HomeMy Public PortalAbout9413 DAINES DR_Electrical__ ;i 663-1:'A.15 2-67 pp�U�Q4U� f FOR EdEMUC AL P, EMU 4
COUNT'' OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING.
'BUILDING AND SAFETY DIVISION 'ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER }
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY reNJ /
F
•c.._= ., NEAREST , F.
FOR APPLICANT TO FILL IN CROSS ST.
NO. EACH FEE
$ $ OWNER j �/ 5 s '
PT._
MAIL
TOTAL FIRST 20 .20 ADDRESS / A/ z- i
H_ OVER 20 .10 CITY' TEL. NO. �—
ING TOTAL FIRST 20 .20 CONTRACTOR
RES OVER 20 .10 ADDRESS- I/ L
E DRYER WTR.HTR.— CITY �/' v TEL. NO. (1 —/SuLp
OOK_DISP. F.A.U.— LICENSE NO.HTR. AIR COND. I HEREBYACKND THIS APj'�LICATION
ANDSTATE THAT THE ABOVE IS CORRECT AND AGREE'A COMPLY
WITH ALL COUNTYORDINANCES AND STATE LAWS REGULATINGHES WASH._DISHWASH._ ELECTRICAL WIRING.
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FAN-OTHER 1.00 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
I;r MOTORS,TRANSFORMERS RATING CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
IND. HEATERS, ETC. HP. KW. KVA. RESIDE IN, THE ABDFE DESCRIBED RESIDEN AL PROPERTY.
SIZE & TYPE OVER TO SIGNATURE
` 0 — 1 1.00 OF PERMITTEEL
l'ow� a2 3q 1 — to 3.00 ® DISTf31CT NO. GRO P ONE P O. E SE_ D BY �V
® •:
10 — so s.00
50 — 100 10.00 -` NOTES: lieG
W
100 - 500 15.00 C-
tn
SIGN,GAS SIGN AND ONE CIRCUIT 3.00
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00
p° SERVICE OVER 600 VOLTS OR 200 AMP 5.00 �5- 4
c
r' TEMP SERVICE, POLE, &APPURTENANCES 3.00 ,` I
e
'APPROVALS DATE INSPECTOR'S SIGNATURE
LTEMP. POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
A WIRING
ISSUING FEE .00 Q746
-`' FIXTURES
SUPPLEMENTARY ISSUING FEE 1.00 -
--..POWERAUTHORIZED
PERMIT FEE .:T UTILITY CO,NOTIFIED
/ /9 A
PLAN CHECK FEE (50% PERMIT FEE) K, FINAL
JOSEPH C. ROOHAN
TOTAL FEE
-:a,, ;. . *.... w --' .',�i...,• , --s--,.,� SUPERVISING ELECTRICA/E NEER'
PLAN CHECK'VALIDATION CK M.C. CASH PERMIT VALIDATION CK. ASH
f N
cv
15
c2�7 2 D 6.v '
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
WORKERS'COMPENSATIONDECLARATION CE806G"(2-80) A1f"PUC/r\MN FOR IS MMIC/i L PLSIISIIG• 7
I hereby affirm that'.1 have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY
:insure, or a certificate of Workers'Compensation Insurance,or ti
aV11
ified c {7Y theregf(Sec. 3800 L b.C.)CfFOR APPLICANT TO FILL IN JOB
y No. ( mpan EACH NO. FEE ADDRESS
New.Residential Bldgs.&Pools
Certified copy is hereby furnished. 1 &2-Family,Sq. Ft.
$ — $ LOCALITY
Multi-family Sq.Ft. NEAREST
�I1p�/1 Certified copy is filed wi9hap�t ,nspection
de Residential Swimming Pools OWNER OR
FIRM NAME
Date Applican Outlets: Rec._Light_ Sw. MAIL
First 20 ADDRESS
C RTIFICATE OF,EXE TION FROM WORKERS' Total No. Additional CIT el No
COMPENSATION INSURANCE PLAN CHECK.t/.
(This section need not be completed if the work involved - APPLICANT 0
by the permit is for one hundred dollars '($100) or less.) Lighting Fixtures First io ADDRESS U
Additional �.
Total No.
I certify that in the performance of the work for whicP
h-this Fixed Appliances Not Over 1 HCITY Tel No.
permit is issued, I shall not employ any person in any manner PERMIT 0
so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT d
Oven _ Dryer_W.M. ADDRESS fA
Top _ FAU _W.H.. ?
Date Applicant -7 r� CITY el No. L
Hood _ Fan _Other-7
NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond Su/� LICENSE OR -��
Exemption, you 'should_ become subject to the Workers' REG. NUMBS ass .J
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PRO 'E ED'BY .
with comply with. such provisions or this permit shall,be Size&Type HP, KW, KVA,or'KVAR xj i
deemed revoked. l/
Up to 1 Incl.
FINAL
Over 1 to 10 Incl. DATE
LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. VALIDATION
[ hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL
9
(commencing with Section 7000 of Division 3 of the Busi- ;BY
( B ) Over 100. �,
cess and Professions.Code, and my license is in full and '�1 49"A
°ffect. Services V
C.— '— 0-200 Amp. Under 600 V
icense Num 7Lic.Class • 201-1000 Amp. Under 600 V-
contractor Date �� Over 1000 Amp.or Over 600 V I ��
HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances
Sign with One Branch Circuit
hereby affirm that I am exempt from the Contractor's g •�.
icense Law for the following reason (Sectionss and Professions Code): 7031.5, Busi- Additional Sign Branch Circuits A
eJ�ze
1 Misc.Conduits&Conductors
1, as owner.of the property, will do the work and the Other (See Complete Fee Schedule)— G f 4:5 1,2 A
structure 's
not intended or offered for sale (Section r
7044, Business and Professions Code). # 0'0,0 0 0 2
CONSTRUCTION LENDING AGENCY
hereby affirm that there is a construction lending agency 21.0,0`0 9..5 0,
r the performance of the work for which this permit is fj
{ PERMIT FEE (Sub-Total) ;
wed(Sec. 3097,Civ.C:). I .o 0 0 0 9. 505
Inder's Name -FourthPLAN CHECKING FEE (OnePermit Fee)
� der's Address - 0324-81
n
{ PERMIT'ISSUING FEE
1
Lertify that I have read this application and state that the TOTAL FEE
ove information is correct.I agree to comply with all County
finances and State laws regulating Electrical wiring, and
feby authorize representatives of this County to enter upon
ab o -me tinned pro erty for inspection pure es. SEE'REVERSE FOR EXPLANATORY LANGUAGE-
3
ignatuf1lermittee Dat