HomeMy Public PortalAbout9334 DAINES DR_Electrical__ I �
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76A665•CEBO6.10.56' A f�P U C AT I O N FOR ' E LLS/ II Il C E II LL M T
BUILDING AND SAFETY DIVISIOIlT
Department of County Engineer BUILDING `
County of LOS Angeles ' ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER
CASSATT D. GRIFFIN. SoUP'T OF BUILDING 'LOCALITY
-- NEAREST.. �
FOR APPLICANT TO FILL IN CROSS ST.
PERMIT FEES
i OWNER
LIGHTS RECEPTACLES SWITCHES /" r
r NUMBER I T EM EACH FEE MAIL
n - - •ADDRESS - - "
TOTAL OUTLETS. $ .10 $ (� , e
ELEC. RANGES, WATER HEATERS, CITY TEL.-NO. t
CLOTHES DRYERS. :50 ECTR.IC IA
ELEC. SPACE HEATERS, STAT-Y. COOK-
ING UNITS, GARB-A.GE .DISPOSERS,-• ADDRESS, a
AUTO WASHERS, DI1;I1W SHED -. .25 -40
LIGHTING FIXTURES ,10 �i� CITY - L. NO
MOTORS STATE LICENSE NO. ���
HORSEPOWER
a H.P. OVER INC. D•IS NO.cGRQ Z , RE JORINSPECT ION
1/2 &LESS .25
, 1/2 - 2 .50 INSPECTION RECORD
a 2 5 1.00 F'
5 15 1.50 ,1
15 50 2.50
50 200 5.00
MISC.
SIGNS I NO.TRANS ' -
NO.LAMPS
SERVICE 0-600V 1.00
SERVICE'OVER 600V 5.00
WIRING PERMIT 1.00 -.
9r
FIXTURE PERMIT 1.00 - -
SUPPLEMENTARY PERMIT .50 APPROVALS
TOTAL FEE F DATE. INSPECTOR'S SIGNATURE
1 HEREBY,ACKNOWLEDGE THAT. I HAVE'READ,THIS APPLICATION
:i AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT gg ! ��
` EWITH ALL LECTRICAL W RNNG,ORDINANCES AND STATE LAWS REGULATING j WIRING X0107 ./, .}9�
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES I /
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
' CALIFORNIA OR THAT t THE LEGAL OWNER OF THE ABOVE POWER �/pr
DESCRIBED RESIDE T►AL P P RTY. UTILITY CO. NOTIFIED'
SIGNATURE
OF PERMITTE
coria FINAL - P
JOHN A.yLAMBIE. ATION ARTHUR C.VEIT,
COUNTY ENGINEER cK Mo ,CASH 'SU IERVISIN•G'ELECTRICAL ENGINEER
8 .20 tp
WORKERS'COMPENSATION DECLARATION 76A663 10/81 n P UC TMD"N FOR 20 ECTMICA ' PE f,�n�Tr
I hereby affirm that l have 'a certificate of consent to self insure,, CE-8066 //�11�1� II I�GW II I FOR U LS L�L��s lop l� L�U U II V II 11
or-a cer,iificate of Workers' Compensation Insurance, or,a certified' COUNTY OF.L'OS'ANGELES...' BUILDING AND SAFETY
copy thereof(Sec. 3800,Lab..C.)
Y. N
Policy No: Company 1 OR AP �3
F PLICANT-,TO FILL IN:.. JOB ��J
0 ,Certified copy 1s hereby furnished. - EACH NO.' FEE ADDRESS .' C/L.
New Residential Bldgs.& PoolsAr
r- 1 & 2-Family,Sq.Ft. $ — $ LOCALITY
Fj Certified copy' is filed 'with the county building inspection
'
NEAREST
department: " Multi-family Sq.
CROSS ST..
Residential Swimming Pools
_
Date Applicant
OWNER OR
. . .. FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS ^' '. MAIL,
t• , COMPENSATION INSURANCE Outlets:Rec ,Light Sw.
.. I ADDRESS
Thin section'need not be completed if the workinvolvedb the
'First.20 ` ' _
( P Y CITY A Tel.No
permit is,for.one hundred dollars ($100)or less.)': Total No. Additional' 'C. . ���"f�7
I certifythat•in the.. erformance.of the work for which this permit PLAN CHECK
P _ �, -.APPLICANT
is.-issued,-:1 tshall not.employ,.any. person in rany manner-so,as,to
become subject to,the Workers'.Compensation Laws.,,- Lighting Fixtures First 20 ADDRESS
Additional
Total No. CITY Tel.No.
Date Applicant,:_
NOTICE .-TO APPLICANT: If, after making 'this Certificate of Fixed.Appliances Not Over 1 HP PERMIT
Exemption,you should become subject,to the Workers'Compensation Range_ Heater_ D.W. APPLICANT
provisions-of the Labor Code, you must,forthwith comply with such Oven Dryer_ W.M. _ ADDRESS
provisions•or,this permit shall be deemed revoked: Top. FAU W.H. -
LICENSED CONTRACTORS DECLARATION Hood Fa Other CITY Tel.No.
I hereby, affirm thatil am,licensed under provisions of, Chapter 9 LICENSE OR
Disp. Hoo�fS o Class.
(commencing.with'Section,7000) of Division 3 of the Business and , REG.NUMBER
Professions Code,and my license 1s in full force"and effect. Power Apparatus&Large Appliances w DISTRICT NO. PRO ES ED BY
Size&Type HP,KW,KVA,or KVAR -�sJ, i0.
t
License Number • Lia Class 'Up to 1 Inc].Incl. � FINAL •
Over 1 to 10 Incl DATE / VALIDATION
Contractor Date Over 10 to 50 Incl. , U
❑ FINAL
I am.exempf under Sec. Over b0 to 100 Inc. BY' W
G-
B.&P:C.for this reason Over'100 N.
Services,Swbd.,MCC& Panelboards Q' - Z
Date: 0- 20O Amp.Under 6OO V` D
Signature's 201•- 1000 Amp.Under 600 V
- _❑ _ Over 1000 Amp.or Over 600 V
Exemption for Reg.Maint.Elect. „
SINGLE FAMILY Temp.-Power Pole&'Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
' I.hereby affirm'that,I am exempt from the Contractor's License Law
Additional Sign Branch Circuits
for the following reason(Section 7031.5, Business and Professions'
Code): _
Mi§c:Conduits& Conductors - ~ '
�7�// I
L I,as owner of the property,will do the work.and the structure,
is'hot intended or offered'for sale (Section 7,044, Business .Qther'(See Complete Fee Schedule)'_ tll
and Professions Code). D _ '27
_
CONSTRUCTION LENDING-AGENCY' f alt k - 3` W
hereby affirm that there is a construction lending agency for the `=��= _''f,;'hi
performance of the work for which this permit is issued,(Sec:3097,• PERMIT FEE (Sub-Total) D ( "
Civ.G.). "H AGE
PLAN CHECKING FEE'
Lender's Name
PERMIT ISSUING FEE. /3 Q•0 Vit(; ji t-t f3 ti'; 10*_
Lender's Address �f�r
I certify that I have read this application land state that the above ,.TOTAL FEE 9a ='�; j r7s �
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
Signature of Permittee f Datk