES BUILDING PERMIT S ADDRESS (/(� (//(��t,/ 66��✓6. FEE NUMBER EACH LOCALITY LIGHT OUTLETS NEAREST CROSS ST RECEPTACLES //j/�//J WALL'SWITCHE6 OWNER TOTAL OUTLETS Sc $ MAIL V /, ADDRESS '3/ -1 I ELEC HEATERS 25 CITY TEL NO FIXTURES 3 5 If 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS MISC APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS '3 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 , HORSEPOWERI ANGELES COUNTY LICENSE. OR 1 AM THE LEGAL OWNER FEE OF THE RESIDEN741522z�� PROPERTY DESCRI ED ABOVE. NEW MVD HP OVER I INC EACH 1/p 8 LESS $ 25 SIGNATURE OFI �Qt 1/z 2 50PERMITTE 2 5 1 OD INSPECTION RECORD 5 15 1 50 1 2- 15 5o _,_.2.50 50 1 200 1 500 20o Soo 10 00 � 500 1000 15 00 OVER 1000 20 00 (� M G SET/FREQ CHANGER-HP O WELDERS AC-KVA GENERATORS-KW TRANSFORMERS-KVA I TEMP MOTORS (75%OF ORIG ) MOVED MOTORS (75%OF ORIG ) MISC SIGNS NO NO TRANS APPROVALS NO NO LAMPS DATE INSPECTOR'S NAME FOR EACH PERMIT CONDUIT WIRING $1 001, r I WIRING FIXTURES $1 00 / FIXTURES SUPPLEMENTARY 50 POWER _a TOTAL FEE $ UTILITY CO NOTIFIED (r� FINAL WORKER'S COMPENSATION DECLARATION 766663 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT 766663 ,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,(Se 3800 Lab C) Po No Co ar �• �G FOR APPLICANT TO FILL IN ADDRESS f ❑ c5 _/ SGS ertifi copy is here furnished New Residential Bldgs &Pools NO EACH FEE $ $ LOCALITY ❑` Certified co is filed with the count building ins e n 1 &2-Family,Sq Ft PY Y 9 P NEAREST department Multi-family Sq Ft CROSS ST Date L pplic t Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL ERTIFICA EXEMPTI KERS' Outlets R —Light Sw OWNER OR ec k COMPENSATION INSURA gFIRM NAME First 20 MAIL (Thissection need not be completed if the work Involved by the ADDRESS permit is for'one fiundred dollars(S100)or less) Total No Additional I certify that in the performance of'the work for which'this permit CIT G Tel No s 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 f , - Total No Additional ADDRESS_ Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP NOTIC TO APPLI ANT If, after making ertificate of CITY Tel No Exemption, you,should become subject to thekers'Compensation OTHER APPLIANCES NOT OVER 3 HP provisions of the Labor Code, you must forthwith comply with such ERM provisions or this permit- ermit shall 'be deemed revoked Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KKVV�fj'or R p ADDRESS - C� 1 hereby affirm that I am licensed under provisions'of Chapter 9 Ove i 3 t 1 �a (commencing with Section 7000) of Division 3 of the Business and CITY /07 ' Tel N��3JZ�111( Professions Code,and my license Is in full force and effect Over 10 to 50 Incl } LICENSE OR �•- "j Class / ", -7 /s Over 50 t0 100 In REG NUMBER ✓ ��/ 0 Over 100 DISTRICT NO PR ;S�SED BY 0 License Number (((G/ Lic ClassPV Services,Swbd,MCC Pa elboards - evi �� (� :( Contractor�1/?/ilr/-('___((( ///... G Date ds� 6-•/L B� Amp .,Y"., i66V" � FINALDATE // � ❑ I am exempt under Sec 400-1000 Amp Under 600 V j Z71� Over 1000 Amp or Over 600 V FINAL Over a 16&P C for this reasonBRANCH CIRCUIT FEES BY 15A,or 20A,120V,Lighting or Recept Z Date _ - - 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits El 41 Or More Branch Circuits — EzempUon for Reg Maint Elect 15A,20A,208V To 277V Lighting Br Circuits SINGLE FAMILY Temp Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION yw I_T°g I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit for the following reason (Section 7031 5, Business and Professions" Additional Sign Branch Circuits —n Code) ' ' t TEI El1,as owner of the property,will do the work and the structure Mlsc Conduits&Conductors _ _ i is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) T_(r riE 8 ,2 = 0 and Professions Code) CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the 'i¢wAtf��t °011 performance of the work for which this permit is issued (Sec 3097, PERMIT FEE (Sub-Total) 5� CIV C) PLAN CHECKING FEE 15 -1 Lender's Name 47"� r ,- ) PERMIT ISSUING FEE — l�I°=— 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 2&- p SIGNATURE OF PERMITTEE DATE