HomeMy Public PortalAbout9451 LONGDEN AVE_Electrical__ 3AG63-CESOO 10-60 APPLICATION FOR ELECTRICAL PERMIT �.
COUNTY OF LAS ANGELES
DEPARMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION nDDREss
JOHN A. LAMBIE, COUNTY ENGINEER 1
WILLIAM A.JENSEN,SUPT OF BUILDING I OCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
PERMIT FEES OWNER
1 TE M NUMBER EACH FEE MAIL
OUT
$10 �0 ADDRESS
LIGHTS RECEP SW. CITY TEL. NO.
LIGHTING FIXTURES /3 ' .10' D
ELEC. RANGESDR ER ELECTRICIAN Richardson El.ectrie co. nc,
W A•T E R E AT E
RG .SO i4DDRESSa
ELEC.SP HTR DISHWASHERSi '
PIT�;an .Gabriel TEL NO.At-7-0 39.
DARSAM�EQ511d® 0-of STATE
WASHERS STA.COOKING UNITS CY ,215 +LICENSE NO.
MOTORS: OVER INC. H.P. ) r DISTeICT NO.. G
0— 1/2 �' /
.25 Oi
2 I j .soh INSPECTION RECORD
2— s 1.00 ����`'''�+'p'°s'f� •? y'� _ ,�,f'"'aLp;�/''� ✓' d
1.50 I
S— 15 1 Ll^cG/C���/-�s�r�� r V V
1s— SO 2.50 I
SO— 200 5.00 / v V •0
NO TRANS.
SIGNS: NO.LAMPS
:'.SERVICE 0-600V 1.00
SERVICE OVER 600V5.00
MISC. /
+ c
1
WIRING PERMIT 1.00 d®
FIXTURE PERMIT 1.00 ® B
SUPPLEMENTARY PERMIT
.50 II
TOTAL FEE S • '
1 HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION . APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT-THE ABOVE IS CORRECT AND AGREE TO COMPLY �+ C.
WITH ALL. COUNTY ORDINANCES AND SPATE LAWS REGULATING CO DUIT
ELECTRICAL WIRING. q f ,/� �f �J�
WIRING /° l�9'�. .,•'�/.;9r'i s
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR i -
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM THE 'LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTI ROPERTY. POR 1 r
SIGNATURE UTILITY CO.NOT ED pfp,�a 'rr I� n�,�•: f
OF PERMITTE
LIDATION ART14UR'C. VETT
CKMo CASH SUPS RVISING ELECTRICAL ENGINEER
U,."?4 ; 4 0 J OCT ? o 1 1 ,4 0
1
WORKERS'COMPENSATION DECLARATION 78-883 I 10/61 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self insure, CE-806G
or a certificate-of Workeg'Cpmpessation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy t,�ereof(Sec.3800,Lab.C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB
❑ ^ � ' ��
Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ADDRESS 7
Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft. $ _ $ LOCALITY-6 NEAREST
department.
Multi-family Sq.Ft. CROSS ST. 'rCftlp
Date Applicant 4Residential Swimming Pools OWNER OR a;j/a� �g4�
I FIRM NAME
CERTIFICATE OF EXEMPTION F M WORKERS' Outlets:Rec Light !Sw. Z MAIL
COMPENSATION INSU ANCE First 20 /0 ADDRESS
(This section need not be completed if the work involved by the t�� CITY Tel.No.
permit Is for one hundred dollars($100)or less.) Total No. Additional
I certify that in the performance of the work for which this permit APPLICANT K
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
NOTICE TO APPLICANT: If, after making this Certificate of PERMIT A/�
Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. APPLICANT (r}
provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS $r
provisions or this permit shall be deemed revoked. Top — FAU _ W.H. _
LICENSED CONTRACTORS DECLARATIONHood — Fan _ Other_ CITY &*-CA D� Tel.No. CQ
LICENSE
I hereby affirm that I am licensed under provisions of Chapter 9 Disp.. — Room Air Cond. REG.NU Class. G'c
OR
si 6
(commencing with Section 7000)of Division 3 of the Business and REG.NU � �v
Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO. f PRO SED BY
Size&Type HP,KW,KVA,or KVAR 6V
License Number�'�J"$ Lic.Class 4—t 0 Up to 1 Inc]. FINAL
Over 1•to 10 Incl.
DATE VALIDATION Q
Contractor� C�^4��� Date 4"—� "'�� Over 10 to 50 Incl. IC-��
FINAL
❑ I am exempt under Sec. Over 50 to 100 Inc. BY W
Over 100 G.
BAP.C.for this reason N
Services,Swbd.,MCC&Panelboards
Date: 0;-200 Amp.Under 600 V
Signature 2011- 1000 Amp.Under 600 V
❑ Over 1000 Amp.or Over 600 V
Exemption for Reg.Maint.Elect.
SINGLE FAMILY Temp.Power Pole&Appurtenances 2
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Law ACC T o 4a
for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits _
Code): j ,x307 450411
❑ i,as owner of the property,will do the work and the structure Misc.Conduits&Conductors 1 ITEMS
Other(See Complete Fee Schedule)
is not intended or offered for sale (Section 7044, Business , 1 TOTAL 45® �I-0
and Professions Code). '
CONSTRUCTION LENDING AGENCY CHECK 45.40
I hereby affirm that there is a construction lending agency for the I CRANE u100
performance of the work for which this permit is Issued(Sec.3097, PERMITIFEE (Sub Total)
Civ.C.).
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE 0259 1 AN10140
Lender's Address 4
I certify that I have read this application and state that the above TOTAL FfE
information is correct.I agree to comply with all County ordinances
and State laws regulating Electrical wiring, and hereby authorize i
representatives of this County to enter upon the above-mentioned
property'fo R pectio p poses. y7 I SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of rmittee Date