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HomeMy Public PortalAbout10938 DANBURY ST_Electrical__ ,ewe„-DEao.a.a. APPLICATION FOR ELECTRIC PERMIT �. COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEERBDUDLR BUILDING AND SAFETY DIVISION ADDREss 7 D JOHN A. LAMBIE, COUNTY ENGINEER CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST PERMIT FEES CROSS ST. .ITEM NUMBER EACH FEE OWNER _ ^" OUTLE s� $ $ MAIL LIGHTS RECEPn[/ W. 10 ADDRESS 1 LIGHTING FIXTURES 1O CITY TEL.NO. ELEC.RANGES CLO.DRYERS ELECTRICIAN WATER HEATERS .50 ADDRESS ELEC SPACE HTRS. DISHWASHERS CITY..4 TEL. NO GAGE DISPOSERS AUTO.- /{ STATE �'"'� WASHERS STA.COOKING UNITS I .25 �� LICENSE NO. ...1 / 7—r7 MOTORS: OVER INC. H.P. DISTRICT NO. GROU ZO E PROCESSED BY O— V. .25 I i / /E— 2 .50 INSPECTION RECORD 2— 5 1.00 5— IS 1.50 15— 50 2.50 50-200 5.00 r SIGNS: NO.TRANS. NO.LAMPS SERVICE 0-600V 1.00 SERVICE OVER 600V 5.00 MISC. WIRfNGPERMIT 1.00 f ° FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT .50 TOTAL FEE S I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION QPPR0VAL5 GATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT , I/ ELECTRICAL WIRING. WIRING Y ' .�/FIs /-✓Y✓ 1 HEREBY CERTIFY THAT I S PROPERLY REGISTERED AND/OR LICENSED A9 REJ��AOL' BY LOSLEGAANGELES UNTT AND STATE OF FIXTURES 1 CALIFORNIA ORAMTHELEGALEROF THE AEOVEDESCRIBEDES' OPERTY. /� POWER p/ SIGNATURE UTILITY CO.NOTIFIED N OF PERMITTE �GGCC FINAL ,� �,� U ®• NATION ARTHUR C.VETT. fA D GSH SUPERVISING ELECTRICAL ENGINEER {Ao 9 1 3 4 AFR 1 1 2A 1 0 .7 0 76A663-DE8061-6e APPLICATION FOR ELEfl CTR9�MIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILADDEss J C! ✓���✓ �L BUILDING AND SAFETY DIVISION BUILDING �� JOHN A. LAMBIE, COUNTY ENGIADI NEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY / c/ /[ L� NEAREST FRECEPT.t- APPLICANT TO FILL IN CROSS ST. NO. ACF FEE / $ $ OWNER 2 % ` / � ELSAIL ��JJJ(�L FIRST 20 .20 ADDRESSIO73 d1)N �Z (�'�jOVER 20 .10CITY/% /[' l(/ TEL. NO� T�4GPLAN CHE KL FIRST 20 .20 APPLICANT FI%TURES /� OVER 20 .10 ADDRESS RANGE-DRYERLWTR.HTR.- CITY TEL. NO. STA.COOK_DISP. F.A.U._ CONTRAC rOR SPACE HTR. AIR COND.— ADDRESS CLOTHES WASH._DISHWASH._ CITY TEL. NO. FAN-OTHER 1.00 U LICENSE IJO. CLASS. MOTORS,TRANSFORMERS RATING IND. HEATERS, ETC, HP. KW. KVA. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI AAT10N SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 0 - 1 1.001 ELECTRICAL WIRING. p I HEREBY CERTIFY REQUIR THAT 1 AM PROPERLY REGISTERED AND/OR L I - ID 3.00 LICENSED AS RE BY LOS ANGELES COUNTY AND STATE OFF CALIFORNIA OR THAT HATI AM THE LEGAL OWNER OF, AND INTEND TO " a ' 10 - $G $.00 RESIDE IN, THEtlOVE DES PIDED RESIDENTIAL PROPERTY. � O SIGNATURE 2" AV 50 - 100 10.00 OF PERMITTEE 2i K 100 - 500 15.00 ' DIST RI• O^G UP _ ONE P CES ED BY rj SIGN.GAS SIGN AND ONE CIRCUIT 3.00 J W TUBE, OR N MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES: Z SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 d Q SERVICE OVER 600 VOLTS OR 200 AMP 5.00 TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE [TElP. POW ER POLE U N OE"LAB WORK ROUGH CONDUIT PERMIT FEE (SUB TOTAL) WIRING FIXTURES PLAN CHECK FEE (50n PERMIT FEET POWER AUTHORIZED PERMIT ISSUING FEE 2.00 Z OU UTIL I T Y CO.N OTI FIED SUPPLEMENTARY PERMIT ISSUING FEE 1.00 d FINAL TOTAL FEE JOS PH C. ROOHAN SUPERVISING ELECTRICALENGIN PLAN CHECK VALIDATION CK, M.O. CASH PERMIT VALIDATION CK. M.0 c sH 68670 OC115 ' 2 D 529- iEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE ,. �� WORKERS CI have COMPENSATIONDECLARATION of corse so-oowDPW.araz APPLICATION ®� ELECTRICAL IG�+�II'l��plL Ir lL�ppO� O 70W1 Y'i lf"If"IL 'LaPi II 'L d"i EHO hereby affirm that haver certificate of consent to self ,CE.8o G insure, era certificate of Workers' Compensation Insurance, • COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certif' d copy thereof (Sec 3800, Lob. C.) Poliyy No.• Company FOR APPLICANT TO FILL IN JOB C�/> DCertified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS F]Certified copy is filed with the county building inspec- 1 8 2-Family, Sq. Ft. $ — $ LOCALITY f tion department. Multi-family Sq. Ft. — NEAREST CROSS ST. Aj TA Date Applicant Residential Swimming Pools OWNER OR FIRM NAME �© CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light�5w. MAIL ® J)& . ` �-. COMPENSATION INSURANCE � First 20 ADDRESS &AJ (This section need not be completed if the work involved by Total No. Y Additional CITY`ZFjMF� r Tel. No. W-,302.3 the permit is for one hundred dollars ($100)or less.): - PLAN CHECK CTY I certify that in The performance of the work for which this APPLICANT permit is issued, I shall nal employ any perso any manner so as to be o sublect to the Workers' nsotion Laws. Lighting Fixtures First 20 ADDRESS Additional Total No. CITY Tel. No. Date Applicant Fixed Applionc s Not Over 1 HP PERMIT NOTICE O A LICANT: If, after'makin this Certificate of APPLICATION Exemption, you should become subject to the Workers' Range— Heater—D.W. — Compensation provisions of the Labor Code, you must forth- Oven _ Dryer —W.M._ ADDRESS with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. CITY Tel. No. Hood Fan —Other— LICENSED CONTRACTORS DECLARATION LICENSE OR Disp. Room Air Cond. REG. NUMBER Class. I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. PR CESSED BY Y and Professions Code,and my license is in full force and effect. �O v O Size 8 Type HP, KW, KVA, or KVAR o License Number Lic. Class Up to 1 Ind. FINAL U Over 1 to 10 Ind. DATE ' ^ VALIDATION Q Contractor Dafe Over 10 to 50 Incl. U OFINAL I am exempt under Sec Over 50 to 100 Inc By W B.BP.C. for this reason Over 100 d Services, Swbd., MCC & Ponelboords D w U) Date: Z 0- 200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp, or Over 600 V - Exemption for Reg. Mainz. Elect. SINGLE FAMILY - a HOME OWNER-BUILDER DECLARATION Temp. Power Pole 8 Appurtenances ;;=1a_I ,v Sign hereby affirm that am exempt from the ContractorSi with One Branch Circuit's License g 1;� 30.!it Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits _ Professions Code): 3 C s owner of the property, will do the work and the Misc. Conduits &Conductors -&f'nfL 0 ® 1 Of structure is not intended or offered for sole(Section 7044, Other (See Complete Fee Schedule)_ _ Business and Professions Code), D 1-F•SH CONSTRUCTION LENDING AGENCY CHANGE 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) 0 (Sec. 3097, Civ. C.). QIlljl l-!,!Q{;1 Ui7 J. PLAN CHECKING FEE _ Lender's Name jti.' fi�`E 15,E. PERMIT ISSUING FEE 60 Lender's Address I certify that 1 have read this application and state that the TOTAL FEE s 1 a iis above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and _ hereby authorize rposentatives of this Countyto ent upon the above-me ed property for inspection p po s. . `` SEE REVERSE FOR EXPLANATORY LANGUAGE Sigfieture of rnm ittee - /D to Os