HomeMy Public PortalAbout6236 LOMA AVE_Electrical__ 7GA663-CES06 10-62 4-11!1 ll IS��7U-'t M FOR - `C Il CAL ll ERM [I,
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING /
BUILDING AND SAFETY DIVISION ADDRESS /v . Q
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A JENSEN, SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
RECEPT. TOTAL NO. I EACH FEE
OUTLETS FIRST 20 ]� $2O $ 00 OWNER
LIGHT q MAIL
ADD' �(J ADDRESS
SWITCH pVER0 (/ •f0 6
TOTAL CITY TEL. NO.
LIGHTING I FIRST 20 f .20 20
FIXTURES 1 ��( ADD'L ELECTRICIAN
OVER 20 •1O
V
RANGES CLO DRYERS WTR.HTRS 1.00 ADDRESS i
GARB.DISP. I STA COOK p
CITY TEL. NO. I
DISHWASH AUTO.-WASH I STATE �1 /
SPACE HTRS STA.APP (y2 H�AX ) 7 .50 ✓ LICENSE NO. /J ,(p
y
MOTORS OVER NOT OVER HP. DISTRICT" VO.. GROUP ZONE PROCESSED B
0 1 1.00 7j 10
/
I 3 1.50 (/ INSPECTI�O.�N'* REc6RD /�
3 S 200 ���i✓�L�Y'
8 15 250
_ Rif/SS►v�-�
15 50 3.00
50 100 5.00 X 4
Q.
SIGNS NO.TRANS ' t�
NO.LAMPS 3
SERVICE 0.60OV-Nor OVER 200A 1.00 Q6
SERVICE 0-60OV-OVER 200 A. 2.00
SERVICE OVER 600V 5.00
MISC.
PERMIT ISSUING FEE 2 00
SUPPLEMENTARY PERMIT ISSUING FEE too
TOTAL FEE ! $ 47
I
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
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ((
ELECTRICAL WIRING WIRING 1 1 �
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR J �
LICENSED AS REQUIRED BY LOS ANGELES COUNTY'AND STATE OF FIXTURES 14
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPVWTY POWER
SIGNATURE ,�. /Q/ . UTILITY CO.NOTIFIED V IdTI
OF PERMITTE '�v�.Gc -
_
LIDATION ARTHUR C. VETT
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
�I•uo9 4 4 ;; Y 18 2 0
17.20-
Y .
NQ ' COMPENSATION DECLARATION 76A66310/81
I here?yo affirm that I have a certificate of consent to self CE-8066 APnCnMN FOR EECT CdL pER 'T
insLire, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certirfiie4icopyy thereof (Sec 3800, Lab C )
Policy Nd 20 86 8&mpony State Fund FOR APPLICANT TO FILL IN JOB
Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS 6236 Loma Avenue
® Certified copy is filed with the county building inspec- 1 & 2-Family, Sq Ft $ — $ LOCALITY Temple City
tion department Multi-family Sq Ft — NEAREST
CROSS ST
16-86 Residential Swimming Pools OWNER OR
Date 9- Applicant FIRM NAME Becker
CERTIFICATE OF EXEMPTION FROM WORKERSOutlets Rec Light Sw MAIL same
COMPENSATION INSURANCE ADDRESS
This section need not be completed if the work involved b First 20
( tip Y Total No Additional CITY Tel No
the permit is for one hundred dollars ($100)or less.)
I certifythat the performance of the work for which this PLAN CHECK
in P APPLICANT
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
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
-NOTICE TO APPLICANT If, after making this Certificate of APPLICANT Environmental Eng.
Exemption, you should become subject to the Workers' Range= Heater_DW —
Compensation provisions of the Labor Code, you must forth- Oven _ DryerW M — ADDRESS 601 N. Poplar
with comply with such provisions or this permit shall be Top _ FAU Z WH —
deemed revoked CITY Orange Tel No639-8281
LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_
Disp — Room Air Cond REGLICESE OR NUMBERB351855 Class C-20
I hereby affirm that I am Incensed under provisions of Chapter 9 >,,;
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO P ED BY 0-
and Professions Code,and my license is in full force and effect Power Apparatus 8 Large Appliances � p t O
iB351855 0-20 Size &Type HP, KW, KVA, or KVAR . `!Lv U
License Number Lc Class Up to 1 Incl FINAL U:
Ev �• Date 9-16-86 Over 1 to 10 Incl p(> DATE / —� VALIDATION
n •
Contractor Over 10 to 50 Incl �i
❑ FIN W
I am exempt under Sec _ Over 50 to 100 Inc B Q.
Over 100
B 8P C for this reason Z
Date Services, Swbd , MCC& Panelboards
0 -200 Amp Under 600 V
Signature 201 - 1000 Amp Under 600 V
❑ Exemption for Reg Maint Elect' Over 1000 Amp or Over 600 V
SINGLE FAMILY Temp Power Pole& Appurtenances
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
Law for the following reason (Section 7031 5, Business and
Professions Code)
❑ I, as owner of the property, will do the work and the Misc Conduits&Conductors
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)— D
7044, Business and Professions Code) 2 5 4 6 2 A
CONSTRUCTION LENDING AGENCY # 0 0 2 ;;00
•
I hereby affirm that there is a construction lending agency for 0 0
,06
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) 0 0 0 2 1,0 0 v
(Sec 3097, Civ C )
PLAN CHECKING FEE 0 9, 1 8,t 8 6
Lender's Name •
PERMIT ISSUING FEE C)
Lender's Address
I certify that I have read this application and state that the TOTAL FEE ?j r
above information is correct I agree to comply with all County
ordinances and State jaws 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
SVqfioture of Permittee Date