HomeMy Public PortalAbout10561 DANBURY ST_Electrical__ 76A603CEB06 10-62 APPLICATION FOR ELECTRICAL PERiffij72d,2
COUNTY OF LOS ANGELES -
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS V V
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OF BUILDING lV LOCALITYca
Q M ACI L
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
RECEPT. TOTAL NO. EACX FEE L. (�
OUTLETS FIRsr 20 $
20 $
OWNER C,_Ck,L+l-1�n 1 \'Q A.LI\64ND
cHiao- 'q ooMAIL
swrtw. ) % aoD'L ADDRE59
OVER 20 10
TOTAL CITY TEL. NO. —S 1
LIGHTING TIRsi 20 .20
FIXTURES J ADD'l 1O ELECTRICIAN I
OVER 20
RANGES CLO.DRYERS WTR,HTR3. 1.00 ADDRESS
GARB.DISPA STA.COOK E
CITY
DISHwA3H., Auio..wa3H. STATE
SPACE"TRS. STA.APP.1./H.P.MA%.I .50 LICENSE NO.
MOTORS: OVER NOT OVER H.P. ` DISTRICT ON�O.r GROUP ZON/ CES ED BY
o 1 "o � -•
1 3 1.50 INSPECTION RECORD
3 s 2.00 r
a
B is 2.50 O
V
15 50 3.00 cc
50 100 5.00 O
SIGNS: NO.TRANS. [Sa1)
NO.LAMPS
N
Z
SERVICE O-GOON-NOT OVER 200A `. 1.00
SERVICE O-600V.OVER 200 A. 2.00
SERVICE OVER 600V 5.00 4
MISC.
L
f
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE 9
I HERESY ACKNOWLEDGE THAT 1 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. WIRINGr),.AfN
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REOUIREO BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM HE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL P P RTY. POWER
SIGNATURE UTILITYCO.NOTIFIED �- 6 01
OF PERMITTEE ♦
FINAL
LI ARTHUR C. VETT
CK MOO CAS CASH SUPERVISING ELECTRICAL ENGINEER
LACO1 4 0 9Z JUL 16 2 D 1 8.90-
WORKERS'COMPENSATIONDECLARATION 68A6 (2-80)
63
CE 6G APPLICATION FOR ELECTRICAL PERMIT
1 hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY
insure, ar a certificate of Workers'Compensation Insurance,or
a certified copy thereof(Sec.3800, Lab. C.)
1C.15123e-18 ^yam FOR APPLICANT TO FILL IN JOB 1 l
Policy No. Company ADDRESS \ CL . O/}�DU
New Residential Bldgs.&Pools EACH NO. FEE
❑ Certified copy is hereby furnished. 1 & 2.Family,Sq. Ft. $ — $ LOCALITY
Certified copy is filed with the county building inspection Multi-family Sq. Ft. NEAREST
O� CROSS ST - ;
Department. Residential Swimming Pools OWNER OR
Date.Applicant FIRM NAMEv`'12L Sa 1-1 A4 A'
Outlets: Rec._Light_Sw 2 ADDRESSFirst.'
,CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITV�Gy/4 �' Tel No. }
COMPENSATION INSURANCE
PLAN CHECK d
(This section need not be completed if the work involved APPLICANT O
r
by the permit is for one hundred dollars Fixtures First 20
s ($100) or less.) Additional ADDRESS 8806 EAST LAS TUNAg nplVc
Total No. SAN GABRIELC O
I'certify that'in the performance of the work for which this Fixed Appliances Not Over 1 HP ,CITV 4IWN A 91776 F
permit is issued, I shall not employ any person in any manner PERMIT LU
so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. _ APPLICANT CA F(fl NI P ni s ONO.- IL
Oven _ Dryer_W.M. ADDRESS 9806 EAST LAS TUNAS DRIVE Z
Date Applicant Top _ Fan _Other— CITY SAN GABRIEL,TI�•(ni�.G � 6
Hood _ Fan —Other— q
NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond.— LICENSE ORM �1b'Z Class ` 5
Exemption, you should become subject to the Workers' REG. NUMBER
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO, PROCESSED BY
with comply with such provisions or this permit shall be
deemed revoked. Size&Type HP,KW, KVA,or KVAR
Up to 1 Incl.
FINAL
Over 1 to 10 Incl. DATE G
LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. (b hZ VALIDATION
I hereby affirm that Iam licensed under provisions of Chapter Over 50 to 100 Inc. FINAL
9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 BY ,
ness and Professions.Code, and my license is in full force and
effect. Services
05 G-3 0-200 Amp. Under 600 V
License Nu/m'b�ei11dT.? I�Z Lic.Class r� I p� 201-1000 Amp. Under 600 V
ContracO - 1 DCIS Date T "L/. O Over 1000 Amp.or Over 600 V
HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances
I hereby affirm that 1 am exempt from the Contractor's Sign with One Branch Circuit
License Law for the following reason (Section 7o 31.5, Busi- Additional Sign Branch Circuits
ness and Professions Code):
Misc.Conduits& Conductors —9 3 b B 4 A
1, 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 000 e o 2
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY Q.o e 3&5 0
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is
issued(Sec. 3097.Civ.C.). PERMIT FEE e 3 &5 p
- (Sub-Total) (Gimeo o
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) G. '6-8.2
Lender's Address
PERMIT ISSUING FEE
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
ordinance and State laws regulating Electrical wiring, and
hereby , horize r ase 9'�}ves of this County to enter upon
the she
-mentio a pr i!rty for inspection purr es. SEE REVERSE FOR EXPLANATORY LANGUAGE
I�
Signature cFf Per ittee D e