HomeMy Public PortalAbout9855 KEY WEST ST_Electrical__ 76A663 CE806 10-62 APPLICATION FOR ELE RICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING Lo �6
BUILDING AND SAFETY DIVISION ADDRESS 1�J7
JOHN A LAMBIE. COUNTY ENGINEER �+
WILLIAM A JENSEN, SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
RECEPT TOTAL NO EACH FEE
LLIGHTf OUTLETS FIRST 20 $.20 $ OWNER te V 0
MAIL
SWITCH ADD'L 10 ADDRESS
OVER 20
TOTAL CITY TEL NO
LIGHTING FIRST 20 20 /
FIXTURES Z
oADD L to ELECTRICIAN
RANGES CLO DRYERS WTR HTR3 1100 ADDRESS lam[ y 4"
GARB DISP STA COOK ( '6
CITY Z TEL NO' v-� "'v
DISHWASH AUTO-WASH - STATE _2
SPACE HTRS STA APP (y¢H P MAX ) 50 LICENSE NO L-
MOTORS OVER NOT OVER H P DISTRICTOW'z1
Z NE PR SED BY
O 1 loo L
I 3 1 SOy+p�,� p INSPECTIONIfRECORyD@��p
3 S 200 di'.Oid{� �' s /w u
8 15
250 r� ^�^ A _ �„,,� g od
1S 50 300 /J `»�-3��v ( r!� O
50 100 500
1 d
SIGNS NO TRANS
NO LAMPS , Npaw ZZ
SERVICE 0.60OV-NOT OVER 200A loo.
SERVICE 0-60OV-OVER 200 A 200
SERVICE OVER 600V 500
MISC
PERMIT ISSUING FEE 200 'O
SUPPLEMENTARY PERMIT ISSUING FEE 100
TOTAL FEE $_
n p It
1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS if d- A DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY !!�
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT W .n
ELECTRICAL WIRING WIRING
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR V_
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM THE LE L OWNER OF THE ABOVE
DESCRIBED RESIDENT ERT POWER -
SIGNATURE r� Lvo• UTILITY CO NOTIFIED ` �T��•."' B��
OF PERMITTEE ^n
FINAL r_�_�
IDATION AREC. VETT
SUPERVISING ELECTRICAL ENGINEER
6;
MO CASH
LAW6 8 3 7 'FuRR 2 Q 2 D 3.6 0-
WORKERS'COMPENSATIONDECLARATION 76A663
CE 806G (2-80) APPLICATION FOR ELECTRICAL PERMIT
I he affym that I have a certificate of consent to self COUNTY OF LOS ANGELES B D SAFETY
insure, or"a certificate of Workers'Compensation Insurance,or
Wrtifiedopy thereof(Sec 3800,L ) ,�
FOR APPLICANT TO FILL IN AU cy o Company EACH NO FE ADDRESS
_ New Residential Bldgs &Pools
Certified copy is hereby furnished a� �� 1 &2-Family,Sq Ft $ — Is LOCALITY
Multi-family Sq Ft NEAREST
�ertified copy is filed with the county building inspection CROSS ST PS
department Residential Swimming Pools OWNER OR / d
FIRM NAME V r
Date ApplicantOutlets RecLight 46 Sw �jl� D AIL
First 20 ADDRESS
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No Wf;� Additional CITY Tel No, -
COMPENSATION INSURANCE }
PLAN CHECK 4.
APPLICANT 0
(This section need `not be completed if the work involved
U
by the permit -is for one hundred dollars,($100) or less.) Lighting Fixtures First ADDRESS aC
- Additional
I certify that in the performance of the work for which this Total Appliances Not Over 1 HP CITY Tel No 0
Fixed
permit is issued, I shall not employ any person in any manner PERMIT rr //l 1 lL
so as to become subject to the Workers' Compensation Laws Range_ Heater_D W APPLICANT L; C =C t Tic C • 0-
Oven
Oven ` Dryer_W M ADDRESSN
W H 0 ?ti Z
Date Applicant Top _ FAU CITY /;Ir�fq�y �{ Tel No
Hood _ Fan —Other_ YS
NOTICE TO APPLICANT If, after making this Certificate of Disp _ Room Air]Cond-_ LICENSE OR V
Exemption, you should become subject to the Workers' REG NUMBER 3l p ?T Class
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO PROQES5eD BY
with comply with such provisions or this permit shall be Size'&Type HP, KW, KVA,or KVAR V r
deemed revoked
Up to 1 Incl
' - FINAL
LZ
Over 1 to 10 Incl DATE
LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl C ( VALIDATION
I FINAL
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 10BY
0 Inc
9 (commencing with Section 7000) of Division 3 of the Busi- Over 100
ness and Professions Code, and my license is in full force and J
effect Services
License Number /00 Lic Class I, / 0-200 Amp Under 600 V
� nn '�� inG 201-1000 Amp Under 600 V
Contractor.L pC� Date ',j2eOver 1000 Amp or Over 600 V
HOME OWNER-BUILDER DECLARATION Temp Power Pole&Appurtenances
I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit
License Law for the following reason.(Section' 7031 5, Busi- Additional Sign Branch Circuits
ness and Professions Code)
Misc Conduits&Conductors
I, as owner of the property, will do the work and theOther.ISee Complete Fee Schedule)— 3 2 a 0 A
structure is not intended or offered for sale (Section
7044, Business and Professions Code) # o o 0 o o 2
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency 12 o o 3.38 0
for the performance of the work fog which this permit is PERMIT FEE (Sub-Total) o o o 33.8 0=
issued (Sec 3097,Civ C)
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) ,2 0 11 -, 80
Lender's Address
PERMIT ISSUING FEE rr
I certify that I have read this application and state that the TOTAL FEES it
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 prope y for inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
gnature of Permittee Date