HomeMy Public PortalAbout6109 IVAR AVE_Electrical__ 76A663-CE806-11-s, Q p p L 0 C A if M N F0 R E L E.0 T M C' P E_ m'9 T
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS /c ,7
)]OHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN,Sup t of Suildinsl LOCALITY
FOR APPLICANT TO FILL IN Y'
NEAREST
PERMIT FEES
ITEM NUMBER EACH FEE OWNER /
OUTLETS: $ $ MAIL
LIGHTS RECEPT. / SW. .10 1 /0'' ADDRESS
LIGHTING FIXTURES .10 CITY TEL.NO.
oi ELEC.RANGES < O.DRYERS
ELECTRICIAN jIE
WATER HEATERS / .50 SOyJ �^
` ELEC.SPACE HTRS. DISHWASHERS . ADDRESS//fD
GARBAGE DISPOSERS AUTO.- CITY 4y.+- TEL.NO. r/Z�Kla
° WASHERS STA.COOKING UNITS .25 STATELICENSE NO.,/O
MOTORS: OVER INC. H.P. - - °:d'• -i�•s4. '
o — I/2 25 DISTRIC O GRO P ZONE READY FOR INSPECTION
1/2 — 2 . .50
z - 5 1.00 INSPECTION RECORD
5 — 15 1.50
15 — 50 2.50
50— 200 5.00
SIGNS: NO.TRANS. '
NO.LAMPS
SERVICE 0-600V 1.00
`r SERVICE OVER 600V 5.00
MISC.
WIRING PERMIT 1.00,
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .50' -
TOTAL FEE $ APPROVALS
I HEREBY ACKNOWLEDGE THAT I HAVE'"READ THIS APPLICATION- DATE INSPECTOR'S SIGNATURE
+� AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY n. CONDUIT /
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 7.
t ELECTRICAL WIRING. WIRING F `�
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ! FIXTURES
CALIFORNIA OR THAT I AM THE LEG4g OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROP/EERR&, ��
POWER . .
SIGNATURE !//!,// C -y UTILITY CO.NOTIFIED
fe
OF PERMITTEE
- - . _�,.:,. .,Y-;; FINAL
LIDATION ARTHUR C.VEIT.
cK Mo CASH SUPERVISING ELECTRICAL ENGINEER
[fGa NOV 17 2 n 1 .60 � :.
DEC
TION
WORKERS'COMPENSATION cafe of corse 71A13 DPW 3/87 /�1 fo�P C n I N FOR
ELECYMCAL� l�L511�(IVII� Il
I hereby affirm that I have a certificate of consent"to self - CE 806E G�11T IT L� G=�1 I1 V lJ- Ili ll
insure, or a Certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
or a certified copy thereof (Sec. 3800, Lab. C.)'
Policy No. Company FOR APPLICANT TO FILL IN JOB /l I O� 'i-v J�_V,
Certified copy is hereby furnished. +4ew.Residentiol Bldgs. 9,Peofs- EACH NO. FEE ADDRESS (0J - /S
Certified copy is filed with the county building inspec- 1 &2-RaF44, Sq. Ft. �L'� $ _ $ LOCALITY � �l
tion department. Multi-family Sq. Ft. NEAREST
Residential Swimming Pools CROSS ST.
Date Applicant OWNER OR
FIRM NAME A �A�
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec�Light Sw. MAIL
First 20 �f-.G�Aq S f�/�
COMPENSATION INSURANCE l ADDRESS
qq Q
(This section need not be completed if the work involved by Total No. 111 1 Additional CITY Tel.-No($jP)5?'I-'aF
the permit'is for one hundred dollars ($100)of less.) ��� PLAN CHECK
I certify that in the performance of the work for which this1C)�� ��/� APPLICANT
permit is issued, I shall not employ any person in any manner v
so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
Additional
Date Applicant
Total No. CITY Tel. No.NOTICE TO Fixed Appliances Not Over 1 HP PERMIT APPLICANT: If, after making this Certificate of 2 APPLICATION
Exemption, you should become subject to the Workers' Range— Heater—D.W. .
Compensation provisions of the Labor Code, you must forth- Oven Dryer J_W.M.J_ ADDRESS
with comply with such provisions or this permit shall be Top FAU W.H. -L-
deemed revoked. CITY Tel. No.
LICENSED CONTRACTORS DECLARATION Hood Fan Other_
Disp. — Room Air Cond. LICENSE OR Class. -
I hereby-affirm that I am licensed under provisions of Chapter 9 REG. NUMBER
(commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PRO SSED DY >_
and Professions Code,and my license is in full.force and effect. a
Size &Type HP, KW, KVA, or KVAR 0 O
License Number Lic. Class Up to 1 Incl. FINAL / V
DATE
Contractor Date Over 1 to 10 Incl. VALIDATION 0
Over 10 to 50 Incl.
FINAL U
I am exempt under Sec. Over 50 to 100 Inc. BY ��-' /' LLJ,
B.&P.C. for this reason Over 100 a
Services, Swbd., MCC& Ponelboards y�% �j U)
Date: -200 Amp. Under 600 V �J V '. - — .
Signature 201 -1000 Amp. Under 600 V
Over 1000 Amp. or Over 600 V
Exemption for Reg. Maint. Elect.
SINGLE FAMILY Tempa Power Pole&Appurtenances - 3307 6,1.`0
HOME OWNER-BUILDER DECLARATION . •..... -
I hereby affirm that l am exempt from the Contractor's License Sign with One Branch Circuit - 1 ITE
MS
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits TOTAL 63.50
3 o 50
1J 4�
Professions Code): �
1, as owner of the property, will do the work and the Misc. Conduits&Conductors IAOJN 63.50
structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ D CHANGE 00
Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for -Q001. '11/22/89
the.performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.). 6963 1 AM ,8:24
Lender's Name
PLAN CHECKING FEE -
PERMIT ISSUING FEE
Lender's Address 3
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
@'
Sig ature of Permittee Date
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PART' iENT
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