HomeMy Public PortalAbout6032 IVAR AVE_Electrical__ 76A689-CE806 3-58 A Il 11 L O C A TM N FOR E LS E C T M C II E R M T
COUNTY OF LOS ANGELES ��
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
CASSATT D. GRIFFIN,SUP'T OF BUILDING LOCALITY
�a
r FOR APPLICANT TO FILL 1N NEAREST 1
PERMIT FEES cRoss
ST.
1 T E M NUMBER I EACH FEE OWNER
OUTLETS/ $ MAIL
LIGHTS RECEPT. SW. .10 ADDRESS
LIGHTING FIXTURES f0 f CITY TEL.NO.
ELEC.RANGES CLO.DRYERS ELECTRICIAN `
WATER HEATERS .50 ADDRESS ' u
ELEC.SPACE HTRS. DISHWASHERS
• CI + TEL..NO
g, GARBAGE DISPOSERS AUTO.-
STATE
WASHERS STA.COOKING UNITS .25 LICENSE NO.
MOTORS: OVER INC. H'.P. DISTRICT O. GROUP,I ZO E I PR ESSED BQY� .
0— 1/2 25 JCC
a
2/2— 2 .50 INSPECTION RECORD
2— 5 1.00
s— 1s 1.50
is— so 2.50
50—200 5.00
NO.TRANS. 9 r
SIGNS:
NO.LAMPS
SERVICE 0-600V 1.00
SERVICE OVER 600V 5.00-
k p
MISC.
WIRING PERMIT 1.00
FIXTURE PERMIT 1.00 00
SUPPLEMENTARY PERMIT .50
TOTAL FEE $ r
s 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
o AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT -
ELECTRICAL WIRING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 4 WIRING
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 M THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL ROPERTY. POWER
SIGNATURE f UTILITY CO.NOTIFIED
OF PE RMITTE
-w. FINAL ���.Z�'-
OF 4 VALIDAT ARTHUR C.VETT,
' CK MO_ CASH
SUPERVISING ELECTRICAL ENGINEER
LAG 4 ' o 21 2 A 2 .40
WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) API UCA 0 �®N FOR EL�EC�•�� ALS PERNT !
�J
I hereby affirm that,I have a certificate of consent to self insure, 76A663
or a certificate of Worker's Compensation Insurance, or a certified COUNTY Or LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec. 3800 Lab.C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB �V J
Certified copy is hereby furnished. New Residential Bldgs:&Pools NO. EACH FEE ADDRESS V
❑ _ $ $ LOCALITY
Certified copy is filed with the county building inspection 1&2-Family,Sq.Ft. NEAREST
department. Multi-family Sq.Ft. CROSS ST.
Date Applicant Residential Swimming Pools ASSESSOR
MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER OR
COMPENSATION INSURANCE Outlets:Rec. Light Sw. FIRM NAME
First 20 � .MAIL
(This section need not be completed if the work involved by the Total No. Additional D ADDRESS
permit is for one hundred dollars($100)or less.)
1 certify that in the performance of the work for which this permit CITY Tel.No. -{ {0-
is issued, I shall not employ any person in any manner so as to /� PLAN CHECK
become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT e
c! n c �,,� Total No. Additional ADDRESS "S
Date CrrV`C Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE TO APPLICANT: If, after making this Certificate of CITY 9c,1-10 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
provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT
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 Incl.
(commencing with Section 7000) of Division 3 of the Business and CITY Tel.No,
Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICESE OR / r' }
Over 50 to 100 Incl. REGNNU BER �(pJ / � Class �./ a
Over 100 DISTRICT NO. PROCESSED BY O
License Number ', Lic.Class 0
G Serv' Swbd��M7CC P ne boards
FINAL
Contractor Date. 5� 0/ m . n e 66600 V DATE '
❑ 400-1000 Amp.Under 600 V �2 t{ 1!' -�'
I am exempt under Sec. / G• VALIDATION W
Over 1000 Amp.or Over 600 V FINAL 10L
B.&P.C.for this reason BRANCH CIRCUIT FEES BY f0
Date: 15A,or 20A,120V,Lighting or Recept. Z
1 To 10 Branch Circuits
Signature 11 To 40 Branch Circuits
❑ 41 Or More Branch Circuits 2
Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits
AC:CT e s•Q-
SINGLE FAMILY Temp.Power Pole&Appurtenances ., -,
HOME OWNER-BUILDER DECLARATION 3 303 123. 20
I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit i ITEM
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch CircuitsS
1
Cade):
El Misc.Conduits&Conductors TOTAL 1 +' p
20
I, as owner of the property,will do the work and the structure 7
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) D CASH 1?J=20
and Professions Code).
CHANGE .00
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the 8/96
performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) O 0000-0001 5f/
Civ.C.)
PLAN CHECKING FEE 6292 1 AN 8:43
Lendq's Name
PERMIT ISSUING FEE a
Lender's Address
I certify that I have read this application and under penalty of purjury state TOTAL FEE Aa /5
that the 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 insp ;urpon. SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNATURE OF PERMITTEE DATE