HomeMy Public PortalAbout9441 DAINES DR_Electrical__ 76A663-CE606 10-59 A u Pj U CAT MN FOR
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COUNTY OF LOS ANGELES IFI�$11 IIL�L�� [�Y- lY.,�- a; .�41��IIII
DEPARTMENT OF COUNTY ENGINEER BUILDING % �y ,s f V i�
BUILDING AND SAFETY DIVISION a ADDRESS i 6
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN,Sup•r of BUILDING LOCALITY
FOR APPLICANT TO FILL IN : NEAss sT
PERMIT FEES . 7 "( lO
` V r
OWNER 7
I T E M NUMBER EACH FEE
OUTLETS: $ $ MAIL n
LIGHTS RECEPT. SW. .IO ADDRESS
LIGHTING FIXTURES 10 CITY /L -TEL.NO. :;
ELEC.RANGES CLO.DRYERS ELECTRICIA
WATER HEATERS .50 ADDRESS
' ELEC.SPACE HTRS. DISHWASHERS
CITYe TEL. NO. -
c GARBAGE DISPOSERS AUTO.- STATE i y'�
WASHERS STA.COOKING-UNITS .25 LICENSE NO. / (/
MOTORS: OVER INC. H.P. DISTRICTNO. GROUP } RZONEPESSE�D/BY.
O— 1/2 .25 I
1/2— 2 .50 INSPECTION RECORD
2— 5 1.00
5— 15 1.50
15— 50 2.50 / �1
50-200 5.00
NO.TRANS.
p ..
SIGNS:
NO.LAMPS
k SERVICE 0-600V 1.00. O d /11_" Zf l /,flf� -,
SERVICE OVER 600V 5.00
MISC. +L/ �,IJ 7dn--lt-
WIRINGPERMIT 1.00
• FIXTURE PERMIT 1.00 d& 2) 7 o A1�91leAl !�q/
SUPPLEMENTARY PERMIT .50 _ ,—, 0 1i�� `l)
TOTAL FEE
1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE ,
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT
ELECTRICAL WIRING. Pte"6 V_ L--Tff k y(,vr1-wr��oT
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR WIRING / i
LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT i AM THE LEGAL OW ER OF: HE ABOVE -
DESCRIBED RESIDENTIAL R ERTY, POWER
SIGNATURE ^ - UTILITY CO.NOTIFIED 41-26-447 (O 1t 2k6il
OF PERM ITT r:.;:�,_. :.aa. ' FINAL [.G°2•.Q 'C!� /� �}q� '.p�..GI,.Gf
OF ARTHUR C.VETT,
CK MO
CK Mocacns SUPERVISING ELECTRICAL ENGINEER.
WORKERS'COMPENSATIONDECLARATION
t _
CE-806G (2-80) APCnN ' FO E ECTMIC L jERNT
I hereby affirm that I have a-'certificate of consent to self , COUNTY OF LOS ANGELEI 7' � � 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 JOB
Policy No. CompanyADDRESS 9 yr "
New Residential Bldgs.'&Pools EACH NO. FEE.
❑ Certified copy is hereby furnished. 1 &2-Family,Sq. Ft: $ — $ LOCALITY C
Multi-family Sq. Ft.` — NEAREST
❑ Certified copy is filed with the county building inspection CROSS ST 6
Residential Swimming Pools d
department. OWNER OR / 7
FIRM NAME d C:� /. ✓( (-�
Date Applicant Outlets: Rec.Light Sw. 3 Q ADDRESS
First 20
CERTIFICATE'OF EXEMPTION FROM WORKERS' Total No. Additional CITY Al �/ Tel No. $ -C90 en
�.
COMPENSATION K
INSURANCE 0
PLAN CHE. • '
APPLICANT U
(This section need. not be completed if the work involvedj O'
Lighting Fixtu ADDRESS
First
liy. the permit is for one hundred dollars ($100) or less.) � Cr 1 Additional 0
Total No.
I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. F-
permit is issued, I"shall not employ any person in any manner PERMIT W
so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT N
Oven _Dryer_W.M._ ADDRESS Z
Date Applicant Top — FAU _W.H.._ CITY Tel No.
Hood _ Fan _Other—
NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond, LICENSE OR
Exemption, you should become subject to the Workers' REG.NUMBER Class
Compensation'provisions of.the Labor Code,•you must forth- Power Apparatus& Large Appliances. DISTRICT NO. PROCE SED @Y
with comply with such provisions' or this permit shall be
deemed revoked. Size&Type HP,KW, KVA,or KVAR
<
Up to 1 Incl. LQ
FINAL ,
Over 1 to 10 Incl. DATE
LICENSED CONTRACTORS DECLARATION Over 10 to.50 Incl. VALIDATION
I hereby affirm that I�am.licensed under provisions of Chapter Over,50 to 100 Inc. FINAL
BY
9 (commencing with Section 7000) of Division 3 of the Busi- Over 100
ness and Professions.Code, and my license is in-full force and
effect. Services
License Number Lic.Class 0-200 Amp. Under 600 V ;
201-1000 Amp. Under 600 V.
Contractor ' Date Over 1000 Amp.or Over'600 V
HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances
I hereby affirm that I am 'exempt from the Contractor's Sign with.One Branch.Circuit
License Law for the following-reason (Section 7031.5, Busi- Additional Sign Branch Circuits
ness and Professions Code):
Misc.Conduits&Conductors 378,0 A
I, as owner of the,property, will do the work and the Other(See Complete Fee Schedule)—
'structure is not intended or offered for sale (Section #,o%o 0 o o. 2.
7044, Business and Professions Code). I ,
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency ? °'° 2 2 3.0
rf
for the performance of the work .for which this permit is r _
issued(Sec. 3097,Civ.C.). PERMIT FEE (Sub-Total) 3 a o io'o 21213 0 0
Lender's Name PLAN CHECKING FEE, '(One-Fourth Permit Fee) �142:68'2
Lender's Address PERMIT ISSUING FEE CI '
I certify that I have read this application and state that the TOTAL FEE
above information is correct.I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and J
hereby authorize representatives of this County to enter upon
,thea Ove-mentioned property for inspection purposes.
SEE'REVERSE FOR EXPLANATORY LANGUAGE
ignature of Permittee Date