HomeMy Public PortalAbout9914 DAINES DR_Electrical__ 76A668-CES06-6-87 .APPLICATION FOR ELECTRIC PERMIT, wl
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A.LAM BI E,COUNTY ENGINEER /
CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST (347
PERMIT FEES
OWNER
LIGHTS RECEPTACLES SWITCHES
NUMBER ITEM EACH I FEE MAIL /�/ P&A"
TOTAL OUTLETS s ADDRESS `�
f0 �
ELEC. RA�, WATER HEATERS, CITY TEL NO
CLOTHES DRYERS 1 5O
ELEC SPACE HEATERS, STAT'Y COOK- ELECTRIC AN
ING UNITS, GARBAGE DISPOSERS, ADDRESS
AUTO WASHERS, DISHWASHER 25 _ _ ,
LIGHTING FIXTURES ,10 CITY TEL.NO.(p V SA+��
MOTORS STATE
LICENSE NO SQ b
HORSEPOWER 13M
DISTRICT NO. GROUP ZONEREADY FOR INSPECTION.
H P., OVER INC
1/�@ LESS 25
1/2 — 2 .50 INSPECTION RECORD
2 — S 100
5 — Is 1 50 _
is — 50 250
50 200 Soo
MISC.
SIGNS NO TRANS
NO LAMPS
SERVICE O-600V loo
SERVICE OVER 600V Soo
WIRING PERMIT 100 -�
FIXTURE PERMIT 100
SUPPLEMENTARY PERMIT •so APPROVALS
TOTAL FEE
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS A LICATION 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 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE POWER
DESCRIBED RESIDEN 1 L PROP R
SIGNATURE UTILITY CO NOTIFIED
OF PERMITTEEFINAL
JOHN A.LAMBIE. ARTHUR C.VEIT,
COUNTY ENGINEER VALIDATION SUPERVISING ELECTRICAL ENGINEER
ck LACO 3 8 4 6- ,OCT 2 9 2 2.5 Q
' ®r
ilORKERS'COMPENSATION DECLARATION 76A663 10/81 G
Y hereby Ghat I have 8 certficate of consent to self Insure, CE-806G APPLICATION 'FOR ELECT • ICAL PERMIT _
or a certificate of -Workers' Compensation Insurance, or a certified COUNTY,OF LOS ANGELES : BUILDING AND SAFETY / �d fl-
copy tore f Sec+3800,Lab C)
Policy Nb parry FOR APPLICANT TO FILL IN , JOB ,, •.
❑ Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO, FEE ADDRESS
? 1 & 2-Family,Sq Ft $ — $ LOCALITY
Certified copy is filed with the county budding inspection —
.departure - Multi-family Sq Ft CROSNEARS ST
n
DResidential Swimming Pools ' OWNER OR
ate Applicant f
c , • FIRM NAME, M41
CERTIFICATE•OF EXEMPTIOIJ,FROM WORKERS' MAIL i ✓i
Outlets'Rec Light — Sw, ADDRESS
COMPENSATION INSURANCE
(This section need not be completed if the work involved by the First 20
Total No
permd'is for one hundred dollars.($100)or less.) Additional. - CITY t Tel N g
,PLAN CHECK/J ;� � a
I certify that m the performance,of the,work,,for which this permitI' APPLICANT, �,
is,issued -not shal-not employ any person in•any manner so as to
'ADDRESS"
' become subject to the Workers',Compensation Laws Lighting Fixtures First 20 �L
Addi ional
i• Total No � - - CITY � � Tel N .•
DateApplicant• Fixed Apphances'Not'Over 1 HPPERMIT
NOTICE, TO APPLICANT If, after• making this Certificate of T
i
APPLICAN �i�
Exemption,you should become subject'to the Workers'Compensation Range_ Heater_ DW , `�
t
provisions of the Labor Code;you;rrfust forthwith comply wdh such Oven _ Dryer _ W M C , � ADDRESS •$��
provisions or this permid.shall be deemed revoked;,, Top FAU _.WH Tel Nd
LICENSED.CONTRACTORS DECLARATION, CITY ^ i
Hood Fan- Other_
1',hereby,affirm that I am-licensed.under,provisions of Chapter'9 LICENSE OR
- Disp Room Air Cond REG NUMBER, Class
(commencing with Section 7000)•of Division 3 of the Business and
Professions Code,and my license is iii-full force and effect ` - DISTRICT NO PROCESSED BY
Power Apparatus&.Large Appliances
T Size Type HP,KW,KVA;or KVAR O D Q
.License Number Y w Z Lic Class ' Up to 1 Incl. 41'0 ` FINAL V
L/1►' l� Over 1 to 10 Incl DATE VALIDATION; Q `
'Contractor- Date f Over 10 to`50 Incl FIN (~�
❑ I am exempt under Sec Over.50 to.100 Inc BY d W
Over 100
B&PC for this reason i ��IF-?•.: 23.':00
Services, Swbd;MCC& Panelboards
" Date 0- 200 Amp Under 600 V i PON-- iFAS-
Signature 201 - 1000 Amp Under 600 V
Over 1000 Amp or Over 600 V I jy` ` m �-0
❑ Exemption for Reg'Maint Elect c )•
(:HE V ° e
`SINGLE,(AMILY Temp Power P,ole,& Appurtenances
' HOME OWNER-BUILDER DECLARATION1•C 7c
• Sign with One Branch Circuit
I hereby affirm that I am'exempt'from the Contractor's License Law
for the following reason(Section 703.1 5, Business and Professions Additional Sign Branch Circuits
Code) JN r73t
Ivlisc'Conduits'& Conductors 3 f i!9
❑ I,as owner of the property,'will do the work and the.structure
~' 1P�F a i�
is not intended or offered for sale (Section.7044,-Business Other(See Complete Fee Schedule)
and Professions'Code) pop. 5
`CONSTRUCTION LENDING AGENCY '
I hereby affirm'that there is a construction lending agency for the
performance of the work for which this permit is,issued(Sec 3097, PERMIT FEE (Sub-Total) r '
.CIV ,C) ,
PLAN CHECKING FEE
Lender's Name, D
PERMIT ISSUING FEE ._.
Lender's•Address ` T�
I certify that I have read this application and state that the above TOTAL FEE -3,SV
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, bove-mentioned
pr0pert for inspection purpq es
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permktee 13to ;