HomeMy Public PortalAbout9435 DAINES DR_Electrical__ 76A663-CE806 L��- IS�
-7.56 APPLICATION FOR ECTR1C, PERMIT Id.
BUILDING AND SAFETY DIVISION
Department of County Engineer BUILDINGe
County of LOS Angeles. ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER .yam
CASSATT D. GRIFFIN, SUP'T OF BUILDING LOCALITY
NEAREST , _ ,
FOR APPLICANT TO FILL IN CROSS ST
PERMIT FEES
NUMBER OWNER44 44
I. LIGHT OUTLETS MAIL -
ADDRESS
RECEPTACLES
WALL SWITCHES FEE CITY - TEL.NO.
. TOTAL OUTLETS @ 54 $ ELECTRICIAN y/
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 25 CITY il r. TEL.N air
KW EA STATE •?j�
LICENSE NO. 6i-
FIXTURES 5
MOTORS FDI,STRI�' O. ZONE READY FOR INSPECTION
NUMBER HORSEPOWER FEE 1G.ROUPI
I/
NEW MVD. HP OVER INC. EACH
I/7&LESS $ .25INSPECTION RECORD
1/z 2 .50
2 5 1.00
5 15 1.50
15 50 2.50
50 200 5.00
MISC.
NO.SIGNS NO.TRANS. - -
NO.SIGNS NO. LAMPS -
FOR EACH PERMIT: -
WIRING PERMIT' - $1.00
FIXTURE PERMIT $1.00 -
SUPPLEMENTARY .50 APPROVALS
TOTAL FEE.. $ �— DATE. INSPECTOR'S SIGNATURE
I HEREBY ACKNOWLEDGE THAT IHAVE READ 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. FIXTURES
5 A
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY -6RNELE CO kTY AND STATE OF POWER ,J .
CALIFORNIA OR THAT I .THE, G 'O 'ER OF THE ABOVE .
DESCRIBED RESIDENTIA PR _ UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTEE y FINAL k u
C'i,':
JOHN A. LAMBIE. /g7 y� ARTHUR C. ELECTRICAL
COUNTY ENGINEER �?�J+■+�ATION SUPERVISING ELECTRICAL ENGINEER
1,0 8 5 1 7 L M,zy,2 4 2 1 .�, `J. In
WORKERS'COMPENSATION DECLARATION 76A663 10/81 /��ry�pn2 �ap �n
I hereby affirm that I have a certificate of consent to self insure,., CE-8066 G'i11�1�1� CAMON FOR EL�L�CTMAL� P[�RINT
or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING.AND SAFETY
copy.thereof(Sec.3800,Lab. C.) rtti
Policy No.• Company - -- - ,. FOR APPLICANT TO-FILL;IN JOB
0 ,Certified copy is hereby,furnished: EACH NO. FEE ADDRESS
.., New'Residential Bldgs..& Pools
❑ 1 & 2-Family,Sq.Ft. $ ' ( _ $ LOCALITY �7 [
Certified copy is' filed with the':county budding inspection
'department. Multifamily Sq.Ft. NEAREST ,- r
Residential Swimming Pools OWNER OR
Date Applicant, (�
FIRM:NAME..
CERTIFICATE OF EXEMPTION FROM-WORKERS' = Outlets:.Rec Light Sw. � ns MAIL --•r
COMPENSATION INSURANCE Z� aJ ADDRESS'
This section need be•corri leted'if4he work involved'.b the First 20 - ✓
( p Y 1 p w,'.' CITY �/ el.No!
permit.is for one hundred dollars($100)or less.) Total No. Additional t^.f �t T�
I certify that'in the performance.of the-•work for which this permit
- '` PLAN CH CK
Y p APPLICANT; .•:`
is issued, I shall not employ-any.person,in,any manner so as,to
become subject to the Workers'Compensation•Laws. . :Lighting Fixtures First 20? ADDRESS
Additional
Total No.: CITY Tel.No.
Date Applicant Fized Appliances Not Over 1 HP
NOTICE:,TO, APPLICANT:;If,-.after making this .Certificate of PERMIT .
Exemption,you should become subject to.the Workers'Compensation Range_ Heater_:D.W APPLICANT .0 �. U
provisions of the Labor,Code,you must forthwith comply,with such Oven Dryer W.M. _ ADDRESS
provisions or this permit shall be deemed_revoked., t Top FAU W.H.
CITY Tel
LICENSED CONTRACTORS DECLARATION Hood Fan Other.
_I No
I hereby affirm that I am licensed under provisions of Chapter 9O ,LICENSE OR
Dlsp. Room Air Cond. REG.NUMBER Class.
(commencing with Section 7000) of Division'3 of the,Business and'
Professions Code,and my license is in full force and effect. Power Apparatus&•Large'Appliances TR I
DISCT NO. PROCESSED BY
Size& Type HP,KW,KVA,or KVAR 5�
O
License Number Lic.Class Up to 1 Incl.
" ,to 10 Incl
Over 1
, -
—F— /C!', DATE 1 Z^ _ VALIDATION .
I U•
Contractor Date 0
❑ Over.•10 to 50 Incl. FINAL' ,
.1 am exempt under Sec. ;-Over 50 '100 Inc. BY Q,-to
B.&P.C.,for this reason' Over 100.
Services CC&Panelboards _ Z
D
Date: 0.200 A4.Under 600.V
Signature 201 - 1000 Amp:Under 600.V "
Over 1000 Amp.or Over 600 V
Exemption for Re 'Maint.Elect. E s
g' T
• 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
for the following reason(Section 7031.5, Business and Professions --Additional Sign Branch Circuits
Misc Conduits& Conductors
I,as owner of the property,will do the work and the,structurey
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule).
U_
and Professions Code).
_� �
CONSTRUCTION LENDING AGENCY „
I hereby affirm that there is a construction lending agency for the i ora e (,f'=,g?i s
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) ; 02 7
Civ.C.). 2_ 1
PLAN CHECKING-FEE
Lender's Name
PERMIT ISSUING FEE J -
Lender's Addressj
I certify that I have read this application and state that the'above TOTAL FEE -7,4
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
r upon the above-mentioned
p . y for inspection ur_oses.
SEE REVERSE FOR EXPLANATORY LANGUAGE -•.
Signature of Permittee Date