HomeMy Public PortalAbout9929 LOWER AZUSA RD_Electrical__ 76A8E8-CE6OS-7.I5E APPLICATION FOR ELECTRIC PERMIT ],
WELDING AND SAFETY DIVISION
Department of County Engineer 13UILDNG
County of TAB Angeles ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER
CASSATT D.GRIFFIN.SUPT OF BUILDING LOCALITY
NEAREST
FPER APr FEES CROSS TO FILL IN CROSS ST.
NUMBER OWNER
LIGHT OUTLETS MAIL
ADDRESS
RECEPTACLES
V WALL SWITCHES FEE CITY TEL.NO.
TOTAL OUTLETS ® 54 5 V ELECTRICIAN
ELEC. RANGES 25 ADDRESS G
ELEC. HEATERS 25CITY TEL.NO. 7k Yho
KW EA STATE P
Z FIXTURES 5 LICENSE NO.
MOTORS DISTRICT NO. IGROUPI READY FOR INSPECTION
NUMBER HORSEPOWER FEE
NEW MVD'. HP OVER INC, EACH
2 LE88 s .25 TV .INSPECTION RECORD
14 2 .50
2 5 1.00
5 15 1.50
15 50 1 2.50
50 200 1 5.00
M ISC.
NO.SIGNS NO.TRANS.
NO.SIGNS NO..LAMPS
FOR EACH PERMIT:
WIRING PERMIT $1.00 Q
FIXTURE PERMIT $1.00 G V
SUPPLEMENTARY .50 APPROVALS
TOTAL FEE O DATE INSPECTOR'S SIGNATURE
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WIRING
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. FIXTURES
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED.AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF POWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PR ERT UTILITY CO.NOTIFIED
SIGNATUREdAA v
OF PERMITTEE .�.FrIINNA�L
COUNTY ENGINEER JOHN A. LAMBIE. VAI'IDAayy�a� SUPERVISING ELECTRICAL ENGINEER
f
7935u MAY 3 2 5.10
WORKERS'COMPENSATION DECLARATION CE-806G '0'81 APPLICATION FOR ELECTRICAL PERMIT
I hereby,affirm that I have a certificate of consent to self insure,
or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof
n ¢
(SeMc.3800,Lab.C.)
Policy No.(8 S )3"Iompany FOR APPLICANT TO FILL IN JOB
rtified copy is hereby furnished. New Residential Bldgs.& Pools .� � EACH NO. F E
ADDRESS 7-(k
1 & 2-Family,Sq.Ft.S 1—a $ — $ LOCALITY G
Certified copy is filed with the county building inspection
department. Multi-family Sq.Ft. NEAREST
— tM
CROSS ST
Jt
Date Residential Swimming Pools OWNER OR -�1 Y<l
Applicant FIRM NAME
CERTIFICATE OF EXEMPTION F M WORKERS' Outlets:RecLight Sw. — MAIL
_ — .
COMPENSATION INSURANCE ADDRESS
(This section need not be completed if the work involved by the First 20
CITY Tel.No.
N
Total Additional
permit is for one hundred dollars($100)or less.) ToPLAN CHECK
I certify that in the performance of the work for which.this permit APPLICANT
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 f-R�'��
Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APPLICANT
provisions of the Labor Code, you must forthwith comply with such Oven Dryer _ W.M._ ADDRESS
provisions or this permit shall be deemed revoked. Top FAU _ W.H. _
CITY S Tel.No.
LICENSED CONTRACTORS DECLARATION `
Hood — Fan _ Other_
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. LICENSE OR 7-fs ass.Cl
(commencing with Section 7000)'of Division 3 of the Business and REG.NUMBER J (�
Professions Code,and my license is in full force and effect. DISTRICT Ng PR SSED BY
Power Apparatus& Large Appliances 5
l Size& Type HP,KW,KVA,or KVAR
License Number. Lic.Class ` Up to 1 incl. FINAL _
/ Over 1 to 10 Incl. DATE_"-r � - VALIDATION
Contractor � 9'te- O
❑ Over 10 to 50 Incl.
I am exempt under Sec. Over 50 to 100 Inc. BY AL W
BAP.C.for this reason Over 100 p„
Services,Swbd.,MCC&Panelboards N
Date: 0-200 Amp.Under 600 V Z
Z
Signature 201 - 1000 Amp.Under 600 V
❑ Over 1000 Amp.or Over 600 V
Exemption for Reg. aint.Elect. �7
- SINGLE FAMILY Temp.Power Pole& Appurtenances 337 L4.1
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 1 ITEMS
I hereby affirm that I am.exempt from the Contractor's License Law Additional Sign Branch Circuits
for'the following reason(Section 7031.5,Business and Professions
Cade): TOTAL 124 ® 15
❑ I,as owner of the property,will do the work and the structure Misc.Conduits& Conductors CHECK 124.15
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule)
and Professions Code). pop.
.
00
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the ••Wd 1 8/13/90
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total)
Civ.C.). PLAN CHECKING FEE 2362 1 AM10:46
Lender's Name
PERMIT ISSUING FEE
Lender's Address
I certify that I have read this application and state that the above TOTAL FEE
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
prop rt for inspection pur
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signatuti of Permittee Date