Loading...
HomeMy Public PortalAbout10122 NADINE ST_Electrical__ r 70AG63 CEBOS 7 5 APPLICATION FOR ELECTRIC PERMIT ], BU=ING AND SAFETY DMSION Department of County Engineer FNEAREST G Gj /�Z County of Los Angeles S JOHN A LAMBIE COUNTY ENGINEER f 1 CASSATT D GRIFFIN SUP T OF BUILDING Y FFOOR APPLICANT ICSTO FILL IN CROSS ST NUMBER OWNER LIGHT OUTLETS MAIL ADDRESS RECEPTACLES WALL SWITCHES FEE CITY TEL NO TOTAL OUTLETS ® s9 S ELECTRICIAN ELEC RANGES 28 ADDRESS a ELEC HEATERS 28 CITY TEL N KW EA STATE FIXTURES g LICENSE NO MOTORS DISTRICT NO I GR_ OUP IXZNE I READY FOR INSPECTION NUMBER HORSEPOWER FEE NEW MVD HP OVER INC EACH ]�8:LESS S 28 �SPELTTON B=RD 2 so If 7- 2 S 100 S 1S 1 SO 15 SO 2 SO SO 200 500 M ISC NO SIGNS NO TRANS NO SIGNS NO LAMPS FOR EACH PERMIT WIRING PERMIT 31 00 FIXTURE PERMIT $100 SUPPLEMENTARY SO APPROVALS TOTAL FEE $ DATE INSPECTOR S SIGNATURE 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI ATION 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 I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF POWER CALIFORNIA OR THAT AM E LEGL �NER OF THE ABOVE DESCRIBED RESIDENTI L RO RTY UTILITY CO NOTIFIED.-?-/4p SIGNATURE OF PERMITTEE FINAL lie g? IT COUNTY ENGINEER VALmAaa A SUPERVISING EARTHUR C LECTRICAL ENGINEER L---*U AP-3 8 6 s- Jm 3 2 1 .50 >A 7®A889 CESOS 756 APPLICATION FOR ELECTRIC PERMIT BUILDING AND SAFETY DIVISION Dep oxtmeat of County Engineer BUILDING County of Los Angeles ADDRESS JOHN A LAMBIE COUNTY ENGINEER CABSATT D GRIFFIN SUP T OF BUILDING LOCALITY NEARES T FOR APPLICANT TO FILL IN CROSSST PERMIT FEES NUMBER OWNER 17 LIGHT OUTLETS MAIL ADDRESS RECEPTACLES WALL SWITCHES EEZ CITY TEL NO -74 TOTAL OUTLETS @ 52 f ELECTRICIAN ELEC RANGES 25 ADDRES O ELEC HEATERS 25 CITY TEL N ' KW EA STATE FIXTURES 5LICENSE NO MOTORS DISTRICT NO GROUP ZONE I READY FOR INSPECTION NUMBER HORSEPOWER FEE NEW MVD HP OVER I INC EACH r� /�! R� 1/2 8 LESS S 25 D INSP IT�ON RECORD 1/2 2 50 2 5 too 5 15 ISO to 50 2 50 50 200 Soo MISC NO SIGNS NO TRANS NO SIGNS NO LAMPS FOR EACH PERMIT WIRING PERMIT $t 00 O FIXTURE PERMIT $100 SUPPLEMENTARY SO APPROVALS TOTAL FEE Q DATE INSPECTOR S SIGNATURE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPEICATION CONDUIT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING FIXTURES e I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF POWER CALIFORNIA OR THAT I fflE GAL WNER OF THE ABOVE DESCRIBED RESIDENTIAL PTY UTILITY CO NOTIFIED SIGNATURE OF PERMITTEE FINAL 71 JOHN A LAMBIE VAMAVOk ARTHUR C VEIT COUNTY ENGINEER CKMo CABH SUPERVIsma ELECTRICAL ENGINEER I A0 370l%U*% DEC27 2 7.90 in WORKERS COMPENSATION DECLARATION CE 806G '°'a' APPLICATION FOR ELECTRICAL PERMIT 1 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 c py'th c 3600 Lab C) Policy llNooV ,d .29 a 154�p C n�a�( FOR APPLICANT TO FILL IN JOB Company ADDRESS /�` ❑ Certified copy is hereby furnished New Residential Bldgs &Pools EACH NO FEE ®�rtified copy is filed with the county building Inspection 1 &2-Family Sq Ft $ — $ LOCALITY 02 P department Muni-family Sq Ft — NEAREST CROSS ST d Date-/--/— A' 9 Applicant 40 ���s-� Residential Swimming Pools OW ER OR N /�� FIRM NAME ( C1 V,_,rr CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rao_Light_Sw MAIL COMPENSATION INSURANCE ADDRESS (This section need not be completed d the work Involved by the First 20 CITY //77 t Tel No permit is for one hundred dollars($100)or less) Total No Additional G• �• I certify that in the performance of the work for which this permit PLAN 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 NOTICE TO APPLICANT if after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT APPLICANT O' ry 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 2Y to provisions or this permit shall be deemed revoked Top - FAU _ WH lu LICENSED CONTRACTORS DECLARATION Hood - Fan _ Other_ CITY ��S p` Tel No I hereby affirm that I am I censed under provisions of Chapter 9 Dlsp - Room Air Cond LICENSE OR _ Class �c7 (commencing with Section 7000)of Division 3 of the Business and REG NUMBER Jr 6o �o Professions Code and my license Is In full force and effect Power Apparatus&Large Appliances DISTRICT NO PROCESSED BY _/�7� �e�6 `D_ Z� Size&Type HP KW KVA or KVAR License Number � V ��..,�,, t ,( Lx; Class Up to 1 Incl FINAL 7 Cont�atof�' ? ` �a-(.-S ate Over 1 to 10 Incl DATE Z✓�° A DATION O� Over 10 to 50 Incl FIry ❑ I am exempt under Sec Over 50 to 100 Inc g B&PC for this reason Over 100 N Services Swbd MCC&Panelboards ► Z Date 0-200 Amp Under 600 V r° Signature 201 - 1000 Amp Under 600 V 13Exemption 1000 Amp or Over 600 V Exemption for Reg Maint Elect �1 2 9 9 A SINGLE FAMILY Temp Power Pole&Appurtenances # 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 1 hereby affirm that I am exempt from the Contractors License Law for the following reason(Section 70315 Business and Professions Additional Sign Branch Circuits f s e ' 750 Code) ❑ I as owner of the property will do the work and the structure Misc Conduits&Conductors s a e 1 7 5©5 Is not intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule) _ and Professions Code) , 212 -88 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) a Cry C) PLAN CHECKING FEE Lender s Name PERMIT ISSUING FEE Lenders Address I certify that I have read this application and state that the above TOTAL FEE NIS 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 Inspect n purposes ^ ' C SEE REVERSE FOR EXPLANATORY LANGUAGE g 'tura of Permittee Date