HomeMy Public PortalAbout8824 ELM AVE_Electrical__ 76A663-CE606-10.56 lrNll Y UC//—v TION FOR ELECTRIC ERMT �
BUILDING AND SAFETY DIVISION R,
- m
Department of County Engineer BUILpING
County of Los Angeles ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER
CASSATT D. GRIFFIN. SUP'T OF BUILDING LOCALITY
vr;: ,. - v.• _,::;.: NEAREST
t FOR APPLICANT TO FILL IN CROSS T.
PERMIT FEES
OWNER S;
LIGHTS RECEPTACLES. SWITCHES -
NUMBER I T E M EACH FEE MAIL
ADDRESS
m TOTAL OUTLETS $ .10
ELEC. RANGES, WATER HEATERS, CITY TEL. NO.
a
CLOTHES DRYERS .50 ELECTRICIAN
ELEC: SPACE HEATERS, STAT-Y.
-COOK '
1. ING UNITS, GARBAGE DISPOSERS, : ADDRESS {,!
i AUTO WASHERS, DISHWASHER
LIGHTING FIXTURES' •10 /A CITY TEL. NO
MOTORS - ,+ STATE LICENSE NO. /Y
HORSEPOWER ,• DISTRICT NO. JGROUPI ZONE I READY FOR INSPECTION
H.P. OVER INC.
I/2 9 LESS .25 t -
s �
1� - z 50 INSPECTION RECORD
2 5 1.00
_ 5 15 1.50 -
15 50 2.50
50 200_ 5.00 -
misc.
SIGNS I NO:TRANS
N0.LAMPS
SERVICE 0'-600V 1.00
SERVICE OVER 60OW • 5.00 qq
WIRING PERMIT - 1.00
q"
FIXTURE PERMIT 1.00
4 SUPPLEMENTARY.PERMIT' .50 $ ® l i' rROViLC
TOTAL FEE
DATE.
INSPECTOR'S SIGNATURE
'HEREBY ACKNOWLEDGE THAT-'1 HAVE READ THIS APPLICA ON
AND STATE THAT THE.ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT t
WITH ALL COUNTY ORDINANCES, AND STATE LAWS REGULATING ;•, r`
ELECTRICAL WIRING. WIRING 12 '" 6
1 HEREBY CERTIFY THAT1 AM PROPERLY REGISTERED AND/OR ie FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM T LEGAL OW OF THE'ABOVE POWER
DESCRIBED RESIDENTIAL OF Y.
SIGNATUREAlrQ� UTILITY CO. NOTIFIED 9qth� /yam /
OF PERMITTEE INAL �,2-
JOHN A. LAMBIE. NALIDA ARTHUR C.VEIT.
COUNTY ENGINEER - SUPERVISING ELECTRICAL ENGINEER
CK MO CASH
1 3 9AUG 6 2 2.8 0
WORKERS'COMPENSATION DECLARATION 76A663 tD/8t t j�Q (� I�� I�p I� �e p
hereby affirm that o have-h Kertificate of consent to self insure, CE-8o6G ,. AIR l��CAMOII�I' OR Lr—LECT��� AL PERNT
or a certificate of'Work ' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec. 3800,Lab.C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB
Certified copy is herebyfurnished. fAGH NO.. FEE ADDRESS
New Residential Bldgs.&Pools
Certified copy is filed with the county building inspection, 1 & 2-,Family, Sq.Ft. $ — $ LOCALITY
department, Multi-family Sq.Ft. — NEAREST
Residential Swimming Pools CROSS ST. CA11IGL-
Date - Applicant OWNER OR... °
FIRM NAME
> �,
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec �® Light Sw. MAIL
COMPENSATION INSURANCE First 0 8 6 L4 0 ADDRESS ' .let
(This section need not be completed-if the work involved by the.
2 �
permit is for one hundred dollars ($100)or less] Total No.�. Additional CITI9 ��� Tel.No.PLAN
1�1�
I certify that in the performance of the,work for which this permit APPLICANT CHECK
is issued, I-shall not employ any person in any manner so as to 3
become subject to the Workers'Com Lighting Fixtures First.20 b E ADDRESS
^2fi � , A Additional
`-i Total No. �l- -�CI Tel:No.
Date Applicant fixed Appliances Not Over 1 HIP
NOTICE TO APPLICANT: If, after making this Certificate' of PERMIT
Exemption,you should become subject to the Workers'Compensation ° Range, Heater D.W. APPLICANT
provisions of the Labor Code, you must forthwith comply with such Oven Dryer _ W.M. ADDRESSV1j(gCyV J?3,CC%q
provisions or this permit shall be deemedrevoked.' Top FAU _ W.H. !.
DJP�
LICENSED CONTRACTORS DECLARATION Hood — Fan. '_ Other_ CITY CITY Tel.No. :?fiT.S
I hereby affirm that I, am licensed under provisions: of Chapter 9Disp. — Room Air Cond. LICENSE OR,
(commencing with Section 7000) of Division 3 of the.Business and REG.NUMBER ���Z'a Class.G
Professions Code,and m license is in full force and effect. DISTRICT NO. PR ES
dy Power Apparatus&Large Appliances
tt Size& Type HP, KW,KVA,�or KVAR ( �
License Number ��0� Lia Class 1 Up to 1_Incl FINA I C�
Contract Date��z"�a® Over 1 to 10 Incl. DAT '1 VALIDATION
Over 10 to 50 Incl.,
BY
El FINAL U
I am exempt under Sec. Over 50 to 1001nc.
B.&P.C. for this reason Over 100 \'•-j ' Q„
Services,Swbd:,MCC& Panelboards J
N
Date: 0-200 Amp.Under 600 V ( °bb a�Signature 201 - 1000 Amp.Under 600 V ,
❑ Over 1000 Amp.or Over 600 V
Exemption for Reg.Maint.Elect. .
_ ..... .. .. ., A •CT n 8
SINGLE FAMILY Temp Power Pole& Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 3347
I hereby affirm that I am.exempt from the Contractor's License Law
MS
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits ��
Code): ..
❑ TOTAL 49 m 00
Misc.•Conduits& Conductors
I,as owner of the property,will do the work and the structure ll��C�t/+.vy°
is not intended or offered'for sale (Section 7044, Business Other(See Complete Fee Schedule) �•fY:.CK
and Professions Code). D .
.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) %3C1 0000-0001. 5/124/901
Civ. C.). i M
PLAN CHECKING FEE 090E 1 AM 7°w1
Lender's Name
PERMIT ISSUING FEE
Lender's Address
I certify that I have read this application and state that the above, TOTAL FEE
information is correct. I agree to comply with all County ordinances
n State laws lating ectrical and hereby authorize
representatives o Is Count t enter n the above-mentioned
proper y r Inspection S. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date