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HomeMy Public PortalAbout10419 LOWER AZUSA RD_Electrical__ 7GA663-CES06 9-57 APPLICATION ®®LICATIO FO - ELECTRIC PERMIT E MIp d � COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING. AND SAFETY DIVISION ADDRESS JOHN A.LAMBIE,COUNTY ENGINEER CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY , NEAREST FOR APPLICANT TO FILL IN CROSS ST. PERMIT .FEES ITEM NUMBER EACH FEE OWNER OUTLETS• $ $ MAIL LIGHTS 71 RECEPT. SW. .10. _ ADDRESS LIG_H71N_G FIXTURES_.'___'=. .10 CITY TE NO ELEC.RANGES+ r CLO.DRYERS -_� :� ELECTRICIAN !� WATER. HEATERS .50 ADDRESS •.,7 ELEC.SPACE HTRS. DISHWASHERS GARBAGE DISPOSERS AUTO.- CITY TEL STATE WASHERS STA.COOKING UNITS .25 LICENSE NO. �-MOaTOAS: OVER INC. H.P. DISTRICT N I GRP Z-NE READY FOR INSPECTION 0 — .1/2 .25 I/2 - 2 .50 z - 5 1.00 INSPECTION RECORD .5 — 15 1.50 15 — 50 2.50 ��^ 50 - 200 5.00 /"0 SIGNS: NO.TRANS. / Qom/�li ext r NO.LAMPS SERVICE 0-600V 1.00 co 6� SERVICE OVER 600V 5.00 M'ISC.. WIRING PERMIT 1.00 ( +Jj FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT .50' TOTAL FEE g APPROVALS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION DATE INSPECTOR'SSIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. - WIRING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/ORS" LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE - POWER + i A DESCRIBED RESIDENTIAL P E p SIGNATURE / J �f�,,,,;�' UTILITY CO.NOTIFIED OF PERMITTEE FINAL r✓ %' VLAUDATION MTHUR C.VEIT, cK MO ' cgsH SUPERVISINC3 ELECTRICAL ENGINEER ' APPLICATION ®R ELECTRIC PERMIT 78A8 6d-CEBO6:10.56 BUILDING AND SAFETY DIVISION Department of County Engineer BUILDING County of Los Angeles ADDRESS r. JOHN A.'L•AMBIE. COUNTY ENGINEER CASSATT D.'.GRIFFIN..SUP'TOF BUILDING LOCALITY ' G' NEAREST y FOR-APPLICANT TO FILL IN CROSS ST. PERNIIT FEES `�} { OWNER LIGHTS RECEPTACLES ! SWITCHES - NUMBER '1 TE.M. EACH FES MAIL - TOTAL OUTLETS $• 10 ADDRESS ELEC- RANGES, WATER• HEATERS, - CITY TEL.-NO. CLOTHES DRYERS -- - .so' ELECTRICIAN ,•� ELEC. SPACE HEATERS, STAT-Y. COOK-. [NO -INITS., GARBAGE DISPOSERS, AUTO WASHERS, DISHWASHER •25 ADDRESS i> LIGHTING FIXTURES .10• CITY '� TEL_N . MOTORS -STATE LICENSE NO. J HORSEPOWER. ' " H.P" OVER INC DISTRICT NO. GR 9P . 3:ONE I READY FOR INSPECTION ' 1/x&LESS .25. /'�- 1/2 - 2' •.50 INSPECTION RECORD 2 5 1.00 • - - 5 15 1.50 ' Is 50- 2.50 50 200 5:00 SIGNS I NO.TRANS '• .. - - - . NO.LAMPS SERVICE O-600V 1.00' SERVICE OVER 600V 5.00 .WIRING PERMIT - 1,00 D FIXTURE PERMIT 1.00 - - SUPPLEMENTARY PERMIT ' :50 APPROVALS TOTAL FEE / $ DATE INSPECTOR'S SIGNATURE 1 HEREBY ACKNOWLEDGE THAT'l HA .READ THIS,APPLICATION AND STATE THAT'THE ABOVE IS CORRECT AND AGREE,TO COMPLY CONDUIT . WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED .BY LOS ANGELES CO%ER, AND STATE OF' CALIFORNIA OR THAT-1-AM THE LEGAL OWOF THE ABOVE- .,POWER DESCRIBED RE PROPERTY. I SIGNATURE �' 'UTILITY CO. NOTIFIED �.- �/f� OF PERM►TTE r �113FINAL 1 41 S v JOHN A. LAMBIE. • , >`-VA IDATION ARTHUR C:'VEIT, COUNTY ENGINEER' SUPERVISING-ELECTRICAL ENGINEER. • C MO CASH .. 0 5- 3:0 cU .p 2 .•: :1 0 4 L - 6-3a- ' WORKERS' COMPENSATION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT ' I hereby affirm that I have a certificate of consent to self CE-806G insure,-ea a'certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) cJ Policy No. Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS F-1Certified Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ tion department. Multi-family Sq. Ft. — NEAREST CROSS ST. Residential Swimming Pools Date Applicant OWNER OR f FIRM NAME tfe,5WIO CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw.?- MAIL COMPENSATION INSURANCE ADDRESS /.ZG This section neenot be completed if the work involved b pFirst t 20 ( tid p y Total No. � Additional CITY Tel. No. 4j1 43_-J,lye the permit is for one hundred dollars ($100)or less.) I certifythat in the performance of the work for which this PLAN CHECK e P APPLICANT permit is issued, l shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 v ADDRESS _ Total No. Additional /�/C_06CITY Tel. No. Date Applicant I �✓ '�/��L Fixed Appliances Not Over 1 HP PER NOTICE TO 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. — �,•-� 37 deemed revoked. CITY Tel. No. Fon _Other_ LICENSED CONTRACTORS DECLARATION Hood _ Dis Room Air Cond. LICENSE M I hereby affirm that I am licensed under provisions of Chapter 9 p' REG. NUMBER ��3 OR Class. (commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. P CE SED BY a1 and Professions Code,and my license is in full force and effect. c O �{ U C! Size &Type HP, KW, KVA, or KVAR' O License Numbere ,3 9'- Lic. Class C l0 Up to 1 Incl. FINAL � Over 1 to 10 Incl. DATE Contractor T� �EDate - VALIDATION W A Over 10 to 50 Incl. FIN I am exempt under Sec. �� ��/�� � Over 50 to 100 Inc. B M B.&P.C. for this reasonloe!^/6 �-Uwk" 1ki)66;V Over 100 z Date: Services, Swbd., MCC& Ponelboards OF 0 - 200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. 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)_ ► 7044, Business and Professions Code). _R 5 7 Q 9 A CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for # o o © o 0 2 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) I ° - 24,00 (Sec. 3097, Civ. C.). PLAN CHECKING FEE o 0 o 2 LL 0 0 C6 Lender's Name PERMIT ISSUING FEE U v ( 0 2 0.-g 6 Lender's Address I certify that I have read this application and state that the TOTAL FEE , above information is correct. I agree tq comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above-m tioned property for inspection purposes. SEE REVERSeFOR EXPLANATORY LANGUAGE Signature of Permittee Date