HomeMy Public PortalAbout10650 DANBURY ST_Electrical__ 9SA663-GEB06 7-58 APPLICATION FOR ELECTRIC PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
CASSATT D. GRIFFIN, SDP'T OF BUILD[HG LOCALITY
FOR 4APPLT TO FILL IN NEAREST
PERMIT FEESICAN "ss ST.
I T E M NUMBER1 EACH FEE OWNER
OUTLET S S MAIL
LIGHTS ..CEPT 1 6W. .IG 0 ADDRESS _
LIGHTING FIXTURES .10 CITY TEL. NO.
ELEC. RANGES) D. o _' _ ELECTRICIAN
WATER HEATS RB .50 ADDRESS
ELEC.SPACE HTR5.' DISHWASHERS
CITY TEL. NO. (ti
AgBAGE OI6POSERB AUTO.- STATE
WASHERS STA. COOKING UNITS .25 / LICENSE NO. [/{'
MOTORS: OVER Inc. H.P.
DIST RI T NO. GROUP ONE PROCESSED BY
{ O— '/I, 26
'— 2 .50 INS CTLON'RECORD
2— 5 1.00 L
5— 15 1.50
15— 60 2.50
50-200 5.00
SIGNS: NO. TRANS.
NO. LAMPS
SERVICE 0-600V 1.00
SERVICE OVER 600V 5.00
MISC.
WIRING PERMIT 1.00 Q
FIXTURE PERMIT 1.00 Q V
SUPPLEMENTARY PERMIT .50 -
TOTAL FEE s APPROVALS
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT ANO AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR -
LICENSED AS REQUIRED BY LOS 6MLELES COUNTY AND STATE OF FIXTURES q
CALIFORNIA OR THAT 1 AM T LEGAL NE OF E ABO
DESCRIBED RESIDENT[ P P POWER .
SIGTURE `y UTILITY CO. NOTIFIED
OFNAPERMITTEE
.,. ..u. FINAL 8
VV�I.IDATION ,ARTHUR C. VETT,
SUPERVISING ELECTRICAL ENGINEER
CK' MO CASH
UC'0 7 6 4 9 Cc 18 2 A 10-05
ION
LARATION
_ WORKER'S COMPcNSATateofConsentto 260019DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT
6A663
I hereby''atfttm That ('have 1a 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. 3000 Lab. C.)
Policy No. Come •?/�// t� FOR APPLICANT TO FILL IN - JOB
9LADDRESS
Certified copy is hereby furnished. New Residential Bldgs..&Pools NO. EACH FEE LOCALITY
G=
❑',. Cenitied~copy is filed with the county building maps 1 &2-Family,Sq.Ft. — $ S- - NEAREST
department. Multi-family Sq, Ft. CROSS ST.
Date���"�9� Applicant Residential Swimming Pools ASSESSOR
MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FR WORKERS' Outlets:Rea_Light-4
—Sw.40— FIRM NAME
' WNER OR
COMPENSATION INSURANCE p
(This section need not be completed if the work Involved by the First 20 'a O _ _ .MAIL ADDRESS Q
IV63
permit Is fci'one hundred dollars(5100)or less.) Total No. Additional r '
I certify that in the performance of the work for which this permit . CITY '��
is issued, I shall not employ any person in any manner so as to PLAN CHECK
become subject to,the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT
Total No. Additional
_ ADDRESS
Date Applicant - RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE TO APPLICANT: If, after making this Certificate of CITY ' rel.No.
Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP.
provisions of the Labor Code, you must forthwith comply with such PERM �r
provisions or this Permit shall be deemed revoked. '
Power Apparatus&Large Appliances APL
ICAITNT
' LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDR ESS
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. xy
(commencing with Section 7000) of Division 3 of the Business end CITY T.I.
Professions Code,and my license is in full force and effect. Over 10 to 50 Ind. �.
LICENSE OR
REG.NU
Over 50 f0 100 Ind. MBER 9 G�
!!-7j[/ Over 100 DISTRICT NO. BED BY
License Number �J.J / Lic.Class ,/p V
o % f"` Services,Swbd. -B-Panelboards / OV Aw— -xii Q
Contractor J/��/ Date G� -399 Amp. Under 60 FINAL 0
400-1000❑ Amp.Under 600 V i Q I am exempt under Sec. Z VALIDATION W
Over 1000 Amp.or Over 600 V FINAL d
B.&P.C.for this reason -- - BY (q
BRANCH CIRCUIT FEES
Date: 15A,or 20A, 120V,Lighting or Recepl. Z
1 To 10 Branch Circuits
Signature 11 To 40 Branch Circuits
❑ 41 Or More Branch Circuits
Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Ughting Br.Circuits'
SINGLE FAMILY-
HOME OWNER-BUILDER DECLARATION Temp.Power Pole 8 Appurtenances
1'Lb
I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit ._7 I( ' 7.6 1
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits '�_ '
Code): _ ITEMS
E7(=
❑ 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) Tt i 1- cI" J
and Professions Code). D �_' �t.�, F7,611
CONSTRUCTION LENDING AGENCY C;ly'l .0111
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)
Civ. C.) PLAN CHECKING FEE U0130—Coo 1 '0/ MAT
Lender's Name / /L 6S 1J 1 n1il° 1
PERMIT ISSUING FEE !i(!� 7
Lender's Address
I certify that I have read this application and under penalty of purlury state TOTAL FEE - o
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 pur SEE REVERSE FOR EXPLANATORY LANGUAGE
' F PERMITTEE �dATE