HomeMy Public PortalAbout9844 DAINES DR_Electrical__ TEMPLr. CDTY
76A663-CE806-8-62 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.NO
RECEPT' TOTAL FIRST 20 yp( $ $A20 ICH EEE OWNER FRIvesy
/
OUTLETS
LIGHT n MAID
��(A/ � AWL ADDRESS -
SWITC J' --�-}-- OVER 20 °.10 , y' /
-LIGHTING-
TOTAL FIRST 20 ,2p ) CITY L. NO. / (O�-�
FIXTURES I
� ADD'L 10 ELECTRICIAN
OVFR 20
RANGES CLO DRYERS- WTR.HTRS. 1.00 ADDRESS ✓•((/{0 d
GARB.DISP I STA COOK ' ;�. �� "' �
CITY TEL.NO. s� 7�C�
DISHWASH AUTO,-WASH. STATE
SPACE HTRS STA.APP.('/¢H.P.MAX ) .50 LICENSE NO,
MOTORS •OVER NOTOVER HP. DIST}3,1•C QtQ. ,GROUP N,E7 CESSED Y
0 t 1.00 5 ]�
t 3 1.50 INSPECTION RECORD
3 8 2.00 A u _ 9-�,4p'd
8 15, 250
15 50 3.00 1
t- 1 n 0,t_fl
50 .100 500
NO.TRANS `' b' f OC
SIGNS NO.LAMPS O
SERVICE 0.600V-Nor OVER 200A 1.00 IVy
. a
SERVICE 0.600V.,OvER 200 A. -2.00 Z
SERVICE OVER 600V 5.00 —
MISC.
PERMIT ISSUING FEE 200 ,
SUPPLEMENTAgY PERMIT ISSUING FEE 1.00 e
TOTAL FEE $ f
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING - WIRING 1 Z--/
1 HEREBY CERTIFY THAT, 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES f ,
CALIFORNIA OR THAT I AM THE LEGAL OWNER,QF THE ABOVE
DESCRIBED RESIDENTIAL P OPERT POWER [�—
SIGNATURE� UTILITY CO.NOTIFIED
OF PERMITTEE -
FINAL
LIDATION ARTHUR C. VEIT �r
CK MO CASH_ SUPERVISING ELECTRICAL ENGINEER
L 1 6 7 5 0 m DEC 1 1 2 D 1 1.1
fTrm that
I, COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT
20-001
I hereby affirm that I'have a certificate of consent to self insure, - ,
or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES' DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV
copy thereof-(Sec 3800 Lab C) ,
P❑DIIcy,NO T Company - FOR APPLICANT TO FILL IN JOB
,-ADDRESS
Certfied copy is hereby furnishedNew Residential Bldgs &Pools NO $ EACH $ FEE'
,y, LOCALITY
�`< Certified copy is filed with the county budding inspection 1•&2-Family,Sq Ft _ NEAREST
department Multi-family Sq Ft CROSS ST
J t "Residential Swimming Pools ASSESSOR
' Date ^ Applicant I MAP BOOK
Ile,-t. ,.�, .� - ,. x �. ,. + PAGE PARCEL ,
CERTIFICATE OF EXEMPTION•FROM WORKERS' QQ 4 v OWNER OR p L
a ; - Outlets ReC Light SL_•Sw FIRM NAME St,L men' , T
COMPENSATION'INSURANCE
-„ First 20 MAIL
-
(This;section need not be completed if the work involved by the / ADDRESS
permit is'for one hundred dollars($100)or less)
Total No Additional /I'CS
Lcer y that in the performance�of the work for which this permit CITY /e' C Tel No
Is issued, I shall not employ any person in°any manner'so'as t0 PLAN CHECK
become subject to the Workers' Compensation Laws Lighting Fixtures First 20 APPLICANT
Total No Additional
D C 'ADDRESS -
Date a Applicant/i RESIDENTIAL APPLIANCES NOT OVER 3 HP
NOT,hC .TO APPLICANT If, after making this Certificate of CITY Tel No
Exemption,you,should'become subject-to the Workers' Compensation OTHER APPLIANCES NOT OVER 3 HP
p�ovisions,of the Labor Code, you must forthwith'comply with.such PERMIT
provisions or this permit shall'be deemed revoked Power Apparatus&Large Appliances APPLICANT
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KV KVAR Q ADDRESS L
I hereby afbrm'that I'am licensed'unde`r provisions of'Cfiapter 9 OGef,6t0101ncl �U
(commencing,with Section 7000) of-Division 3 of the Business and CITYen
Tel No 33�.
Professions Code, and my license is in full force and effect Ove 10 to 50 Incl
LICENSEClass
' q Over 50 to 100 Incl REG NUMBER d
License Number 6 � ! UC Class Over 100 DISTRICT NO PRO SSED BY 0
Services,Swbd,MCC&Panelboards a:
// C�`f/�_ �ecf yo 9 0-399 Amp'Under 600 V FINAL 0Contractor e DATE
❑ 400-1000 Amp Under 600 V
!am exempt under Sec VALIDATION
Over 1000 Amp or Over 600 V FINAL LLId
' B&P C for this reason BRANCH CIRCUIT FEES BY
(/)
�7Date 15A,or 20A, 120V;Lighting or Recept Z
~Signature 1 To 10 Branch Circuit r '
I I'To 40 Branch Circuits -
❑ r 41 Or More Branch Circuits
Exemption for Reg Maint Elect 15A,20A,208V To 277V Lighting Br Circuits
SINGLE FAMILY Temp Power Pole&Appurtenances Y
HOMEOWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit
for the following reason (Section 703'1'5, Business and Professions Additional Sign Branch Circuits ?` 3C'F�7`
Code) µ_ y
I, as owner of'the property, will do the work and the structure Misc Conduits&Conductors
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) k iL 9
and Professions Code)
-7=
CONSTRUCTION LENDING AGENCY i Limos_ I, ,
I hereby affirm that tF ere is a construction lending agency for the t• tE3s3t s)+I
performance_ of the work for which this permit is Issued (Sec 3097, PERMIT FEE (Sub-Total) .
Civ C)
PLAN CHECKING FEE j r 1
Lender's Name L-�i`s_i_—'L JJt: y<< <f t
PERMIT ISSUING FEE L44
7
il. i-li'i _ t:
Lender's,Address �j "
I certify that I have read this application and under penalty of puqury state TOTAL FEE pL,"
that the above 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 DATE