HomeMy Public PortalAbout9437 PENTLAND ST_Electrical__ DESASA II RE APPLICATION FOR ELECTRIC PERMIT
DIVISION OF BUILDING AND SAFETY
Department of County Engineer BUILDING 3 �N�/I
C,pynty pt ]�ngyjeg ADDRESS
JOHN A LAIv1B1E• COUNTY ENGINEER }�
CABBATY D GRIFFIN SUP T OF BUILDING LOCALITY G /•�
FOR APPLICANT TO FILL IN NEAREST ia�Q�� /
PERM FEES C DSS ST C
NUMBER OWNER O C
LIGHT OUTLETS �, y�J
MAIL f/
RECEPTACLES ADDRE99
WALL SWITCHES FEE CITY/G / TEL O
TOTAL OUTLETS a ELECTRICIAN
ELEC RANGES 215 ADDRESS
ELEC HEATERS 25
CITY TEL NO
KW EA
STATE
FIXTURES a LICENSE NO
MOTORS DISTRICT NO GROUP I ZONE I RUDY MR INSPECTION
NDMeER HORSEPOWER FEE
NEW MVD HP OVER INC EACH
}h a LEER i 215 1 INSPECTION RECORD
2 ao n S� C� yIIRSut� .511L ( dk
2 a 1 OO n
5 Is 1150
Is 90 250
50 200 a 00 Q L. Q LTJ L I
MISC �
p - 1.1 Na . 4
II iw� 1• INAb , �r
NO SIGNS NO TRANS
NO SIGNS NO LAMPS
FOR EACH PERMIT
WIRING 3100
FIXTURES 31 00
SUPPLEMENTARY 50 aY"ROV WA'L*L�
c
TOTAL FEE i DATEINSPECTOR S SIGNATURE
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING n
ELECTRICAL WIRING WIRING rj
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND ATE OF
CALIFORNIAO 1 THE LEGAL WN OF POWER
DESCRIBED RE ETI PRR OPERTY
SIGNATURE UTILITY CO NOTIFIED
OF PERMITTEE FINAL O
JOHN A LAMBIE.COUNTY ENGINEER VA RIA ARTHUR C VEI ,CHIEF E SPECTOR
A9 6 4 9��23 2 2.50 o
TION
WORKERS CI have COMPENSATION of corse 2llamcDPW 9,6) APPLICATION FOR ELECTRICAL PERMIT
enm
I hereby affirm that I have a certificate of consent to self �goyD
insure or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS
or a certified copy thereof (Sec 3800, Lab C )
Policy No 1:�Y 2� Company �/!/l�n d)`l� FOR APPLICANT 70 FILL IN JOB
❑Certified copy is hereby furnished New Residential Bldgs 8 Pools EACH NO FEE ADDRESS
�ertified copy is filed with the county build, inspec 1 8 2-Family Sq Ft $ — S LOCALITY
non department Multi family Sq Ft — NEAREST
Residential Swimming Pools CROSS ST J/
Date /7-S' gy Applicant g
OWNERFIRM NAME
CERTIFICATE OF EXEMPTION ROM WORKERS Outlets Rer�L,ght�Sw�
COMPENSATION INSURANCE IL MAIL
First 20 `•J O �S- ADDRESS
(This section need not be completed If the work Involved by Total No s Addil,ona l� CITY Tel No
the permit Is foi one hundred dollars ($100)or less ) x _ � PIAN CHECK
I certify that ,n 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 ADDRESSB
Total No / y Additional t SD
Date Applicant CI r Tel N
NOTICE TO APPLICANT If after making this Certificate of Fixed Appliances Not Over i HP / PERM
e-r�Heater_DW L/ APPLICATION
Exemption you should become subject to the Workers Range
Compensation provisions of the Labor Code, you must forth- Oven r✓Dryer LAW M - - ADDRESS ,
with comply with such provisions or this permit shall be Top FAU —W H
deemed revoked Hood CITY - " Tel No
LICENSED CONTRACTORS DECLARATION Fan —Other_ 6-V �- - UCENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp Roam Air Cond REG NUMBER Class
(commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO
and Professions Code and my license,s in full force and effect E ED B; d
Size 8 Type HP KW KVA or KVAR �(� O
License Number-995 a/ Lic Class Up to I Incl FINAL - - O
Contractor -y ri ' "'T to 'JR4` Over 1 to 10 Incl DA's Z _ 9 - VALIDATION 0
❑ Over 10 to 50 Incl FINAL
1 am exempt under Sec Over 50 to 100 Inc BY W
11
B 8P C for this reason Over 100 rn
Dote Services Swbd MCC 8 Ponelboords , Z
0- 200 Amp Under 600 V P/
Signature 201 201 - 1000 Amp Under 600 V
❑ Ot er 1000 Amp or Over 600 V '
Exemption for Rag Moine Elect
SINGLE FAMILY Temp Power Pole 8 Appurtenances
HOME OWNER BUILDER DECLARATION Sign with One Branch Grant
I hereby affirm that I am exempt from the Contractor s License
Low for the following reason (Section 7031 5 Business and Additional Sign Branch Circuits
Professions Code)
❑ 1 as owner of the property will do the work and the, Mix Conduits 8 Conductors
structure is not intended or offered for sale(Section 7044 Other (See Complete Fee Schedule)_
Business and Professions Code) r� 7
CONSTRUCTION LENDING AGENCY 1•`�eQ•
I hereby affirm that there is a construction lending agency for LL Qi((yy
the performance of the work for which this permit is issued PERMIT FEE (Sub-Totai) • 8400.
s '
sec 3097 civ c ) 1 205-88
PIAN CHECKING FEE
Lenders Name
Lenders Address
PERMIT ISSUING FEE 49
d
I certify that I have read this application and state that the TOTAL FEE
above mformotion 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 above mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date
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