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HomeMy Public PortalAbout9128 HERMOSA DR_Electrical__ 76^663-CEB0E 1017E, APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION ADDRESS LOCALITY F777, NEAREST OH APPLICANT TO FILL IN CROSS ST, OUTLETS NO. EACHI FEE OWNER OR $ $ FIRM NAME RECEPT._ MAIL FIRST 20 25 ADDRESS LIGHT TOTAL OVER 20 Cl TV TEL. NO. SWITCH_ 10 PLAN CHECK LIGHTING FIRST 20 25 APPLICANT FX OVER 20 ADDRESS TURES TOTAL 10 RESIDENTIAL APPLIANCES CITY TEL. NO. PERMIT RANGE—DRYER #.. WTR. HTR._ APPLICANT STA. COOKDISP. F.A.U._ ADDRESS SPACE HTR. AIR COND. CITY TEL. NO, CLOTHES WASH. DISHWASH. LICENSE OR CLASS. REG. NUMBER FAN_OTHER 1.00 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS. TRANSFORMERS HATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. SIZE & TYPE OVER TO HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR (L 0 — 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF THAIp CALIFORNIA OR THAI I AM THE LEGAL OWNER OF THE ABOVE V 7 — 10 3.00 OESCRIPED RESIDENTIAL PROPERTY. w J PERMITEE 1+ 10 — SO 500 SIGNATURE r z 50 — 100 1000 DISTRICT NO. PROCESSED BY CD 100 — SOO 1500 _ - �- L SIGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE wsPE[TDR's sIGNATO RE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 100 TEMP. POWER POLE SERVICENOTOVER600VOLTSOR200AMP 3.00 UNDERSLAS WORK SERVICE OVER 600 VOLTS OR200AMP 10.00 ROUGH CONDUIT TEMPSERVICE,POLE, &APPURTENANCES 5.00 WIRING TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED FINAL PERMIT FEE (SUB TOTAL) NOTES: PLAN CHECK FEE PERMIT ISSUING FEE 300 TOTAL FEE PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH r SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 76A663-CEBO6 10/72 APPLICATION FOR ELECTRICAL PERMIT g COUNTY OF LOS ANGELES ,DEPARTMENT OF COUNTY ENGINEER JOB ( / ' "BUILDING AND SAFETY DIVISION ADDRESS stff ,r�.• f�.!?•[[,lf+4..... $J! LOCALITYr4 r• NEAREST FOR.APPLICANT-TO FILL IN, I CROSS ST. OUTLETS - NO. EACH I FEE OWNER OR / y!(' 5 FIRM NAME / . MAIL LIGHT FIRST 20-. A25 F < ADDRESS ( Y •'L��'(.QA'fZ:{'�' J SWIiCH�} _L OVER 20CITY '� v TEL. N0. - .10 'PLAN CHECK. LIGHTING l TOTAL - FIRST 20 25 FIXAPPLICANT _ 1 OVER 20 "q ' ADDRESS TURES -.10 . f� RESIDENTIAL APPLIANCES CITY TEL. NO. RANGEPERMIT . ' - ``yyJJ r• v f 4 ANT /STA. COOKI015P. F.A.U.- A60RESSp f `I SPACE HTR. I AIR COND. CITY U/JU /"'STJ�S IEa TEL. NO.I,r• I nnC CLOTHES WASH.-DI SHWASH:_.: LISECER REG.NNUM9ER :2-Z O F CLASS. FAN_OTHER -/ 'I'.00 / D✓ I HENE.1 ACKNONLEDGE THAT I HAVE READ THIS APPLICATION ✓ AND STATE THAT THE ABOVE IS''CORRECT AND AGREE TO COMPLY 1 MOTORS. TRANS FORM EflS .RATING WITH ALL COUNTY ORDINANCES AND STATE .LAWS REGULATING IND. HEATERS, ETC. HP. KW. KVA. _ ELECTRICAL WIRING. SI Z E B TYPE OVER TO - HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR Y 0'- 1 1 DD ,LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF a ' CALIFORNIA Ofl THAL. I AM TOE LEGAL///OWNER OF THE ABOVE CD 1 - 10. 3.00 OESCR'IRED BES IOENTIAU Py PERTT� /. - U PTEE 10 - '50 500 - SEGNAITURE• 7'SE�l/ '�/ .�� ✓J.M1 u. SO - 100 1000 DISTRICT N0. P`R�O ESSEpZ °f BY 100 — S00' 10 00 4j S fis= c � Of SIGN, GAS SIGN AND ONE CIRCUIT 5.00 TUBE, OR APPROVALS.. DATE INSPECTOR'S SIGNATURE H MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE SERVICE NOTOVER 600 VOLTS OR 200 AMP' / . 3.00 .• �� UNDERSLASWORK - SERVICE OVER 600 VOLTS OR 200 AMP IOAO- ROUGH CONDUIT TEMP SERVICE,POLE,'&APPURTENANCES. 6.00 • WIRING TEMP LIGIT-OR RECEBT. SYSTEM 3.00 FIXTURES'- POWER.AUTHORIZED, UTILITY CO. NOTIFIED NAL PERMIT FEE (SUB TOTAL) NOTES: ` PLAN CHECK FEE PERMIT ISSUING FEE _ 300 TOTAL FEE ••• - i. �� PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M,O. "CASH T SEE BACK OF APPLICATION FOR COMPLETESCHEDULE I WORKERS'COMPENSATIONDECLARATION CE,806 APPLICATION FOR ,ELECTRICAL PERMIT CE 806G 12-801 LJ I hereby affirm that I have a certificate.of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or a certi£j'.e, copy jhereof(Sec. 3800,Lab. C.) ' 192-f 4690-2 FOR APPLICANT TO FILL IN Og' Policy No. Company Ins. Co. ADDRESS 9128 Hermosa of the Wast New Residential Bldgs.&Pools EACH NO. FEE Certified copy is hereby furnished. 1 & 2-Family,Sq. Ft. $ — $ LOCALITY Temple City © Multifamily Sq. Ft. — NEAREST Certified copy is-filed with the.'county building inspection CROSS ST Las Tunas department. - Residential Swimming Pools OWNER OR FIRM NAME 4-6-81 Edwards Electric Date Applicant Outlets: Rec.—Light—Sw._ ADDRESS . - .First 20 CERTIFICATE OF EXEMPTION FROM WORKERS' (.Total No. Additional CITY Tel No. COMPENSATION INSURANCE Y • - PLAN CHECK APPLICANT �- (This section need not be completed if the work involved _ ` O by the permit is for ones hundred,dollars ($100) or less.) Lighting Fixtures First Additional I certify that in'the performance of the work for which this F xed Appliarices Not Over 1 HP .CITY Tel No. 0 permit is issued, I shall not employ any person in any manner PERMIT W so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. _ APPLICANT E 6. • Oven _ Dryer_W.M._ ADDRESS t 2535 S. 3rd Ave. Z Date Applicant Top. _ FAU _W:H.._ CITY Tel No. Hood _ Fan _other_ Arcadia 447-5096 NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond._ - LICENSE OR - Exemption, you should become subject -to the Workers' - REG. NUMBER ClassC—In Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY with complywith such provisions or this permit shall beI deemed revoked. Size&Type HP, KW,KVA,or KVAR Up to 1 Incl. � FINAL /� s - Over 1 to 10 Incl. DATE G VALIDATION LICENSED CONTRACTORS DECLARATION Over 10 to 50 Iricl. I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. BY AL ,® 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 ness and Professions.Code, and my license is infull force and effect. Services , License Number 257191 Lie. Class C-10 0-200 Amp. Under 600 V 201-1000 Amp. Under 600 V Contractor Edwards Elee �e July 1982 Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances. _ I hereby affirm that I am exempt from the ContractorSign with One Branch Circuit 's Additional Sign Branch Circuits License Law for the following reason (Section 7031.5, Busi- ness and Professions Code)'. - 1 Misc.Conduits&Conductors Ell, as owner of the property, will do the work and the, Other (See Complete Fee Schedule)— ' structure is not intended or-offered for sale (Section - 7044, Business and Professions Code).' CONSTRUCTION LENDING.AGENCY �,4 7&0 A I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is PERMIT FEE ISu b-Total) a-e 'Z issued (Sec. 3097,Civ.C.). Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) •e e e o e e Lender's Address PERMIT ISSUING FEE 0 4 1 41-8 I certify that I have read-this application and state that the TOTAL FEE No 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� G�property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Vim-- ` LrWOg 4-6-81 Signature of Permittee' Date