HomeMy Public PortalAbout5039 FIESTA AVE_Electrical__ 76AG63-CE60610-59 APPLICATION FOR ELECTRIC PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESSPJ ,
JOHN A. LAMBIE. COUNTY ENGINEER
WILLIAM A.JENSEN,SUPT of BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST ,p
PERMIT FEES CROSS ST.
1 T E M NUMBER I EACH FEE OWNERMAIL
OUTLETS: $ $ ADDRESS
LIGHTS RECEPT. SW. .10
LIGHTING FIXTURES 10 CITY /~EL.NO. 7 b
ELEC.RANGES CLO.DRYERS ELECTRIC
WATER HEATERS .50 ADDRESS
ELEC.SPACE HTRS. DISHWASHERS
CITY
GARBAGE DISPOSERS AUTO.-
STATE
WASHERS STA.COOKING UNITS .25 LICENSE NO.
MOTORS: OVER INC. H.P. DISTRIC NO. GROUP Z Npp P
O— 1/2 .25
I Z a
1i2- 2 .50 INSPECTION RECORD
2— 5 1.00
5— 15 1.50
IS— 50 2.50
50-200 5.00
SIGNS: NO.TRANS.
NO.LAMPS
SERVICE 0-600V 1.00 _vo
SERVICE OVER 600V 5.00
MISC.
WIRING PERMIT 1.00
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .50
TOTAL FEE $ +�}
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
1 AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT
ELECTRICAL WIRING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR WIRING
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. POWER
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTEE
FINAL
ARTHUR C-
VEIT
®P CK MO CASH SUPERVISING ELECTRICAL ENGINEER
CK MO �C�ASH� '
LC07 5 7 7 2 MOR 1 0 2 A 2.Q 0 ko
WORKERS'COMPENSATION DECLARATION CE 806G (2-80) APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES ']� BUILDING AND SAFETY
insure, or a certificate of Workers'Compensation Insurance,or / i
a certified copy thereof(Sec. 3800,Lab. C.)
FOR APPLICANT TO FILL IN
Policy No. AD Company New Residential Bldgs.&Pools EACH NO. FEE ADDRESS
Q Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — Is LOCALITY
❑ Multi-family Sq. Ft. NEAREST 7 ®�
Certified copy is filed with the county building inspection CROSS ST
department. Residential Swimming Pools OWNER OR
FIRM NAME
Date Applicant Outlets: Rec._Light Sw. MAIL
First 20 ADDRESS,15;0 34
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY ° Tel No. r
COMPENSATION INSURANCE ' A
PLAN CHECK
(This section need not be completed if the work involved APPLICANT 0
by the permit is for one hundred dollars Fixtures First 20
s ($100) or less.) Additional ADDRESS cc
No. 0
I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP
CITY Tel No.
an 0
permit is issued, I shall not employ y person in any manner PERMIT
so as to become subject to the Workers' Com ensation Laws. Range_ Heater_D.W. APPLICANT 4ef4!?--077 J*I W
CL
Oven _ Dryer_W.M. ADDRESS ,_ S�-� U)
Date ' �i pplicant 1� - Top _ FAU' _W.H.._
Hood _ Fan —Other CITY.. ✓Z� Tel No. 3?D3
NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond.— LICENSE OR _ C� C—10
Exemption, you should become subject to the Workers' REG.NUMBER A lass
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY
with comply with such provisions or this permit shall be
\ Size&Type HP,KW, KVA,or KVAR �1 b
deemed revoked. ` Up to 1 Incl.
�.,� / FINAL
LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl.Over 10 to 50 Incl. DATE `gip y��/ VALIDATION
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL
9 (commencing with Section 7000) of Division 3 of the-Busi- Over 100 BY d
ness and Professions.Code, and my license is in full force and
effect. Services
0-200 Amp. Under 600 V //7 �y
License Number , Lic.Class C— Q201-1000 Amp. Under 600 V �f
ContractorC•� Date Over 1000 Amp.or Over 600 V
HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances
'I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit
License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits
ness and Professions Code): 3 0 O A
isc.Conduits&Conductors
I, as owner of the property, will do the work and the Othe�See Com ete Fee Schedule)— 0 0 0 0 0 2
structure is not intended or offered for sale (Section -,v ,�,
7044, Business and Professions Code). 2 0 - 29.50
CONSTRUCTION LENDING AGENCY
4
I hereby affirm that there is a construction lending agency A
(Sub-Total) o 0
for the performance of the work for which this permit is PERMIT FEE (Sub-T 0 2 9.5 0 v
issued (Sec. 3097,Civ.C.). / 0 2.2 2'-8 2
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee)
Lender's Address PERMIT ISSUING FEE 4 (�
I certify that I have read this application and state that the TOTAL FEE 9 �
above information-is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby authorize repre tatives of this County to enter upon
the above-mentioned r-Z
the for inspection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE
�r��
Signature of Permittee Date