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HomeMy Public PortalAbout5643 ENCINITA AVE_Electrical__ COUNTY LOS ANGELES Department OF County Engineer APPLICATION FOR PERMIT DIVISION OF BUILDING & SAFETY IFEL 'CTROC a' WILLIAM J. FDX, County Engineer _ _ FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZDNE PERMIT NO. ELECTRICIAN /l� I' _/ RECEIVED BY READY FOR DAT'll ISSIYED ADDRE90cn � .o FIRST INSPECTION CITY X i/�. Wy_ Air, f�'�LµJJ I-T �� � COUNTY LICENSE NO. J c- EXPIRES '�o'_ AD OREBS /eE�J .(�A Y/N.I�/il✓� �[S� PERMIT FEES �wMNUMBER EACH FEE LOCALITY / J� LIBHT'OUTLET9 y NEAREST d DROSS.ST. ICJ RECEPTACLES WALLSWITCHES .e OWNERiI/y//�L�[/LVO/frJ.//y'�, �J���^/,,. TOTAL OUTLETS Sc S I MAIL ADDRESS �� 7 (/ T CJr 'PL(♦4w.0 CJL/..MC/ ELEC. RANGES 25 ELEC. HEATERS 28 I�� . I� I --. CITY ` ♦ TEL. NO. - FIXTURES S 1 HEREBY ACKNOWLEDGE. THAT 1 HAVE READ THIS MISC• - APPLICATION AND STATE THAT, THE ABOVE 18 CORRECT NUMBER OF LIGHT CIRCUITS AND AGREETOCOMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. MOTORS I CERTIFY THAT 1 POSSESS THE ABOVE VALID .LOS NUMeeR HORSEPOWER FEE ] ANGELES COUNTY .LICENSE. OR 1 AM THE LEGAL OWNER New MvP. HP oven E. EACH OF THE REBIDENTIA ROPERTY DESCRIBED ABOVE. I�3A Lees S :25 g10NATURF. OF / Iia 2 50 PERMITTE 2 s D° INSPECTION RECORD s 15 LSD - - is so 2.SO !� ?.'S .5- � _ 50- 200 - 5.00 /1/J,eU)( m 4:i�3 eD";r`ZC75 200 500 10.00 ��/ A.dr/se­ `- J sO0 ]DOO- 15.OD Q OVER iDDD M.G. SET/FRED. CHANGER-HP WELDERS:AC-KVA O GENERATORS - KW /L -.� TRANSFORMERS - KVA TEMP. MOTORS (75% or ORIG.) C /77Ii IApLA -- MOVED MOTORS (75°/ .1 oRIG.) MISC. ,� _ L.v 3v �wYPs/l •--.,� SIGNS J� NO. / NO.TRANS. APPROVALS NO. NO. LAMPS - DATE INSPECTOR'S NAME FOR EACH PERMIT: WIRING 51.00 /�) CONDUIT FIXTURES $1.00 a�r�— WIRING SUPPLEMENTARY .s0 - FIXTURES - POWER TOTAL FEE SI�. "� UTILITY CO. NOTIFIED FINAL yy/ '�"�•' Sly 76A663 DBS#5A 2-53 that I have a certificateMrtof consent to self insure, ls200 -001018 DPW(12-91) hereby a;firm51) APPLICATION FOR ELECTRICAL PERMIT 0 or a certificate of Worker's Compensation Insurance, Or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec. 3800 Lab, C.) PDIi��n rf�7y�Fmnpany U/i4/C FOR APPLICANT TO FILL IN 1400RESS —/, �J• ❑ Codified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH . FEE LOCALITY Certified c is filed with count but in ms ctio 1 &2-Family,Sq.Ft. _ $ $ �� PY Y 9 NEAREST dep tme L Multi family Sq.Ft. CROSS ST, Date Applic t Residential Swimming Pools ASSESSOR p MAP BOOK 6 PAGE DI5�1 PARCEL �� CERTIFICATE OF EXEMPTIO FRO WOR RS' Outlets:Rec�Light�Sw.� - OWNER OR COMPENSATION I SURANCE x� FIRM NAIVE � First 20 MAIL (This section neetl not bed completed 0 the we k involved by the AOORESS �� / permit is for one hundred dollars(5100)or less.) Total No.� Additional I certify that in the performance of the work for which this permit CI �� _ To is issued, I shall net employ any person in any manner se as to PLAN CHECK become,subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date ApplicantRESIDENTIAL APPLIANCES NOT OVER 3 HP. N Exemption, APPLICANT: after making this Certificate of CITY Tel.No. Exeemption,, youshould become subject to the Workers' Compensation OTHER APPLIANCES NOT OVER 3 HP. . provisions of-the Labor Code,.you must forthwith comply with such qp PLICA provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS 7OC97 1 hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to tO Incl. (commencing with Section 7000) of Division 3 of the Business and CITY �' V Tel.No. Professions Code, and my license is in full force and effect. Over 10 to 50 lec1. LICENSEB Class. } Over 50 t0 100 Inc. REG,N0M3ER d . SE License Number Lie Class� Over 100 DISTRICT NOPROCESO` (� Services,Swbd.,MCC&Panelboards J •© � ��/J�r /� �� f' 0-399 Amp.Under 600 V FINAL O Contractor / �Date DATE El I am exempt under Sec. 400- 1000 Amp. Under 600 V �- g--�� VALIDATION U Over 1000 Amp.or Over 600 V FINAL U.l B.&P.C.for this reason - BRANCH CIRCUIT FEES Oy W Date: 15A.or 20A. 120V, Lighting or Recept. Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ .1 41 Or More Branch Circuits Exemption for Reg.Main.Elect. 15A.20A,208V To 277V Lighting Br.Circuits i SINGLE FAMILY Temp.Power Pole&Appurtenances;C; sg HOME OWNERBUILDERDECLARATION it h C B with One Branch Circuit --- I hereby affirm that I am exempt from the Contractor's License Law Sign w .1,5IJ7 41.is i c for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): i ITEMS ❑ 1, as owner of the property, will do the work and the structure Misc.Conduits&Conductors • - - A i �_ is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) °• TOTAL _ 4 3 � and Professions Code). D CHECK 41,7.1 CONSTRUCTION LENDING AGENCY CHANGE ,IJU 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) D Civ. C.) ' PLAN CHECKING FEE �(JQQ-41(11]1 cil.�li/9=' Lender's Name 6422 1 AN I 8:45 PERMIT ISSUING FEE Lender's Address I certify that 1 have read this application and under penalty of purjury state TOTAL FEE that the above information is correct. I agree to comply with all County ordinances and State laws regulet ng Electrical wiring,and hereby authorize , representeC es of this County t enter upon the above-mentioned property - for inspectio pur sesx- / SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATU E OF P MITTEE DATE