HomeMy Public PortalAbout9834 HALLWOOD DR_Electrical__ 76A663-CE806 10/72 QPPMCAIMN FOR EdEMUCAL pERNU
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER EADDRE
BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN
OUTLETS N0. EACH FEE OWNER OR
$ is FIRM NAME U
RECEPT._ MAIL
LIGHT TOTAL
FIRST 20 25 1
ADDRESS ° dD-b
CITY TEL. NO.
SWITCH - OVER 20 .10
PLAN CHECK
LIGHTINGTOTAL FIRST 20 25 APPLICANT
FIXTURES .10
OVER 20 ADDRESS
RESIDENTIAL APPLIANCES CITY TEL. N0.
PERMIT
RANGE DRY ER_WTR. HTR. APPLICANT r-- E I- -e. e i,i
STA. COOK DISP. F.A.U. ADDRESS I G'-" (f{�.
SPACE HTR, AIR COND. CITY , TEL. NO.
CLOTHES WASH. DISHWASH. LEIC
RG. NUMBER ENSE OR E. CLASS.y�-ra9'o
11 I'} M
FAN OTHER 1.00 p 1 :! 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
1 AND STATE THAT THE ABOVEIS 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 LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THATI AM THE LEGAL OWNER OF THE ABOVE
1 — 10 3.00 DESCRIPED RESIDENTI L PROPERTY. a
E
PERMITE
U
10 - 50 5.00 SIGNATURE
O
50 - 100 10.00 v
DISTRICT NO PRCEED BY W
1 00 - 500 t 5.00 O -
SIGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE_ INSPECTOR'S SIGNATURE
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE
SERVICENOTOVER600 VOLTS OR 200AMP 3.00 UNDERSLAB WORK
SERVI CEOVER 600 VOLTS OR 200 AMP 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 c
PERMIT ISSUING FEE 3.00
TOTAL FEE
...,..._... CK. M.O. ..C..
PLAN CHECK VALIDATION ASH PERMIT VA D TION CK. M.O. CASH
yl :t 18 0 _� +';.z.� l.c_t u� v
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE ..w
WORKERS'COMPENSATION DECLARATION - 10/81
CE-806G A nL0CATI®N FOR ELE
OfELECTRICAL PERMIT
I-•liereby,affirm than(have a'certificate of consent to self insure,
°oc a certificate'of-Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec.3800,Lab.C.)
Policy-No. Company FOR APPLICANT TO FILL IN- JOB Q1'} '
❑ Certified copy is hereby furnished. New Residential'Bldgs.&Pools EACH• NO. FEE - ADDRESS 6'03' �
Certified copy is filed with the'county building inspection
1 & 2-Family,Sq:Ft. $ — $ LOCALITY
department. Multi-family Sq.Ft. NEAREST.
CROSS ST.
Residential Swimming Pools OWNER OR
Date Applicant q� FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS'
Outlets:Rec Light SW.OC 0 MAIL
COMPENSATION INSURANCE � O ADDRESS W
(This section need not be completed if the work involved by the 3 First 20
Total No.• Additional CITY r� Tel.No.� .�
permit is for one hundred dollars ($100) or less.) ,
I certify that in the performance of the work for which this permit PLAN CHECK
APPLICANT
is•issued, I shall not employ any person in any manner so as to t\
become subject.to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
r Additional
0- -S TotaLNo. CITY Tel.No.
Date ' Applic�J Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after aki this Certificate G'R � t
Ezemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. APPLICANT L.
provisions of the Labor Code, you-must,forthwith comply with such Oven _ Dryer _ W.M. ADDRESS , o_
provisions or this permit shall be deemed revoked. Top — FAU. W.H. 1.1 -
LICENSED CONTRACTORS DECLARATION CITY �� Tela N
Hood — Fan Other
o.
_, _
I hereby affirm that I am-licensed under provisions-of Chapter 9 Disp. —'Room Air Cond. LICENSE B
(commencing with Section 7000).of.Division 3 of the Business and REG.NUMBER Class.
Professions Code,and my license is in full force and effect. _ DISTRICT NO. PROCESSED Y
- -Power.Apparatus& Large Appliances _
��.
Size& Type HP,KW,KVA,or KVAR O
License Number Lic.Class Up to 1 Incl: FINAL
Over 1 to 10 Incl. DATE Z`
Contractor Date Over 1.0 to 50 Incl. FINAL V @ �4 A O
❑ I am exempt under Sec. Over 50 to-100'Inc. BY # o;o 0 0 0 2, W
• B.&P.C.for this reason l
Over 100 - '67,7.25 N
Services Swbd.,MCC&Panelboards,
Dater 0- 200 Amp.Under 600•V ���
Signature 201 - 1000 Amp.Under.600 V:
.0-oo77-2505
Over 1000 Amp.or Over 600 V
❑ Exemption for Reg.Maint.Elect.. 222
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 Law
for the following reason (Section 7031:5, Business and Professions' Additional Sign Branch Circuits -
Code):
Cas
owner of the property,will do the work and the structure Misc.Conduits&Conductors ' r
is not intended or offered for sale (Section 7044,Business Other(See Complete Fee Schedule) D
and Professions Code}
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency forthe
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total)' '
Civ. C.).
PLAN CHECKING FEE
Lender's Name
'
Lender's Address PERMIT ISSUING FEE '
•� ^ '
I certify that I have read this application'and state that the above TOTAL FEE t o
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
rZ _-V r ?
e of P rmI ee Date