HomeMy Public PortalAbout10510 FREER ST_Electrical__ Ft6A663-CE806 5-62 APPLICA ® F® ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER f
ILDING S—J
BUILDING AND SAFETY DIVISION DRESS
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN, SUPT OF BUILDING CALITYAREST
FOR APPLICANT TO FILL IN OSS ST.
RECEPT TOTAL NO, EACH FEE
LIGHT /S MAIL
OUTL FIRST 20 /ll$20 $ OWNER
SWITCH. ADD'L �V 10 ADDRESS
OVER 20
TO AL CITY TEL.
LIGHTING FIRST 20 .20 0
FIXTURES AOWL 1O ELECT RI N /
OV R 20
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRE Y
GARB.DISP. STA.COOK CITY TE O. !/
DISHWASH. AUTO.-WASH. STATE
SPACE HTRS, STA.APP.(y■HIP.MAX .50 LICENSE NO.
MOTORS: OVER NOT OVEA H.P. DISTRICT O. GROUP ZONE PR BY
O 1 1.00
1 3 1.50 INSPECTION RECORD
3 6 2.00
s 15 2.50 0-
0 O
15 50 3.00 U
50 100 5.00
O
NO.TRANS ~
SIGNS: NO.LAMPS W
H
SERVICE 0.60OV-NOT OVER 200A 1.00 Z
SERVICE 0.60OV-OVER 200 A. 2.00
SERVICE OVER 600V 5.00
MISC.
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.001 j
TOTAL FEE $
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APP CATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY CONDUITWI
TH COUNTY ORDINANCES AND STATE LAWS REGULATING _ YY
L WIRING.
WIRING A'/�i7,!/ .f';,,.•.,_ •-�-��n .D
Y CERT FY THAT 1 AM PROPERLY REGISTERED AND/OR � �/,/CAl
AB REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES (I f 1U1./,'W'
IA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE �d k v
RESIDENTI L PROPERTY. i POWERREUTILITY CO.NOTIFIEDITTEE
e� FINAL /I!
LIDATION ARTHUR C. VEIT 'r
/ C MO CASH SUPERVISING ELECTRICAL ENGINEER
L, l;o 7 42 1 Z03 JUL 1 2 ? 0 1 4.90!-
. WORKERS'COMPENSATIONDECLARATION CE-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have"I certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY
insure, or a certificate of Workers'Compensation Insurance,or '
a certified copy thereof(Sec. 3800,Lab.C.)
FOR APPLICANT TO FILL IN JOB
Policy No. Company New Residential Bldgs.&Pools EACH NO. FEE ADDRESS /0.�d O /—XP _
Certified copy is hereby furnished. -1 &2-Family,Sq. Ft. $ — Is LOCALITY
Multi-family Sq. Ft. NEAREST ^
•Certified copy is filed with the county building inspection CROSS ST ro� /C
department. Residential Swimming Pools OWNER OR
FIRM NAME GVH
Date Applicant Outlets Rec_Light Sw. AMAIL
DDRESS S"/�'lrJ�
First 20
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No Additional CITY Tei No -�Q� a
' COMPENSATION INSURANCE PLAN CHECK O
(This section need not be completed if the•work involved APPLICANT U
by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS
Additional
Total No. O
I certify that in the performance of the-work for which thisCITY Tel No. U
permit is issued,-I shall not em Fixed Appliances Not Over 1 HP
p employ y an y person in any manner PERMIT LU
so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT d
Oven _ Dryer_W.M. ADDRESS ) z
Date Applicant Top _ FAU _W.H. ,
Hood _ Fan _Other_ CITY Tel No.
NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond. LICENSE OR
Exemption, you should become subject to'the Workers' REG.NUMBER Class
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PR E D BY
with comply with such provisions or this permit shall be
deemed revoked. Size&Type HP,KW, KV or KVAR �/
' Up to 1 Incl.1. C—/ � (�
FINAL
• AA
LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATE Over 10 to 50 Incl.
VALIDATI
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL
BY
9 (commencing with Section 7000)of Division 3 of the Busi- Over 100
ness and. Professions Code, and my license is in full force and r
effect. Services
License Number Lic.Class 0-200 Amp. Under 600 V
201-1000 Amp. Under 600 V'
Contractor 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):
Misc.Conduits&Conductors
I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)—
structure is not intended or offered for sale (Section
7044, Business and Professions Code). 2 4 9.6 A•
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending'agency
for the performance of the work for which this permit is # 0 0.010-o2
PERMIT FEE (Sub-Total)
issued (Sec.'3097,Civ.C.). 2.° o 1 9,50
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee)
Lender's Address PERMIT ISSUING FEE 0.0 0 1 9 5 O•Ft
I certify that I have read this application and state that the TOTAL FEE' 00,7 80
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
Signature of Permittee Date