HomeMy Public PortalAbout5702 NOEL DR_Electrical__ if TEMPLE CITY
76A669-CE806 6.62 APPLICATION FOR, ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS Q
JOHN A LAMBIE COUNTY ENGINEER
WILLIAM A JENSEN SUP T OF BUILDING LOCALITY l..
NEAREST
FOR APPLICANT TO FILL IN CROSS ST �/ d
RECEPT TOTALPDL
O EACH FE!
OUTLETS S 20 $ OWNER
LIGHT ow-
MAIL
SWITCH t0 ADDRESS
/J1It
LIGHTING TOTAL 20 CITY Cc TEL NO * -'
FIXTURES } 10 ELECTRI IAN 9E 046 lzlrml
20
RANGES CLO DRYERS NRR HTRe . 100 ADDRES8 67
GARB DISP BTA COOK
CITY TEL NO
DISHWASH AUTO WASH STATE
SPACE HTRS BTA APP (%H P MAX) $p LICENSE NO
MOTORS OVER NOT OVER H P D18TRICT�VO R ED
0 I too a
I s too INSPECTION RECORD
s e 200
Is 250
1s so Soo >
s0 too sool It
V
SIGNS2 NO TRANS cle
NO LAMPS O
SERVICE O SOOV NOT OVER 200A 1 00 j
SERVICE O 800V OVER 200 A 2 00
SERVICE OVER 800V goo
+ Z
MIsC
PERMIT ISSUING FEE 1200
SUPPLEMENTAIRY PERMIT ISSUING FEE too
TOTAL FEE i
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI TION PP ALB CATS INSPECTOR 8 SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING WIRINGAw
1 HEREBY CERTIFY THAT 1 AM PROPERLY ROISTERED AND/OR
LICENSED AB REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM T E LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PRS Y POWER
SIGNATURE UTILITY CO NOTIFIED
OF PERMITT Zftd�� —
FINAL
VALme (T� A V c EIT
f IF
CK MO CASN SUPERVISING ELECTRICAL ENGINEER
Leo 2.3 7 9% Ate 7 20 4.00- 9
4
wm that I COMPENSATION DECLARATION CE S06G 10/81 APPLICATION FOR ELECTRICAL PERMIT
i hereby affirm that I have a certificate of consent to self insure
or a ce of Workers Compen Insurance or a certi d COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy 380 C)
PCI Com FOR APPLICANT TO FILL IN JOB
Certified copy is hereby furnishe EACH NO FEE 'ADDRESS
New Residential Bldgs &Pools
Ce ied copy is fled with coon uikUng rasp n 1 &2 Family Sq Ft $ — $ LOCALITY
de rim Multi family Sq Ft — NEAREST
Residential Swimming Pools GROSS 3T r
Date Applic OWNER OR
FIRM NAME
CERTIFICATE OF EXEMOWFROM W ERSI MAIL L/' O
COMPENSATION INSURANCE , Outlets Rec�Light FIreS20 ADDRE aS ,
(This section need not be completed if the work Involved by the CITY I
permit Is for one hundred dollars($100)or less) Total No Additional
1 certify that in the performance of the work for which this permit PLA CHECK
APPLICANT
is Issued 1 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 pEApRPUCA
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 _
Y
LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ CITNoo-
I hereby affirm that I am licensed under provisions of Chapter 9 Disp — Room Air Cond LICENSE
OR
(commencing with Section 7000)of Division 3 of the Business and REG NUMBER
Professions Code and my license is in full force and effect Power Apparatus&Large Appliances DISTRICT NO PROC SEED By
`fes Size&Type HP KW KVA or KVAR
Licen Num v Lic Clan Up to 1 Incl FINAL /
Ao V �_Over 1 to 10 Incl DATE f/ �2
Cont Date Over 10 to 50 Incl VALIDATION Q
❑ am exempt un c Over 50 to 100 Inc FINAL�� a
B&PC for this reason Over 100 N
Services Swbd MCC&Panelboards ► Z
Date 0 200 Amp Under 600 V
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
HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit 2
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 ACCT
Code) '❑ 7 Misc Conduits&Conductors 23.80
I as owner of the property will do the work and the structure _ ITEMS
is not intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule) Poo. TOTAL. 23�,,�a
and Professions Code)
CONSTRUCTION LENDING AGENCY (NECK 23•uj
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) / g {KA .00
Civ C)
PLAN CHECKING FEE 0000-0001 1I10I91
Lenders Name
PERMIT ISSUING FEE b
.Or
Lenders Address 4947 1 AM11• i
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
I'vNeentmatives County to enter upon the m nb d
rope wpegion purposes / SEE REVERSE FOR EXPLANATORY LANGUAGE
ature of 6-mi to