Loading...
HomeMy Public PortalAbout8756 HERMOSA DR_Electrical__ 'DS-5AII-== APPLICATION FOR ELECTRIC PERMIT 1 DIVISION,OF BUILDING AND SAFETY Department of Co=tp Engfnee BUILDING �"�. /J?7✓d u�-•�C Co=ty of Los Angeles ADDRESS JOHN A. LAMBIE,COUNTY ENGINEER CASSATT D: GRIFFIN. SUPT OF BUILDING LOCALITY 7�-° FOR APPLICANT TO FILL IN NEAREST / (!l PERMIT FEES CROSS ST. 1. Z NUMBER OWNER LIGHT OUTLETS MAIL RECEPTACLES - -ADDRESS {{�•AI WALL SWITCHES FEE CITY LkX-L /EL. NOaJX TOTAL OUTLETS @ 52 S -ELECTRICIAN w ELEC. RANGES 25 ADDRESS -r—�sv� ELEC. HEATERS 25 KW EA CITYTEL. NO. STATE FIXTURES g © LICENSENO. MOTORS DISTRICT NO. GROUP ZONE READY FOR INSPECTION NUMBER HORSEPOWER FEE I S I�/ NEW 1V7. HP OVER INC. EACH Ya a LEGS $ .25 INSPECTION RECORD 2 .50 2 5 1.00 5 15 I.50 15 50 2.50 50 200 5.00 JJ 1 MISC. NO. SIGNS NO.TRANS. - NO. SIGNS NO. LAMPS FOR EACH PERMIT: WIRING FIXTURES $1.00 SUPPLEMENTARY .50 APPROVALS TOTAL FEE $ DATE INSPECTORS SIGNATURE 1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE I$ CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING Vh ELECTRICAL WIRING. WIRING I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRE Y LOS ELES COUNT AND STATE OF CALIFORNIA OR THA I M TH 'EG OWNS OF TH ABOVE POWER DESCRIBED RESIDENT AL R SIGNATURE /s ! UTILITY CO.NOTIFIED OF PERMITTEE \ ������W[[�i"'��w`�[[[��i FINAL SI TNA TL.T JOHN A. LAMBI�;BOUNTY ENG INERR VALIDATUM ARTHUR C.VEIT,CHIEF ELECT. INSPECTOR J�(/f J/ CK MO �Fjw-B'y/ 1 _ ��D9 1 V I� YiU:i ��. � 2 7 n n ION ' '•�. •�-,MORKERS'ave a certificate of consent CE-806 ,D,B, APPLICATION FOR ELECTRICAL PERMIT {� I hereLry affirm that I have a certificate of consent to self insure, CE-806G LJ or a Cartificasp of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY dolly thereof(Sea-3800Lab.C.) 'Policy No. - ' Company FOR APPLICANT TO FILL IN JOB r,i . -❑ Certified 1bpy is here furnish d. EACH NO. FEE ADDRESS 7Y q New Residential Bldgs.8 Pools ❑ t.0 1 & 2-Family, LOCALITY PL6 C-1 ertifietl copy is filed with the County building inspection Y•��Ft $ — $ department. Multi-family Sq.Ft. — NEAREST -L Date Applicant Residential Swimming Pools OWNER OR IRM NAME Ueno Sw. CERTIFICATE OF EXEMPTION FROM WORKERS' 67 '� MAIL r /'_ 71m� COMPENSATION INSURANCE ) ADDRESS V 1 I� Outlets:Rec Light q First 20 (This section need not be completed if the work involved by the __J&J l CITY f7. Tel.No. permit Is for one hundred dollars IS 100)or less.) Total No. Additional L ' 1 certify that performance of the work for which this permit "is issued, I shalll not PLAN CHECK not employ any person in any manner so as to APPLICANT become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional Y Total No. CITY Tel.No. / Date Applicant Fixed Appliances Not Over 1 HP NOTI E TO APPLICANT: If, altar making is Certificate of PERMIT Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APPLICANT provisions of the Labor Code.you must forthwith comply with such Oven _ Dryer _ W.M._ ADDRESS previsions or this permit shall be deemed revoked. Top — FAU W.H. 4N 9 . LICENSED CONTRACTORS DECLARATION Hood — Fan Other— CITY TelNo. I hereby affirm that I am licensed under provisions of Chapter 9 LICEN OR (commencing with Section 7000) of Division 3 of the Business and Map. ROOM Air Coral. REG.NUMBER Class. Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICTpo. POC SED v Size& Type HP,KW,KVA,or KVAR / - Q License Number Lic.Class - U Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE Z Contractor Date I /I71 0 ) VALIDATION p ❑ Over 10 to 50 Incl. I I U FINAL am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C.for this reason Over 100 L N 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 4 Exemption for,Reg.Maint. Elect. n SINGLE FAMILY Temp.Power Pale& Appurtenances ' 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ACCT.i 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): i`"- JJv Misc.Conduits& Conductors 1-ITEM - --- �Y I,as owner of the property,will do the work and the structure TOY w� AA is not intended or Coffered for sale'(Section 7044, Business Other(See Complete Fee Schedule) , .... TOTAi.- and Professions Code). CONSTRUCTION LENDING AGENCY - Ct/KM 39.75 1 hereby affirm that there is a construction lending agency for the CHANCE •00 performance of the work for which this permit is issued(Sec.3097, . PERMIT FEE (Sub-Total) - -'---"- Civ.C.). .__... -_...._-. PLAN CHECKING FEE 0000-MOI 7/18/89 Lender's Name PERMIT ISSUING FEE /O Q 4A3 i AM BSSO Lender's Address -- I certify that I have 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 representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE /Signature d9lt I Signature of P mitteetee Date•