HomeMy Public PortalAbout9632 LONGDEN AVE_Electrical__ 16A6699-.ce6es1B 12/7s APPLICATION FOR ELECTRICAL PERMIT
BUILDING AND. SAFETY DIVISION
FOR APPLICANT TO FILL IN ,JOB
New Residential Bldgs.&Pools EACH NO. FEE ADDRESS
1 &2 Finaily Sq. Ft. $ — $ LOCALITY
Multi-family Sq.Ft. — NEAREST
CROSS ST. Ln T OLS
Residential Swimming Pools OWNER OR a
FIRM NAME
Outlets: Light,Switch&Receptacle MAI L
ADDRESS /7 Q /�
O
First 20 f
Additibnal CITY 19 cl (Cr. Tel. No,
PLAN CHECK
Lighting Fixtures APPLICANT
s _
First 20 / Q ADDRESS
Additional CITY Tel.No.
PERMIT
Fixed Appliances Not Over 1 HP APPLICANT , 0
Range_ Heater_ D.W. ADDRESS /yo 140115t
Oven _ Dryer _ W.M.
Top _ FAU _ W.H. CITY Oqp^CrcetL Tel.No.
Hood _ Fan LICENSE OR p
EG. NUMBER `� —
D.isp. A.C. RClass. v12,
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY (—
Power Apparatus&Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING W
Size&Type HP,KW,KVA,or KVELECTRICAL WIRING, y
Up to 1 Incl. Z
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
Over 1 to 10 Incl. LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
Over 10 to 50 Incl: DESCRIBE.RESIDENTIAL PROPERTY.
Over 50 to 100 Incl. PERMITEE ,
Over 100 • SIGNATURES
DISTRICT NO. PROCESSED BY
Services
0-200 Amp. Under 600 V d
201 -1000 Amp. Under 600 V APPROVALS DATE INSPECTOR'S
SIGNATURE
Over 1000 Amp,or Over 600 V
IROUGH
EMP.POWER POLE
Temp: Power Pole&Appurtenances NDERS�WORK -,7 7�
Sign with One Branch Circuit
Additional Sign Branch Circuits CONDUIT
(Other) IRING
IXTURES
OWER AUTHORIZED
PERMIT FEE (Sub-Total) 16 UTI LITY CO.NOTIFIED
PLAN CHECKING FEE (One-Fourth Permit Fee) 14 FINAL
PERMIT ISSUING FEE
TOTAL FEE NOTES
PLAN;CHECK VALIDATION 'CK. M.O. CASH PERMIT VALIDATIONC M.O. CASH
6 2 2r--FEB 9 u 6.1 0aL,,,
WORKERS'COMPENSATIONDECLARATION CE-806G (2-SO)
CE-806APPLICATION FOR ELECTRICAL PERMIT
C
I Hereby affirm that I have a certificate of consent to self' COUNTY OF LOS ANGELES e BUILDING AND SAFETY
insure,or a.certificate of Workers'Compensation Insurance,or T ! !
a certified copy thereof(Sec.3800,Lab.C.) .
FOR APPLICANT TO FILL IN JOB
Policy No. Company_ iADDRESS 632 Lo n..
New Residential Bldgs.&Pools EACH NO. FEE
Certified copy is hereby fdi•nished• , 1 &2-Family,Sq. Ft. _ A3I.P' $ '— $ LOCALITY 1 e-
Multi-family Sq.Ft. — NEAREST �.
Certified copy is filed with the county building inspection CROSS ST V
department. Residential.Swimming Pools OWNER OR �+ �Q
Date Applicant FIRM NAME J-J NGv f- • /��-V`e
Outlets: Rec.—Light Sw. MAIL.
First 20 .ADDRESS M ¢1.V
CERTIFICATE OF EXEMPTION FROM WORKERS'` I Total No. Additional' CITYeI-No.
COMPENSATION INSURANCE 4 �'� H 7 � a
p PLAN CHECK
(This section need not be completed if the work involved APPLICANT / � !1W C1
by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First20 ADDRESS i . �qde
Total No. Additional O
I certify that in the performance of tfie work'for which 'thisCITY Tel No. H
is issued I shall not employ Fixed Appliances Not Over 1 HP s
.permitp y an y person in any manner PERMIT VW
so as to become subject to the Workers'Compensation Laws. Range_Heater D.W._ APPLICANT A?.P JC &lead
Oven — Dryer—W.M.._ ADDRESS N
Date Applicant Top _ FAU _W.H.,—
Hood _ Fan —Other CITY Tel No.
NOTICE TO APPLICANT: If, after making this Certificate of Disp. —Room Air Condom LICENSE OR
Exemption, you should become subject to the Workers' REG.NUMBER Class
Compensation provisions of the Labor Code, you must forth= Power Apparatus&Large Appliances r DISTRICT NO. PROC SS D BY
with comply with such provisions or -this permit shall be
deemed revoked. ( Size&Type HP,-KW,KVA,or KVARQ
Up to 1 Incl.
0 Incl. DATE LICENSED CON
1 to 1
.ORS DECLARATION � Over 10 to 0 1 Incl. G —/7—e7— VALIDATION
I
T hereby affirm that I am licensed under provisions of Chapter I Over.5.0 to 100 Inc. FINAL
9 (commencing ith Section 7000)of Division 3 of the Busi- �_ Over 100 BY
w
ness and Professions.Cod e, and my license is in full force and'
effect. Services
0-200 Amp.Under 600 V '
License Number Lic.Class--. 201-1000 Amp.Under 600 V
Contractor 'Date Over 1000 Amp.or Over 600 V
HOME.OWNE)i-BUILDER.DECLARATION Temp.Power-Pole&Appurtenances
I hereby •affirm that I am exempt from the Contractor's f Sign.with One Branch Circuit `
License Law for the following reason (Section 7031.5, Busi- Aditional Sign Branch Circuits
ness'and Professions Code): I I -.'4.2.6 5 A
1 Misc.Conduits&Conductors
I, as. owner of the property, will do the work and the •Other(See Complete Fee Schedule)— # o o 0 o o.2
structure is not intended or offered for sale (Section
7044,Business and Professions Code). 2 0 0 6A 9 5
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency , 0.0 0 6 4,9 5 U
for the performance of the work for which this permit is PERMIT FEE (Sub-Total)
issued(Sec.3097,Civ.C.). 6-7 0302-81
Lender's Name PLAN CHECKING FEE (One-Fourth Permit.Fee)
(Lender's Address �' PERMIT ISSUING FEE
I certify that I have read this application and state that the TOTAL FEE
above information is correct.Lagree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives of this y to enter upon
theWati,,kied rope r' sp o urposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE
C f' f
i nat of-Perinitfee Date:
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