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Home My Public Portal About5340 ENCINITA AVE_Electrical__ r - EIS DAPPLICATION FOR ELECTRIC PERMIT 1 DBS SA 12 54 SA DIVISION OF BUILDING AND SAFETY Department of CountyLEngmneerCO13IIty Of LDS ABUILDINGWM J FOX, COUNTYEER ADDRECASSATT D GRIFFIN, SUPILDING /p FOR APPLICANT TO FILL IN LOCALITY PERMIT FEES NEAREST FEE CROSS ST NUMBER EACH LIGHT OUTLETS OWNER ` MAIL RECEPTACLES ADDRESS WALL SWITCHES TOTAL OUTLETS 50 $ CITY TEL NO ELEC RANGES 25 ELECTRICIAN ELEC HEATERS 25 ADDRESS < / I KW EA CITY TEL NO FIXTURES 5 LICENSE NO NUMBER OF LIGHT CIRCUITS DISTRICT NO GROUP ZONE READY FOR INSPECTION NUMBER OF RECEPTACLE CIRCUITS � t' MOTORS y{�IIJJ NUMBER - HORSEPOWER FEE INSPECTION RECORD NEW MVD HP OVER INC EACH LESSr $ 25 �2 2 50 2 5 1 00 5 15 1 50 15 1 50 2 50 50 200 5 00 MISC NO SIGNS NO TRANS NO SIGNS NO LAMPS FOR EACH PERMIT WIRING $100 FIXTURES $1 00 SUPPLEMENTARY 50 APPROVALS TOTAL FEE DATE INSPECTOR S SIGNATURE 7 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CONDUIT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ' ELECTRICAL WIRING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED ASREOUIR D BY OS ANGELES COUNTY AND STATE OF POWER h CALIFORNIA OR TA Ht A THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDEN ALIP OP RTY� UTILITY CO NOTIFIED '4 SIGNATURE OF PERMITTEE FINAL WILLIAM J FOX;COUNT ENGINEER VALIDATION 1, 2 O US An 27 2 1.10 G r - "DEPUTYe t _ 1p� q 78A883 DHS SA 34 APPLICATION FOR ELECTRIC _PERMIT 1 12 DIVISION OF BUILDING AND SAFETY Department of County Engineer County of LOB Angeles BUILDING WM J FOX, COUNTY ENGINEER ADDRESS CASSATT D GRIFFIN, SUP T OF BUILDING FOR APPLICANT TO FILL IN LOCALITY PERMIT FEES NEAREST //L-� 01 CROSS ST ./ xYw V' FEE N-UMBBE�R- EACH LIGHT OUTLETS ,,, OWNER �— MAIL RECEPTACLES Y a ADDRESS WALL SWITCHES TOTAL OUTLETS 50 S CITY TEL NO ELEC RANGES 25 ELECTRICIAN ^7 yP�t?�'��/'�' ELEC HEATERS EF2ADDRESS X liC c7 /� �( W � 99�� /KWEA CITY /Jtj:2- Qo ATEL NOAr"CvFIXTURES i�C / O 47 LICENSE NOe �L/6'7" NUMBER OF LIGHT CIRCUITS DIST�T NO GRO P ZONE READY FOR INSPECTION _ NUMBER OF RECEPTACLE CIRCUITS � � MOTORS NUMBER HORSEPOWER, FEE INSPECTION RECORD NEW 'WF"P HP OVER INC EACH I /� 1/2&LESS $ 25 2 50 2 5 1 00 5 15 1 50 is 50 2 50 50 200 500 MISC �ige 5(AD�d! VeN T F-AN NO SIGNS NO TRANS NO SIGNS NO LAMPS FOR EACH PERMIT WIRING $100 PIC FIXTURES _ $100 SUPPLEMENTARY 50 - APPROVALS TOTAL FEE $ DATE INSPECTOR S SIGNATURE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CONDUIT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF POWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY � UTILITY CO NOTIFIED SIGNATURE �� . . w �t"" FINAL OF PERMITTEE WILLIAM J FOX, COUNTY ENGINEER VALIDATION 2 2 4303U 'NpY PUTY WORKERS' COMPENSATION DECLARATION 20-0019 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT I herepy affirm.that I have a certificate of consent to self ce e006G insure,,or d cdriificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lab. C.) Poljcy No. , Company FOR APPLICANT TO FILL IN JOB ,L / ❑Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS ❑Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ ❑ $ LOCALITY tion department. Multi-family Sq. Ft. NEAREST CROSS ST. Date Applicant Residential Swimming Pools OWNER OR rI FIRM NAME _._N ( C AZ;- CERTIFICATE OF EXEMPTION FROM WORKERS' � / C MAIL , COMPENSATION INSURANCE Outlets: Rec Light SW. ADDRESS �y U '1��`rNl Ave- First ��+� (This section need not be completed if the work involved by Total No. Addititi onal CITY Tel. No. __ 0 the permit is for one hundred dollars ($100)or less.) PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS ` , 1, Total No. Additional CITY Tel. No. Dater -AV1, Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of PERMIT Exemption, you should become subject to the Workers' Range— Heater—D.W. — APPLICATION .liZ'Lj 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. Hood — Fan —Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR Disp. — Room Air Cond. Class. I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER (commencing with Section 7000)of Division 3 of the Business Power Apparatus & Large Appliances DISTRICT NO. P O ESSED BY and Professions Code, and my license is in full force and effect. Size &Type HP, KW, KVA, or KVAR 3�/ !L�sr-a-sL°� O License Number Lic. Class Up to 1 Incl. FINAL U Over 1 to 10 Incl. DAT VALIDATION CC OContractor Date Over 10 to 50 Incl. FIN ❑ I am exempt under Sec. Over 50 to 100 Inc. gy LL B.&P.C. for this reason Over 100 a Z Date: Services, Swbd., MCC & Panelboards , Z 0- 200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole &Appurtenances i HOME OWNER-BUILDER DECLARATION rr• s I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit �u-• j :__ Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits _w_ Profssions Code): __ h,ye Conduits &Conductors LJ I, as owner of the property, will do the work and the Misc. y structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ , UTHI•, M a Business and Professions Code). L�� _,, ' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for r� � � �(-1!= the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) V (Sec. 3097, Civ. C.). PLAN CHECKING FEEli 6i l !-'I I l i/2S y° Lender's Name PERMIT ISSUING FEE ;_ t; i AIri 9:04 Lender's Address I certify that I have read this application and state that the TOTAL FEE 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 purposes. {p SEE REVERSE FOR EXPLANATORY LANGUAGE es Signature of 01rmi tee Date I