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Home My Public Portal About9156 FORTSON DR_Electrical__ 76A663-CE806 8-62 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING" BUILDING AND SAFETY DIVISION ADDRESS JOHN A LAMBIE, COUNTY ENGINEER WILLIAM A JENSEN, SUP T OF BUILDING LOCALITY GAJ '7r LJ NEAREST FOR APPLICANT TO FILL IN CROSS ST RECEP,T TOTAL NO EACH FEE OUTLETS FIRST 20 $20 $ OWNER �S LIGHT MAIL sw17cH ADD'L 10 ADDRESS OVER 20 TOTAL I CITY TEL NO LIGHTING FIRST 20 20 FIXTURES Aoo'L 10 ELECTRICIAN OV R 20 RANGES CLO DRYERS WTR HTRS loo ADDRESS 4/-6y GARB DISP _STA COOK ' CITY TEL NO 7/j 4v DISHWASH AUTO-WASH _ STATE SPCE HTRS STA APP (/a H P MAX ) 50 ALICENSE NO a+ MOTORS OVER NOT OVER HP DIST5jCTNO. GR NE P ESSED BY 100 _ + 3 Iso INSPECTION RECORD 3 8 200 ` 8 15 250, 15 50 300 d 50 100 500 0 SIGNS NO TRANS IZ NO LAMPS SERVICE 0.600V-NOT OVER 200A 100 00 W SERVICE 0.600V-OVER 200 A 200 Q. t7 SERVICE OVER 600V Soo ? MISC i PERMIT ISSUING FEE 2 00 SUPPLEMENTASY PERMIT ISSUING FEE 1 00 TOTAL FEE $ 1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI ATION + APPROVALS DATE INSPECTOR'S SIGNATUREi AND STATE THAT THEABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING WIRING ` tt 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR e LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY _ POWER SIGNATURE UTILITY CO NOTIFIED OF PERMITTEE — � I FINAL LIDATION ARTHUR VEIT y' MO CASH SUPERVISING ELECTRICAL ENGINEER CK tv T � I DBS S-A 6-46 .DEPARTMENT ®F DUII.DING AND SAFETY� APPLICATION FOR PE COUN'T'Y OF LOS ANGELES ` ELECTRIC WM. J. FOX CHIEF ENGINEER NAME DISTRICT NO. GROUP ZONE PERMIT NO. U ADDRESS K U CITY TEL NO. RE/ ABY READY FOR DATE ISSUED A COUNTY I FIRST INSPECTION �� W CERT.NO. (P lD 0 (PEXPIRES 6 APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY � DESCRIPTION OF WORD ADDRESS NUMBER OF OUTLETS ON CIRCUITS LOCALITY LOCATION BY ROOMS NEAREST LIGHT OUTLETS ' 1SWW. PLUGS FIXT CROSS ST. CIRCUIT A B C D E FIG H It NAME Z MAIL -71 112-1 3 ADDRESS O CITY TEL NO. I AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFI!CA�TE OF QUALIFICATION... tU I _ ^ _ ELECTRICIAN. 1„Q Pv 1_AM THE ISGAL OWNER OF THE PROPERTY DESCRIBED ABOVE OWNER. y� � �v�p �T COR EMONS _ J Z S O TOTAL 1.2 No. of OUTLETS $ '` APPROVALS .,t NO. OF FIXTURES $ J 4 DATE INSPECTOR'S NAME NO OF MOTORS H P. $ CONDUIT NO OF SIGNS TRANS. $ WIRING NO OF RANGES OR HEATERS $ FIXTURES MISCELLANEOUS $ POWER PERMIT FEE qqA Y $ g� �V UTILITY CO.NOTIFIED -7TOTAL FEE .Ji ws () FINAL `,la' 1/ r WORKERS'COMPENSATION DECLARATION76A663 DPW 3 e7 APPLICATION FOR ELECTRICAL PERMIT 76 I hereby affirm that I have a certificate of consent to self CE-806G -- insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certif/ie►d/eco y thereoff(Sec. 3800, Lab �C�/)��f� /� Policy NofdL �'company!-ry�C.,.��0�6e0 FOR APPLICANT TO FILL IN JOB �► r_1Certified copy is hereby furnished. New Residential Bldgs & Pools EACH NO FEE ADDRESS Certified copy is filed--with th count m ins 1 &2-Family, Sq. Ft. $ _ $ LOCALITY tion d p tment / ui�� t� Multi-family Sq. Ft NEAREST CROSS ST. Residential Swimming Pools Date Applicant OWNER OR • FIRM r NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw. MAIL _- COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work involved by First 20 CITY Total No. Addtl Tel. No. the permit is for one hundred dollars ($100)or less.) iionaPLAN CHECK I certify that in the performance of the'work for which this APPLICANT permit is issued, I shall not employ any person in any manner Lighting Fixtures First 20 ADDRESS so as to become subject to the Workers'Compensation Laws Additional Date Applicant Total No. CITY Tel. No NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range— Heater—D.W. _ APPLICATION ALI Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS ; ' ` with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked HJood — Fan —Other— CITY LICENSED CONTRACTORS DECLARATION Disp. — Room Air Cond. — LICENSE OR 1 hereby affirm that I am licensed'under provisions of Chapter 9 REG NUMBERC (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NCS PRO 1 SED BY >- and Professions Cod ,and my license is in full force n fect. d .� Size &Type HP, KW, KVA, or KVAR �' License Number L,c. Class 0 Up to 1 Incl FINAL O Contractor € - -- — Over 1 to 10 Incl. DATE (!1� VALIDATION ❑ Over 10 to 50 Incl. FINAL �J r U I am exempt under Sec. Over 50 to 100 Inc. BY �J lL B&P C. for this reason Over 100 I` a- Date: Services, Swbd., MCC & Panelboards �,� /� Z 0-200 Amp.,Under 600 V ► "� Is�'(fJ — Signature 201 - 1000 Amp. Under 600 V �v ❑ Over 1000 Amp. or Over 600 V Exemption for Reg Maint. Elect. SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp. Power Pole 8 Appurtenances 1 hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code)• ❑ 1, as owner of the property, will do the work and the Misc. Conduits &Conductors structure is not intended or offered for sale'(Section 7044, Other (See Complete Fee Schedule)_ ' Business 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 PERMIT FEE (Sub-Total) (Sec 3097, Civ C ). _ Lender's Name PLAN CHECKING FEE T :• a� PERMIT ISSUING FEE ` Lender's Address �• :N; z., 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 jaws regulating Electrical wiring, and , hereby out o ize representatives of this County to enter upon C•i' >''L' 1•.I ' the a 8 ntioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date FJ 76A663-CE80610172 APPLICATION FOR ELECTRICAL PERMIT tD . COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER JOB / BUILDING AND SAFETY DIVISION ADDRESS , LOCALITY d NEAREST ..r� FOR APPLICANT TO FILL IN CROSS ST. OUTLETS NO. EACHI FEE OWNEFIRM R OR 1 r $ $ RECEPT.._ I MAIL FIRST 20 ADDRESS LIGHT TOTAL 25 rOVER 20 C1 TY 4^" / TEL. N0: SWITCH 10 PLAN CHECK _ FIRST 20 25 APPLICANT LIGHTING TOTAL FIXTURES OVER 20 .10 ADDRESS � ' RESIDENTIAL APPLIANCES CITY TEL. NO. PERMIT RANGE DRYER_WTR. HTR._ APPLICANT i STA. COOK DISP. F.A.U. ADDRESS SPACE HTR. AIR COND. CITY TEL. NO. CLOTHES WASH. REG. NUMBER DISHWASH. LICENSE CLASS. FAN OTHER 1.00 - I HEHEBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. SIZE & TYPE OVER TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 — 1 100 LICENSED AS REQUIRED BY LOr S ANGELES COUNTY AND STATE OF > _ CALIFORNIA OR THAI I AM THE LEGAL OWNER OF THE ABOVE O 1 — 10 300 OESCRMED RESIDENTIAL PROPERTY. f U �" i W PERMITEE 10 — 50 5.00 SIGNATURE " ' �+- 50 — 100 10.00 DISTRICT N0., PROCESSED BX. 100 — 500 15.00 O SIGN, GASL SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE INSPECTOR'S SIGNATURE 1W-� , TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE SERVICENOTOVER600VOLTS OR200AMP 3.00 UNDERSLAB WORK SERVICEOVER 600VOLTS OR200AMP 10.00 ROUGH CONDUIT TEMPSERVICE,POLE, &APPURTENANCES 5.00 WIRING TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED FINAL PERMIT FEE (SUB TOTAL) NOTES: PLAN CHECK FEE PERMIT ISSUING FEE 3.00 - TOTAL FEE PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE