The URL can be used to link to this page

Home My Public Portal About10243 NADINE ST_Electrical__ 76A66j CESOS %66 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING " BUILDING AND SAFETY DIVISION ADDRESSKko � r JOHN A LAMBIE COUNTY ENGINEER COLEMAN W JENKINS SUPERINTENDENT OF BUILDING LOCALITY yam'- NEAREST FOR APPLICANT TO FILL IN CROSS ST cc RECEPT NO $AC S F OWNER V JS MAIL bl\ LIGHT TOTAL FIRST 20 � 20 ADDRESS �l � SWITCH OVER 20 10 CITY ��\) EL NO PLAN CHEC LIGHTING �,TOTAL FIRST 20 20 APPLICANTFIXTURES OVER 20 10 ADDRESS 1 RANGE—DRYER—WTR HTR — CIT �'- TEL NO (J STA COOK_DISP _F A U _ CONTRAC TOR SPACE HTR AIR COND ADDRESS `` CLOTHES WASH _DISHWASH CITY �V TEL NO d FAN—OTHER 1 00 LICENSE NO _% CLASS MOTORS TRANSFORMERS RATING IND HEATERS ETC HP KW KVA 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SIZE B TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS R ULATIN ELECTRICAL WIRING 0 - 1 1 00 I HEREBY CERTIFY THAT I A ROPER REGIS D AND/OR 1 - 10 3 00 LICENSED AS REQUIRED L AN ELE LINTY STATE OF CALIFORNIA OR THAT I M LE R OF INTEND TO 10 - 50 Soo RESIDE IN THE A VE PE PERTY O SIGNATURE V 50 - 100 1000 OF PERMITTEE DC 100 - 500 11500 W DISTRIC NO GP zaN7 SED BY TUBE SIGNA SIGN AND ONE CIRCUIT 3 00 MARQUEE N ADDITIONAL CIRCUITS i 00 NOTES Z SERVICE NOT OVER 600 VOLTS OR 200 AMP 2 00 SERVICE OVER 600 VOLTS OR 200 AMP Soo TEMP SERVICE POLE &APPURTENANCES 3 00 APPROVALS DATE INSPECTOR S SIGNATURE TEMP POWER POLE UNDERSLAB WORK ROUGH CONDUIT PERMIT FEE (SUB TOTAL) 2 WIRING FIXTURES PLAN CHECK FEE (50% PERMIT FEEL POWER AUTHORIZED /L PERMIT ISSUING FEE 2 00 UTILITY CO NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1 00 FINAL TOTAL FEE JOSEPH C ROOHAN SUPERVISING ELE L ENGINEER PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION cK M O GASH 5 7 6 2 AUS 6 2 D 6 �4 0� Q SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE F.,�WCIRKERS COMPENSATION DECLARATION 76A663 10/81 APPLICATION FOR ELECTRICAL PERMIT 'a3rei �itn that I have a certificate of consent to self CE 8066 're or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec 3800 Lab C ) Policy No Company FOR APPLICANT TO FILL IN JOB e Certified copy is hereby furnished New Residential Bldgs &Pools EACH NO FEE ADDRESS Q n P/N t S ❑ = Certified copy is filed with the county building mspec 1 8 2 Family Sq Ft $ $ LOCALITY tion department Multifamily Sq Ft NEAREST Residential Swimming Pools CROSS ST V tt IV R Date Applicant OWNER OR S11RICH1191M CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec.�2Light�Sw4_ MAIL COMPENSATION INSURANCE First 20 7 0 ADDRESS 101A 43 A1401111`1 ST (This section need not be completed If the work Involved by Total No Additional �` CITY 'rt P IRA If f T Tel No 57-4_162 6j the permit Is for one hundred dollars($100)or loss) PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit is issued I shall not employ any person in any manner so as to become subject to the Workers Com ensation Laws Lighting Fixtures First 20 ADDRESS g -A-5-fib S '' ' N" Total No Additional CITY Tel No DateApplicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT If after making this Certificate of APPLICANT Exemption you should become subject to the Workers Range_ Heater_D W Compensation provisions of the Labor Code you must forth Oven _Dryer W M — ADDRESS with comply with such provisions or this permit shall be Top _ FAUH — deemed revoked Hood Fan Other_ CITY Tel No LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp _ Room Air Cond �'v`� REG NUMBER Class (commencing with Section 7000)of Division 3 of the Business power Apparatus&Large Appliances DISTRICT NO P BY and Professions Code and my license is in full force and effect 8 Size 8 Type HP KW KVA or KVAR �L 0 License Number Lic Class Up to 1 Incl FINAL 13: Over 1 to 10 Incl DATE O Contractor Date VALIDATI Over 10 to 50 Incl FINAL I am exempt under Sec Over 50 to 100 Inc BY d B&P C for this reason Over 100 Z Date Services Swbd MCC&Ponelboards 0 200 Amp Under 600 V Signature 201 1000 Amp Under 600V ❑ Exemption for Reg MaOver 1000 Amp or Over 600 V mt Elect SINGLE FAMILY Temp Power Pole&Appurtenances HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor s License Additional Sign Branch Circuits for the following reason (Section 7031 5 Business and Prof ssions Code) I 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)_ ► I116 }�7044 Business and Professions Code) CONSTRUCTION LENDING AGENCYy SO 1 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 ) ?,(r. PLAN CHECKING FEE Lender s Name PERMIT ISSUING FEE �D Lender s Address I certify that I have read this application and state that the TOTAL FEE 2 S above information is correct I agree to comply with all County ordinances and State jaws regulating Electrical wiring and hereby authorize representatives of this County to enter upon thea men/ion prNperty�fotion purposes SEE REVERSE FOR EXPLANATORY LANGUAGE If OU—IJ& Signature of Permittee Date