HomeMy Public PortalAbout9419 PENTLAND ST_Electrical__ 76A663-CER06 B•62 APPLICATION FOR ELECTRICAL P"IT _
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS 9 Li ',5-r A+U
JOHN A LAMBIE COUNTY ENGINEER
WILLIAM A JENSEN SUPT OF BUILDING LOCALITY f
NEAREST
1FOR APPLICANT TO FILL IN caoss er a.
gECEPT 'I TOTAL FIRST 2D NO 9 2O B ZE 0 ,OWNER P L I IJ I p
llll5 OUTLETS O MAIL
ADDLIGHT IL/
OVER 20
ADDRESS M
SWITCH OYER'L 1G
TOTAL ✓CITY TEL NO
LIGHTING F)RST 20I 20 Q�
FIXTUR ES3 '7j VER 2 10 ELECTRICIAN _j t1 N 1'� wA
VER 20
RANGES CLO DRYERS WTR HTR9 too-- ADDREBB 0 �`J
GARY DISP RA COOT(
CITY ( i TEL NO l
DIBHWASM AUTO WASH STATE 0
SPACE HTRV STA ARP (y.H R MAX 1 SO LICENSE NO �. V
MOTORS OVER NOT OVER H R DISTRICT O GROUP Z E P ESSE,D 9 j
O — 1 1 00 '�Z���
1 — D 150 INSPECTIOq N/RECORD n //�
s — B 200
tiY
B — 15 250 / V
Is — 50 300
60 — 100 SOO / . -n` _rf=jJ /
LDrin.O�iv ,/jos U
SIGNS NO TRANS a /r / Of
NO LAMP. V O
SERVICE 600V NOT OVER 200A 1 00 j
SERVICED 600V OV 200A 2Op y
SERVICE OVER SOOV 500
MIBC
PERMIT ISSUING FEE 200 00
SUPPLEMENTARY PERMIT ISSUING FEE 100
TOTAL FEE p
1 HERESY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION A"ROVALS DATE INxPz=oR usamwTugg
AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING WIRING
I HERESY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGP;EKS COUNT AND BTA F FIXTURED
CALIFORNIA OR THAT THE LEGAL OWNE OF THE A OVG
DESCRIBED 12010¢ L PRo ERTY POWER
SIGNATURE / UTILITY CO NOTIFIED
OF PERMITTEE FINAL
VA IDATION ARTHUR C VETT 1
C MO CASH SUPERVISING ELECTRICAL ENGINEER
_100068 7t2 FEB 7 2 D 5 4 0,^ 01
Wm that I haw a COMPENSATION DECLARATION CE-663 ,n/a, APPLJCATION FOR ELECTRICAL PERMIT {�
I here�Ty affirm that I have a certificate of consent to self insure,
DB-a63G LJ
or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec. 3800,Lab.C.)
• Policy No. CompwW FOR APPLICANT TO FILL IN JOB
❑ Certified copy is hereby furnished. New Residential Bldga.& Pools EACH NO. FEE ADDRESS 94,1�7 �',✓ 4
❑ Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft. $ — $ LOCALITY
department. Multi-family Sq.Ft. NEAREST
CROSS ST.
Date Applicant
Residential Swimming Pools OWNER OR / s� ✓
FIRM NAME C O✓/
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rao_6 Light •? Sw. _92-111 - 9 MAIL
COMPENSATION INSURANCE .�' '� �J ADDRESS M G/
(This section need not be completed if the work involved by the / 7 Firs!20 CITY Tel.No.
permit Is for one hundred dollars($100)or less.) Total No.Lit Additional
certify that in the performance of the PLAN CHECK
rk f0 which this permit APPLICANT
is issued, I shall not employ any peri in f manner so as to
become subject to the Workers'Comp as 2W& Lighting Fixtures First 20 ADDRESS
Additional
Total No.� CITY Tel.No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTI E TO APPLICANT: 11, aft making this Certificate of APPLICANT
Exemption,you should become su ct to the Workers'Compensation Range_ Heater_ D.W. _
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 _ W.H.
CITY Tel.No. �f
LICENSED CONTRACTORS DECLARATION Hood Fan Other_
I hereby affirm that I am licensed under provisions of Chapter 9LICENSE R G
(commencing with Section 7000) of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER
Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PRESSED BY
Size&Type HP,KW,KVA,or KVAR • P 0
License Nu bar f
Lie.Class Up to 1 Incl. FINAL y V
Contractor Date Over 1 to 10 Incl. DATE VALIDATION 0
❑ Over 10 to 50 Ind. F
FINAL U
I am exempt under Sec Over 50 to 100 Inc. gy IyI
BARC.for this reason Over 100 d
n
Services,Swbtl.,MCC 8 Panelboards ► Z
Date: 0- 200 Amp.Under 600 V
Signature 201 - 1000 Amp.Under 600 V
Over 1000 Amp. or Over 600 V
❑ Exemption for Reg.Maint.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 Law tIIr.t T,A
for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits
Code): JJUt JJ.rTJ
❑ I,as owner of the property,will do the work and the structure Misc.Conduits& Conductors
Other (See Complete Fee Schedule)
is not intended C offered for sale (Section 7044, Business m;t
and Professions Code). ► 1!1'rAL 33. 45
CONSTRUCTION LENDING AGENCY �.-ASH �`.d.4
I hereby affirm that there is a construction lending agency for the �`kl
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE _ (Sub-Total) 6 �, CHANGE
Civ. C.).
Lender's Name PLAN CHECKING FEE 1)UOf)-001(Q 1 10/301171
PERMIT ISSUING FEE
Lender's Address 9752 1 AMSa:<
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 I a regulating Electrical wiring, and hereby authorize
na resentati sof I(5 Co ty to enter upon the above-mentioned
Property t insP A ps Dies.
vel(F SEE REVERSE FOR EXPLANATORY LANGUAGE
i
Signatur Per ttee Date