HomeMy Public PortalAbout10645 DAINES DR_Electrical__ 0='S 1; APPLICATION FOR ELECTRIC, PERMIT g
DIVISION OF BUILDING AND SAFETY
Dep. Rut of County Engineer 6uILO1NG •1 1t /'/[ 1�A S S f� .
County of Los Angeles ADDRESS f C t>—f t V `!J
JOHN A. LAtv�B1E. COUNTY ENGINEER •r�M �L C ITV
O. GRIFFIN, SUPT of SUILDING LOCALITY
FOR'APPLICANT TO FILL7-ADDRESS
NEAREST PERMT FEESCROSS ST.NUMBEROWNER LIGHT OUTLETS MAILRECEPTACLES
r
WALL SWITCHES FEE CIT TEL. NO.%
TOTAL OUTLETS @ 54 S ELECTR CIAN
ELEC. RANGES 25
ELEC. HEATERS 25 ADDRESS
KW EA GIN TEL.NO.
STATE
FIXTURES 5 LICENSE NO.
MOTORS DISTF;IC�5T NO. I GROUP I Z qE I READY FOR INSPECTION
rvumeER HORSEPOWER FEE p
NEW MVD. HP OVER INC. EACH INSPECTION RECORD
yS a LES. S .25
s lit 2 .50 VIL M•� ��
' 1
2 5 1.00 .�I�/i•�L, ��O M /rt✓/% �/VY�I
5
_ Z /iI rC✓1 �/
14 SO 2.50
SO vmp
MISC. C/iYO✓ /�
1 ! G
NO. SIGNS NO.TRANS. f
NO. SIGNS NO. LAMPS r •9
FOR EACH PERMIT: U i J/
WIRING $1.00
FIXTURES $1.00 v
SUPPLEMENTARY .50 APPROVALS
TOTAL FEE S DATE INSPECTOR'S SIGNATURE
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY . CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING 'Z 'J
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
j
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF -
CALIFORNIA ORTHAT I AM THE LEGAL OWNER OF THE ABOVE POWER
DESCRIBED RESISI DENT PROPERTY.
SIGNATURE UTILITY CO.NOTIFIED 7 rDN' �i
OF PERMITTE FINAL
JOHN A.LAMBIE. COUNTY ENGINEER ATION ARTHUR C.VEIT,CHIEF ELECT. INSPECTOR
CK MO CASH
LG 2 0 0 4 NOV 2 1 .2 0 m
' m.
WORKERS' COMPENSATION DECLARATION CEA ,DiB, APPLICATION FOR ELECTRICAL PERMIT
'f hereby affirm that I have a certificate of consent to self
insure, of a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof (Sec. 3600, Lab, C.)
Policy No. Compony FOR APPLICANT TO FILL IN JOB t
Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS
❑ Certified copy is filed with the county building inspec- 18 2-Family, Sq. Ft. $ — $ LOCALIT
tion department. Multi-family Sq. Ft. — NEAREST
Residential Swimming Pools CROSS ST.
Date Applicant OWNER OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec_Light_Sw._ -MAIL
COMPENSATION INSURANCE ADDRESS
First 20
(This sectipermit
i need or one be red dolga if the work involved by Total No. Additional CITY Tel. No.
the permit is for one hundred dollars ($100)or less.) PLAN CHECK r
I certify that in the'. of the work for ich this
permit is issued, I shall nal am
y any erson in y manner APPLICANT
so as to m s the or er '4ompen alio L ws Lighting Fixtures First 20' ADDRESS
tol No. Additional
Date A plica I CIT Tel. No
NOTICE O APPLICANT: If, a er o s Cert cote Fixed Appliances Not Over I HP PERMIT
Exemption, you should beco a subject to the Workers' Range_ Heater_D.W. APPLICANT
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. — fj
deemed revoked. CITY Tel. NaCo
LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_
LICENSE OR
Class
I hereby affirm that I am licensed under provisions of Chapter 9 Disc. — Room Air Cond. REG. NUMBE }
(commencing with.Section 7000) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. PROCESSE BY DL
and Professions C Ii "n full fort an ff _ 7j�/ U
Size 8 Type HP, KW, KVA, or KVAR L(f o
License umb Class �— Q
Up to I Incl. FINAL
Over I to 10 Incl. DATE
Contract ate VALI TION U
❑ Over 10 to 50 Incl. FINAL W
xempt under Se Over 50 l0 100 Inc. BY D-
n
B.BP.C. for this reason over 100 Z_
Date: Services, Swbd., MCC S'Ponelboords
0 - 200 Amp, Under 600 V
Signature 201 - 1000 Amp. Under 600 V
❑ Over 1000 Amp. or Over 600 V
Exemption for Reg. Maint. Elect. 2 6 9 5 6 Q
SINGLE FAMILY Temp. Power Pole 8 Appurtenances
HOME OWNER-BUILDER DECLARATIONSign with One Branch Circuit # e e 0,?.,* 'Z
I hereby affirm that exempt from the Contractor's License
Law for the followingg r reason (Section 7031.5, Business and Additional Sign Branch Circuits j) ,• o29.50
Professions Code): e - 29,505.
❑ 1, as owner of the property, will do the work and the Misc. •'Conduits 8 Conductors
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ D
7044, Business 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 PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE
Lenders Name
PERMIT ISSUING FEE
Lender's Address
I certify that I have read this application and state that the TOTAL FEE
above information is car ct. 1 agree to comply with all County
ordinance and State aws regulating'Electricol wiring, and
h ieb a thorize rep esenmtives of ty to enter upon
t e a o e lion pr er f r ins ction put es. SEE REVERSE FOR EXPLANATORY LANGUAGE
i to of � inee to