HomeMy Public PortalAbout6002 IVAR AVE_Electrical__ 76A663-CE806 B-62 fX,lPl!'MCAlJ N, FOR ELECUMCAL PERNT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING ✓�
BUILDING AND SAFETY DIVISION , ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN, SUPT OF BUILDINGLOCALITY �-
-s-; n_ - .Ja 3.•' �1'.-.uC;` :r NEAREST r
FOR APPLICANT TO FILL IN V CROSS ST.
IfF REC EPT. TOTAL NO: $EACH FEE ✓ Y ,. -
OUTLET$ FIRST 20 20 $ OWNER
LIGHT 'MAIL
ADD'L ADDRESS
SWITCH'. y 9 OVER 20 •10 £_..
TOTAL -� CITY - L-NO.
i .LIGHTING � Flasr20 .20 � _
FIXTURES }� I ADD'L
OV R 20 10 ELECTRICIAN
_ 1 F
RANGES 'CLO.DRYERS WTR.HTRS. 1.00 ADDRESS Z4Z
GARB.DISP. STA.COOK
CITY TEL.NO. f
i' DISH WASH. AUTO.-WASH. 51. STATE +L
PACE HTRS. .STAv APP.(,/z H.P.MAX.) •50 7 LICENSE NO.
<.MOTORS: OVER NOT OVER H.P. ISTRICT NO GROUP. ONEOCESSED Y
A.
O 1 1.00
1 3 1.50 INSPECTION RECORD
3 8 2.00
8 15 2.50 -
15 50 3.00
D.
s: 50 - 100 5:00 • u
SIGNS: NO.TRANS d'
NO.LAMPS O
�d F"
`. SERVICE 0.600V-NOT OVER 200A 1.00 W
a
w SERVICE 0.60OV-OVER 200 A. 2:00 `
SERVICE OVER 600V 5.00 .m _
s. MISC. '
h.
PERMIT ISSUING FEE 2.00 C?
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE ffi
1 HEREBY ACKNOWLEDGE THAT'.1.HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND.STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT A
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING J
ELECTRICAL WIRING. WIRING
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR p�
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT\1 AM THE LEGAL OWNER OF THE ABOVE ♦ - _
DESCRIBED RESIDENTIAL P v f- POWER _
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTEE
FINAL
LIDATION ARTHUR C. VEIT
MO CASH SUPERVISING ELECTRICAL ENGINEER
u�c
5'L3=Q AUG° 2 A 5Q7O4,
W' WORKRS'COMPENSATION DECLARATION 76A663 10ie1 o 0 0 0 0 0
e I }e[eby a }rm hat' I,.have a certificate of consent to self CE-806G APPUC AT ON FOR ELEC��L3 CAL pC�G3�n 7
insure, or :certificdte of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
of a certified copy thereof (Sec. 3800, Lab. C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB V�
Certified co is hereby furnished. EACH NO. FEE ADDRESS C) V
PY Y New Residential Bldgs. & Pools
1 & 2-Family, S Ft. $ — $ LOCALITY �� LD
Certified copy isfiledwith the county building inspec-. Y, q
❑ NEAREST
tion department. Multi-family Sq. Ft. ILYN
CROSS ST.
Date Applicant Residential Swimming Pools M OWNER OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec g � � MAIL
COMPENSATION INSURANCE �Li ht Sw. (� ADDRESS
This section need not be completed if the work involved b� First 20 _ �y
( p Y Total No. Additional CITY <", Tel. No.
the permit is for one hundred dollars ($100)or less.)
I certifythat in the performance of the work for which this PLAN CHECK
P APPLICANT
permit is issued, I shall not employ any person in any manner
so as to become subject to the Workers',Compens ' n Laws. Lighting Fixtures First 20 ADDRESS
Total No. - Additional
Date — CITY Tel. No.
Applicant
Fixed Appliances Not Over 1 HP PERMIT
�
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT. .'e-a- {yY(�i^'
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 ,( ,g yl
with comply with such provisions or this permit shall be Top •_ FAU —W.H. —
deemed revoked. Hood Fan _Other_ CITY S e P 0,e N T& Tel. NgZ_0
LICENSED CONTRACTORS DECLARATION. LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. _ J REG. NUMBER Classes d
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROC S D BY
and Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances
Q l Size &Type HP, KW, KVA, or KVAR' O
License Number �t`V �� Lic. Class'^/ Up to 1 Incl. FINAL V
09
�'�C.: rt C Dat 2 A ' �� Over. 1 to 10 Incl. DATE 1 � �� VAL ATION. O
Contractor ! �` Over 10 to 50 Incl.
FINA U
F-1I am exempt under Sec. Over 50 to 100 Inc. _- BY us
B.&P.C. for this reason Over 100 H
Dat Services, Swbd., MCC & Panelboards
0 -200 Amp. Under 600 V
Signaturel&� ` P 201 - 1000 Amp. Under 600 V g 2 0.9 2 A
❑ Over 1000 Amp. or Over 600 V
Exemption for Reg. Maint. Elect.
# oo0'•002
SINGLE FAMILY Temp. Power Pole &Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit o ? 4.2 5 0
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 o o o 42-5 0 5
Professions Code):
❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors o 5 2 2—8 5
structure is not intended or offered for sale (Section. Other (See Complete Fee Schedule)— D
7044, 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
Lender's Address
PERMIT ISSUING FEE
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
ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
the above-mentioned property for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date