HomeMy Public PortalAbout6214 ENCINITA AVE_Electrical__ 76AGGS-CES06-10.33 APPLICATION FOR ELECTRIC PERMIT
BUILDING AND SAFETY DIVISION
Department of County Engineer Bu1LDlrvc j
County of Los Angeles- ADDREss
JOHN A. LAMBIE. COUNTY ENGINEER
CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN DRoss
PERMT FW
OWNER G!/
LIGHTS RECEPTACLES SWITCHES MAIL
M1 NVMBER I T E M EACH FEE MAILS
/ 1 TOTAL OUTLETS s .IO S io
/-F— ELRC. RANGES, WATER HEATERS, CITY TEL. NO
CLOTHES DRYERS .50
ELEC. SPACE HEATERS, STAT Y. COOK.OELECTRICIA}INVy�
IND UNITS, A R SAGE DISPOSERS, ADDRESS. �1 1
AUTO WASHERS.ERS, DISHWASHER WASHER .25 Y.
LIGHTING FIXTURES .10
CITYNO. S
MOTORS STATE /
LICENSE NO;
HORSEPOWER "-
H.P, OVER INC. ffIlIST7�CT,NROUP ZONE READY FOR INSPECTION
I/¢ IS LESS .251 1
h - 2 .50CTION RECORD
z 5 1.00
5 15 1.50
15 50 2.50 50 200 5.00J//LI
MIG . ' in/,rl.v ,t3,97 ,�adN,
SIGNS I NO.TRANS
NO.LAMPS
SERVICE O=800V 1.00
SERVICE OVER 600V 5.00
WIRING PERMIT 1.00
rEL..T.,CAL
E PERMIT 1.00
EMENTARY PERMIT .50 APPROVALS
TOTAL FEE B DATE INSPECTOR'S SIGNATURE
Eey ACKNOWLEDGE THAT I 'HAVE READ THIS APPLICA ION
ATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
ICAL WRTH ALL NNG•TY Oft01NANCES ANO STATE LAWS REGULATINGWIRINGn EBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR tFIXTURESIK`S—/ fD AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF NIA OR THAT 1 THE LEGAL OWN OF THEABOV POWER
ED RESIDENTI PR ERTYTURE UTILITY CO. NOTIFIEDp .enERMITTEE FINAL 9•�-I� U / ilei 121a/
JOHN A. LAMBIE. �I�LLIDRTION ARTHUR C.VETT,
COUNTY ENGHNEER SUPERViBINO ELECTRICAL ENGINEER
1�1 1 1 8 Am 14 2 3.60 2
WORKERS'COMPENSATION DECLARATION
..- loiel
--hereby afirm that I have a certificate of consent to self CE-806G APPLICATION FOR ELECTRICAL rG MIU ,I
IIfI
insure, ar a cerlificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof ( ec. 3800, Lob. C.)
Policy No. Company Fr-4. tit L411-`r FOR APPLICANT TO FILL IN JOB
Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS
Certified copy is filed with the county building inspec- 18 2-Fomily, Sq. Ft. $ — 8 LOCALITY
tiopn/d�e�p�art ens. Multi-family Sq. Ft. — NEAREST
9 � f1'r t Residential Smingoos OWN
I=\ ( . CROSS ST.
,i / ResentawimER OR
FIRM NAME
Date Applin nh,/.1, �/M� �
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RecLight $w.�• r MAIL e.
COMPENSATION INSURANCE ADDRESS
completed if the work involved h First 20
(This section need not he con P T Toral No. CITY Tel. No.
the permit Is for one hundred dollars ($100)or less.) Additional T. C
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
Total No._.c-_ Additional
Dote Appl icons CITY Tel. No.
Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of �^+
Exemplion, you should become subject to the Workers' Range_ Heater_7CD.W. — APPLICANT
Compensation provisions of the Labor Code, you must forth- Oven — Dryer — W.M.— ADDRESS o -a It-)at k t- S
with comply with,such provisions or this permit shall be Top FAU —W.H.
deemed revoked. Hood _ Fan _Other_ CITY Tel. No.g'.-7 -244
LICENSED CONTRACTORS DECLARATION LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REG. NUMBER47 IS 2-� Class. }
(commencing with Section 7000) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. PROC S BY �-
and Professions,Code,and my license is in full force and effect. Q^ /�v O
ZZ _ Size 8 Type HP, KW, KVA, or KVAR' �J t r+fJ V
License Number 4� I S Lia Class Up to I Incl. FINAL O
.T �ate Over 1 to 10 Incl. DATE VA ATION U
Contractor s`.o• (-o.,.r ro.c
❑ Over 10 to 50 Incl. FINAL L+J
I am exempt under Sec. Over 50 to 100 Inc. BY N
B.BP,C. for this reason Over 100 z
Date: Services, Swbd., MCC 8 Ponelboards
0 -200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600 V
QExemption for Reg. Mains. Elect. Over 1000 Amp. or Over 600 V
SINGLE FAMILY Temp. Power Pole 8 Appurtenances 3 0 1.6,A
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License #.e e e o a2
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits
Professions Code):
Misc. Conduits 8 Conductors LI o.? .3 IrJ 0
I, as owner of the property, will do the work and the
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ ll Ll L g
7044, Business and Professions Code). D
CONSTRUCTION LENDING AGENCY
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
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
ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
the above-mentioned property for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
r � � /,
Signature of Permittee Dote