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Home My Public Portal About10629 DAINES DR_Electrical__ 0085A 25MBETS 1-48 DEPARTMENT OF BUILDIl49 AND SAFETY APPLICATION FOR PEIIMIT COUNTY OF LOS ANGELES ELECTRIC C' RIC HIEF 1 NAME ' DISTRICT NO. GRT/OUP /ZONE PERMIT NO. ADDRESS n O' CITY TEL.NO. J�V�®q/�B.,V,� FIRST INSPECTIONRECREADY FOR DATE ISSUED / J COUNTYNO. EXPI //2'_61 i /�_ 7 bl APPIICAMF FILL IN HEAVILY OUILMD PO R TION ONLY JOB DESCRHMON OF WORK ADDRESS. NUMBER OF OUTLETS ON CIRCUITS LOCALITY /d Y 17n....._K i LOCATION BY ROOMS LGHT OUTLETS SW. PLUGS IQT NEAREST CIRCUIT A B C D E . F G H 0 NAME �l• �,. �.0 [J-,o�.�PA> i Z MAIL '7 I �n . �I. 0 } ADDRESS \ !//��J jI Cm TEL►r7o. �• 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANG9LES COUNTY. CERTIFICATEOF QUALIFICATION.. � - ELERRICIAN.i 1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED, B AOVE uk' CdA OWNER. ' CORRECFIONS • J Q �.Z. _n E —Tr O LTOTAL NO. OF OUTLETS `/'/ $ I_ O I APPROVALS NO. OP FIXTURES $ 4 n DATEtINS EP�OR'8 NAME NO. OF MOTORS H.P. $ CONDUIT V _ NO. OF SIGNS TRANS. $ WIRING NO. OF RANGES,OR HEATERS / $ [I]. S. FIXTURES M S EL OU6 $ POWER PERMIT FEE $ �' � 7 UTILITY CO.NOTIFIED TOTAF 8 � 3 r) FINAL �� /� >6A6G3 +^ DeB.51112,5A APPLICATION FOR ELECTRIC,-P.E.RIV IT 1 ,1 . DIVISION OF BUILDING AND,SAFETY •�- - Department of County'Engineer County of Los-Angeles - „,BU ILDiNG, LL at { nn ll )A�)(� WM. J. FOX.'COUNTY ENGINEER ADOR ESS l(J'V (�(�-� ,•��l /,l�L CASSATT D. GRIFFIN, SUPT OFBUILDING .�J � o .r FOR APPLICANT TO FILL IN OF —••Lo0AL1ry '�'-P/YH ,a1 PERMIT FEES . ,NEAREST. CROSS ST. FEE i NUMBER EACH 'LIGHT OUTLETS •OWNER 1 + RECEPTACLES MAIL �� /] ADDRESS +�lt�/./L.Jf.�!. - _ - WALLSWITCHES TOTAL OUTLETS 50 $ CITY .TEL. NO. u ELEC..RANGES _ 25' ELECTRICIAN •••Pi(.A ELEC. HEATERS 25' ^ H1 ' � � •w a ADDRESS�i!�; yy�1 tt KW EA CITY �,A�. TEL NOVQ71 / _f .FIXTURES ./ 5.' O2 LICENSE NOJ NUMBER OF LIGHT CIRCUITS DISTRICT_'O. I GROUP' ZONE EEADY FOp INSPECTION NUMBER OF RECEPTACLE CIRCUITS ILI MOTORS NUMBER HORSEPOWER FEE INSPECTION RECORD, NEW -MVD. HP OVER 'INC. EACH _ I/1&LESS', '$'w .25 Ih 2 .50 -- 2 /5 • . .1.00 _ 5 15 • 15S0 50. 200 5.00 NO. SIGNS NO.TRANS. NO. SIGNS NO. LAMPS FOR EACH PERMIT: WIRING - .. $1.00 FIXTURES $1.00 SUPPLEMENTARY ;50 _ - - APPROVALS ' TOTAL FEE $ DATE' INSPECTOR'S SIGNATURE 1'HEREBY ACKNOWLEDGE THAT'IHAVE'REAO THIS APPLICATION' 'CONDUIT " AND STATE THAT THE ABOVE IS CORRECT AND AGREE.TO COMPLY - _ .-� -/�.,._�,� / WITH ALL COUNTY ORDINANCES:'AND STATE LAWS' REGULATING 'WIRING ELECTRICAL WIRING. . . - y 1HEREBY CERTIFY THAT I. AM PROPERLY REGISTERED AND/OR FIXTURES " LICENSED AS REQUIRED BY LOS ANGELES COUNTY ANDSTATEOF , ,'POWER CALIFORNIA OR THAT I,AM-THE LEGAL'OWNER OF THE ABOVE + DESCRIBED RESIDE TIAL PROPERTY. UTILITSIGNATURE PERM TTE •y'P �FINALY CO. NOTIFIED WILLIAM J. FOX,/COUNTY ENGINEER, VALIDATION • '. ' 'L5''6'8 4", .nn_ 15 . 2. 2.30 In BY. ® - ' DEPUTY ' WORKERS' COMPENSATION DECLARATION, 76A663, 10[81 APPLICATION i . consent pD mL ICA4I/ N FOR ELECTRICAL m ERMIT ,hereby affirm that I have a certificate of to elf CE-8066 sure, - . or a certificate Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a,{certified T copy thereof (Sec 3800, Lab, C.)C.)) Wa c'y'I� !It �w Company` -J "'' FOR APPLICANT TO FILL IN JOB' �/ - - ADDRESS F/p �ryilop Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. PEE . - I & 2-Famil — LOCALITY Certified copy is filed with the county building inspec- y, Sq. FL $ — $" tion department. - Multi-family Sq,Ft. 'NEAREST / //LL�� .�� n�� Residential Swimming Pools 't "' CROSS ST. Date Applicant ACPA . &tl�af OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec�Light�Sw� EMAIL . . COMPENSATION INSURANCE - Fst 20 ° 3 ADDRESS Q '� r' �N {This section need not be completed if the work involved by Total No.,_ additionairl' , . CITY Tel. No- �—O '• :the permitfis For one'hundred dollars ($ 100)artless!). ' PLAN CHECK' " ('certify that in the performance-of-the'work`for which this APPLICANT permit is issued, I shall not employ any personin any manner - - ( - so as to become'subject to:the Workers'Compensation Laws, Lighting Fixtures First 20 3 ADDRESS , r Additional - Total No. - - CITY Tel: No. 'Date Applicant - - Fixed-A Lances Not Over I HP NOTICE TO APPLICANT: If, aPERMIT fferfmaking this Certificate of PP Exemption, you should become, subject to the Workers' HAPP Range_ eater_D.W. _ 4 6 Compensation provisions of the Labor Code, you•must,forth- Oven _ Dryer — W.M._ ADDRESS e- with comply with such provisions or thispermitshall,be Top FAU 'W.H. _. deemed revoked. - .. Hood Fan /_Other_ CITY (V�r °C4V1,yA T.I. o. b$ LICENSED CONTRACTORS DECLARATION LICENSE OR ' Disp. Room,Air Cond. _ . '� Q. Class. I hereby affirm that I am licensed under provisions of Chapter REG: NUMBER j �j - (cammencing.with Section.J000) of.Div isipn &of fheBusiness DISTRICT NO. PROCES ED BY and Professions Code, and my licenseis in full force ondeffect: Power Apparatus.& Large Appliances ,. } Size.B Type HP, KW, KVA, or KVgR' _ �Q Q enu License Nmber�F•�n ✓� Lic-Clads - Up r I Incl.1 to 101nc1. L DATE Opp C.ntractor Over VALIDATION Over 10 to 50 Incl. FINAL 0 am exempt under Sec. Over 50 to 100 Inc. - BY / �- B.BP.C. for this reason Over 100 ,y _ 'Services; Swbd., MCC 8'Panelboards Date: . 0 - 200,Ampr Under 600 V - O Signature " 201 - 1000 Amp. or Over 0 V e ^ - ❑ Over 1000.Amp. or Over 600V Exemption for Reg. Mainz. Elect., .SINGLE FAMILY 'Temp. Power Pole.B Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit .. I hereby affirm that lam exempt from the Contractor's License - b Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and , - - -- - - .21 69- OA- Professions Code)_ „ • �• •'° ii,. ❑ I, as owner of the property, will do the work and the Misc. Conduits B,Cdnductors - structure is not intended 'or.offered for sale,(Section _ Other (See Complete Fee Sched"ulel_ D ..2 • °2 6.75 7044,.Bdsiness and Professions Code). -' -' - CONSTRUCTION LENDING AGENCY •'O, !,2 0 S hereby affirm that there is a construction lending agency for 1. - _ _ _ he performance of the work'for which this permit is issued PERMIT FEE -- - -- - (Sub-Total) -- _ 0 0 3 8 3 (Sec.3097, Civ. C.). ' i 1 - 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.abov - entio ed property for inspection purposes. - SEE REVERSE FOR.EXPLANATORY LANGUAGE - Signoture.of Pe'lltee Date - _ WORKERS'COMPENSATION DECLARATION !:E 806 10/F)v APPLICATION PP I,/�!rp TION FOR ELECTRICAL- eg ECTRIC ii p PERMIT ' I hereby affirm that I have a certificate of consent-to self CE:BD6G' Yi lr IL 'bPY g gCl tl- II'( IG IL II g'( P91L Ir GYlYH9 0 ' insure,'or a certificate of Workers' Compensation Insurance, -COUNTY OF, LOS ANGELES BUILDING AND.SAFETY or acertified copy thereof (Sec 3800, Lob. C.,I Policy No. - company ., FOR APPLICANT TO FILL iN _ JOB Certified copy is hereby furnished. New Residential Bldgs. & Pools - EACH NO. FEE- ADDRESS f e, Pill le < Certified copy is filed with the county building inspec- I & 2-Family,.Sq. Ft. $ — $ LOCALITY tion department. . Multi-f6mily Sq. Ft: NEAREST CROSS ST. r (r/ Date Applicant. Residential Swimming Pools OWNER OR - FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Reclighi_Sw._ 'MAIL COMPENSATION INSURANCE ADDRESS` First..20 (This section need not be completed if the work in by Total Na- Additional- CITY doTel. No. 8-020. the permit is for one hundred dollars'(SI00)or less.) PLAN CHECK I.certify that in the performance'of the work for which this _ APPLICANT " Permit is issued, I shall not employ any person is any.manner- so as to become subject to the Workers'Compensatibn Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional - Date—Applicant-- ' `' CITY TeL No. Fixed Appliances Not Over I HP PERW NOTICE TO APPLICANL'If, after making Ihis•Certificale of APPLICANT 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 with comply,with such provisions or this permit shall be Top _ FAU —W.H. _ deemed revoked. - •, Hood Fan _ Other_ CITY Te I. No. _ LICENSED CONTRACTORS DECLARATION - ' hereby affirm that am licensed under provisions of Chapter 9 CisP. — Room Air Cond. LICENSE OR- 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 ). Size &Type HP, KW, KVA,or KVAR' �• V fl O License Number Lic. Class• Up to I Incl. FINAL - W Over• 1 to 10 Ind. DATE �' VALIDATION 0 CoNractor. - Date Over 10 to 50 Ind. - �. H ❑ FINAL a m,exempt under Sec. Over 50 to 100 Inc. BY IL B.&P.C. for this reason '• Over 100 �r 11�� d V rA �- Services, SWbd.,)MCC & Panelboards D - - Z te " Da : 0 - 200 Amp. Under 600 V " Signature - -201 - 1000 Amp. Under'600 V - - t ❑ Over 1000 Amp. or Over 600 V _ - 1B.26 '8 A ' Exemption for Reg. Mainz. Elect. #1�e�b, 3.a'• e2 SINGLE FAMILY .Power Pole &Appurtenances - _ - t _ HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 2i• 2.S S hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Law for the-following reason.(Section 7031.5, Business and 1 •.e • a 2'a'5 Q;s• Prof essionsCode): - _ _ ' 1, as owner'of the property, will do the work and the Misc. Conduits &.Conductors O b.�O 8 structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ D. 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCYhereby affirm that there is a construction lending:agency for - - - -he performance of the work for which this permit:is issued 'PERMITTEE - (Sub-Total) (Sec. 3097, Civ. C.). i - '• '.PLAN CHECKING FEE Lender's Name - � - - PERMIT ISSUING FEE - 0 - Lender's Address - certify that. have read this application and state that the TOTAL FEE aft e informationis correct. I'ogree fo comply with all County -- r an and State law`s regulating Electrical wiring, and - r y autho ize representatives of this County to enter upon' ` - - -' - t e bgve-m boned for is0�ection.purposes. .SEE REVERSE FOR EXPLANATORY LANGUAGE azure o P rmittee