HomeMy Public PortalAbout10433 MILOANN ST_Electrical__ .A.sR.eaasa..,o-R. APPLICATION FOR. ELECTRIC PERMIT
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ISAS68.CESOS.I0.8G _APPLICATION FOR�- EL•ECTRI-C PERMIT .1 .
BUILDING AND SAFETY DMSION
Department Of COuaty Engineer BUILDING 1,030-3�}�
County of LOS Angeles ADDRESS J
JOHN A.LAMBIE. COUNTY ENGINEER /-
CASSATT D. GRIFFIN. SUPT OF M.U1LDIN6 LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CRos r L IFAX
PERNIIT .FEES. l .�
'I OWNERW,- L. / //aA1 d .0.
LIGHTS RECEPTACLES SWITCHES MAIL -
NUMBER I ITEM $CH $ FEE ,ADDRESS 'D �.,$� �o/�L92 I14
TOTAL OUTLETS 10 D
ELEC. RAN68S, WATER HEATERS, -(CITY l bC 41. TEL.NO.
CLOTHES DRYERS :50 - IF
ELEC. SPACE HEATERS, STAT'Y. COM ELECTRICIAN
ING UNITS, GARBAGE DISPOSERS; ;ADDRESS
AUTO WASHERS, OISNWASHER .25
LIGHTING FIXTURES ,10 CITY TEL. NO.
MOTORS 4STATE
(LICENSE NO.
HORSEPOWER
H.P; OVER INC. .. + DISTRICT NO.. GROUWBECORD Y FOR INSPECT..
. 1*a LESS .25
14 — 2 .50 INSPECTIO
2 — 5 1.00
5 18 1.50
1S 50 2.50
SO 200 5.00 '
MISC.
it U,I�l All
• .� ;�� 1,
SIGNS No,TRANS +
I. NO.LAMPS
SERVICE O-600V 1.00
SERVICE OVER BOOV 5.00 11 A jft, If� , ,1 � �s✓J �' '
WIRING PERMIT1.00 4 'r 6 R � U r
00
FIXTURE PERMIT 1.00 . •14,6E 1 lOV7,, e t tri
SUPPLEMENTARY PERMIT .50 APPROVALS
TOTAL FEE. $ l DATE INSPECTOR'S SIGNATURE
I HEREBY ACKNOWLEDGE THAT 'I HAVE READ THIS APZkrCA 0
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 R961ST.EREO AND/OR FIXTURES..
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND. STATE OF
CALIFORNIA. OR THAT 1 AM THE LEGAL OWNER OF THE ABOV5 POWER
DESCRIBED RESIDENTIAL PROP RTY.
$1GNATURE f J. UTILITY CO.NOTIFIED
OR PERMITTEE_.(� e
FINAL
IOHN A.LAMBIE. VALIDA ARTHUR C.V
.OUNTY SNGINEBR CK Mo SUPERVISING RLECTRICAL ENGINEER
4
; * :V�(ORIzERS'COMPENSATION DECLARATION CE806,oat
- G APPLICATION FOR ELECTRICAL PERMIT
1`11 ereby affirm that I have a certificate of consent to self insure,
or 4 certificate of Workers' Compensation Insurance, or a certified• COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec.3800,Lab.C.)
Policy Nb. Company FOR APPLICANT TO FILL IN JOB 0 33 �w i
❑
ADDRESS �J (��
Certified copy is hereby furnished. New Residential Bldgs.&Po EACH NO. FEE
E] Certified'copy is filed with the county building inspection 1 &2-Family,Sq.Ft.
$ _ $ NEAREST
LOCALITY c ,
department. Multi-family Sq.Ft. CROSS ST.
Date Applicant Residential Swimming Pools OWNER OR
...• L FIRM NAME c
CERTIFICATE OF EXEMPTION FROM WORKERS' MNL
Outlets:Rec Light Sw. ���
COMPENSATION INSURANCE ADDRESS
(This section need not be completed f the work Involved by the First 20
10
permit is for one hundred dollars($100)or less.) Total No. Additional CITY Tel.No.
I certify that in.the performance of the work for which this permit PLAN CHECK
is issued, I shall not employ any person 'n any manner so as to APPLICANT
become subject to the Workers'Compe tion Laws. Lighting Fixtures First 20 u v ADDRESS
Total No._ Additional ITY Tel.No.
Date "— Applicant hihrc Fixed Appliances Not Over 1 HP
NOTICE TO APPLICANT: If, afte ma mg is Certifica a of APPLICANT s
Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W.
caw
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. _
LICENSED CONTRACTORS DECLARATION Hood — Fan Z Other_ CIT`! en _ Tel.No.
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR L't� Class.
(commencing with Section 7000)of Division 3 of the Business and REG.NUMBER AURW
Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO. �rV/ PROCESSE Y
¢�{J�J Size&Type HP,KW,KVA,or KVAR 5< </ tl Q
License Number4W5& Class —� Up to 1 Incl. FINAL V
(� + Over 1 to 10 Incl. DATE (!l I VA ATION Q
Contractor Date p ��J Over 10 to 50 Incl.
❑ FINALts
I am exempt u er Sec. Over.50 to 100 Inc. BY W
B.&P.C,for this reason Over 100 N
Date:
Services,Swbd.,MCC&Panelboard� ► Z
0-200 Amp.Under 600 V 1 1 &8A
Signature 201 - 1000 Amp.Under 600 V
❑ Over 1000 Amp.or Over 600 V } ° o o ° o
Exemption for Reg.Maint.Elect.
SINGLE FAMILY Temp.Power Pole&Appurtenances I ° ° 8 J
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Law -1 '° I �' x
for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits 4" 0
Code): l i, i 6--C 8
❑ 1,as owner of the property,will do the work and the structure Misc.Conduits&Conductors
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) pool.
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(Sec.3097, PERMIT FEE (Sub-Total)
Civ.C.). ;
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE
Lender's Address T^
I certify that I have read this application and state that the above i TOTAL FEE (.]
information is correct.I agree to comply with all County ordinances
and StIte laws regulating Electrical wiring, and hereby authorize
repres atives of this County to enter upon the above-mentioned
prop4y f r inspection ose SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature ofrm tee Date