HomeMy Public PortalAbout5320 FRATUS DR_Electrical__ 76A66C CE#806 5 61
APPLICATION FOR ELECTRICAL PERMIT LLL��111
COUNTY OF LOS ANGELES
DEPARMENT OF COUNTY ENGINEER BUILDING –
BUILDING AND SAFETY DIVISION ADDRESS ✓� �/
JOHN A LAMBIE, COUNTY ENGINEER
WILLIAM A JENSEN, SUP T OF BUILDING LOCALITY
NEAREST
r FOR APPLICANT TO FILL IN
CROSS ST
PERMIT FEES OWNER 14c-7
I T E M NUMBER EACH FEE MAIL
OUTLE $ $ ADDRESS
LIGHTS RECEPT 13 SW 10lei CITY TEL NO
LIGHTING FIXTURES
ELEC RANGES CLO DRYERS 10 ELECTRICIAN /Y O'L.C�GL1Lis���
�
WATER HEATERS 59 ADDRESS t
ELEC SPACE HTRS DISHWASHERS •
CITY ejTEL NO Q
dAGE DISPOSER AUTO- STATE
WASHERS STA COOKING UNITS 25 LICENSE NO
MOTORS OVER INC H P DIST CT NO I GRff
ESSED B
0— 1/2 25
1/2— 2 50 INS
P
ECTION) RECORD,'/')
2— 5 foo
5— 15 ISO �-�i f �° ,� � v� �➢
IS— 5009
250
O
50— 200u
B 00 C7
68!
SIGNS NO TRANS
NO LAMPS N
SERVICE 0-600V 1 00 r'fJ
SERVICE OVER 600V Soo
MISC
WIRING PERMIT 100
FIXTURE PERMIT 100 -21
SUPPLEMENTARY PERMIT 50
TOTAL FEE s 1
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE I INSPECTO{R�S(,SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT 1 f , •� �i 7 i�/'
WITH ALL COUNTY ORDINANCES AND STATC LAWS REGULATING -1 f
ELECTRICAL WIRING WIRING
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR -
LICENSED AS REOUIRCD BY LOS GELES COUNTY AND STATE OF FIXTURES j W
CALIFORNIA OR THAT 1 AM 7 LEGAL O ER OF THE ABOVE
DESCRIBED RESIDENTIAVFSROP v POWER ® /
SIGNATURE UTILITY CO NOTIFIED
OF PERMITTEE - FINAL11111101101
�VALIDATION ART UR`C VEIT
/ cW MO CASH SUPERVISING ELECTRICAL ENGINEER
Ltd Q`i 4 -_25 2 D Ci
r WORKERS' COMPENSATION DECLARATION herbyID/81 R ELECTRICAL PERMIT
- I affirm ikCE 8 6G APPLICATION F
� O Oat_� ve a certificate of consent to self
insure or a certificate Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof (Sec 3800, Lab -C )
Policy No R'7 `(0 OCompany FaIr"OAt FOR APPLICANT TO FILL IN JOB
Certified co is hereby furnished EACH NO FEE ADDRESS
PY Y New Residential Bldgs & Pools
❑ Certified copy is filed with the county building inspec- 1 & 2-Family, Sq Ft $ — $. LOCALITY "
tion epar ent Multi-family Sq Ft — NEAREST
CROSS ST
Date
Residential Swimming Pools� OWNER OR
Applicant Z _ FIRM NAME
CE TIFICATE OF EXEMPTION FROM WORKERS' MAIL
COMPENSATION INSURANCE Outlets Rec Light Sw_ _' ADDRESS
is section neehot completed if the work involved b First 20
(Thtd t bp y Total No Additional CITY Tel No�
the permit is for one hundred dollars ($100)or less )
that in the performance of the work for which this PLAN CHECK
1 certify P APPLICANT
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 Additional
CITY Tel No
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT If, after making this Certificate of APPLICANT1521Zit
Exemption, you should become subject to the Workers' Range_ Heater_D W _
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 CITY Lltly�J Tel No
LICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other_
LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp Room Air CondClass r
REG NUMBER
(commencing with Section 7000) of Division 3 of the Business Power Apparatus & Large Appliances DISTRICT NO PRO BY a
and Professions Code,and my license is in full force and effect U
Size 8 Type HP, KW, KVA, or KVAR
License Number Lic Class Up to 1 Incl FINAL IY
' Q Over 1 to 10 Incl DATE �—/f�t1 � VALIDATION O
Contractor IC 1 CQ Date \) �'..// W
❑ Over 10 to 50 Incl FIN
I am exempt under Sec Over 50 to 100 Inc BY CL
B &P C for This reason Over 100 Z
Date Services, Swbd , MCC& Panelboards
0 - 200 Amp Under 600 V
Signature 201 - 1000 Amp Under 600 V
❑ Over 1000 Amp or Over 600 V
Exemption for Reg Maint Elect 1
SINGLE FAMILY Temp Power Pole & Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
Law for the following reason (Section 7031 5, Business and
Professions Code) 9486.8
❑ 1, as owner of the property, will do the work and the ' Misc Conduits 8 Conductors # o 0 0,0 0
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_
7044, Business and Professions Code) 2550
CONSTRUCTION LENDING AGENCY 2 S 5 0
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) (� 9-8 6
(Sec 3097, Civ C )
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE
Lender's Address �— �1
I certify that I have read this application and state that the TOTAL FEE aJ l J(J
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
011
Lure of Permittee Oate