HomeMy Public PortalAbout9842 OLIVE ST_Electrical__ IABSS-CESOO 10-52 APPLICATION F R ELECTRIC�PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEERBUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER �/d
WILLIAM A.JENSEN,SUP 'T OF BUILDING LOCALITY 1 L/1 I
NEAREST p ')r
FOR APPLICANT TO FILL IN CROSS ST. UtlIIVV /
RECE-A TOTAL NO. EACH FEE .I
/ OUTLETS FIRST 20 .111 20 $ WNER
LIGHT /•-•'j AIL -
SWITCH. �y1/([ ADD'L DDRESS
OVER 20 1O
TOTAL ITY TEL.NO.LIGHTING IFIRST 2O .20 FIXTURES ADD'L
OVER 20 .10 p -r
RANGES CLO.DRYERS WTR.HTRS. 1.00 - ADDRESS 89 23 EL Pfo a.dm
GARB.DISPASH. STA.COOK 1 CIT EL.NO.
DISH WASH. AUTO.-WASH' STATE
ACE HTRS. STA.APP.(+/z H.P.MAX.) '.50 a LICENSE NO. - 17-8987
MOTORS: OVER NOT OVER H.P. DISTRICT N GROUP ZONE IPJR=ESSED BY
O f 1.00
1 s 1.50 INSPECTION RE RD
s a_ 2.00
B' 15 2.50
A'
50 8.00 I
50 100 5.00
SIGNS- NO.TRANS. A
NO.LAMPS
p:
SERVICE O-SOOV-NOT OVER 200A 1.00 ' e'
SERVICE O-SOOV-OVER 200 A., 2.00'
SERVICE OVER SOOV 5.00
MISC.
PERMIT ISSUING FEE 2.;0 ®®x;
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE a
I HEREBY ACKNOWLEDGE THAT-1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY ' CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULAT (�'
ELECTRICAL WIRING. WIRING A j
1 HEREBY CERTIFY THAT AM PROPERLY RE T ED I)IOR
LICENSED AS REQUIRED BY S ANGELES Y NO ATE O FIXTURES
CALIFORNIA OR THAT I THE LEGAL F ABO
DESCRIBED RE D TIAL OPERTY. POWER ,y
SIGNATURE UTILITY CO.NOTIFIED 10 Olt
OF PERMITTE
FINAL
LIDATION AR HUR C:VEIT
SUPERVISING ELECTRICAL ENGINEER ,
CK- MO CASH
LC03274G DEC 9 2 D 15..44N
ox�
WORKERS'COMPENSATION DECLARATION! _ ' 9 1018 APPLICATI®N FOR OCTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self SCE-806G
insure, 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 9 g A Z Oe-!si tv
rtified co is hereby furnished. EACH NO. FEE ADDRESS `T
PY Y New Residential Bldgs. &Pools
$ — $ LOCALITY (e C%.
Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. i2•'1�
tion department. I Multi-family Sq. Ft. — 'NEAREST
L, .L� (3 Residential Swimming Pools CROSS ST. !FA-(, tl.
Z CpJ/i� L Cie C, t g OWNER OR
VA
Date Applicant L�
FIRM'NAME C7(I fiS
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RecZ�Light 1. Sw.� .ADDRESS
COMPENSATION INSURANCE First 20 i
(This section need not be completed If the work Involved by Total No.s-3 Additional CITY Tei.`No.
the permit is for one hundred dollars($100)or less.) 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'Compensation Laws: Lighting Fixtures First 20 ADDRESS
Total No.- 7 Additional CITY Tel. No.
Date Applicant !i Fixed Appliances Not Over 1 HP PERMIT a
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 2 t-W NLSED
Ye
with comply with such provisions or this permit shall be Top — FAU —W.H. —
deemed revoked. CITY �2C,p�La S 7 r,6
Hood _Fan _Other—
LICENSED CONTRACTORS DECLARATION LICENSE,OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER �J Z�� �' G(C
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO. P
Power Apparatus&Large Appliances >
and Professions Code,and my license Win full force and effect. IL
Size&Type HP, KW, KVA, or KVAR' O
License Number -,L`D o g b Lic. Class L-I CWp to 1 Incl. FINAL ` W
�
C Over 1 to 10 Incl. DATE r '�('� � * VALIDATION
Contractor "s C ACII �1 1 E a,Date /017-1 ' 0 Z FINAL 0
Over 10 to 50 Incl.
❑ I am exempt under Sec. Over 50 to 100 Inc. BY
Over 100
N
B.&P.C. for this reason �
Date:
Services, Swbd., MCC&Ponelboards ® �
0 -200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600 V
❑
Exemption for Reg. Mdint. Elect. Over 1000 Amp. or Over 600 V
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
Law for the following reason (Section 7031.5, Business and _
Professions Code): i Q '/ A
❑ I, as owner of theMisc.. property, will do the work and the Conduits&Conductors ® ; ;: „ G0 o
structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_
7044, Business and Professions Code). a Z p p C
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 PERMIT FEE (Sub-Total) C.2 2 - Q j
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE 0
Lender's Name
PERMIT ISSUING FEE
Lender's Address
I certify that I have read this application.and state that the TOTAL FEE
above 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 ab ve-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
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natuof a Z!
Sigy_ Permittee D to