HomeMy Public PortalAbout10653 DANBURY ST_Electrical__ 70AS63-EBOO-6_57 APPLICATION FOR ELECTRIC PERMI
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER D BUILDING
BUILDING AND SAFETY DIVISIONADORE$$
JOHN A.LAMBIE,COUNTY ENGINEER 4
CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICAT TO FILL IN CROSS ST.
N
PERMIT FEES
LIGHTS RECEPTACLES SWITCHES OWNER
��
NUMBER 1 T E M EACH FEE MAIL
TOTAL OUTLETS S .10 9
ADDRESS
t
ELEC. RANGES. WATER HEATERS, CITY TEL.NO.
aorHEs DRYERS .50 ELECTRICIAN
1L ELEC. SPACE Hf�MTER6, STAT'T. COOK _
H— Ixc uxITS, GL+reaCGE DISPos ERs, M ADDRESS
AUTO WASHERS, DISHWASHER .25 J�
LIGHTING FIXTURES ,10 d CITY
STATE
MOTORS LICENSE NO.
HORSEPOWER DISTRICT NO. GROUP ZON / READY FOR INSPECTION
OVER INC.
%a LESS .25
i - z 50 INSPECTION RECORD
2 5 1.00
5 15 1.50
15 50 2.50
50 200 5.00
MIND.
SIGNS I NO.TRANS
NO.LAMPS
SERVICE O-600V 1.00 �lV
SERVICE OVER 600V 5.00 '
WIRING PERMIT 1.00
e FIXTURE PERMIT 1.00 U
SUPPLEMENTARY PERMIT .50 APPROVALS
TOTAL FEE S
GATE INSPECTOR'S SIGNATURE
HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS A LI T N
1
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUITWITH ALL
ELECTRICAL COUNTY ORDINANCES
ORDINANCES AND STATE LAWS REGULATING WIRING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
o CALIFORNIA OR THAT I AM TH LEGAL OWNE F THE ABOVE POWER
DESCRIBED RESIDENTI ROP
SIGNATURE UTILITY CO.NOTIFIED ,�
OF PERMITTE
FINAL
JOHN A.LAM BIE. ION ARTHUR C.VEIT.COUNTY ENGINEER (� . CN SUPERVISINGELECTRICAL ENGINEER
l.APp 0 7 0 4 0R MAY 8 2 A 8.8 5
WORKER'$COMPENSATION DECLARATION 20-001019 DPW(12-91) APPLIC*TFON FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to sell insure, 6-0
663 or a certificate of Worker's Qofi¢ansation Insurance, or rtitied COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy theredf(Sec. 3600 Lab. C.) r /� ^J
Policy No. Company FON APPLICANT TO FILL IN JOB
ADDRESS
Certified copy!Is hereby furni New Residential Bldgs.&Pools NO. EACH FEE
❑ _ $ $ LOCALITY
Certified copy is file the county building inspection 1 &i- Family,Sq.Ft. NEAREST
department. Multi-family Sq.FL CROSS Si.
Residential Swimming Pools ASSESSOR
Data Applicam MAP BOOK PAGE PARCEL
TIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light_Sw._ OWNFIRM NAME
�i• COMPENSATION INSURANCE
FdMAIL /
(Ts section need not be completed If the work involved by the Total No. Additional MADNESS /
permit is for one hundred dollars($100)or less.) �.
I certify that in the performance of the work for which this permit CITU 1 Tel.No.yh/ —w 3
is issued. I shall not employ any person in any manner So as t0 PLAN CHECK
become subject to the Workers'Compe tion Laws. Lighting Fixtures First 20 APPLICANT
Total No. Additional
ADDRESS
Date� Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOT E.TO APPLICANT: If, after making this Certificate of CITY Tel.No.
Exam 110n, ou should become subject to the Workers' Compensation OTHER APPLIANCES NOT OVER 3 HP.
provisions 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 8 Type KW,KVA,or KVAR / ADDRESS 3 _76 L
I hereby affirm that I am licensed under provisions of Chapter 9 /J( Over 3 to 101nc1. q.l
(commencing with Section 7000)of Division 3 of the Business and CITY Tel.No. /U
Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. }
LICENSE OR //� Cla.'r ��J
��/(/ �(j /\J
Over 50'0 100 I/ICI. REG.NUMBE C�� a
License Numbpi'N YJJ �j 2_ Lic.Claes C_�`' Over 100 DISTRICT NO. PROC /BED BY 0
Services,Swbd.,MCHC&,9Pannallbbooaary�ys �l/�?t�•
/ / _ 0-399 ArRp�if ed r b00 V FINAL 0
CdnVec[c � Date DATE
400- 1000 Amp.Under 600 V VALIDATION W
❑ am exempt under Sec. 2
Over 1000 Amp.or Over 600 V FINAL
B.&P.C.for this reason BRANCH CIRCUIT FEES BY 4.
D 15A,or 20A,.120V,Lighting or Receipt. Z
I To 10 Branch Circuits
Signature 11 To 40 Branch Circuits -
❑ 41 Or More Branch Circuits
Exempt/Offered
g.Main'.Ele 15A,20A,206V To 27N Lighting Br.Circuits
SINGL FAMILY Temp,Power Pole&Appurtenances _
NER- ILDER DECLARATION - a �
I hereby affirm axe pt from the Contractor's License Law Sign with One Branch Circuit i-1�.�•T.v
for the followin (S tion 7031.5, Business and Professions Additional Sign Branch Circuits " - 3307 69 ')7
Code): V
❑ 1,as oa property,will do the work and the structure Misc.Conduits&Conductors 1 ITENS
is not iOr offered for sale (Section ]044, Business Other(See Complete Fee Schedule) TATAL 69 ® 2,C.�kndPrCode). _RUCTION LENDING AGENCY CHECK69.n1
I hereby affirm that there is a construction lending agency for the CHANGE ' .OU
performance,ol the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) '
Civ.C.) -
PLAN CHECKING FEE 01300-0001 1/12/93
Lender's Name _
PERMIT ISSUING FEE a J 75688 1 AN 9:01
Lender's Address
I certity that I have read this application and under penalty of purlury state TOTAL FEE [/Y_
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 toe ter upon the above mentioned property
to s ctio urposees SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNATURE OF PERMITTEE ATE