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HomeMy Public PortalAbout9556 LOWER AZUSA RD_Electrical__ n 76g6f,3-CE80610/72 APPLICATION F ELEC AL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER JOB BUILDING AND SAFETY DIVISION; ADDRESS LOCALITY AfV C NEAREST FOR APPLICANT TO FILL IN CROSS ST ` (/ OUTLETS NO EACH FEE OER OR N NAME RECEPT-S $ $ / l MAIL FIRST 20 ADDRESS LIGHT TOTAL 25 CITY TEL NOJW,"- 9yep OVER 20 SWITCH 10 PLAN CHECK LIGHTINGTOTAL FIRST 20 25 APPLICANT FIXTURES OVER 20 10 ADDRESS RESIDENTIAL APPLIANCES CITY TEL NO PERMIT RANGE DRYER_WTR HTR APPLICANT STA COOK DISP F A U ADDRESS SPACE HTR AIR COND CITY TEL NO CLOTHES WASH DISHWASH LICENSE OR REG NUMBER CLASS FAN OTHER 100 1 HEHEBI ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORSTRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND HEATERS, ETC HP KW KVA ELECTRICAL WIRING SIZE & TYPE OVER TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 - 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE 1 - 10 300 0ESCRIPED RESIDENTIAL PROPERTY O PERMITEE C1 10 - 50 500 rDISTRICT OR O 50 - 100 1000 NO O 0 ES ED BY W 100 - 500 1500 �- Z SIGN GAS SIGN AND ONE CIRCUIT 500 PPROVALS DATE INSPECTOR' SIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 100 POWER POLE SERVICENOTOVER 600 VOLTS OR 200AMP f 300 UNDERSLAB WORK SERVI CE OVER 660 VOLTS OR 200 AMP 1000 ROUGH QONDUIT TEMPSERVICE,POLE, &APPURTENANCES 500 WIRING TEMP LIGHT OR RECEPT SYSTEM 300 FIXTURES OF w woo POWER AUTHORIZED UTILITY CO NOTIFIED FINAL 0Loor/61 PERMIT FEE (SUB TOTAL) NOTES PLAN CHECK FEE PERMIT ISSUIWG FEE 1 300 �,� TOTAL FEE oto, 7 PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION cK M 0 CASH 1 9 2iET 2 2 © 10.7 5 s SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE WORKERS'COMPENSATION DECLARATION CE-76A663 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm That I have a certificate of consenf'to,self CE-806G' insure, or a certificate of Workers Compensation Insurance, COUNTY OF LOS ANGELESe BUILDING AND SAFETY or a certified copy thereof (Sec 3800, Lab C ) / Policy No CompanyFOR APPLICANT TO FILL IN JOB ADDRESS w q Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ❑ 1 &2-Family, Ft $ — E LOCALITY ` r Certified copy is filed with the county building inspec- Y� S9 r C Cc tion department Multi-family Sq Ft CROSS ST NEAREST -/ Date Applicant Residential Swimming Pools OWNER 1� FIRM NAME D ( E -CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets RecrLight, Sw 7 MAIL Lbwt° Ai s 2d COMPENSATION INSURANCE �/� ADDRESS V This section need not be completed If the work Involved b First ti ( p it Total No Additional CITY Tel No �r- L�� the permit is For one hundred dollars($100)or less) I certify that in the performance of the work for'which this PLAN P LICANTK 1� permit is issued, I shall not employ any person in any manner so as to become sub ct to the Workers'Compensation Laws Lighting Fixtures First 20 ADDRESS �j,(/ 4 Total No Additional C '' X in DateIVIpelican CITY jp �G C Tel No qqg- NOTICE T A CANT If, after making this Cerfif of Fixed Appliances Not Over 1 HP PERMIT Exemption, yo6 should become subject to the Workers' Range_ Heater_D W _ APPLICANT D Compensation provisions of the Labor Code, you must forth- Oven _ Dryer —W M — ADDRESS - o LU�{ e--( with comply with such provisions or this permit shall be Top — FAU —W H — , deemed revoked CITY ��/� LC o j-4'/f- LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_ Disp _ Room Air Cond LICENSE Class I hereby affirm that I am licensed under provisions of Chapter 9 REG NUMBER (commencing with Section 7000) of Division 3 of the Business STRICT NO S BY and Professions Code,and m license is in full force and effect Power Apparatus 8 Large Appliances DIPROCE Y y Size 8 Type HP, KW, KVA, or KVAR 5—,40� Go- License Number Lic Class Up to 1 Incl FINAL V Contractor Date Over 1 to 10 Incl DATE VALIDATION 0 ❑ Over 10 to 50 Incl FINAL 13 I am exempt under Sec Over 50 to 100 Inc BY d B&P C for this reason Over 100 Z Date Sery s, S Pa elboards ► 0 -200 Amp Under 600 Signature 201 - 1 mp Un er V 77 ❑ Exemption for Reg Maint Elect Over 1000 Amp or Over 600 V SINGLE FAMILY Temp Power Pole&Appurtenances 2 7 6 a 4 A HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit # o e s • o 2 1 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 g 2 211 Q X Professions Code) I ( g ❑ 1, 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) 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 O � PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the TOTAL FEE 3 Q o above information is correct I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes � 1 f-�� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date /