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Home My Public Portal About8622 HALDEMAN ST_Electrical__ IGAE63-CESOG 4.60 1APPLICATI®N FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A.LAMBIE, COUNTY ENGINEER / n WILLIAM A.JENSEN, SUP'TOF BUILDING LOCALITY CFORAPPLICANTTOFILLIN EAREST ��r�/ CROSS ST. i. PERMIT FEES ' } OWNER ITEM NUMBER EACH FEE MAIL OUTLETAT $ ADDRESS LIGHT6 RECEPT SW. .10 ,,.... LIGHTI G FIXTURES 10 CITY TEL.NO i ELEC. RANGES CLO. DRYERS ELECTRICIA chueller El eC r lc WATER HEATERS .50 ADDRESS6JLW O,C"1'noLT• � ELEC.SPACE HTRS. DISHWASHERS CITYDua r e• TEL.NO. •— SERB' AUTO.- STATE- LICENSE LICENSE NO. ` WASHERS STA.COOKING UNITS .25 MOTORS: OVER INC. H.P. DISTIY�T NO. I GROUP 4ONE P OCESSED BY O — I/2 .25 -►— lie — 2 .50 J INSPECTION RECORD 2 — 5 1.00 -� 7 f2 G719 e/ G gt�l�i ~�� ✓ Off. 5 — is 1.50 Ov 15 — 50 2.50 O so — 200 5.00 U NO TRANS. uj SIGNS: a NO. LAMPS Z SERVICE 0.600V 1.00 a " SERVICE OVER 600V 5.00 MISC. WIRING PERMIT 1.00 FIXTURE PERMIT 1.00 'E SUPPLEMENTARY PERMIT .50 i w TOTAL FEE $ 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT ELECTRICAL WIRING. WIRING I HEREBY C FY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS RE IRED BY L03 AN GELE COU NTY AND STATE OF FIXTURES CALIFORNIA OR T AT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESID NTI PROPERTY. POWER ►/,�� SIGNATURE '�.�E+� �� s UTILITY CO. NOTIFIED,, p t OF PERMITT FINA f IDATION ARTHUR C.VEIT. CK MO CASH SUPERVISING ELECTRICAL ENGINEER (h 299.01 FEB 24 2 A 10.30 WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT Ll ` I her�y affirm that I have a certificate of consent to self Insure, 76A663 or a,ertificat'G copy Areof(Sec Worker's Compensation !nsur&ce or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV ec 3800 Lab C) ,A• Policy NO Company FOR APPLICANT TO FILL IN JOB /�CpC,.n/t ��I �T QTNI I ❑ Certified copy Is hereby furnished New Residential Bldgs &Pools NO EACH FEE ADDRESS OLOCALITY ElC�'l — Certified — 1 &2-Family,Sq Ft $ $copy is flied with the county building Inspection _ NEAREST e.(1970 lO�department Multi-family Sq Ft CROSS ST D( Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL i CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec _Light Sw Oiaan R OR /V I r COMPENSATION-INSURANCE71 ME First 20 MAIL (This section need not be completed if the work involved by the Total No � Additional ADDRESS Ocf�i7(�y OJ'Jl/J permit is for one hundred dollars($100)or less) ! NoO/O L6 r+��O I certify that in the performance of the work for which this permit CITY 6�Jrj/Zl€L- Is Issued, I shall not employ any person In any manner so-as to PLAN CHECK become subject to the Workers' Compensation Laws Lighting Fixtures First 20 APPLICANT Total No Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP NOTICE TO APPLICANT If, afte} making this Certificate of CITY Tel No Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP provisions of the Labor Code, you must forthwith comply with such PERMIT �w provisions or this permit shall be deemed revoked Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION &Type HP,KW��I}�VA//[o KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 _ O4er2� n� / (commencing with Section 7000) of Division 3 of the Business and - CITY Tel No Professions Code, and my license is in full force and effect Over 10 to 50 Incl LICENSEClass } Over 50 t0 100 Incl REG NUMBER a Over 100 DISTRICT NO Ppp SSED BY 0 License Number Lic ClassIV QO e T� SO es,S/wjfaf� � n ards iYGf�/�•liJL�/�2-' cc Contractor Date V- A do' 600 V DATE 0 ❑ I am exempt under Sec 400-1000 Amp Under 600 V / H VALIDATION V Over 1000 Amp or Over 600 V FINAL W B&P C for this reason BRANCH CIRCUIT FEES BY (11 Date 15A,or 20A, 120V,Lighting or Recept Z_ 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits 7 Exemption for Reg Malnt Elect 15A,20A,208V To 277V Lighting Br Circuits ACCTAI.JL SINGLE FAMILY Temp Power Pole&Appurtenances , ��ii HOME OWNER-BUILDER DECLARATION ,S,a03 �°� 1 hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit M for the following reason (Section 7031 5, Business and Professions Additional_Slgn Branch Circuits 1 ITEMS Code) 376 ®25 TOTAL I,as owner of the property,will do the work and the structure Misc Conduits&Conductors it r s not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) CHECK ��°L and Professions Code) , I CHANGE °00 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the �/q 1 f�� performance of the work for which this permit is issued (Sec 3097, PERMIT FEE (Sub-Total) [000—(0ol i / Civ C) PLAN CHECKING FEE 7392 1 PM 1°14 Lender's Name PERMIT ISSUING FEE 1-76 Lender's Address I certify that I have read this application and under penalty of purlury state TOTAL FEE Z9 15% that the 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 puSEE REVERSE FOR EXPLANATORY LANGUAGE IGNATURE OF PERMITTEE DATE WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self Insure, 76A663 or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec 3800 Lab C) Policy NO Company FOR APPLICANT TO FILL IN JOB IRA I �"JL Certified copy Is hereby furnished New Residential Bldgs &Pools NO EACH FEE ADDRESS 'r'/ F t El 1 &2-Family,Sq Ft LOCALITY Certified copy Is filed with the county building Inspection _ $ $ NEAREST department Multi-family Sq Ft CROSS ST �UR/o Residential Swimming Pools ASSESSOR Date Applicant MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec -Light Sw OWNER OR NAME COMPENSATION INSURANCE �, .'j •/1 LlA� M sr (This section need not be completed If the work involved by the First 20 MAIL L)E Total No Additional ADDRESS permit is for one hundred dollars($100)or less.) I certify that In the performance of the work for which this permit CITY 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 APPLICANT CHECK ICANT Total No Additional ADDRESS - Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP NOTICE TO APPLICANT If, after making this Certificate of CITY Tel No Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP provisions of the Labor Code, you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I,am licensed under provisions of Chapter 9 Over 3 to 10 Incl `t CITY Tel No d (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect Over 10 to 50 Incl Over 50 to 100 Incl REG NNU BER Class SE OR O H Over 100 DISTRICT NO PROCESSED BY W License Number Lic Class J Services,Swbd;MCC&Panelboards %j.' `✓ �r`{ ILL FINAL Contractor Date f% ?t I 06;g 399 Amp Underi600 V DATE } ED - I -1000 Amp Under 600 V Cc I am exempt under Sec VALIDATION Q Over 1000 Amp or Over 600 V FINAL Q B&P C for this reason BRANCH'CIRCUIT FEES BY 0 Date 15A,or 20A, 120V,Lighting or Recept r N g 1 To 10 Branch Circuits W Signature 11 To 40 Branch Circuits ED 41 Or More Branch Circuits Exemption for Reg Maint Elect 15A,20A,208V To 277V Lighting Br Circuits SINGLE FAMILY Temp Power Pole&Appurtenances 5a HOME OWNER-BUILDER DECLARATION Oil I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit .tf�t for the following reason (Section 7031 5, Business and Professions Additional Sign Branch Circuits Code), n I, as owner of the property,well do the work and the structure Mlsc Conduits&Conductors vM 5 , Is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , ✓ � 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 (Sec 3097, PERMIT FEE (Sub-Total) 1 � f E1 Civ C) s�1 PLAN CHECKING FEE 7301 - ts Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE that the 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