HomeMy Public PortalAbout5517 ENCINITA AVE_Electrical__ . r7
7GA663-CEBO610-62 APPLICATI N FOR fLtCTRIC PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING ,At��7WBUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY
NEAREST �o v
FOR APPLICANT TO FILL IN cRoss ST. _
RECEPT � TOTAL NO. EACH FEE �J
OUTLETS FIRST 20 $20 $ OWNER 14. ILC!L ✓�°'-
LIGHT _ - G� �r MAIL
SWITCH.
/49r, VER 20 .10 `a.��� ADDRESS
TOTAL CITY 7 TEL. NO.
LIGHTING AL FIRST 20 ! .20
FIXTURES / 4d ADD'L 1D ELECTRICIAN, �? J �1✓ � � �
111 OVER 20
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS7,Xi 1
RB.DISP. STA.COOK �,;
CITY :rr.�'L� _ 7 TEL. NO. .�'.�.>w lllrrr
DISHWASH. AUTO.-WASH. STATE 'ry
SPACE HTRS. STA.APP.(%z H.P.MAX.) ,50 �� 'LICENSE NO. /
MOTORS: OVER NOT OVER H.P. DISTRjgT N G.R UP N PF2,0 E E BY
O 1 1.00 '-� `
I 3 1.50 INSPECTION RECORD
3 8 2.00 O
8 15 2.50
of
15 50 3.00
50 100 15.00
d
SIGNS: NO.TRANS.
NO.LAMPS
SERVICE 0.60OV-NoT OVER 200A 1 1.00
SERVICE 0-600V-OVER 200 A. 2.00
SERVICE OVER 600V 5.00
MISC.
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE $
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI ATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING r
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR TH T 1 AM THE LEGAL'OWNER OF THE ABOVE u b '✓
DESCRIBED RESMEN IAL PROPERTY. POWER In
°` , _
SIGNATURE UTILITY CO.NOTIFIEDr �
OF PERMITTEE'
FINAL <�-.-
LIDATION ARTHUR C. VEIT
MO CASH SUPERVISING ELECTRICAL ENGINEER
LAU0 6 4 9 6' Il,,R 11 ? D 1 4.90-
'
��lL�
WORMERS' COMPENSATION DECLARATION 76A663 1081 - APPLICATION FOR ELECTRICAL PERMIT
p l hereby,off�rrr that I have a certificate of consent to self CE-806G
insure, or a cc 7tificate„of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified ccipy thereof (Sec. 3800, L b. C. ^ r
Policy No q(0 Company u `d FOR APPLICANT TO FILL IN JOB
ADDRESS
❑ Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE
(� 1 & 2-Famil S Ft. $ _ $ LOCALITYeM 19
L Certifi d co y is filed with the c my b it nspec- Y- 4
tion d part ent Multi-family Sq. Ft. NEAREST
Q Residential Swimming Pools CROSS ST.
Date W/ Applicant OWNER OR
_�j FIRM NAME
RTI CATE OF EXEMPTION FROM WORKERS' Outlets: Rec 1•' Light Sw. AIL
COMPENSATION INSURANCE All ADDRESS
s section neenot completed if the work involved b First 20
(Thitid t b
p y Total No. Additional CITY Tel. No.
the permit is for one hundred dollars ($100)or less.)
that in the performance of the work for which this PLAN CHECK
I certify p 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
Total No. Additional
CITY Tel. No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT
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. — n
deemed revoked. Hood _ Fan _Other_ CITY Tel. No. 7—U
LICENSED CONTRACTORS DECLARATION LICENSE O
1 hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. — REG. NUMBER ! 7 Class.
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCESSED B p.,er
Power Apparatus& Large Appliances
and Professions Code and m Ii n e is in full force and effect. `/ O
Size &Type HP, KW, KVA, or KVAR (V 0
License Nu e Lic. Class �� �Up to 1 Incl. FINAL fL'
/n Over 1 to 10 Incl. DATE VALID N IO---
Contract to W Over 10 to 50 Incl. FINAL L�ii
❑ I am exempt under Sec. Over 50 to 100 Inc. BY a
B.&P.C. for this reason Over 100 ��fJ�(�yy Z
Services, Swbd., MCC& Panelb-bd�rds
Date: 0 -200 Amp. Under 600 V I*A
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 ;2 0 6 Q 2 A
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit # o o o o o 2
1 hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits (� o o29,20
Law for the following reason (Section 7031.5, Business and
Professions Code): o o o 2 9 2 0 c
❑ I, as owner of the property, will do the work and the Misc. Conduits & Conductors
structure is not intended or offered for sale (Section Other (See.Complete Fee Schedule)_ ► 9.06-88
7044, Business and Professions Code).
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 PERMIT FEE (Sub-Totol)
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE
Lender's Name PERMIT ISSUING FEE
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
a din ces and State laws regulating Electrical wiring, and
her y uthorizeffptatives of thi ounty to enter upon
t ab ve tipert r 'ns ction purposes.
8gSEE REVERSE FOR EXPLANATORY LANGUAGE
Sig Lure of Permittee Date