HomeMy Public PortalAbout9409 PENTLAND ST_Electrical__ 7EA6E3-CE60612-03 APPLICATION FOR ELECTRIC L PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING D
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS, SUPERINTENDENT OF BUILDING, LOCALITY
mm
mmomNEAREST
FO APPLICANT TO FILL IN CROSS BT
RECEPT _1 TOTALEACH
LIGHT Jly OUTLETS I FIRST 20 NO $20 s �lOO OWNER
MAIL
SWITCHADD L 10 ADDRESS
OVER 20
TOTAL CITY TEL NO
LIGHTING 1 FIXTU ES Fl 20 20 20 �Q
FIXTURES J ADD L 10 CONTRACTOR
OVER 20
RANGE. DRYERS WTR HTR. 1100 ADDREB
OAR. DIEP STA COOK
CITY TEL NO
DI.HWA.H AUTO WASH STATE
.PACE HTRS STA A 60 � LICENSE NO yO
MorortB OVER Nor OVER H P DISTRIC N G P Z P D B
o — 1 100 i
1 — 3 130 INSP ION R RD a
O
3 — S 200 u
Ed
B — 13 250 rO
13 30 1300 W
O
SO 100 1500 z
Z
SIGNS NO TRANS
NO LAWS
SERVICE O 600V NOT OVER 200A 100
SERVICE O 600V OVER 200 A 200
SERVICE OVER SOOV 500
OTHER (SEE COMPLETE FEE SCHEDULE)
PERMIT ISSUING FEE 200
SUPPLEMENTARY PERMIT ISSUING FEE 100 APPRQVALQ DATE INSPECTOR a NIGNA�
TOTAL FEE
1 HEREBY ACKNOWLEDGE THEABOVE
THAT HAVE READ THIE APPLICATION
UNDERSLAB WORK n
AND STAT!THAT THE ORDINANCE.
1E CORRECT AND AWS TO COMPLY ROUGH CONDUIT -
WITH RIC COUNTY OROINANCIE AND STAT! LAW. REGULATING
ELECTRICAL WIRING
WIRING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT THE LEGAL OWNER OF AND INTEND TO POWER
RESIDE IN THE ABO O CRI D REBID TIAL PRO [R
SIGNATURE UTILITY CO NOTIFIED IP
OF PERMITTE
FINAL
I ATION JOSEPH C ROOHAN
CK MO CASH SUPERVISING E"rC ELECTRIGL ENGINEER
U{�o2900n JUN 17 2 D 8.60~ 7
WORKERS CI have COMPENSATIONDECLARATION
of corse CIE76A663 806 '1007 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self ��6G
insure or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof (Sec 3800 Lab C j
PZ, � �,�❑ali,cy N. mpany /��Gk FOR APPLICANT TO FILL IN JOB
ADDRESS �/ Oi✓ '
Certified copy is hereby furnished New Residential Bldgs 8 Pools EACH NO FEE
Certified copy is filed with the county building inspec 1 8 2 Family Sq Ft $ I —Is LOCALITY 7, jy1*E
tion deportment Multi family Sq Ft — NEAREST
77 Residential Swimming Pools CROSS ST
DateL Apphcan OWNER OR r (�
II FIRM NAME J
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Re c Light,�/�Sw 'MAIL
COMPENSATION INSURANCE First 20 •�, _ADDRESS
(This section need not be completed If the work involved by Total No CIN Tel No
the permit is for one hundred dollars ($100)or los ) ` Additional
I certify that in the performance of the wbrk,for which this PIAN CHECK
permit is issued I shall not employ any person to APPLICANT any manner ,
so as to become subject to the Workers Compensation Laws Lighting Fixtures First 20, l ADDRESS
' Total No I Additional _
CITY _ Tel No
Date. Applicant Fixed Appliances Not Over 1 HP PERMIT //
x NOTICE TO APPLICANT If^after making tFiis Certificate of n APPLICANT/. C! Vw1Q
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 _-r ADDRESS/7,7.� 67(1 _./�
woh`comply with such provisions or this permit shall be Top _ FAU —W H —
deemed revoked - - = 4/lrl
i CITY Tel No 63
LICENSED CONTRACTORS DECLARATION Hood _ Fan" _ Ofher_
' Disp- .— Room Air Cond LICENSE OR Class
hereby affnm that I am licensed under provisions of Chapter 9 REG NUMBER -
(commencing with Section 7000) of Drvisioni3 of the Business DISTRICT NO PROCE Y—
and Professions Code and my license is in full force andreffect Power Apparatus 8 Large Appliances _ d
��77 TQ ��jj // Size 8 Type HP KW KVA, or KVAR `S O
License Number c��6//7 L¢ Class , - - - - _ _ V
t Up to 1 Incl FINAL
Over 1 to 10 Incl DATE _ VALIDATION O
Contract to///Y/ Over 10 to 50 Ind l C
❑ FINAL
I am exempt unde Over 50 to 100 Inc BY �.�
B 8P C for this reason Over 100 Z
Date Services Swbd MCC &'Ponelboards ►
0 - 200 Amp Under 600 V
Signature 201 1000 Amp Under 600 V
❑ Exemption for Reg Motor Elect Over 1000 Amp or Over 600 V - 7 2 7 2 A
SINGLE FAMILY Temp Power Pole 8 Appurtenances ° ° ° ° ° 2
HOME OWNER-BUILDER DECLARATION 1 Sign with One Branch Circuit {
I hereby affirm that I am exempt from the Contractors License Additional Sign Branch Circuits 2 °,° 1 O,25
Law for the following reason (Section 7031 5 Business and
Professions Code) ce ° ° 1 Q 2 5 3
Muc Conduits 8 Conductor's 12�' 1`-83
I as owner of the property will da the work and the Other�(See Complete Fee Schedule)_
structure is not intended or offered for sale (Section , ,
7044 Business and Professions Code) � -
CONSTRUCTION LENDING AGENCY r - _-
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) ; s „
(Sec 3097 Civ C ) ,
PLAN CHECKING FEE -
Lender s Name ��11
PERMIT ISSUING FEE
Lender s Address '
I certify that I have read this application and state that the TOTAL FEE Y Zy« 1
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 '
th a roperry for inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of PatplotwE // Date - `