HomeMy Public PortalAbout8909 HERMOSA DR_Electrical__ 76A6B3.CEPOB -62 APPLICATION FOR ELECTRICAL PERNCIT
'i - COUNTY OF LOS ANGELES
OLPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND.SAFETY DIVISION ADORES6 C/ G•Sc� /Ji-�Y`-
JOHN A. LAMBIE. COUNTY ENGINEER /
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY 751-44 ��• E /
NEAREST JJ/ _ ,/A �r�
FOR APPLICANT TO FILL IN
NCROSSEAREST
T //" i J %�-=d
RECEPT. TOTAL NO. EACH FEE 7
OUTLETS FIRsr 20 $20 $ OWNER
uBur MAIL
SwlTcu ADD'L ADDRESS �i"Y/ FJ.
OVER 20 .1D
TOTAL CITY + A ') ) TEL. NO.
LIGHTING I FIRST 20 .zo
FIXTURES I A00'L
OYER 20 .to ELECTRICIAN PC74'�e'
RANGES CLO.DRYERS WiR.HTRS. 1.00 ADDRESS P /�•'FK� n.
GARB.DISP. / STA.COOK I C+✓'-SII
Q� CITY TEL. NO. I L� G
DISHWASH. AUTO.-WASH. I j/,,'
STATE
SPACE HTRS. STA.APP.(1/H.P.MAX.)MAK.) .50
LICENSE NO. n
MOTORS: OVER NOT OVER H.P. DISTR CT NO. GROUP ZONE PRO ESSED Y
O 1 1.00 -
(��-„� i — 3 1.50 INSPECTION RECORD _
3 — B 2.00
e 15 2.60 O
15 50 3.00 l/V 7A Uf-/'� �+K !w
50 too 5.00
SIGNS: NO.TRANS. I�JJ
d
NO.LAMPS 'Al
z_
SERVICE O-6OOV-NOT OVER 200A 1.00 10
SERVICE 0.60OV-OVER 200 A. 2.00
SERVICE OVER 600V 5.00
MISC.
PERMIT ISSUING FEE 2.001 146
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE - . $
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION - .APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT -..1
WITH ALL COUNTY ORDINANCES AND STATE LAWS. REGULATING
ELECTRICAL WIRING.
WIRING
1
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR '� ` ).
LICENSED A9 REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR JHAT 1 AM THE LEGAL OW R OF THE ABOVE -
DESCRIBED flE91DENTIA OPER � POWER
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTEE �•R� �+
FINAL VJ
VALIDATION ARTHUR C. VEIT f 1 F
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
L'{4 7 8 4 5 Q Aill 2 5 2 0 6.2 0;�,':a
- .I i
WORKERS' COMPENSATION DECLARATION rm 76A llnvTieT APPLICATION FOR ELECTRICAL PERMIT O
4heceby affithat I have a certificate of consent to sell JGAyy3
ceeoaa
insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
or o certified copy thereof (Sec. 3800, Lab. C.)
Policy No. PC943677 CompanyRepubl i c Indemn.i ty FOR APPLICANT TO FILL IN JOB
❑Certified copy is hereby furnished. New Residential Bldgs. 8 Pools, EACH NO. FEE ADDRESS 8909 East Hermosa Dr.
❑Certified copy is filed with the county building inspec- 18 2-Family, Sq. Ft. $ — $ LOCALITY Temple City
tion department, OR
q' Multi-family Sq. Ft. — NEAREST
6/17/ np Residential Swimming Pools CROSS ST.
Dote plicanl
FIRM NAMEMr. & Mrs . David Lan
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec—Light_Sw._ MAIL 8909 East Hermosa Dr.
COMPENSATION INSURANCE First 20 ADDRESS
(This section need not be completed if the work involved by Total No. Additional CITY Temple C 1 t Tel. No.
the permit is for one hundred dollars ($100)or less.) PLAN CHECK
I certify that in :he performance of the work for which this
APPLICANT
permit is issued, shall not employ any person in any tion Laws.
so as to become subject to the Workers'Compensation Lows. Lighting Fixtures First 20 ADDRESS
Total No. Additional CITY Tel, No.
NOTICE APPLICANT: If, after Date—Applicant, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT
Exemptionn,, you should become subject to the Workers' Range— Heater—D.W. APPLICATIONBryant Heatin & A/C
Compensation provision's of the Labor Code, you must forth- Oven — Dryer —W.M._ ADDRE551350 East Las Tunas Dr
with comply with such provisions or this permit shall be Top — FAU —W.H. —
deemed revoked. Hood — Fan —Other— CITYSan Gabriel Tel, No.
LICENSED CONTRACTORS DECLARATION Disp. _ Room Air Cond. _ LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER 221751 Class.
(commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. PRO ESSED BY >_
and Professions Code,and my license is in full force and effect. G
221751 Size 8 Type HP, KW, KVA, or KVAR O
License Number Lic. Class C-20 Up to 1 Incl. FINAL U
Over I to 10 Incl. VALIDATION
Contractor Bryant Htg. & A/�,e 6/17/92 DATE ! ,d CC
Over 10 to 50 Incl. FINAL -- ti✓i.' �-
❑ I am exempt under Sec. Over 50 to 100 Inc. gyLU
/y� U
a-
/ 3 l/�
8.8P.C. for this reason Over 100 Tn
Date: Services, Swbd., MCC 8 Ponelboards , y� �� A Z
0- 200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600 V
❑ Exemption for Reg. Moine. Elect. Over 1000 Amp. or Over 600 V
SINGLE FAMILY Temp. Power Pole 8 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 Additional Sign Branch Circuits jOJ Vit, �i_
Professions Code):
.I a t l-I T-' —
El 1, as owner of the property, will do the work and the Misc. Conduits 8 Conductors
FSI _
AL �. ji-L°s
Other (See Complete Fee Schedule
structure is not intended or offered for sole(Section 7044, ( P )—
—
Business and Professions Code). , CHECK
CONSTRUCTION LENDING AGENCY i_H jci�F viz
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 24 75
Lender's Address $34.43
I certify that I have read this application and state that the TOTAL FEE
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
6/17/92
o:
Signature of Permittee Dote