HomeMy Public PortalAbout9826 DAINES DR_Electrical__ -7-0- ' ,�C 7-. .f _
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76A663-CE306 4.65 APPLICATION FOR ELECTRICAL 'PERM'IT
COUNTYiOF LOS ANGELES
vEBUILDING
BUILDING AND SAFETY DIVISION NG
FNEARE
LD I9826 ,W
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS. SUPT of BUILDING Temple Cit
FOR APPLICANT TO FILL IN G lden West
RECEPT'ACLE TOTALEACH FEECO 2005 Conner
--1 OUTLETS $ SOWNER
LIGHT J} FIRST 20 .20 40 MAIL
SWITCH 2 ADD'L 10 ADDRESS same
OVER 20
l TOTAL FIRST 20 .20 CITY Temple City TEL No. 286-4920
LIGHTING l FIXTURES
FIXTURES )( 10 CONTRACTOR Guardtone
-OVER 20
2
RANGES CLO DRYERS WTR HTRS 1.00 ADDRESS 7315 Lankershim Blvd.
GARB DISP- STA COOK CITY N Hollywood, TEL No875-1663
DISHWASH. AUTO.-WASH. STATE , 217816 C10
SPACE HTRS STA.APP.I'/.H.P.MAX ) .50 LICENSE NO
MOTORS OVER NOT OVER HP. DISTRICT NO. GROUP ZOQeE I PROCESSED BY
O 1 1.00
1 3 150 INSPECTION RECORD
3 8 200
8 15 2.50
15 50 300 / a ./ /r Q
50 100 500 J
CC
NO TRANS O
SIGNS NO LAMPS
W
SERVICE 0.600V-NOT OVER 200A 100,
d
N
SERVICE 0-60OV-OVER 200 A 2.00 Z
SERVICE OVER 600V Soo
OTHER (SEE COMPLETE FEE SCHEDULE)
PERMIT ISSUING FEE 200 2 00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 -
TOTAL FEE 1$ ZI 40 APPROVALS DATE INSPECTOR'S SIGNATURR
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION UNDERSLAB 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
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO POWER
R E SIDE IN,THE ABO DESCRIBED RESIDE IAL PROPERTY _
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTE�i
FINAL
�LMID CASH SH SUEC. ROOH
SUPERR VISING ELECTRICAL ENGINEER
CK MO C
u; � 4 9 0 9'.f.' scP22 2 D 2.40—
1,740RXERS'COMPENSATION DECLARATION 76A663
CE-806G,(2-80) - APPLICATION FOR, ELECTRICAL PERMIT
�INhe`reby affirm 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 JOB
Policy No Company ADDRESS
New Residential Bldgs &Pools EACH NO FEE:
0 Certified copy is hereby furnished 1 &2-Family,Sq Ft $ — $ LOCALITY
Multifamily Scl Ft — NEAREST
Certified copy is filed with the county building inspection CROSS ST
department Residential Swimming Pools OWNER OR
FIRM NAME 'Al
Date Applicant Outlets Rec night S. � MAIL
First 20 ADORESS
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No Additional CITY Tel No
COMPENSATION INSURANCE }
PLAN CHECK tl
APPLICANT 0
(This section need not be completed if the work involved
Lighting Fixtures First ADDRESS U
permit is for one hundred dollars ($100)-or less.) Additional by the nal �
Total No
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, I shall not employ any person in any mannerPERMIT
so as to become subject to the W rkers' Compen ion Laws Range_,Heater�.D.W _I APPLICA T O d
Oven _ Dryer_W M._ ADDRESS aa, �. �o to
Date Applican Top FAU W-H CITY r Tel No
Hood _ Fan /-Other_ T-- 4s
NOTICE TO APPLICANT If, after making this Certificate ofDRoom Air Cond LICENSE OR
isp _ -_
Exemption, you should become subject to the 'Workers' REG NUMBER 2ZE12Cl.s§
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO PRO BY
with comply with such provisions or this permit shall be Size&Type HP, KW, KVA,or KVAR
deemed revoked
%Up to 1 Incl
� r ver 1 to 10 Incl A E
LICENSED CO
CONTRACTORS DECLARATION I Z - $ ' VALIDA N
Over 10 to 50 Incl
I 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 Over 100 �+' �-`-i---'`-•
ness and Professions Code, and my license is in full force and
effect / Services
License Number_ �+�/��' Lic Class ( , v 0-200 Amp Under 600 V
201-1000 Amp. Under 600 V f
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 7031.5,1Busi- Additional Sign Branch Circuits
ness and Professions Code)
Misc Conduits&Conductors "
❑ I, as owner of the property, will do the work and the Other (See Complete Fee ScHedule)— 2)515,6 A
structure Is not intended or offered for sale (Section
7044, Business and Professions Code). 4,0 0 to 10 0 2
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency 2;o'o 3 1,2 0
for the performance of the work for which this permit is PERMIT FEE (Sub-Total)
issued(Sec 3097,Civ C) o''o'o 3 1,2 Qi 0'
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee)
80
Lender's Address
PERMIT ISSUING FEE -
I certify that I have read tlits application and state that the TOTAL FEE
above information is correct I agree to comply with all County
ordinances and State laws regulat g Electrical wiring, and .
hereby raze rep entad s rs County to enter upon
thea e- endo ro y r spect� purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Perms ee Date