HomeMy Public PortalAbout5203 FARAGO AVE_Electrical__ 76A665-CE8069-59 APPLICATION FOR ELECTRIC PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
CASSATT A. GRIFFIN,SUPT OF BUILDING LOCALITY P� ,c
FOR APPLICANT TO FILL 1N NEAREST
PERMIT FEES CROSS ST.
I T E M NUMBER EACH FEE OWNER .--
MAIL
LOIGHTST RECEPT. SW. $ ,10 $ ' ADDRESS
LIGHTING FIXTURES �. 10 Q CITY TEL.NO.
ELEC.RANGES CLO.DRYERS ELECTRICIAN
WATER HEATERS .50 ADDRESS /j Yeld
ELEC.SPACE HTRS. DISHWASHERS CITY TEL. NO
GARBAGE DISPOSERS AUTO.- STATE ,e; y�
WASHERS STA.COOKING UNITS .25 LICENSE NO. 1;7e a
MOTORS: OVER INC. H.P. ICT(�lU, IGRO ZONE E55715D
O— 1/2 .25
1/2- 2 .50 INSPECTION RECORD
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2— 5 1.00
5— 15 1.50 _
15— 50 2.50
50-200 5.00
SIGNS: NO.TRANS.
NO.LAMPS
SERVICE 0-600V 1.00 U
SERVICE OVER 600V 5.00
MISC.
WIRING PERMIT 1.00 / b a
FIXTURE PERMIT 1.00 (�
SUPPLEMENTARY PERMIT .50
TOTAL FEE
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT
ELECTRICAL WIRING. WIRING
I HEREBY CERTIFY THAT I AM 'PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES �r
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PAQPERTY. - /. POWER
SIGNATURE ua///� UTILITY CO.NOTIFIED
OF PERM ING rL f
FINAL
OF DATION ARTHUR C.VEIT,
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
1 +
✓ WORKERS COMPENSATION DECLARATION 76A663CE
10i81 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self insure CE 8o6G
or a certificate of Workers Compensation Insurance or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy there f ec 380 Lab C) JOB
Policy Company `
31I+2 �/ "Z FOR APPLICANT TO FILL IN r
No ADDRESS
+ lJ
❑ Certified copy is hereby furnished New Residential Bldgs &Pools EACH FNO = FEECertified copyis"fded with the county budding inspection 1 &„2 Family Sq Ft $ $ LOCALITY �/m C
,/d art nt _ Multi family Sq Ft NEAREST
CROSS ST 2r�Date Applicant ,/ �� Residential Swimming Pools OWNER OR FIRM NAME {4 5S rrJ
7 A CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec' Light Sw MAIL
COMPENSATION INSURANCE ADDRESS
This section need not be completed the h First 20 �1L�
( I?eted if the work Involved b y Total No Additional CITY /�m Tel No 7 /
permit is for one hundred dollars ($100),or less)
I certif {that in the+performance of the work for which this permit Y PLAN CHECK k °�
Y P APPLICANT
is issued I shall not employ any person in any manner so as to
t become subject to the Workers Compensation Laws Lighting Fixtures' First 20 ADDRESS f
+ Additional
Total No CITY Tel No
Date Applicant
NOTICE�TO, APPLICANT.. If after making this Certificate of APPLICANT / C- }
Exemption you should become subject to the Workers Compensation tRange_ Heater_ DW
p'rovisions,of the Labor Code you must forthwith comply with such Oven Dryer _ W IM ADDRESS 60 3 v S 21!1,1-H6 �4LL
Tprovisions or this permit shall be deemed revoked Top s FAL; W H ++ y�
LICENSED CONTRACTORS DECLARATION Hood Fan Other_ CITY /''O/_ /O ✓1 Tel No
Thereby affirm that I am licensed under provisions of Chapter 9 Dis Room Air Cond LICENSE OR ` Z. (� Class C /0-z
'
,(commencing with Section 7000) of Division 3 of the Business and , p ”, REG NUMBER J
Professions Code and my license is in full force and effect ' DISTRICT NO PROCESSED
k , � Power Apparatus& Large Appliances �
License Number Z 15 8Z 2-81
����+2� Size& Type HP KW KVA or KVAR CJ O
/� Lic Class Up to 1 Incl FINAL /��2 U
I�1;, _�r 'b �� _ �/ Over 1 to 10 Incl DATE s'c✓ 00
VALI TION
Contractor rl Date o Over 10 to 50 Incl 0
E] exempt
V
I am exempt under Sec Over 50 to 100 Inc BY W
j + B&PC for this reason Over 100 Q_
Services Swbd MCC&Panelboardsl 292,2 5 A Z
Date
+ v
0 200 Amp Under 600 V ° o rs
Signature 201 1000 Amp Under 600 V - ,
Ovef 1000 Amp or Over 600 V # 0 0 0 oso 2
❑ Exemption for Reg Mamt Elect $ j
SINGLE FAMILY Temp Power Pole& Appurtenances j io 0 36,00
HOME OWNER BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors License Law Sign with One Branch Circuit °o e o
for the following reason(Section 7031 5 Business and Professions Additional Sign Branch Circuits + } 3
Code) S w i'
❑ Misc Conduits&Conductors o322-. 88 -
I
8 -
I as owner of the property will do the work and the structure
is not intended or offered for sale (Section 7044 Business Other (See Complete Fee Schedule)
Pol-
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) y
{
Civ C) �
+ PLAN CHECKING FEE
r
Lenders Name
+ , PERMIT ISSUING FEE�_ 7 t �
Lenders Address,
I certify that I have read this application and state that the above TOTAL FEE (J "
information is correct I agree to comply,with all County ordinances
and State laws regulating Electrical wiring and hereby authorize
represent Ives of this County to enter upon the above mentioned r -
propert or inspectio rposes °
3�� SEE REVERSE FOR EXPLANATORY LANGUAGE `
° � A
%
nature of erm tee Date Y
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