HomeMy Public PortalAbout8615 HERMOSA DR_Electrical__ 18"863
-CEDOG 4-6
0 APPLICATION FOR ELECTRICAL PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING (�/ /�
BUILDING AND SAFETY DIVISION ADDRESS D lO/
JOHN A.LAMBIE, COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEARESTCROSS Sr
PERMIT FEES OWNER
ITEM INUMBtR EACH FEE MAILTLEI
GL GHTST RECEPT. BW. $.10 $ ADDRESS `�
f0 U' CITY- TEL.NO T. "-Sy
-11
LIGHTING FIXTURES
ELEC.RANGES CLO- DRYERS ELECTRICIAN
R HEATERS .50 DDRESS
ELEC.SPACE HTR DISHWASHERS CAITY TEL.NO.
GARBAGE DISPOSERS AUTO.. STATE
WASHERS STA.COOKING UNITS ,25 LICENSE NO.
MOTORS: OVER INC. H.P. DISTR NO. GROUP Z I P ESSEDBY
O _ %z .25
V. — 2 50 1� p �YINSPECTIOWRECORD
2 — 5 1.00
5 — Is 1.50 /' �--.. :.- r. 0
Is — so 2.50 �i� >9'�t�� ��cr;% v�•.' .l.r 1+ �,n.l p
so — 200 ,♦
5.00
NO c / / w
SIGNS: NO. LAMPS Q IA Ue 1 �Y -1 /d R1I Otte T6 Z
y r
SERVICE 0-600V I,pp (�/ .�lTv i_/4.-� T.l ♦`/ — SLAA rLY♦^N 1 /�
SERVICE OVER 600V 5.00 7�?'�'U�/ . . '_RC1 �•A iLs`'i:G.I�l^{'Ir.
MISC. v,
WIRING PERMIT 1.00 L�
FIXTURE PERMIT
SUPPLEMENTARY PERMIT .50
TOTAL FEE 5 '
1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
ANO STATE THAT THE ABOVE 1E CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT /
ELECTRICAL WIRING. WIRING
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/ORq
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
���� l /.
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RE51DENTIAL PROPERTY. POWER
SIGNATURE `(,� /QQ.V ytJ UTILITY CO. NOTIFIED A
OF PERMITTE
FINA
• DATION ARTHUR C.VETT.
CK D CASH SUPERVISING ELECTRICAL ENGINEER
�r' A2 8 0 8 �� 2 �, 4.0 5 ;,
WORKERS' COMPENSATION DECLARATION 76A663 10781 APPLICATION FOR ELECTRICAL PERMIT -II
CE806G
luf
. ,I hArek affirm that I have o certificate of consent to self
insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof (Sec. 3800, Lab. C
Policy No. Company FOR APPLICANT TO FILL IN JOB
Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO, FEE ADDRESSg3E. rM o� .
Certified copy is filed with the county building inspec- 18 2-Family, Sq. Ft. $ — $ LOCALITY'S 4 Al
tion deportment. Multi-family Sq. Ft. — NEAREST p
Date Applicant CROSS ST. 0
Residential Swimming Pools OWNER OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION Rec�Light�Sw.L MAIL r M=
COMPENSATION INSURANCE First 20 ADDRESS n
(This section need not be completed if the work involved by Total No. Additional CIT�g Al
the permit is for one hundred dollars ($)00)or less.) PLAN CHECK
1 certify that in the performance of the work for which this APPLICANT
permit is Issued, I shall not employ any person in any manner
so as to become subject to the Wor rs'Compensation Laws. Lighting Fixtures First 20 ADDRESS
/
�6 Total No. Additional
CITY
No.
Date Applic r Fixed Appliances Not Over 1 HP PERMITNOTICE TO APPLICANT: If, a er making this Certificate of v APPLICANT
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 — FALL —W.H. —
deemed revoked. CITY - Tel. No.
LICENSED CONTRACTORS DECLARATION Hood Li Fan _ Other—
LICENSE OR
Class.
Disp. Li Room Air Canal.I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER }
(commencing with Section 7000) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. ,�// PROC S BY R
and Professions Code,and my license is in full farce and effect. PP g PP " A.TI. C.O.)
Size 8 Type HP, KW, KVA, or KVAR' vv YY
License Number Lic. Class Up to 1 Incl FINALO
DATE _
Contractor Date Over I to TO Incl.
VA "TION
❑ Over 10 to 50 Incl. FIBNA W
1 am exempt under Sec. Over 50 to 100 Inc. Y d
N
B.&P.C. for this reason Over 100 Z
Dote: Services, SwEd., MCC 8 Ponelboards
0 - 200 Amp. Under 610 V
Signature 201 - 1000 Amp. Under 600 V
El
Over 1000 Amp, or Over 600 V
Exemption for Reg. Mainz. Elect.
SINGLE FAMILY Tem Power Pole 8 Appurtenances Circuit ances 4 713 A
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit r
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits o e o 0 0 'Z
Law for the following reason (Section 7031.5, Business and
Professions Code):
157
1J I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors _( o - 5500
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ Poo
a n _
o 0 x
7044, Business and Professions Code), Oe
CONSTRUCTION LENDING AGENCY O O
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.).
PLAN CHECKING FEE
-Lender's Name
PERMIT ISSUING FEE
Lender's Address -
I certify that I have read this application and state that the TOTAL FEE Ss
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 Perm, ee Dote