HomeMy Public PortalAbout8915 HERMOSA DR_Electrical__ 78A6E3.CEB0E.7.59 APPLICATION FOR ELECTRIC PERMIT 1
BUILDING AND SAFETY DIVISION
Department of County Engineer BUILDING Q
County of Los Angeles ADDRESS 1
JOHN A. LAMBIE, COUNTY ENGINEER -
CASSATT D. GRIFFIN, SUP ,�T OF BUILDING LOCALITY D: IIA_
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES CROSS R
NUMBER OWNER
LIGHT OUTLETS MAIL
ADDRESS
2. RECEPTACLES
WALL SWITCHES FEE CITY QM//_,' TEL. NO.
TOTAL OUTLETS ® 50 5 ELECTRICIAN
y11 1 A Y - !tr.�.
ELEC. RANGES 25 ADORE`$��5 �pI.�r-1 ��1 -iZve.e�`. w-
ELEC. HEATERS 25 CITY All" G16 'TEL. NO.
KW EA STATE �
FIXTURES 5 LICENSE NO. 4
MOTORS DISTRICT NO. GROP ZE xEADr sox Ins xECT ION
NUMB Ex HORSEPOWER FEE I �U�
NEW MVO, HP OVER INC. EACH
Vi a LESS s .25 INSPECTION RECORD
Vi 2 .50 2 -.21-6' O. a - ✓A
2 5 1.00
5 15 1.50 ,
15 50 2.50
50 200 5.00
MISC.
NO. SIGNS NO. TRANS.
NO.SIGNS NO. LAMPS
FOR EACH PERMIT:
WIRING PERMIT 51.00
FIXTURE PERMIT $1.00
SUPPLEMENTARY .50 APPROVALS
TOTAL FEE g Q S DATE INSPECTORS SIGNATURE
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CONDUIT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING
ELECTRICAL WIRING. FIXTURES
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF POWER
CALIFORNIA OR THATI M T E EGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIA ROP T UTILITY CO.NOTIFIED �T
SIGNATURE
PERM TTEE FINAL `1r'� 1
JOHN A. LAMBIE. VALIDATT3:0Ph ARTHUR C. VETT.
vSN AR+H SUPERVISING ELECTRICAL ENGINEER
COUNTY ENGINEER CX Mo
i, 5 4 0 c-� F-E21 2 2.40
WORKERS'COMPENSATION!DECLARATION /6- 10/81 APPLICATION FOR ELECTRICAL PERMIT
BOS
!'hertbtl affirmrthat I have a certificate of ConsenT to self insure, CE-805G
or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof (Sec.3800.1_ab.C.) /' f�
Policy Na— Company .57ATE •GVVID FOR APPLICANT TO FILL IN JOS yolasa_
❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ADDRESS
'Certified co � $ — $ 'LOCALITY
copy is-filed withthe county building inspection 1 & 2-Family,S q'FL
department, Multi-family Sq.FL — NEAREST
-z2-9n Residential Swimming Pools OWNER OR
Date Applicant
FIRM NAME 1.V\ Gh
CERTIFICATE OF EXEMPTION FROM WORKERS' qqQQ MAIL ��jj
COMPENSATION INSURANCE Outlets'.RecZ Light Sw. �. O ADDRESS (9/
(This section need not be completed if,the work involved by the First 20
l CITY Tel.No.
Additional permit is for one hundred dollars ($100)or less.) Total No. ,
I certify that in the performance of the work for which this permit APPLICANT K
is issued, I shall not employ any persori.in any manner so as to �.
become subject to the Workers'Compensation Laws., Lighting Fixtures First 20 ADDRESS
Total No. Additional - CITY - Tel.No.
Date Applicant Fixed Appliances Net Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of
Exemption,you should become subject to the.Workers'Compensation Range_ Heater_ D.W. APPLICANT -Q
provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M._ ADDRESS
provisions or this permit shall be deemed revoked. Top — FAU _ W.H. CITYTel.No.
LICENSED CONTRACTORS DECLARATION
Hood — Fan Other_ td
I hereby affirm that I am licensed under provisions of Chapter 9LICENSE OR
Oisp. ROOM Air DOnd. - Class.
(commencing with Section 7000) of Division 3 of the Business and REG.NUMBER 6
Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT No, PR ED By
Size& Type HP,KW,KVA,or KVAR (]� U
LicenseNumber Lia Class L� Up to 1 Incl. FINAL
ContractoryyL(+ 0� G�LC�b S_ Date Q�-� �- 09 �1-T-- Over 1 to 10 Incl. D DATE J VALIDATION - Q
Over 10 to 50 Incl. FINAL U
ElI am exempt under Sec Over 50 to 100 Inc.. By 77 Wa.
B.&RC. For this reason Over 100 co
Z
Services, Swbd.,MCC & Panelboards
Date: 0- 200 Amp.Under 600 V f'
Signature 201 - 1000 Amp. Under 600 V
❑ Over 1000 Amp.or Over 600 V
Exemption for Reg.Maint.Elect.
SINGLE FAMILY Temp.Power Pale& Appurtenances Z
HOME OWNER-BUILDER DECLARATION SignwithOne Branch Circuit I /:�; z
I hereby affirm that 1 am exempt from the Contractor's License Law Additional Sign Branch Circuits ri " I '8
for the following reason (Section 7031.5, Business and Professions
Code): ,=,7.7=
❑ I,as owner of the property,will do the work and the structure Misc.Conduits 8 Conductors 1 17EMIS
is not intended or offered for sale (Section 7044, Business _ Other(See Complete Fee Schedule) T--
and Professions Code). rj"#T'A'a 67= 75
CONSTRUCTION LENDING AGENCY . ., CHECK _75
I hereby affirm that there is a construction lending agency for the ( r
M3E EIIJ
performance of the work for which thispermit is issued(Sec.3097, PERMIT FEE (Sub-Total) r
Civ.C.).
Lender's Name
PLAN CHECKING FEE - - §//i7J�_
7
PERMIT ISSUING FEE 2498 1 AM 9,1 C1
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, n y SEE REVERSE FOR EXPLANATORY LANGUAGE
SI na re of ermittee Date