HomeMy Public PortalAbout10828 DAINES DR_Electrical__ 76A663-cE606 12-66
APPLICATION FOR ELECTRICAL P RMITT LJ
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAM BIE, COUNTY ENGINEER //
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY ��i MPi_9 �' 1r
NEAREST L MO N
FOR APPLICANT TO FILL IN CROSS 5i.
RECEPT. TOTAL NO. EACH FEE //��
ouners� �^ s 6 OWNER CARL- R+ AdWAM k /rJ--A
LIGHT FIRST 20 / .20 �. h
MAIL
SWITCH J � OVADD L ER 20 000111 .10 ADDRESS Q 0C D /
TOTAL FIRST 20 .10 CITY � L G' 1. TEL. NO..
LIGHTING 1 FIXTU RE6
FIXTURES 1 ADD'L 10 CONTRACTOR AL
OVER 20
RANGES DRYERS WTR.HTRS. 1.00 ADDRESS Ql r
GARB.DISP. ETA.COOK
CITY jCL TEL. NO. O
DISHWASH. AUTO.:WASH. STATE
SPACE HTRS. STA. ARPL. .50 LICENSE NO. `
MOTORS: OVER NOT OVER M.P. DISTRICT G ONE P
O 1 1.00 ' 7..Q
1 3 1.50 INSPECTION RE RD O
3 a I 2.00 I V
a Is 2.50
f
15 50 3.00 W
d
50 100 5.00 N
?
SIGNS: NO.TRANS,
NO.LAMPS
SERVICE 0.600V-NOT OVER 200A 1.00
SERVICE 0-600V-OVER 200 A. 2.00
1 1
SERVICE OVER 600V 5.00
OTHER (SEE COMPLETE FEE SCHEDULE)
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 APPROVALS DATE INSPECTOR-9 BIGNATU
TOTAL FEE 6
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
UNDERSLAS WORK
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING 6r-e-7 ..—�
HEREBY CERTIFY THAT 1 PR ERLY O A R Fri
LICENSED AS REQUIRED B T �
CALIFORNIA OR THAT I A T POWER
RESIDE IN.TME ABOV C IBED 5 DENTI 'OF
SIGN ATU RE UTILITY CO.NOTIFIED
OF PERMITTEE -
FINAL T/ P
VALIDAT JOSEPH C. ROOHAN
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
mss"16� OCT 27 2 0 2.60IN
-
WORKERS COMPENSATION DECLARATION r 76A663
6CE,306G (2-80) APPLICATION FOR ELECTRICAL PERMIT
I hereh7.aPkrm that I have a certificate of consent to self COUNTY OF LOS ANGELES - BUILDING AND SAFETY ,
insure, or a certificate of Workers'Compensation Insurance,or '
a'certified copy thereof(Sec. 3800', Lab. C.)'
" FOR APPLICANT TO FILL IN ,IOg
Policy No. Company EACH NO. FEE ADDRESS Q pr, E.. J/
❑ New Residential Bldgs.&Pools _
Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY
1' C(aro'e LCI, elT`
Multi-family Sq. Ft. - — NEAREST
Certified copy is filed with the county building inspection CROSS ST HCl i-ItIlsorn
department. Residential Swimming Pools OWNER OR / /J �r
FIRM NAME LES 111 uJ(G/r 6JTT (-O
Data Applicant Outlets: Rec. Light !Y• . 0 d / )MAIL
First20ESS 1420 N TO A)'t0 IZD
CERTIFICATErOF EXEMPTION FROM WORKERS' Total No. Additional' �CITVE CU ,� Tel.No.Sq L
. -COMPENSATION INSURANCE }
PLAN CHECK 1
(This- section need not be.completed if the work involved APPLICANT
.by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS
Total No. O Additional Q
I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. O
permit is issued, l shall not employ any person in any manner PERMIT - a V
so'as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT Gas fir.tl/t K./r-IS /--Ap ` W
- IV ,', f (�.�^
Oven _ Dryer ✓W.M._ ADDRESS,'Ol (I(�'mwz6 ILD
�6�� b ApplicantZ,, h/LyWu, , t'/�1 Top — FAD _W.H.. Z
Date CTel N 5
- Hood _ Fan _Other_ ITY o.��II C A'9l 14 J'1 (e/
NOTICE TO APPLICANT:7f, after making this Certificate of Disp. Room Air Cond._ d LICENSE OR
Exemption, lou should become subject to the Workers' REG. NUMBER Za4 p c
Class
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. e/ PRrOCESSEM BY '
with comply with such provisions or this permit shall be '•PD d
deemed revoked. . Size&'Type.H ,KW, KVA,or KVR
A -. o
Up to 1 Incl. FINAL
Over 1 to 10 Inc[. DATE z L.$' i�/ VALIDATION
:LICENSED CONTRACTORS DECLARATION - - Over 10 to 50 Incl. 0 /
'I herebv affirm that I am licensed undern
rovisios of Chapter Over 50 to 100 Inc. FINAL
P P `—. .
9 (commencing with Section 7000) of Division 3 of the Busi-. Over 100 By
ness and Professions.Code, and my license is in full force and
effect. Services - ,
License Number Lic. Class 3 1 ' 0-200 Amp, Under 600 V
-f1�} 201-1000 Amp. Under 600 V -
7 Contracto A, - Date 6 Over 1000 Amp.or Over 600 V
HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appuitenances
I hereby affirm [hat'I am exempt from the ContractSign with One Branch Circuit.
or's Additional Sign Branch Circuits -
License Law for the following reason (Section 7031.5, Busi-
ness and Professions Code): -
Misc.Conduits& Conductors
I, as owner property, will the work and the Other (See Complete Fee Schedule)—
structure is not not intended or offered
d for sale,(Section -
' 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 PERMIT FEE (Sub-Total) -
issued (Sec. 3097,Civ.C.).
Lender's Name PLAN CHECKING FEE (OneFourthPermit Feel
Lender's Address PERMIT ISSUING FEE - 2 4 3.2,A +.
# e o e o.e 2 .
1 certify that I have read this application and state that [he TOTAL FEE
above information is correct. I agree to comply with all County 2 e e 39. 90
.
'ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon .3 9. 9 0 mu
the abovee-mee(n�ttone�dy(p,(/�o�pe�rt
/^ yyfor inspection purposes. (�- SHE-REVERSE FOR EXPLANATORY LANGUAGE -
Signature of Permittee Date _