HomeMy Public PortalAbout8731 HERMOSA DR_Electrical__ 76A663-CE806 B-62 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER
WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITY
NEAREST �� l
FOR APPLICANT TO FILL IN CROSS ST.
RECEPT. TOTAL NO, EACH FEE
OUTLETS (FIRST 20 $ 20 $ OWNER
LIGHT r MAIL �- 1
ADD'L I 10 ADDRESS 1 yA�l A f v
SWITCH. OVER 20
GHTING
LITOTAL CITY
FIRST 20 20 % TEL. NO.
1 .
FIXTURES II ADD'L ELECTRICIAN r
OVER 20 I .10
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS,///-?It'
DDRESS
GARB.DISP. STA.COOK CITY TEL. NO.
DISHWASH. AUTO.�W'ASH. STATE 1 E r
SPACE HTRS. STA.APP.II/i H.P.MAX.1 ,$0 LICENSE NO.
MOTORS: OVER NOT OVER H.P. DISTRIC NO. GR�O�UP Z NEP CESSED Y
0 1 1.00 1 P -�
1 — 3 1.50 INSPECTION RECORD
3 B 2.00
B is 2.50
15 50 3.0
00
0 1
50 100 5.00 0)
SIGNS: -NO.TRANS. BE
NO.LAMPS O
F
SERVICE 0.6OOV-NOT OVER 20 1. IVLI
a
SERVICE O-600V-OVER 20 2.00 IZ
n
SERVICE OVER 600V � 5.00 /F,N —
MISC.
t
PERMIT ISSUING FEE 2.00 (Y
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE $ _�
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALLCOUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
6'.
1 HEREBY CERTIFY THAT 1 AM PROPS LY REGISTERED DIOR /
LICENSED AS REGUIRED T L09 ANGE COUN _AN 9 E OF FIXTURES
CALIFORNIA OR THAT I AM T E LEG OWH OF ABOVE
DESCRIBED RESIDENT( P Rrr. POWER
SIGNATURE / UTIL ITY CO.NOTIFIED
OF PERMITTEE / rZ
FINAL !J
0 LIDATION ARTHR C. VEIT
CK U
MO CASH SUPERVISING ELECTRICAL ENGINEER
6 6 6 9 a f-Y R 1 7 2 A 3 .4 0
�lf all;l�
.Wm that I have a certificate
DECLARATION 76"663 'prfi, APPLICATION FOR ELECTRICAL PERMIT {�
I`�fereby affirm that I have a certificate of consent to self insure,
CE-606G u
or 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
❑ Certified copy is hereby furnished. - EACH NO. FEE ADDRESS :1New Residential Bldgs. & Pools
❑
Certified copy is filed with the county building inspection 1 & 2-Family, Sq.Ft. $ — $ LOCALITY
department. Multi-family Sq. FL NEAREST �����
CROSS ST
Date Applicant Residential Swimming Pools OWNER ORK/i '
FIRM NAME MAILtltl.J
CERTIFICATECOMPENSATION EXEMPTION
CE WORKERS' Outlets: Rec— Light _ Sw. — ADDRESS O[ E• C�r� Q•
(This section need not be completed if the work involved by the First 20
permit is for one hundred dollars ($100)or less.) Total No. Additional CITY S, - Tel.Nc,g1q_�'_y py
PLAN CHECK
I certify that h l rot a employ
of the work for which this permit APPLICANT
is Issued, I shall not employ any person in any manner so as to
become subject to the Workers'Compe sation Laws. Lighting Fixtures First 20 ADDRESS
Total No. Additional CITY el.No.
Date r+ r Applicant ��� O Fixed Appliances Not Over 1 HE NOTIC TO APPLICANT: It, after makin this Certificate of PERMIT
Exemption,you should become subject to the WorkersCompensation Range_ Heater_ D.W. _ APPLICANT
11
provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer _ W.M. _ ADDRESS
provisions or this permit shall be deemed revoked, lop FAU W.H.
LICENSED CONTRACTORS DECLARATION Hood — Fan OtherCITY Tel.No.
_
hereby affirm that I am licensed under provisions of Chapter 9RES.NU
(commencing with Section 7000) of Division 3 of the Business and Disp. Room Air Cond. REG.NUMBER Gass.
Professions Code,and my license is in full force and effect. DISTRICT NO. PROCES Y
Power Apparatus&Large Appliances }
C� !) ILI
Size& Type HP,KW,Ior KVAR v-J t (/ 0
License Number Lia Class Up to 1 Incl. FINAL
U
Over 1 to 10 Ind. DATE VALID ION it
Contractor Date Over 10 to 50 Incl. _ V
E] I am exempt under Sec. Over 50 to 100 Inc. BY W
B.& P.C.for this reason Over 100 � /�JZ I"'
Services, Swbd,MCC& Panelboards // Z
Date: 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. �6 8 1.3 A
SINGLE FAMILY Temp.Power Pale& Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit # • • - * 9 2
I hereby affirm that I am exempt from the Contractor's License Law
efor th following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits .I - - 2550 2550
Cod
I,as owner of the property,will do the work and the structure Misc.Conduits& Conductors • . • 2 5 5,0 e
is not intended or offered for sale Section 7044, Business Other (See Complete Fee Schedule) ,
and Professions Code).
04.06-87
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,
Civ. C.). PERMIT FEE (Sub-Total)
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE
Lender's Address
I certify that hatIhave read this application and state that the above TOTAL FEE
information is correct. I agree to comply with all County ordinances
and State laws regulating Electrical wiring, and hereby authorize
representat s of this County to enter upon the above-mentioned
propert or pspection purpos
SEE REVERSE FOR EXPLANATORY LANGUAGE
X -,�-V
Sigh -0 ture of ermittee Date