HomeMy Public PortalAbout5434 PERSIMMON AVE_Electrical__ 76AG63-CES06 3-64 APPLICATION FOR ELECTRICAL PE MIT
COUNTY OF'LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING ? [�
BUILDING AND SAFETY DIVISION ADDRESS S V. e."Sf'yrl >•+� o
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. �J .e— F
RECEPT. TOTAL NO. EACH FEE
OUTLETS FIRST 20 $.20 $
OWNER , d e d✓@�
LIGHTMAIL
ADD'L .1O ADDRESS
SWITCH.. OVER 20 b- �f
LIGHTING 1j TOTAL �ADD'L
ST 20 .20 CITY TEL.NO. p ®off,
FIXTURES 1 .1O ELECTRICIAN /^YDS! L �c-1riR 20 �+
j �.
RANG CLO.DRYERS NRR.HTRS. 1.00 fy� ADDRESS +J%
( / �.fes 4j'4v SSL7
GARB.DIBP. STA.cooK
CITY
S Set%% 4;<4i♦ EL.NO. f
DISHWASH. AUTO.-WASH. STATE 2
SPACE HTRB._ STA.APP.(ys H.P.MAX.) ,50 LICENSE.NO.
MOTORSe OVER NOT OVER II.P. DISTRICTO. GROUP ZONE P ESSED B�(+
O 1 1.00 «Q�6
I 3 1.50 rs°~ INSPECTION/ RECORDph
e
3 e 2.00 � 7 J / d�r��1�'�' e�,s � r'!� ,r U
S Is .2.50 �T �. �_�� 99
to 50 3.00 !Y r �r 10-
50
50 100 5.00
H
SIGNSI NO.TRANS. Z
NO.LAMPS
SERVICE 0.600V-NOT OVER 200A 1.00 G
SERVICE 0.600V-OVER 200 A. 2.00
SERVICEOVER.600V 5.00
MISC.
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE s
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY_ CONDUIT
WITH ALL•COUNTY ORDINANCES AND STATE LAWS REGULATING•
ELECTRICAL WIRING. / WIRING
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR -
LICENSED AS REQUIRED BY LOS ANGELES COUNTY ANd STATE OF FIXTURES
CALIFORNIA OR THAT I THE LEGAL. OWNER THE ABOV
DESCRIBED RESIDE TIAL OPERTY. POWER
SIGATURE UTILITY CO.NOTIFIED
N
OF PERMITTEE
FINAL J '
ALIDATI AR HUR C. VETT
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
a'
Lhl,o 5 5 9 7 SEP 1 .5 2 D 4.00.-
WORKERS'COMPENSATION DECLARATION 76A663 10%81
I hereby affirm that I have a certificate of consent to self insure, CE-806G APPLICATION FOR ELECTRICALS PERMIT
or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY '
copy thereof`(Sec."3800,Lab.C.) _
Poli.y No., 4 FOR APPLICANT 70 FILL IN JOB
19Certified copy is hereby furnished. EACH NO. FEE ADDRESS
New Residential Bldgs.&Pools r
❑ Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. $ — $ 1 LOCALITY
.,department. Multi-family Sq.Ft. — NEAREST
CROSS ST.
Y L9 Residential Swimming Pobls OWNER OR
Date Applicant l .FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' a MAIL
Outlets:Rec—Light_Sw.—
COMPENSATION INSURANCE ADDRESS
(This section need not be completed if the work Involved by the First 20
permit is for one hundred dollars($100)or less.)
Total No. Additional CITY Tel.No. 7
I certify that in the performance of the work for.which this permit PLAN CHECK
is issued, I shall not employ any person in any manner so as to 1 APPLICANT
become subject to the Workers'Compensation Laws. ; Lighting Fixtures First 20 ADDRESS
Total No. Additional CITY Tel:No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT
Exemption,you should become subject.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 FA.0 _ W.H.
CITY 'Tel.No.
LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. LICENSE OR Class.
(commencing with Section 7000)of Division 3 of the Business.and REG.NUMBER
Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO. PRq5WfiEQ BY
lb
License
•7' Size&Type HP,KW,KVA,or KVAR Q
License Number Lic.Class Up to 1 Incl. FINAL �� V
Over 1 to 10 Incl. DATE VALIDATION
Contractor. Date �''� 1 G` f
Over 10 to 50 Incl.. FINAL ()}�/
❑ I am exempt under Sec. Over 50 to 100 Inc.. BY !r �J ff� a
Over 100
B.&P.C.for this reason N
Service f Swbd.,MCC&'Panelboards
Date: I 200 Amp.Under 600 Vazi
�.
Signature T %lG��i' ��.• 201 - 1000 Amp.Under 600 V
❑
Over 100.0 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 ,
for the following reason(Section 7031.5,.Business-and Professions Additional Sign Branch Circuits..
Code): i
❑. I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors '
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule)
and Professions C.oae).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the 2
performance of the work for which this permit is issued(Sec.3097, I PERMIT FEE (Sub-Total) O
Civ.C.):
PLAN CHECKING FEE
Lender's Name PERMIT ISSUING FEE 2 4
Lender's Address
I cerfify that I have read this application and state that the above ' TOTAL FEE �p S 6
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 above-mentioned ,
Property for inspection urposes.. SEE REVERSE FOR EXPLANATORY LANGUAGE
lO o— v a
Signa ure of Permittee ilDate