HomeMy Public PortalAbout5538 PERSIMMON AVE_Electrical__ (2) 78A888-CEBOS 12-58 APPLICATION FOR ELECTRIC PERMIT �.
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER 'BUILDING 1
BUILDING AND SAFETY DIVISION ADDRESS Snx
JOHN A.LAMBIE.COUNTY ENGINEER
CASSAT'I'D.GRIFFIN,SUPT of BUILDINS LOCALITY
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES
CROSS.ST.
o
ITEM NUMBER EACH FEE OWNER'
OUTLETS: g g EMAIL
LIGHTS RECEPT. SW. ,IO .ADDRESS
LIGHTING FIXTURES 10 CITY TEL.NO.
ELEC.RANGES CLO.DRYERS ELECTRICIAN %c
t
WATER HEATERS .50
ADDRESS
. ELEC.SPACE HTRS. DISHWASHERS
CITY TEL.N /
GARBAGE DISPOSERS AUTO.-
STATE
WASHERS STA.COOKING UNITS .25 LICENSE NO.
MOTORS: OVER INC. H.P. DISTRICT NO. GROUP Z NE ESSED Y
0— 1/2 .25
1/2— 2 •50 INSPECTION Rvr-011hl
2— 5 1.00
5— 18 1.50
15— 50 2.50
50-200 5.00
SIGNS: NO.TRANS.
NO.LAMPS
SERVICEO-600V 1.00 QQ
SERVICE OVER 600V 5.00
MISC.
WIRING PERMIT 1.00 00
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .50
TOTAL FEE s APPROVALS
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT q
ELECTRICAL WIRING. WIRING
1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL P ERTY. POWER
SIGNATURE UTILITY CO.NOTIFIED �,J
OF PERMITTE L
FINAL
�Jn VAIMA ARTHUR C. VETT.
CK Mo CABH SUPERVISING ELECTRICAL ENGINEER
CK Mo C:H
0550- 2 A 2.50 i'
9 � /
C It
NOR ERS'COMPENSATION DECLARATION
mer78-80B G 10/st APPLICATION FOR ELECTRICAL PERMIT1,471,47,
I hereby.�JCE-808An that I have a certificateca
,of nsent to self insure,
or a certificate cf Workers' Compens idn I!1su�ance, or a certified COUNTY OF LOS.ANGELES BUILDING AND SAFETY
copy thereof(Sec.3800,Lab.C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB ' �-
ri Certified co is hereby furnished. EACH NO. FEE ADDRESS �� � 5Im
PY Y New Residential Bldgs.&Pools r �, Asuj
�
F11 &2-Family,Sq.Ft. $. — $ LOCALIT ,
Certified copy is filed with the county building inspection
department. Multi-family Sq.Ft. NEAREST
—
CROSS
Date Applicant Residential Swimming Pools OWNER OR
I
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL
First 2
COMPENSATION INSURANCE Outlets:Rec Light t 20 ,1 40316 ADDRESS
(This section need not be completed if the work Involved by the /�F/
permit is for one hundred dollars($100)or less.) �
Total No. 0— Additional CITY Tel.No.
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 APPLICANT
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
� � �1��� T Additional
Total No. CITY Tel.No.
Date Applicant` ' �,l� Fixed Appliances Not Over 1 HP
NOTICE TO APPLICANT: If, after making this Certificate of PERMIT
Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. APPLICANT
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.N .
LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR --
(commencing with Section 7000)of Division 3 of the Business and REG.NUMBER `a Glasse I 1D
Professions Code,and my license is in full force and effect. DISTRICT NO.. PROCESSED BY
Power Apparatus&Large Appliances
r Size&Type HP,KW,KVA,or KVAR �) 8Q
License Number`=) �clC-'AO LI..Class LCL Up to 1 Incl. V FINAL
G 2-�x Over 1 to 10 Incl. DATE _ VALIDAT
Contractor 16 16 q 0
r,'�S�! f`l Date Over 10 to 50 Incl.
❑ FINAL 15
I am exempt under Sec. Over 50 to 100 Inc. EZa a
LL1
B.&P.C.for this reason Over 100 N
Services,Swbd.,MCC&Panelboards Z
Date: 0-200 Amp.Under 600 V bl�1C� , &0864A
Signature 201 - 1000 Amp.Under 600 V # 0 0 0 0 0 2
Over 1000 Amp.or Over 60.0 V
E] Exemption for Reg.Maint.Elect. 10 o 5 E 5 0
SINGLE FAMILY Temp.Power Pole&Appurtenances o 'o o 5 5,5 0 55
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits (� 8
for the following reason(Section 7031.5,Business and Professions 0,0 y
Code):
❑ Misc.Conduits&Conductors
I,as owner of the property,will do the work and the structure I
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ ►
and Professions Code).
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(Sec.3097, PERMIT FEE (Sub-Total)
Civ.C.).
PLAN CHECKING FEE
Lender's Name "-
PERMIT ISSUING FEE
Lender's Address
I certify that I have read this application and state that the above TOTAL FEE V V •�
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
ro erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signa ure o Permittee Date `