HomeMy Public PortalAbout5835 ENCINITA AVE_Electrical__ COUNTY NF LOS ANGELES APPLICATION FOR PERMT
DEPARTMENT OF COUNTY ENGINEER ^ n
DIVISION BUILDING 6 SAFETY II IS u
WII.I.IAM 1.. F FOX, COUNTY ENGINEER
UNI
FOR APPLICA TO FI L IN DISTRICT GROUP ZONE PERMIT N,0,
ELECTRICIAN -7 2- f
ADDRESSRECEIVED BY READY FOR DATE ISSUf D
J FIRST INSPECTION `
CITY TEL. NO. ,! 4 4 p�Ge� • y 4J
COUNTY LICENSE N EXPIRES O- R. BUILDING L
PERM FEES ADDRESS J
FEE
NUMBER EACH LOCALITY
LIGHT OUTLETS NEAREST
RECEPTACLES . ROSS T
dA
WALL SWITCHES OWNER
TOTAL OUTLETS Sc $ MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 25
CITY TEL. NO.
FIXTURES 5
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
misc.
APPLICATION AND STATE THAT THE .ABOVE 18 CORRECT
NUMBER OF LIGHT CIRCUITS
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
�i NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
it}\ . MOTORS I CERTIFY THAT 1 POSSESS THE, ABOVE VALID LOS
NUMBER i HORSEPOmos.
ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
New Mvo. HP oven OF THE RESIDENTIAL PROPERTY D RIBED ABOVE.
SIGNATURE OFy1 PERMITTE z INSPECTION RECORD
6 15 50
200 500 10.00 J
500 1000 15.00 Q
Z
OVER 1000 20.00
M.G. SET/FRED. CHANGER-HP R'
WELDERS: AC-KVA O
GENERATORS KW
TRANSFORMERS-KVA
TEMP. MOTORS (75% OF ORIG.)
MOVED MOTORS (75% OF ORIG.)
MISC.
SIGNS
NO. . _ NO. TRANS. APPROVALS
NO. NO. LAMPS
FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING $1.00 CONDUIT / i
FIXTURES $1.00 WIRING _. le 1.1.1
FIXTURES
SUPPLEMENTARY .50
FIXTURES
/ POWER ,f
TOTAL FEE $ 1 I S \ UTILITY CO. NOTIFIED .i//4
1� �i J FINAL v
70^663 0991I OA. 1.61
I
WORKERS', I lko ENSkTION DECLARATIONcorse s6�19A,x53 3i87 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm �Ihot I hove a certificate of consent to sell "7EA�
insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
or o certified copy thereof (Sec. 3800, Lab. C.)
Policy No. Company fAIRA4,AJr
— FOR APPLICANT TO FILL IN JOB
O Certified copy is hereby furnishe New Residential Bldgs. 8 Pools EACH NO. FEE
ADDRESSS G I Abd
Certified co is filed with the count buildin inspec- 1 82-Fomil S Ft. 171 7 S — $ LOCALITY
tion department. Multi-family Sq. Ft. — NEAREST
Residential Swimming Pools CROS ST.
Dote- - 14 Applicant 1-4'61 1-il.)A CtG. I, OWNER OR
FIRM NAME rJ
CERTIFICATE OF EXEMPTION FROM WORKERS' bullets: Rec—Light_Sw._ 'MAIL
COMPENSATION INSURANCE First 20 ADDRESS O.E! AhwX
(This section need not be completed if the work involved by CITY .
the permit is for one hundred dollars ($100)or less.) Total No. Additional r' el. NoSSg 9y/8
certify that in the performance of the work'for which this PLAN CHECKAPPLICANT
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
Additional
Date �' Iw' v Applicant LA�AJ kWA /,BY Total No. CITY Tel. No.
NOTICE TO APPLI ANT: If, after making this Certificate of Fixed Appliances Not Over I HP PERMIT
Exemption, you should become subject to the Workers' Range— Heater—D.W. — APPLICATION /
Compensolion provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS Q-P
with comply with such provisions or this permit shall be Top — FAU —W.H. CITY
deemed revoked. Hood — Fan —Other_ �,_A4A.b .eA Tel. No401-74-lir/
LICENSED CONTRACTORS DECLARATION LICENSE OR -
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. REG. NUMBER Class.6-(p
(commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT N P O S D BY Y
and Professions Code,and my license is in full force and effect. Cl-
Sim
Size 8 Type HP, KW, KVA, or KVAR O
License Number x-11 X4� Lic. ClassD Up to I Incl. FINAL ) 0
Contractor b>hA k AA r r-;= Date' /3 ' 90_ Over 1 to 101nc1. DATE / V VALIDATION 0
O r— Over 10 to 50 Incl. F-
FINAL
am exempt under Sec. Over 50 to 100 Inc. BY t ED
B.BP.C. for this reason Over 100 / d
D
Services, Swbd., MCC 8 Ponelboards z
Z
Date: 0- 200 Amp.'Under 600 V
Signature U&I HLUA LES 201 - 1000 Amp. Under 600 V
❑ Over 1000 Amp. or Over 600 V
Exemption for'Reg. Mainz. Elect. .-I
SINGLE FAMILY Tem Power Pole 8 Appurtenances L
HOMEOWNER-BUILDER DECLARATION ,P. PP 'tX T +
Sign with One Branch Circuit ty`.�.t.r
I hereby affirm that am exempt from the Contractor's license 9.8 -r:
Law for the following reason (Section 7031.5, Business,and Additional Sign Branch Circuits ��7�17 s/�.��J
Professions Code): 1 ITEMS
Ell, as owner of the property, will o the work and the Misc. Conduits 8 Conductors I
s f I I
structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ T:7AL 98 u 85
Business and Professions Code). D CHECK F
CONSTRUCTION LENDING AGENCY CHANGE Oct
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-Total)
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE 00313-0001 2/14PYI1
Lender's Name PERMIT ISSUING FEE 8932 1 AM C•2•`.r
Lender's Address ,
I certify that I have read this application and store 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 properly for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
-4wzx &,P- _>-/3- �Ls
Signature of Permittee �s