HomeMy Public PortalAbout10611 OLIVE ST_Electrical__ GAG63-CEBOB..10.56 APPLICATION FOR ELECTRIC PERMIT
BUILDING AND SAFETY DMSION
Depwbnent of County Engineer BUILDING
County
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JOHN
of IAS Angeles ADDRESS
JOHN A.LAMBIE,COUNTY ENGINEER //
CASSPk
ATT D. GRIFFIN.SUPT OF BUILDING :,LOCALITY �� 4 4 0
NEAREST
FOR APPLICANT TO FILL IN CROSS
- PERMIT FEES OWNER
LIGHTS RECEPTACLES SWITCHES Q
NUMBER I T E M EACH FEE mAL
.ADDRESS l a 6!! /��
TOTAL OUTLETS S .10 S e �® �r Q
ELEC. RANGES, WATER HEATERS, Lj
:CITY T /e `I TEL.NO.�-.�
CLOTHES DRYERS .50
ALE.C. SPACEIIEATBRS, STAVY. DOOR.. ..ELECTRI IgqAN�y1�.9 v ®3e� et.,v&.
INS UNITS, GARBAGE DISPOSERS, ADDRESS 'V tS �J �YE�Y'I
AUTO WASHERS, DISHWASHER .25 �.p+ ,/ �o
1 LIGHTING FIXTURES ;10 0 CITY l C� 4 TEL. NO.
MOTORS
STATE e �t
LICENSE NO.
HORSEPOWER
H.P. OVERINC. ,DISTRICT NO. G OUP ZONE READY FOR INSPECTION
1/i B:LESS .25 Q �O
31h — z 50 SOSPECTION BECOBD
2 5 1.00
5 15 1.80 t ► `, a L7 1 .
rn
15 50 2.50
50 200 5.00
MISC.
w r t9 ej O
NO.TRANS _
SIGNS NO.LAMPS
SERVICED-SOOV. 1.00d-'.
SERVICE OVER SOOV 5.00 qy w
WIRING PERMIT 1.00
FIXTURE PERMIT 1.0.0 d
SUPPLEMENTARY PERMIT .50 ,fir APPROVALS
TOTAL FEE $ :� Tdt D TE INSP TOR'S SIGNATURE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION . �1
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT 1 W R
WITH ALL COUNTY ORDINANCES AND STATE. LAWS REGULATING
ELECTRICAL WIRING. WIRING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNE OF THE ABOVE POWER
DESCRIBED RESIDENTI PROP 13Y. /� I
SIGNATURE /� /' UTILITY CO.NOTIFIED t
OF PERMITTEE FINAL �
[OHN A.LAMBIE, ATION A RTR C.VEIT.
.OUNTY EMO CASH
NGINEER SUPERVISING ELECTRICAL ENGINEER
CK
LACo 3 4 - 6 f-AR 1 F 2 A 2.90
WORKERS'COMPENSATION DECLAVATION 20-0019 DPW 3/87
hereby affirm.!.hat I have a certificate of consent to self CE806G3 APPLICATION FOR ELECTRICAL PERMITO
insure, or a certll c6te of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
or a certified copy thereof(Sec. 3800, Lob. C.)
' Policy No. Company 1. FOR APPLICANT TO FILL IN JOB C
❑Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS L I i Li S 1
❑Certified copy is filed with-the county building inspec- 1 &2-Family, Sq. Ft. $ —Is I LOCALITY I j
tion department. l Multi-family Sq. Ft. — NEAREST
CROSS
Residential Swimming Pools OWN RST.OR
Date Applicant FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL r
COMPENSATION INSURANCE First 20
ADDRESS
(This section need not be completed if the work involved by CITY s Tel. No.
the permit is for one hundred dollars($100)or less.)' Total No. Additional OS
� I ti PLAN CHECK
I certify that in the performance of the work for which this I i APPLICANT
permit is issued, I shall not employ any person in any manner
so as to become sub" cf to the War rs'Compensa' n Laws. Lighting Fixtures First 20 ADDRESS
i Additional
Total No. CITY Tel. No.
Date pplicant Fixed Appliances Not Over 1 HP PERMIT �+ �a
NOTICE TO APPLICANT: If, after making this Cerfificate of APPLICATION
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 ��T
with. comply with such provisions or this permit shall be- 1 Top FAU —W.H. —
deemed revoked. Hood — Fan —other_ CITY S AAJ 6 A&R?& Tel. N 3 074/1
LICENSED CONTRACTORS DECLARATION 1 LICENSE OR p
I hereby affirm that I am licensed under provisions of Chapter 9 I Disp. _ Room Air Cond.,— REG.NUMBER + Q Class. C (f
(commencing with Section 7000 of.Division 3 of the Business
( g' ) Power Apparatus 8 Large Appliances i DI NO. PR SED BN a
and Professions Code,and. Ylic Benis in full force and effect.
Size 8 Type HP, KW, KSTR
VA, or KVAR s 0
License Number.5/ I ic.Class Up to 1 Incl. FINAL U
/ r �,� i� J Over 1 to 10 Incl. DATE VALID TION
Contract w '�'a Over 10 to 50 Incl. qN 10
FINAL F'
❑ I am exempt under Sec. Over 50 to 100 Inc. BY U
Over 100 W
B,BP.C. for this reason d
rl -
MCC&Panelboards Z
Date:_ m n er 600Signature Amp, nder 600 V
❑ mp. or Over 600 V
Exemption for Reg. Maint. Elect.
SINGLE FAMILY Temp. Power Pole 8,Appurtenances
HOME OWNER-BUILDER.DECLARATION
Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License ,i gC(�.v
Law for the following reason (Section 7031-.5, Business and Additional Sign Branch Circuits �•y
Professions Code): 3,707 31.00
IDI, as owner of the property, will do the work and the I Misc. Conduits 8 Conductors j ITEMS
structure is not intended or offered for sale(Section 7044, Other(See Complete Fee Schedule)_ a ® �QfL ��
Business and Professions Code): I
CONSTRUCTION LENDING AGENCY CASH 31.00
1 hereby affirm.that there is a construction lending agency for I
the performance of the work for which this permit is issued I PERMIT FEE (Sub-Totol) CHANGE o00
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE
Lender's Namei (000-0 01 3/ 2/90
PERMIT ISSUING FEE
Lenders Address 92162 1 AM 92.113
1 certify that I have read this application and state that the i TOTAL FEE e0
above information is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby authorize represent ti s of this County to enter upon '
t ove-mentione ro y for inspecti. purposes. ;
I` I • SEE REVERSE FOR EXPLANATORY LANGUAGE
®s
Signature of Permittee ✓ Date fI