HomeMy Public PortalAbout6147 ENCINITA AVE_Electrical__ APPLICATION FOR ELECTRICAL PERMIT 'Q
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING j
BUILDING AND SAFETY DIVISION ADDRESS •1'� / ('GG) =G�-�'1C3'CZ{J
JOHN A.LAMBIE, COUNTY ENGINEER _
WILLIAM A. JENSEN. SUPT OF BUILDING LOCALITY
FOR APPLICANTTO FILL IN NEAREST
CROSS ST.
PERMIT FEES OWNER ')L'4t Z c
I T E M NUMBER EACH FEE MAIL f
OUTLET 22 j S $ //I ADDRESS
i_ LIGHTS RECEPT..J 8W. 3 .10 1S.L .
LIGHTING FIXTURES 10 CITY TEL NO.
ELEC. RANGES CLO. DRYERS ELECTRICIAN
WATER H EATERS .BO ADDRESS
BLED.SPACE HTRS. DISHWASHERS CITY YL/
GARBAGE DISPOSERS AUTO.. STATE �✓
WASHERS BTA. COOKING UNITE 25 LICENSE NO. ��-3` L
MOTORS: OVER INC. H.P. DISTRIC�fN
V P oaN..., P ED,
O %z .25
— 2 SP
.5o INECTION kECORD
2 5 1.00
S IS 1.50
O
U
15 50 2.50 C
50 200 5.00 O
U
w
SIGNS: z.
NO TRANS. 6
NO. LAMPS N
SERVICE O.SOOV 1.00 C+>•>
SERVICE OVER 500V 5,00
MISC.
WIRING PERMIT 1,00
FIXTURE PERMIT 1.00 �Jn
SUPPLEMENTARY PERMIT .50
TOTAL FEE $ a(,/
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION x APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY I ,+
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT _ ' l l*,r/1'6L
1/
ELECTRICAL WIRING. WIRING Of ✓ I rvv,✓Y•4V
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIA PROPER . POWER
SIGNATURE ( UTILITY CO. NOTIFIED r7. LI /'4�•M/.`YfrY /I�
OF PERMITTE � � / vI VY%Ivwl ..SJ
FINAL
DATION ARTHUR C.VETT,
CK MQ GBH SUPERVISING ELECTRICAL ENGINEER
L"I'l1 0 9 3 JPd i b 2 G 4 .9 7 "/
WORKERS'COMPENSATION DECLARATION 76-663 10181 APPLICATION FOR ELECTRICAL PERMIT {�
I hereby affirm !hat I have a certificate of conse,nt to self insure,= GE-606G LJ
o c-2rtificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy e f
POlic P pany FOR APPLICANT TO FILL IN JOB
❑ Certified c is hereby furnished New Residential Bldgs.8 Pools
EACH NO. FEE ADDRESS
♦ 1 8 2-Family,Sq.FL S — $ LOCALITY
Certified copy is h the cou b din ins e n —
partm I. ♦ Multi-family Sq.FL NEAREST
CROSS ST.
Date Applicant Residential Swimming Pools OWNER OR
FIRM NAME MlUv
CERTIFICATE OF EXEMPTION FROM WO S, Outlets:Rec-- Light I— Sw. 4 MAIL 1
COMPENSATION INSURANCE x yO / ADDRESSin
(This section need not be completed if the work involved he First 20TZ 7�
permit is for one hundred dollars($100) or less.) Total No. Additional CITY 1 7e1.No.
PLAN CHECK
I certify that in the performance of the work for which this permit - gpPLICANT
is issued, I shall not employ any person in any manner so as to
become subject to the Workers'Com ion La� Lighting Fixtures First 20 . ADDRESS
Additional20
Total No. �• CITY Tel.No.
Date 13 PPlicant�40 Fixed Appliances Not Over 1 HIP r
NOTIC TO APPLICANT: 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 } P
provisions or this permit shall be deemed revoked. Top — FAU W.H.•—
CITY Tel. NoS7
LICENSED CONTRACTORS DECLARATION Hood Fan Other_ 04 10
1 hereby affirm that I am licensed Under provisions of Chapter 9LICENSE OR �J /•�
(� U
(commencing with Section 7000) of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER Clsss.
Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. p PROCESSED BY
2 Size & Type HP,KW,KVA,or KVAR 06P 1>17. t
License Nu be• S ^ Lint.Class lL(-= Up to 1 Incl. FINAL '/^]�9V
DATE j� �
Over 1 to 101nc1. VALIDATION. O
Conlrac[o C • Date l�-30 .90 ( /Over 10 to 501nd. — U
L �f
E] FINA
am exempt under Sec. OverInc.O50 to 100 IBY f_lllfw �Le�. t! Wa
BAPC.for this reason Over 100 (((/// N
Services,Swbd.,MCC & Panelboards J { Z
Date: 0- 200 Amp.Under 600 V Ni}
Signature 201 - 1000 Amp.Under 600 V
❑ i
Exemption for Reg.Maint.Elect. Over 1000 Amp. or Over 600 V
SINGLE FAMILY Temp.Power Pole& Appurtenances I1
HOME OWNER-BUILDER DECLARATION Sign with One Branch CircuitAl'CT•>r+
I hereby affirm that 1 am exempt from the Contractor's License Law
for the fallowing reason (Section 703 1.5, Business and Professions •Additional Sign Branch Circuits `.
Code): 3307 78.i"1
❑ Misc. Conduits & Conductors 1 1 IEMS
I,as owner of the property,will do the work and the structure Other(See Complete Fee Schedule)
is not intended or offered for sale (Section 7044, Business � TOTAL 78 - 20
and Professions Code).
CHECK. 78.10
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the CHANGE ,VI
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (SubTotal) 1p x j
Civ.C.).
Lender's Name
PLAN CHECKING FEE 2 131300-131001 9/15/913
PERMIT ISSUING FEE i
2853 i AM 9:31
Lender's Address
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
rop ty fon a
r iction purpo s. SEE REVERSE FOR EXPLANATORY LANGUAGE
p
Signature o ermrttee ate