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Home My Public Portal About9960 HOWLAND DR_Electrical__ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of County Engineer DIVISION OF BUILDING & SAFETY WILLIAM J. FOX, County Engineer EloDuTRIC FOR APPLICANT TO FILL IN DISTRICT NO. (3 N ROUP ZOE PERMIT NO. ELECTRICIAN/f, d � n - -� _ADDRESS � d��A°djj �.d��p�Q-�7 (/R E�C�-E}�I'�V�"E�,Y FIRST�INSPECTION DY FOR DATE 19SUryD CITY Q A4 //4DA _ �/ TEL. NO. �p-U O// ` / - ✓� V COUNTY LICENSE NO. EXPIRES BUILDING ADDRESS PERMIT FEES --- FEE •,� NUMBER EACH _ LOCALITY LIGHT OUTLETS NEAREST // (.K be �d _ RECEPTACLES CROSS ST. � •' WALL SWITCHES OWNER,C1 A/. Lem• 4Iq 4 d Nom_ TOTAL OUTLETS Sc $ MAIL _ /�p/� ,/ � AODRESS� ELEC. RANGES 25 ELEC. HEATERS 25 CITYJjy/ �y TEL. NO. Q FIXTURES 5 1 HEREB ACKNOWLEDGE THAT 1 HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. MOTORS 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER NEW MVD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. / °/2 & LESS .25 SIGNATURE D .� V2 2 .50 PERMITT 2 s 1.00 INSPECTION RECORD _ s is 1.50 _ 15 5o 2.50 so 200 5.00 _ 200 Sao 10.00 500 1ODO 15.00 Q - Z OVER 1000 20.00 G M.G. SET/FREE). CHANGER-HP WELDERS' AC-KVA O GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (75% OF GRIG.) MOVED MOTORS (75% OF ORIG.) MISC. SIGNS AT NO. NO.TRANS. APPROVALS NO. NO. LAMPS FOR EACH PERMIT: _ DATE INSPECTOR'S NAME WIRING $1.00 CONDUIT -_ FIXTURES $1.00 � WIRING SUPPLEMENTARY ,50 FIXTURES POWER _ TOTAL FEE `�� UTILITY CO. NOTIFIED FINAL 76A663 DBS#5A 4-52 « A �, V RKERS'COMPENSATION DECLARATION CE-806 tout Qppp CATMN FOR ELECT o CAL po E oRnn�5r • �^ CE-806G L� Il V FOR uU u V u 11 I here6y'affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified.copy thereof (Sec. 3800, Lab. C.) - Policy No. - Company FOR APPLICANT.TO FILL IN JOB D ^ Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS / /SOC/ �10 n Certified copy is filed,with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY ic17 y ` tion department. Multi-family Sq. Ft. — NEAREST , LDIV//*y gz_0 Residential Swimming Pools CROSS ST. v/ V kJ Date Applicant OWNER OR. -po ` DI it 2f/_ ' FIRM NAME ✓ s �(� �'r1C CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL /J_ -' COMPENSATION INSURANCE ADDRESS 47i 27 L First 20 (This section need not be completed if the work involved byCITY Tel. No. the permit is for one hundred dollars ($100)or less.) Total No. Additional I certify,that in the performance of the work for which this PLAN CHECK P APPLICANT permit is issued, I shall not employ any personin any manner so as to become subject to the Wor rs'.Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional Z ,� �� Total No. CITY Tel. No. Date '� �/� Applicant Fixed Appliances Not Over 1 HP PERMIT L NOTICE O•`APPLICANT. If, after/maker g this Certific e of APPLICANT. T,951L ON L Ly Exemption, you should become 'subject' to the Workers' Range_ Heater—D.W. — Compensation provisions of,the Labor Code, youmusf forth- Oven _ Dryer _ W.M.— ADDRESS i411f U with comply with such provisions or this permit.sholl be Top FAU —_ W.H. — deemed revoked. Hood Fan Other_ CITY �� t 9/7,?C� � r3 Tel. No: �- q;Z i _ _ LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I-am licensed under provisions of Chapter 9 Disp. _-Room Air Cond. REG. NUMBER •Class. - (commencing with Section 7000) of Division 3 of.the Business' DISTRICT NO. OCES D BY Power Apparatus& Large Appliances -� and Professions Code,and my license is in full force and effect. l G Size &Type HP, KW, KVA, or KVAR O License Number Lic. ClassUp to 1 Incl. -FINAL Contractor Date ' Over 1 to 10 Incl DATE r7 j�:� VALIDATION O 2 1174 Over 10 to 50 Incl. FINAL / U ❑. I am exempt under Sec. Over50 to 1;00 Inc. BY UJ 0. B.&P.C. for this reason Over 100 of Services, Swbcl , MCC& Panelboards D Date: 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp Under 600 V aOver 1000 Amp. or Over 600 V Exemption for Reg. Mainz. Elect. SINGLE FAMILY Temp. Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and Professions Code): ' I, as owner'of the property, will do the work.and the Misc. Conduits&.Conductors structure is not intended or offered for sale (Section: Other (See Complete Fee Schedule)_ 7044, Business and Professions Code). �- 26 0 IL 55 A CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for # o o a o 0 2' the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) 2�,Jr Q (Sec. 3097,Civ. C.). PLAN CHECKING FEE o,u ® �5.5 Lender's Name PERMIT ISSUING FEE A� Lender's Address 2 0 2-8 6 I certify that 1-have read)this application and state that the TOTAL FEE V - above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and her y authorize representatives of this County to enter upon th bove-mentioned property for inspection purposes. ' SEE REVERSE FOR EXPLANATORY LANGUAGE Si .ature of Permittee Date