HomeMy Public PortalAbout5420 ENCINITA AVE_Electrical__ 76A6631_�' CF80E912/75 • APPLICATION FO ELECTRICAL PERMIT
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BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN /
EACH NO. FEE ADDRESS ;L A=A&New Residential Bldgs. & Pools _
1 &2 Finaily Sq. Ft. $ — $ LOCALITY TC G,e f
Multi-family Sq. Ft. — NEAREST
CROSS ST.
Residential Swimming Pools
OWNER ^ n
FIRM NAMM E Fid/
Outlets: Light, Switch &Receptacle /(� MAIL
/
First 20 ADDRESS
Additional CITY_ - Tel. No.
PLAN CHECK
Lighting Fixtures 1 APPLICANT
First 20 T ADDRESS
Additional
CITY Tel. No.
PERMIT /
Fixed Appliances Not Over 1 HP APPLICANT
Range Heater_ D.W. f o. 60
x /
(C�
Oven Dryer _� w.m.
1— ADDRESS r,
Top FAU W.H. CITYCj Al ` f}-p_l•� Tel. No. ^-q//
Hood Fan / LICENSE
NUMBE
Disp. A.C. R I/ Class. e%d
_� b REG.
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION Q
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY V
Power Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING LLJ
Size&Type HP, KW, KVA,or KVAR ELECTRICAL WIRING.
Up to 1 Incl. z
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
Over 1 to 10 Incl. LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
Over 10 to 60 Incl. DESCRIBED RESIDENT AL PROPERTY.
Over 50 20 100 Incl. PERMITEE
Over 100 1 SIGNATURE
Services
DISTRICT NO. P CE ED BY
/ �✓ O
0-200 Amp. Under 600 V � Q V j/0
201 - 1000 Amp. Under 600 V APPROVALS E INSPECTOR'S
SIGNATURE
Over 1000 Amp.or Over 600 V
TEMP. POWER POLE
Temp. Power Pole&Appurtenances UNDERSLAB WORK
Sign with One Branch Circuit
Additional Sign Branch Circuits ROUGH CONDUIT
(Other) WIRING
FIXTURES
POWER AUTHORIZED
PERMIT FEE (Sub-Total) UTILITY CO.NOTIFIED
PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL
PERMIT ISSUING FEE
NOTES
ITOTALFEE /
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT V LI A ION CK. M.O. CASH
_r
8 9 9N*fPR 13 2 0 � 4 5.0 0 A
WORKERS'COMPENSATION DECLARATION 76-663 10/81
CE-806G APPLICATION FOR ELECTRICAL PERMIT
I-herel y"affirm that I have a certificate of consent to self insure,
or a ckrtiftcate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy tti reof(Sec. 3300,Lab.C.)
0
Policy NO. Company FOR APPLICANT TO FILL IN JOB _sIr ADDRESS 7F
E] Certifiedcopy is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE
E] 1 & 2-Family,Sq.Ft $ — $ LOCALITY
Certified copy is filed with the county building inspection
department. Multi-family Sq.Ft. — NEAREST
CROSS ST. (i
Date Applicant Residential Swimming Pools OWNER OR 7–
CERTIFICATE OF EXEMPTION FROM WORKERS' Red-1-7--tightS � MAIL NAME / - Z
Outlets: Sw. J&44719 ��GZ 7-
COMPENSATION COMPENSATION INSURANCE ADDRESS
(This section need not be completed if the work involved by the "� "� First 20 /757 ,
CITY �// �j Tel.No.
permit is for one hundred dollars ($100) or less.) Total No.ZGCc Additional G< CiY
I certify that in the performance of the work for which this permit PLAN CHECK
is issued, I shall not employ an _ APPLICANT
p y y person in any manner so as to .
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 + ADDRESS
R1
oyz-_ 15 Additional
�– y Total No. CITY Tel,No.
Dat Applicant Fixed Appliances Not Over 1 HP
NOTICE TO A PLICANT: 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.— ADDRESS
provisions or this permit shall be deemed revoked. Top — FAU — W.H. —
CITY Tel.No.
LICENSED CONTRACTORS DECLARATION Hood — Fan Other—
I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR
(commencing with Section 70.00) of Division 3 of the Business and Disp. — Room Air Cond.- REG.NUMBER Class.
Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO. P SSBY
Size& Type HP,KW, KVA,or KVAR ,�, wed
License Number Lic.Class Up to 1 Incl. FINAL y U
Over 1 to 10 Incl. DATE VALIDATION
Contractor Date Over 10 to 50 Incl. FINAL V
❑ I am exempt under Sec. Over 50 to 100 Inc. BY u W
B.&P.C.for this reason Over 100 N
Services, Swbd.,MCC&Panelboards , Z
Date: 0-,200 Amp.Under 600 V.
Signature 201 - 1000 Amp. Under 600 V
Over 1000 Amp.or Over 600 V
Exemption for Reg. Maint.Elect.
SINGLE FAMILY Temp.Power Pole& Appurtenances 2
HOME OWNER-BUILDER DECLARATION
Sign with One Branch CircuitTag
I hereby affirm that I am exempt from the Contractor's License Law ,
for the following reason (Section 7031.5, Business and Professions. Additional Sign Branch Circuits A, � 30®25
Z1,
.77,�3uu +3V
Misc.Conduits& Conductors 1 ITEMS
as owner of the.property,will do the work and the structure �.
is not intended or offered for sale (Section 7044, Business Other (See Complete Fee Schedule) , TOTAL .��
and Professions Code). tiG.�� 30.25
CONSTRUCTION LENDING AGENCY CHE r�'tyr�1y
1 hereby affirm that there is a construction lending agency for the �� .UV
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total)
Civ.C.). kill
PLAN CHECKING FEE or
�p
Lender's Name 8/24/07
PERMIT ISSUING FEE 5253 q AM 9:3
Lender's Address � �Gri S F'f!f .71
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
and State laws regulating Electrical wiring, and hereby authorize
representatives of this County to enter upon the above-mentioned
' property for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
�g ature of Permittee Date