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HomeMy Public PortalAbout9165 HERMOSA DR_Electrical__ TEWIPILE CRTY °0A0°°.°°°°°'°° APPLICATION FOR ELECTRICAL PERMIT 'I COUNTY OF LOS ANGELES _ DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESSL':�L JOHN A.LAMBIE. COUNTY ENGINEER WILLIAM A.JENSEN, SUP'TOF BUILDING LOCALITY e 1 FOR APPLICANT TO FILL IN CROSS STT 601 ��/`'e PERMIT FEES OWNER �Y LI r-c ii ea ITEM NUMBER EACH FEE MAIL OUTLET ADO RE LIGHTS RECEPT. SW. .10 _ LIGHTING FIXTURES f0 / CITY TEL.N '+ n ELEC. RANGES CLO. DRYERS ELECTRICIAN Ii-P ////. .C1% 'L:✓' WATER HEATERS .50 ADDRESS Sn C•'-c / ELEC.SPACE HTRS. DISHWASHERS CITY ( TEL.N0.0'7_6 6 S S� GARBAGE DISPOSERS AUTO.. STATE WASHERS BTA.COOKING UNITE .25 LICENSE NO. MOTORS: OVER INC. H.P. DIST ICTN . GR(� fflNE I P, SSED BY 0 — V. .25 5i I V2 — 2 so INSPECTION RECORD 2 — 5 1.00 7 a 5 — 15 LBO O V 15 50 2.50 m SO 200 5.00 0 V W SIGN$I NO TRANS, 1 1 NO. LAMPS / Z SERVICE 0.600V 1,00 ( UQ SERVICE OVER 600V 5.00 MISG. WIRING PERMIT 1,00 Oa FIXTURE PERMIT 1,Oo U SUPPLEMENTARY PERMIT ,50 TOTAL FEE $ 3 Q 1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR LICEN9E0 A8 REOUIR BY L08 -NGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR T M T OWNER OF THE ABOVE DESCRIBED RE81 AL P POWER SIGNATURE UTILITY CO. NOTIFIED - A/ IM U FINAL LIDATION ARTHUR C.VEIT. CK Mo CASH SUPERVISING ELECTRICAL ENGINEER Lf,_CD4692 �— AR31 2 D 3.70 \Z.WORKER' COMPENSATION DECLARATION 20-ools DPW(1z-9n have - APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to sell Insure, 6-683 or a certfEcate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof.(Sec.�3800 Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN AOOR ESS `I1Y U-P_rW0.%a �r, F1. Certified copy is hereby furnished." .New Residential Bldgs.&Pools NO. $ EACH $ FEE LOCALITY T IC G Coo Ci'''&C) ❑""Certified copy is filed with the county building inspection 1&2-Family,Sq.Ft. department. Multi YSo:Ft. _ NEAREST CROSS ST. Date ° Applicant Residential Swimming Pools ASSESSOR ' MAP BOOK o PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' it ( OWNER OR Outlets:flet _Light Sw. G RM NAME JM(A 10 thil COMPENSATION INSURANCE First 20 /o / tL �j^ (This section need not be completed if the work involved by the MAIL (�] permit is for one hundred dollars(5100)or less.) 7�' p Total No. Additional ADDRESS g+i I certify that in the performance of the work for which this permit CITY LU LQ"1� el. is issued, I shall not employ any person in any manner so as to became subject to the Workers' Compensation Laws. Lighting Fixtures First 20 PLAN CHECK I P APPLICANT Total No. Additional U ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. Od$" NOTICE TO APPLICANT: If, alter making this Certificate of CITY Tei.No. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT ppAPPLICANT Power Apparatus&Large Appliances t_lj�i(f7e,(y provisionsor this permit shall be deemed revoked. , LICENSED'CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS - I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Ind.(commencing with Section 7000) of Division 3 of the Business and CITY T.I.No. Professions Cade, and my license is in full force and effect. Over 10 to 50 Ind. LICENSE OR 7• Over 50 to 100 Ind. REG.NUMBER Claes. d Over 100 DISTRICT NO. P CESSED BY O License Number Lic.Class 0 Services,Swbd.,MCC&Panelboards Contractor - Date. 0-399 Amp.Under 600 V FINAL 0 ❑ Iam exempt under Sec. 400-1000 Amp. Under 600 V VALIDATION W Over 1000 Amp.or Over 600 V FINAL .., d B.&P.C.for this reason - - BRANCH CIRCUIT FEES BY ct) Date: 15A,or 20A, 120V,Lighting or Recept. Z 7 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits 'Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Sr.Circuits SINGLE FAMILY3 TT=Temp. Power Pole&Appurtenances _ 1'_: HOME OWNERBUILDERDECLARATION "��4 8 I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit AM.A.0 7230 �.0 for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits II-- ii'' �!. fir[ Code): tii DVT'. L Cr f'1pL'� eliil I, as owner of the property,will do the work and the structure Mine,Conduits 8 Conductors is not intended of offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). CONSTRUCTION LENDING AGENCY fSS�I(i{—L) 111� SyY I hereby affirm that there is a construction lending agency for the 'r!i l ASL performance of the work for which this permit is issued (Sac. 3097, PERMIT FEE (Sub-Total) ' Civ. C.) .. PLAN CHECKING FEE Lender's Name ... , PERMIT ISSUING FEE alp Lender's Address TOTAL FEE a 3 I certify that)have read this application and under penalty of purjCury state that the above information is correct. I agree to comply with all ounty ordinance�s��mld State laws regulating Electrical wiring,and hereby authorize represe tafives of This County to enter upon the above-mentioned property - for in tion purp �s' SEE REVERSE FOR EXPLANATORY LANGUAGE /L- Z- 9� -TORE OF PERMITTEE DATE v( t ,�.,,c cICUMPENSATIONDECL RATION 76A663 t0i81 /L ��I APPLICATION foR° EL CT.RICAL .PERMIT ­177S_ nereby a firm that I have a certificate of consent'to se'f CE-8066 A L A insure or'L{certificate of Workers Compensation Insurances }- •i COUNTY OF LOS ANGELES• BUILDING'AND SAFETY or'a certified-� xiy thereof (Sec 3800,-I,ab.,C.) r ,i Policy NO. <. Company > "'P: FOR APPLICANT TO FILL IN - -- - 'TOB HE4 44©� O ,;Certified copy is hereby furnished. } New Residential Bldgs. 8 Pools EACH NO. DDRESS FEE ; AJ Certified copy is filed with the county building inspect 18.2-Family, Sq. Ft. $ — $ LOCALITY ' T5wC tion department. - - Multi-family Sq. FL — 'NEAREST ' } CROSS ST. G I Date Applicant +' Residential Swimming Pools OWNER OR FIRM.NAME LCJ d E CERTIFICATE OF EXEMPTION FROM WORKERS' 1 Q2 -Z,d .MAIL _ Outlets: Rec_Light�Sw._ ADDRESS / C COMPENSATION INSURANCE 1 I (� I t0 0 6 £j�4 (This section need not be completed if the work involved by` Total No. ,5�. First 20 CITY y� Tel. No. S" the permit is for one hundred dollars ($100 or less.) - t Additiona6 I l 6 certify that in the performance of the k foeic s PLAN CHECK �cr permit is issued, shall not employ any son ins APPLICANT WA-/L c�"Aso as to become subject fo the Worke 'Comp . Lighting Fixtures ' First 20 v '✓" ADDRESS - Total No. Additional CITY Tel. Na. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, a making his 'ertificat of• �/ .. Exemption, you should become subject to' the Workers' Range— Heater—D.W. APPLICANT C� �/( Q �p Compensation provisions of the Labor Code, you must forth- Oven _ Dryer _ W.M.— ADDRESS with complywith such provisions, or this permit shall be Top — FAU —W.H. — deemed revoked. - - _ CITY Tel. No. LICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other_ LICENSE OR y� hereby affirm that am licensed under provisions of Chapter 9 Disp. _ Room AirCond: REG. NUMBER (/ Class. (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCESSE Y and Professions Code, and my license is in full force and effect. Power Apparatus 8 Large Appliances �/ 0. Size &Type HP, KW, KVA, or KVAR' .� ' � Ur[ O License Number Lic,Class Up.to 1 Incl FINAL U Over 1 to 10 Incl. DATE VALID ON Contractor Date Over 10 to 50 Incl. O F-1FINAL am exempt under Sec. Over 50 to 100 Inc. BY W CL B.BP.C. for this reason Over 100 Z Date: - Services, Swbd., MCC & Panelboards /< 2 9 9 1.S A 0 - 200 Amp. Ude.6Dn v lJ 10, Signature ,"� 201 - 1000 Amp. Under 600 V x V # e e e,e e 2 ElOver 1000 Amp. or Over 600 V (y Exemption for Reg. Moinf. Elect. - ✓ � , /"y �,('• e7,1. rj Q SINGLE FAMILY Temp. Power Pale 8 Appurtenances 70,5 Q�._ HOME OWNER-BUILDER DECLARATION Sign with One.Branch Circuit V I hereby affirm that I am exempt from the Contractor's License additional Sign Branch Circuits \� 062.1 -88 Law fo he following reason (Section 7031.5, Business and - Prof Bions Code): Misc. Conduits 8 Conductors I, 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 I hereby affirm that there is a construction lendingagencyfor 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 ,l PERMIT ISSUING FEE (J S (� Lender's Address - I certify that I have read this application and state that the TOTAL FEE e yave-me,tii motion is correct. I agree to comply with all County - - and State law r gylating Electrical wiring, and horize rep iv sof this County to enter upon the r ty f inspection purposes(�} qq SEE REVERSE FOR EXPLANATORY LANGUAGE nature of Pfffa Date