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Home My Public Portal About10114 NADINE ST_Electrical__ 76AS63 IPESOS 756 APPLICATION FOR ELECTRIC PERMIT 1 BUILDING AND SAFETY DIVISION Department of County Engineer BUILDING County of Los Angeles ADDRESS JOHN A LAMBIE COUNTY ENGINEER pp CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY 4 FOR APPLICANT TO FILL IN NEAREST PERM FEES CROSS ST � NUMBER OWNER LIGHT OUTLETS MAIL ADDRESS RECEPTACLES WALL SWITCHES % FEe CITY TEL NO Z Lt TOTAL OUTLETS ® St S A ELECTRICIAN ELEC RANGES 25 ADDRESS ELEC HEATERS 25 CITY TEL N ltUll KW EA STATEjy FIXTURES 5 5-0LICENSE NO ((// 7 MOTORS DISTRICT NO GROUP I Z NE I READY FOR INSPECTION NUMBER HORSEPOWER FEE NEW MVD HP OVER INC EACH � �� 12 Sc LESS $ 25 �S TION =ORD Y2 2 50 2 S 100 5 15 too 15 50 250 50 200 500 M ISC pa 9 it NO SIGNS NO TRANS < NO SIGNS NO LAMPS FOR EACH PERMIT WIRING PERMIT Si 00 a G FIXTURE PERMIT $1 00 SUPPLEMENTARY 50 APPROVALS TOTAL FEE t� DATE INSPECTOR S SIGNATURE IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP ICATION CONDUIT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING FIXTURES I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNT AND STATE OF POWER CALIFORNIA OR THAT 1 A T LEG OF THE ABOVE C DESCRIBED RESIDENTIAL P E UTILITY CO NOTIFIED SIGNATURE OF PERMITTEE FINAL JOHN A LAMBIEVAI.IDA ARTHUR C VEIT COUNTY ENGINEER CK MO SUPERVISING ELECTRICAL ENGINEER 4 6 0 6ew* JAN3 0 2 725 0 • 4_ �WORKERS COMPENSATION DECLARATION CE 806G '°'81 APPLICATION FOR ELECTRICAL PERMIT i herbby.•affirm that I have a bertificate of consent to self Insure or a Rertificate of Workers Compensation Insurance a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thOref)f(Sec 31 00 Lab_C) $ollcy N` pmpany FOR APPLICANT TO FILL IN JOB 40 ElCe fled copy is hereby furnished New Residential Bldgs &Pools EACH NO FEE ADDRESS ertifled copy is filed with the county buil inspection 1 &2-Family Sq Ft $ — $ LOCALITY department Multi-family Sq Ft — NEAREST CROSS ST Date —2 — Applicant Residential Swimming Pools OWNER OR CERTIFICATE OF EXEMPTION FROM ORKERS FIRM NAME LL.. Outlets Re Light Sw L COMPENSATION INSURAN E First 20 ADDRESS (This section need not be completed d the work Involved by the CITY Tel No permit is for one hundred dollars($100)or less) Total No S Additional I certify that in the performance of the work for which this permit PLAN CHEC Is issued I shall not employ any person in any manner so as to APPLICANT become subject to the Workers Compensation Laws Lighting Fixtures First 20 d" ADDRESS Additional Total No CITYTel No 0 Date Applicant Fixed Appliances Not Over 1 HP 606 NOTICE TO APPLICANT If after making this Certificate of PERMIT APPLICANT Ga a COr Exemption you should become subject to the Workers Compensation Range_ Heater DW _ 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 _ WH LICENSED CONTRACTORS DECLARATION Hood — Fan OtherCITY Tel No _ I hereby affirm that I am licensed under provisions of Chapter 9 Disp — Room Air Cond LICENSE OR 8 Class (commencing with Section 7000)of Division 3 of the Business and REG NUMBER Professions Code and my license Is in full force and effectpower Apparatus&Large Appliances DISTRICT NO P SSED Size&Type HP KW KVA or KVAR15. License Number Llc Class Up to 1 Incl FINAL ev Over 1 to 10 Incl DATE �f� Contractor Date VALIDATION ❑ Over 10 to 50 Incl FINAL / 1 am exempt u er Sec Over 50 to 100 Inc FBY INAL B&PC for this reason Over 100 N Services Swbd MCC&Panelboards Z Date 0-200 Amp Under 600 V On Signature 201 - 1000 Amp Under 600 V ❑ Exemption for Reg Maint Elect Over 1000 Amp or Over 600 V SINGLE FAMILY Temp Power Pole&Appurtenances 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit �/+ I hereby affirm that 1 am exempt from the Contractors License Law Additional Sign Branch Circuits ACCT AV for the following reason(Section 70315 Business and Professions �n Code) 337 30.75 ❑ I I as owner of the property will do the work and the structure Mlsc Conduits&Conductors i ITM Is not Intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule) and Professions Code) ► TOTAL :30.75 CONSTRUCTION LENDING AGENCY CKCK 30.75 1 hereby affirm that there Is a construction lending agency for the Tuwf.� performance of the work for which this permit is Issued(Sec CHANE �M 3097 PERMIT FEE (Sub-Total) W Civ C) PLAN CHECKING FEE 0WO_-=� nnn Lenders Name 1 8/2YN PERMIT ISSUING FEE Lendera Address 5213 1 AN10-806 1 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 r upon the above-mentioned DroperIx for inspectio purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 1310TRaturdWPermittee Date WORKERS COMPENSATION DECLARATION 3 ,O/e, CE ao6G APPLICATION FOR ELECTRICAL PERMIT {� I hereby affirm that I have a Certificate of consent to self insure CE 8of..l sorsa ceNficate of Workers'Compensation Insurance or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thef(Sec 36tO Lab C) Pslicy N05 1w Company FOR APPLICANT TO FILL IN JOB ❑ Certified copy is hereby furnished New Residential Bldgs &Pools EACH NO FEE ADDRESS Lf ❑ 1 &2-Family Sq Ft $ — $ LOCALITY certified ed copy is filed with the county budding inspection NEARES department Multi-family Sq Ft CROSS ST Residential Swimming Pools OWNER OR Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec—Light—Sw MNL COMPENSATION INSURANCE ADDRESS (This section need not be completed d the work Involved by the First 20 CITY Te 3Q permit Is for one hundred dollars($100)or less) Total No Additional I certify that in the performance of the work for which this permit PIAN CHECK 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 APPUCANT Exemption you should become subject to the Workers Compensation Range_ Heater D W q 001, provisions of the Labor Code you must forthwith comply with such Oven _ Dryer _ W M _ ADDRESS Bf+ &tSft1&V&dC provisions or this permit shall be deemed revoked Top — FAU _ WH _ LICENSED CONTRACTORS DECLARATION CIT� � Hood — Fan Other_ TIVW I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR G (commencing with Section 7000) of Division 3 of the Business and Disp — Room Air Cond REG NUMBER � a-O 3 Cl— (commencing Professions Code and my license is in full force and effect DISTRICT NO PROC D BY 8f Power Apparatus&Large Appliances OWE //�/Size&Type HP KW KVA or KVAR �/ Q License Numberic Class Up to 1 Incl FINAL 1 Q ' Over 1 to 10 Incl DATE VALIDATION C Contrac Date 4p— Over 10 to 50 Incl ❑ I am exempt under Sec Over 50 to 100 Inc W B&PC for IN reason Over 100 FINAL N S - Services Swbd MCC&Panelboards ate 0-200 Amp Under 600 V Signature 201 - 1000 Amp Under 600 V ? ElExemption for Reg Maint Elect Over 1000 Amp or Over 600 V Rr�l ��rr f s T SINGLE FAMILY Temp Power Pole&Appurtenances330725-5(1 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 1 hereby affirm that I am exempt from the Contractors License Law Additional Sign Branch Circuits ITEM for the following reason(Section 70315 Business and Professions Code) TOTAL 25.50 ❑ 1 as owner of the property will do the work and the structure Misc Conduits&Conductors I is not intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule) _ , CHECK 25.50 and Professions Code) OVINISEs I 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) Q 1 10/ 5/8r- Civ C) PLAN CHECKING FEE1 1 Pfl 2'33 Lenders Name / PERMIT ISSUING FEE Lenders 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 winng and hereby authorize rep tives of thiFC nter u n the above-mentioned fo ^ SEE REVERSE FOR EXPLANATORY LANGUAGE ; r ��. Ignatureof Per ee As Date