HomeMy Public PortalAbout4814 FIESTA AVE_Electrical__ 76A663
5A 11 99
DBS APPLICATION FOR ELECTRIC PERMIT
9A
DIVISION OF BUILDING AND SAFETY
Dopa, ent of County Engineer rBUILDING
Co
Los of Los Angeles DDRESS 0
JOHN A LAMBIE COUNTY ENGINEER
CASSATT D GRIFFIN SUP T OF BUILDING OCALITY
FOR APPLICANT TO FILL IN NEAREST L w elk K.I_us� D
PERM FEES cRoss ST o
NUMBER
` OWNER e
LIGHT OUTLETS MAIL
j p
RECEPTACLES ADDRESS`1�1� �Q T, e. ��I�'
WALL SWITCHES FEE CITY��h��4.` C.IT'% TEL NO N�Wl t
TOTAL OUTLETS ® 5 I $ ELECTRICIAN
ELEC RANGES 25 ov
ADDRESS
ELEC HEATERS 25
KW EA CITY TEL NO
STATE
FIXTURES g LICENSE NO
MOTORS DISTRICT NO I GROUP I ZONE I READY FOR INSPECTION
NUMBER HORSEPOWER FEE
NEW MVD HP OVER INC EACH INSPECTION RECORD
O V 1�&LESS $ 25
Y.- 2 50 �rI�[1 f1, M-4-J QU
A
2 5 Too Q ^k Jt .�..
5 1s ISO
15 50 250
50 200 Boo
MISC
NO SIGNS NO TRANS
NO SIGNS NO LAMPS
FOR EACH PERMIT
WIRING $1 00 00
FIXTURES $100 00
SUPPLEMENTARY 50
APPROVALS
TOTAL FEE $ DATE INSPECTOR S SIGNATURE
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING WIRING I
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE POWER
DESCRIBED RESIDENTIAL PR PER;
SIGNATURE UTILITY CO NOTIFIED
OF PERMITTEE FINAL S��
JOHN A LAMBIE COUNTY ENGINEER VALID ARTHUR C VETT CHIEF ELECT INSPECTOR
c CASH
L02 SZR SEP 24 z 2.3 t?
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WORKERS'COMPENSATION DECLARATION -663 10/81
• CE-60613, APPLICATION
PPLI -TIO FO® ELECTRICAL
PERMIT
I hereby affirm that l have a certificate'of consent to self insure,
or a certificate of Workers' Compenaation•Irisdrance, of a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
coy. ereof(Sec.3800,Lab. C.)
Policy No. Company FOR APPLICANT TO,FILL IN JOB
❑ Certified copy is hereb furnished. EACH NO. FEE ADDRESS'
Y New Residential Bldgs.& Pools
— $ G`
Certified copy ism filed with the county building inspection 1 & 2-Family,Sq.Ft. $ LOCALITY
'department Multi-family Sq.Ft. NEAREST Z
CROSS ST.
Date Applicant Residential Swimming Pools OWNER OR
FIRM NAME
ERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec Light —L Sw. MAIL
COMPENSATION INSURANCE ADDRESS
This section need not be completed if the work involved b the First 20
( P y Total No. Additional CITY Tel.
permit is for one hundred dollars($100)or less.)
I-certifythat in the performance of the work for which this permit PLAN CHECK
P P APPLICANT
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 nA ADDRESS
�� Total No.—� Additional CITY Tel.No.
Date 5 Applica Fixed Appliances Not Over 1 HP PERMIT
NOTIC O APPLICANT: If, after making this 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
provisions or this permit,shall be deemed revoked. Top — FAU 4/'W.H.
LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ CITY Tel.N
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR \\
(commencing with Section 7000) of Division 3 of the Business and REG.NUMBER ` Z Clas<--li J
Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT PROCES B y;-
CL
/ �i/,� ^/ Size& Type HP,KW,KVA,or KVAR � (l u U
License Number tv 8 Lic.Class Up to 1 Incl. FINAL
s e \ Over 1 to 10 Incl. DATE 0
Contr ctn e, 4�+s�— Date v VALIDATION O
❑ Over 10 to 50 Incl. FINAL`; 11���� U
I am exempt under Sec. Over 50 to 100 Inc. BYW
B.&P.C.for this reason Over 100 a
Services,Swbd.,MCC& Panelboards +f Z
Dater
0-200 Amp.Under 600 V
Signature / 201 - 1000 Amp. Under 600 V
❑ Over 1000 Amp.or Over 600 V
Exemption for. Reg.Maint. EI
SINGFAMILY Temp.Power Pole& Appurtenances 2
HOME OWNER- ILDER DECLARATION Sign with One Branch Circuit y
I hereby affirm that I am e mpt from the Contractor's License Law ACCT.IF
rCT.IF
for the following/reasonection 7031.5,Business and Professions Additional Sign Branch Circuits ��Code): 3307 47a 0
Misc.Conduits& Conductors 1 T ccI,as ownoperty,will do the work and the structure 4TGMS
is not intffered for sale (Section 7044, Business Other(See Complete Fee Schedule) ® _
and Pr f6ssions Code). TOTAL TAA 47 . 70
CONSTRUCTION LENDING AGENCY CHECK 41.7131
I hereby ffirm that there is a construction lending agency for the .����� � p
perfor nce of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total)
Civ.
PLAN CHECKING FEE
Le der's Name 0000-00171 7/ �4/` I,
PERMIT ISSUING FEE
�� � ,-+
Lender's Address � n._
1 certify that I have read this application and state that the above TOTAL FEE 1 R
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 ispection purpose .
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date