HomeMy Public PortalAbout10106 LANDSEER ST_Electrical__ 76A66C-CE#606 5.61 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARMENT OF COUNTY ENGINEERBUILDING%D C !/VW
BUILDING AND SAFETY DIVISION
Q ADDREss
JOHN A. LAMBIE. COUNTY ENGINEER /
WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
PERMIT FEES OWNER
1 T E M NUMBER1 EACH FEE MAIL
OUTLE / hham, S $ ADDRES
LIGHTS //
CITYTEL. NO (D
LIGHTING FIXTURES .10 O
ELEC. RANGES CLO. DRYERS EL`ECTRI IAN
WATER HEATERS .50 ADDRESS
ELEC.SPAC HTRS. DISHWASHERS /
/L/ CITY L NO. f�O
GARBAGE ISPOSERS / AUTO.- STATE /
WASHERS STA.COOKING UNITS 4 1 ,25 LICENSE NO.
MOTORS: OVER INC. H.P. DIST CT I[O. G OUP N CESSED Y
0— '/2 / .25
1/2— 2 .5O / s� INSPECTION RECO
v� R n i 1
2— 5 1.00 // � �i a.f2
5— 15 1.50
15— 50 2.50
50— 200 H
5.00 U
W
SIGNS. NO TRANS. N
NO.LAMPS
SERVICE 0-600V 1.00
SERVICE OVER 600V 5.00
misc.
WIRING PERMIT 1.00
FIXTURE PERMIT 1.00 �T
SUPPLEMENTARY PERMIT 50
TOTAL FEE $I
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT J n/�//�� // /A J Z
ELECTRICAL WIRING. WIRING /� /r�0xv
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELESfN
UNTY AND STATE OF FIXTURES ��/(j CST ,,W
CALIFORNIA OR THAT AM THE L ALE THE ABOVE r r
DESCRIBED RESIDENTIA PR ERTY. POWER Q/,,�ppQ
SIGNATURE UTILITY CO.NOTIFIED OI1"lgJ2 A–
„✓` �,..�s%,�lY,`P.�';f /
OF PERMITTEE -U ,yL.t� •6,: ..-,�-r�,, �
FINAL
LIDATION ARTHUR C. VEIT
cK MO cnsH SUPERVISING ELECTRICAL ENGINEER
.5 4 1 5 NOV 2 4 2 D 11-0 0 �
COMPEI—``aTION DECLARATION 76A663 10/81
here}' affir - t:� have u cerflTicate of consent to self CE-8066 APPLICATION FOR ELECTRICAL PERMIT
insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof (Sec. 3800, Lab. C.)
Policy No._ Company FOR APPLICANT TO FILL IN JOB /
Certified c?py is hereby furnished. New Residential Bldgs & Pools EACH NO FEE ADDRESS
S —
Certified cc; v,is filed with the county building inspec 1 & 2-Family, 9• Ft. $ $ LOCALITY
tion de artrr.,�t. Multi-family S Ft. NEAREST
p y 9" CROSS ST
Date Applicant Residential Swimming Pools .OWNER OR I
FIRM N
• CERTIFICATE OF'EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL _
COMPENSATION INSURANCE ADDRESS /0/104 �SJiJ ('cam
This section need not be completed if the work involved b Total No First ti � I el ,r
( P Y CI pf Tel. No
the permit is for one hundred dollars ($100)or less.) Additional !L
I certify that in the performance of the work-for which this APPLICANTK
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 Additional
_ CITY Tel. No.
6 Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICETO APPLICANT: If, after making this Certificate of APPLICANT
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.
Hood _ Fan _ Other— CITY Tel. No.
LICENSED CONTRACTORS DECLARATION �_ LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REG NUMBER Class.
(commencing with-Section 7000) of Division 3 of the Business DISTRICT NO PROC D BY
and Professions Code, and my license is in full force and effect Power Apparatus& Large Appliances ^ d
Size & Type HP, KW, KVA, or KVAR U Q
License Number Lic Class Up to 1 Incl FINAL U
Over 1 to 10 Incl. DATE-7 7 -� VALI TION 0
Contractor Date Over 10 to 50 Incl U
❑ FINA
I am exempt under Sec Over 50 to 100 Inc. BY
CL
B.&P.0 for this reason Over 100 i 1A
Services, Swbd., MCC& Panelboards '' Z
Date: 0 -200 Amp Under 600 V e'
Signature 201 -,,1000 Amp. Under 600 V
❑
Over 1000 Amp or Over 600 V
Exemption for Reg Maint Eject z'1 7 3,6 A
SINGLE FAMILY Temp. Power Pole &Appurtenances 0 0 0 0'02
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit.
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits :,I 0 0 29.00
Law for the following reason (Section 7031 5, Business and
Professions Code) I o o',0 2 9.,0 0 U
201- N1 "
/
I, as owner of the property, will do the work and the isc. Conduits &Conductors_ a'2 S—8 5
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ Pool 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
PERMIT ISSUING FEE IS
Lender's Address
I certify that I have read this application and state that the TOTAL FEE O
above information is correct I agree to comply with all County
ordinances and State jawFels
uIating Electrical wiring, and
hereby uthorize represe of this County to enter upon
the e-mentioned p or inspection pure es.
SEE REVERSE FOR EXPLANATORY LANGUAGE
gnat of Permittee �/ Date