HomeMy Public PortalAbout5224 DOREEN AVE_Electrical__ '6AG63-CEBOG 10-BI APPLICATION FOR E ECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING !�� 1
BUILDING AND SAFETY DIVISION ADDRESS '1 /
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY ��
NEARErm ST
FOR APPLICANT TO FILL IN CROSS ST.
T E M NO. EACH FE
OUTLETS: FI r 20) 7�� � $ 2O S OWNER
MAIL
OUTLETS: p DLUN 10 ADDRESS
LIGHTS / RECECEPT.PT. BW.
LIGHTING FMURES: (FIRST 201 .20 CITY TEL. N
LIGHTING FIXTURES: (ADDITIONAL) .10 ELECTRICIAN
7
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRE � � / /C /•J
GARB.DISP. STA.COOK _
��- CIL TEL. O
DISHWASH. AUTO.-WASH. STATE
SPACE HTRS. STA APP (:G H.P. AX.) .50 LICENSE NO. / ok
MOTORS: OVER NOT OVER H.P. DISTRICTI-NO, G OLP Z E P SSED BY
O 1 1.00 / 9
I a 1.50 INSPECTION RECORD
}
a B 2.00 51 ,� L, ✓.fU/ '(Q2� 0
6 15 2.50 �T / U
15 50 9.00
O
50 — 100 5.00 �c G
w
a
SIGNS: NO.TRANS. N
NO.LAMLAMPS Z
SERVICE 0-600V-NOT OVER 200A 1.00
SERVICE O-600V-OVER 200 A. 2.001
SERVICE OVER 600V 5.00
MISC.
TT
PERMIT ISSUING FEE 2.00 (ICS
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE 5
1 HEREBY ACKNOWLEDGE THAT I HAVE HEAD THIS APPLIC TION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO C MPLY CONDUIT A
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING Y
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANDIOR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES /
CALIFORNIA OR THAT I THJEE LEGAL OWNER OF THE ABOVE
DESCRIBED pe91DEN AL EA'
�•.T ) UTILITY CO.NOTIFIED [ ^ n
SIGNATURE /JCS
OF PE..... FINAL / OAC, Y1
�LIDATION ARTHUR C. VEIT '
MO CASH SUPERVISING ELECTRICAL ENGINEER
CK
L/Co 3 9 0 6 SEP 4 2 0 1 4.4 0
WORKERS' COMPENSATION DECLARATION CE-663 ,D.B, APPLICATION FOR ELECTRICAL PERMIT {�
CE-806G LJ
I hereby affirm,that 1 have a certificate of consent to self insure,
or a �,rtif�c;stefP Workers' Compensation Insurance, or a certifie ' COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy tt:e�f Sec. 8 0 Lab.C.) '� '
Policy N am FOR APPLICANT TO FILL IN JOB
❑ ADDRESS �^ Ai
Certified copy is hereby furnished. New Residential Ridge.8 Pools EACH NO. FEE I if
❑' 1 & 2-Family, Sq.FL $ — S LOCALIT
Certified copy is filed with the county building inspection NEAREST
d �tme 1. /I ' Multi-family Sq.Ft. CROSS ST.
Date // Applicant L/.✓ x✓••'V " �• / Residential Swimming Pools OWNER OR trAtf
f. FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets'Ree— Light _ Sw. MAIL /T
COMPENSATION INSURANCE ADDRESS w .1
(This section need not be completed if the work involved by the First 20
permit is for one hundred dollars ($100)or less.)'
Total No. Additional CITY I.No.441 -,40C
PLAIN
I certify that in the performance of the work for which this permit APPLICANT CHECK
is issued, I shell not employ any person in any manner so as to
become utile t to he Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
G Total No. Additional \ CITY Tel.No.
/'
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE T• - PPLICANT: If, after making' this Certificate of mo
Exemption,you should become subject to the WorkerCopensation Range_ Heater_ D.W. APPLICANT
s' m
_
provisions of the Labor Code,you must forthwith comply with such Oven _ DryerM._ ADDRESS `7 � N.
provisions or this permit shall be deemed revoked. Top — FAU .H. �„J
CITY I.No.
LICENSED CONTRACTORS DECLARATION Hood Fan Other-
1 hereby affirm that 1 am licensed under provisions of Chapter 9LICENSE 0R -
(commencing with Section 7000) of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBS Class.
Professions Code,and my license in full force and effect. Power Apparatus& Large Appliances _ DISTRICT NO. P SSED BY
p
Size& Type HP, KW,KVA,or KVAR J, p
License Numberl�" Lic.Class Up to 1 Incl. FINAL U
Over 1 to 10 Incl. DATE
r Date - 2 - VALIDATION
Contracto
Over 10 to 50 Incl. U
❑ FINAL
I am exempt under Sec. Over 50 to 100 Inc. BY W
B.&P.C.for this reason Over 100 (-
to
Services,Swbd.,MCC & Panelboards , Z
Date: 0- 200 Amp.Under 600 V
Signature 201 - 1000 Amp,Under 600 V
❑ - Elect.
Exemption for Reg. MOver 1000 Amp.or Over 600 V 2
aine
A�CC^T.e
FAMILYSINGLE Temp.Power Pole 8 Appurtenances
HOME OWNER BUILDERDECLARATION .J7JL!71,73 42.50
Sign with One Branch Circuit
hereby affirm that 1 am exempt from the Contractor's License Law Additional Sign Branch Circuits 1 ITEMS
Code):
for the following reason (Section 7031.5,Business and Professions
Code ' TOTAL 4r ® 5D
Misc. Conduits 8 Conductors
I,as owner of the property,will do the work and the structure CHECK Q
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) CHECK 4..•'
and Professions Code). ► .CHANGE •00
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) '• OWO-0001 3/11/96
Civ.C.). C
PLAN CHECKING FEE 5231 •1 PM12:24
Lender's Name
PERMIT ISSUING FEE p2 -
Lender's Address
I certify that I have read this application and state that the above TOTAL FEE sD
information is correct. I agree,to comply with all County ordinances '
and State laws regulating Electrical wiring, and hereby authorize _
represa halves of this County to to upon the amove-me tioned
proper for inspecfi� p r ses. ^ SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Pe_mi tee// Jh Date ,