HomeMy Public PortalAbout6204 ENCINITA AVE_Electrical__ 3C- CEBefi612/]5 APPLICATION FOR ELECTRICAL PERNIT �1
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN JOB
New Residential Bldgs. & Pools EACH NO. FEE ADDRESS 7
1 &2 Finaily Sq. Ft
Multi-family Sq. Ft. - NEAREST
Residential Swimming Pools CROSS ST. C/
OWNER OR
FIRM NAME
Outlets: Light, Switch& Receptacle MAI KESS ,
First 20 IJ
Additional //. �L .J CIT ,A Tel. No.,
PLAN CHECK
Lighting Fixtures -APPLICANT
First 20 �� ADDRESS
Additional
C Tel. Na.
PERMIT
Fixed Appliances Not Over 1 HP APPLICANT f.
Range_ Heater D.W. ADDRESS a /
Oven Dryer W.M.
Top FAU W.H. CITY ,4 �. No. S >
Hood Fan LICENSE OR CD
Disp. A.C. REG. NUMBER Class.�� v
OC
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION O
A ED STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY H
Power Apparatus& Large AppliancesORDINANCES AND STATE LAW. A.ECLATIEG LU
LU
Size&Type HP, KW, KVA,or KVAR ELECTRICAL""R'"'c' d
h
Up to 1 Incl. Z
I HEREBY CERTIFY TEST I A. PROPERLY REGISTERED AEG'..Over 1 to 10 Incl. _
OVE
ver 10 to 50 Ind.
CALIFORNIA( AESE THAT
Over 50 to 100 I net. PERMITEE ' /v /�LE /aGAL DINER F THE o
Over 100 SIGNATURES //moi
Services DISTRICT. PROCED i
0-200 Amp. Under 600 V
201 - 1000 Amp. Under 600 V APPROVALS DATE 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 '�77
FIXTURES
-J POWER AUTHORIZED
PERMIT FEE (Sub-Total) �u / UTILITY CO.NOTIFIED
PLAN CHECKING FEE (One-Fourth Permit Fee), LJ _ FINAL �7�
PERMIT ISSUING FEE /
NOTES
TOTAL FEE '1 � Z�
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK. M.0. CASH
0 0 4 i;AUG 5 2 B 2320 -
Wm that I havea COMPENSATION DECLARATION CE-860 toiea APPLICATION FOR .ELECTRICAL PERMIT �1
I hereby affirm that I have a certificate of consent to self insure, CE-806G _ �J
or a certificate of WorkeiG Compensation Insurance. or a certified COUNTY OF LOS lANGELES1 'BUILDING AND SAFETY
copy thereof(Sec.3800.Lab.C.)
Policy No: Company _ - OCR APPLICANT TO FILL IN I JOB
❑ Certified copy_is hereby'turnished. EACH NO. FEE ' ADDRESS
New Residential Bldgs.8 Pools
Certified copy. Is filed with the county building inspection 1 & 2-Family, Sq..Ft. $ — $ LOCALITY -
h depar e ` Multi-family Sq.FL t,' — NEARESTST
g /[�(•� - OR
Residential Swimming Pools CR055 .
Daft APP icant FFIIRM NAME =_Z OH
CERTIFICATE.OF EXEMPTION FROM WORKERS'i Outlets:Rec d� Cight. Sw. MAIL ��•r
COMPENSATION INSURANCE r ADDRESS:
(This section need not be'completed if the work Involved by the First 20.
permit is for one hundred.dollars ($100)or less:) Total No. Additional .GITY Tel.No.
I certify that in the performance of the work-for which this permit - PLAN CHECK
APPLICANT8,Ole
.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
Total No. - - 41
CITY - Tel.No.
Date Applicant Fixed,Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT
beciSme, after making the 'Certificate of APPLICANT
' Exemption,you should become subject to the Workers'Compensation Range Heater_ D.W.
provisions of the:Labor Code, you must forthwith comply with such - Oven Dryer _ W.M._ ADDRESS c 1
provisions or this permit shall be deemed 'revoked.' Top .,_ FAU W.H. .
'LICENSED CONTRACTORS DECLARATION Hood Fan Other_ CITY - Tel.NI (�
I hereby affirm that I am licensed under provisions of Chapter 9LICENSE OR
(commencing witF Section 7000) of Division 3..of the Business and - Disc. Room Air Cone. REG.NUMBER �•� Class.
ast
Professions Code;and my IIInse Is infull force and effect.- DISTRICT NO. _1 // PROCESSED
Power Apparatus& Large Appliances ULY
D�� Size & Type HP,KW,KVA,or KVAR ,
License Number, / q Lic.Class Up to l Incl. '- FINAL U
n _
Contractor C���^-l.O�s� at 0 7 . Over 1 to 10 Ind. yALI TION 0
DOver 1O to 50 Incl.
- FINAL ItJ
Elf..
I am exempt under Sec. Over 50 to 100 Inc. BY
BAP,C,for this reason' Over 100 4.
• Services, Swbd.,MCC It Panelboards D fn
- 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. �,8 2 66 A
' SINGLE FAMILY Temp.Power Pole& Appurtenances # e,o s 11,e 2
HOME OWNER-BUILDER DECLARATION' Sign with One.Branch Circuit 'r
I hereby affirm that I sm exempt from the Contractor's License Law , I ° o 2 U,2 5
for the following reason(Section 7031.5,Business and Professions ' Additional.Sign Branch Circuits
Code): I 1 e_ 'i 2 4.2.&5
❑ "I,as owner of the property,will do the work and the structure Misc:,Conduits & Conductors -
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) — D - 1 11,0 3.7 8 7
'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(Sec.3097, .PERMIT FEE - - (Sub-Total) . ..-
Civ. C:), .
PLAN CHECKING FEE _
Lender's Name -
PERMIT ISSUING FEE U
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 f this Co pty to enter upon the above-mentioned -
property for In Fiction pose
SEE REVERSE FOR EXPLANATORY-LANGUAGE
SignSign—J�ittee 0
e 3