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HomeMy Public PortalAbout5936 IVAR AVE_Electrical__ 76AG63-CEBOG-6-57 APPLICATION FOR ELECTRIC PERMIT, 1- COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A.LAMBIE,COUNTY ENGINEER CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. PERMIT FEES OWNER : Gr LIGHTS RECEPTACLES SWITCHES NUMBER 1 TEM EACH FEE MAIL .�. TOTAL OUTLETS $ .10 g ADDRESS ELEC. RANGES, WATER HEATERS, CITY TEL.NO. CLOTHES DRYERS .50 ELECTRICIAN -' 1 ELEC. SPACE HEATERS, STAT-Y. COOK- ' ING UVTS, GARBAGE DISPOSERS, 5' ADDRESS �� \ ` AUTO WASHERS, DISHWASHER .2 LIGHTING FIXTURES ,10 CITY TEL.NO. MOTORS STATE Q b LICENSE NO. HORSEPOWER .:. ._.. . H.P.- OVER INC. DISTRICT NO. GROUP ZONE READY FOR INSPECTION LESS .25 ® , '2 - 2 .50 INSPECTION RECORD 2 — 5 1.00 5 — 15 1.50 - - 0, FOR 15 — 50 2.50 I I G� + n 50 — 200 5.00" MISC. j� Ale!YV ^ Y SIGNS I NO.TRANS NO.LAMPS SERVICE O-600V 1.00 go C) SERVICE OVER 600V 1 5.00 WIRING PERMIT 1.00 FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT .50 APPROVALS TOTAL FEE g I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS API`7CA�TIIA 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 AND/OR FIXTURES �` 7!� LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE POWER ' DESCRIBED RESIDENTIAL PROPERTY. SIGNATURE C UTILITY CO.NOTIFIED — - OF PER ITTE&M AAA 2 FINAL JOHN A.LAMBIE. VALIDAP-'�N ARTHUR C.VEIT, COUNTY ENGINEER CK Mo SUPERVISING ELECTRICAL ENGINEER �JCo 2.6 5 8 P; SEP 2 5 2 �7.�6 5 j ®P WORKERS' COMPENSATION DECLARATION zo-ool9DPW sia7 APPLICATION FOR ELECTRICAL PERMIT O CE-806 *karybj�ffirm that I have a certificate of consent self ce-aoeG � ;I- ' irisunn or a certificate of Workers' Compensation In ur nce, Q COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or u c tified co he f (Sec. 38 _ ,.Lab. .) a "l� ( Polio ompan FOR APPLICANT TO FILL IN JOB Certifie copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS Certified copy is filed with 4th c my building inspec- 1 &2-Family, Sq. Ft. $ — $ LOCAL IT rime t. Multi-family Sq. Ft. — NEAREST Residential Swimming Pools OWNERCROSS SOR T. Dat Appl icon FIRM NAME CER INCATE OF EXEMPTION FROM WO RS' Outlets: Rec Light Sw._ ADDIL RESS COMPENSATION INSURANCE First 20 (This section need not be completed if the work involved by Total No. Additional CITY Tel. No. the permit is for one hundred dollars ($100)or less.) I certifythat in the erformance of the work for which this PLAN CHECK at e P APPLICANT permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No. Date Applicant Additional CITY Tel. NFixed Appliances Not Over 1 HP PER NOTICE TO APPLICANT: If, after making this Certificate of APPLI Exemption, you should become subject to the Workers' Range— Heater—D.W. Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— , ADDRESS with comply with such provisions or this permit shall be Top — FAU �—W.H. — deemed revoked. CITY Tel. Hood Fan —Other— J LICENSED CONTRACTORS DECLARATION Q LICENSE OR Disp. _ Room Air Cond. REG. NUMBER �7 ass I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. (/ PROCE S BY d m and Professions Code nd y license is in full fo and effect. �([J i Size&Type HP, KW, KVA, or KVAR O License N ber / Lic. CIII Up to 1 Incl. FINAL U Over 1 to 10 Incl. DATE VALIDATION Contrac r Date Over 10 to 50 Incl. 0 F-1FINAL U I am exempt under Se Over 50 to 100 Inc. BY LL B.&P.C. for this reason Over 100 t1 Services, S CC& Panelboards U) Date: Z 200 Amp. U er 600 V SignatureAmp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits - Professions Code): - -. ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors rl _ ' ` structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ Business and Professions Code). CONSTRUCTION LENDING AGENCY 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 U '« Lender's Address 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 ordinand State laws regulating Electrical wiring, and hereb out ize representatives of this County to enter upon thea ove- nt' d property for inspecti n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE .11 - . �)eq Signature of Perm' a Date ©s ISI