HomeMy Public PortalAbout6033 PRIMROSE AVE_Electrical__ 76AlOfi'�E906 8-62 APPLICATION FOR E.LEC RICAL PER rIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN,SuP'T OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
RECE_PT. TOTAL NO. EACH FEE 1
OUTLETS FIRST 20 $,2O S OWNER
LIGHT n
ADD'L .1C ADDRESS V
SWITCH. 1- OVER 20
FIRST 20 .20 F
LIGHTING TOTAL CITY TEL.NO.
1
FIXTURES 1 ADD'L .10 ELECTRIC AN
OVIER 20
RANGES GI.e�ORiw- W�RrHSRer 1.00 ADDRESS
GARB.DISP. STA.COOK CITY TEL.NO. S
DISHWASH. AUTO.-WASH. STATE
SPACE HTRS. STA.APP.Iy$X.P.MAXI .50 ,�Q LICENSE NO. Q
MOTORS: ovER NOT OVER H.P. DISTRI T GR UP Z ON P SEED BY
O 1 1.00
1 s 1.50 INSPECTIO RECORD
S S 2.00
s 1s 2.50 "o,loolr
1s so
a
so foo 5.00 O
SIGNS: NO.TRANS. f
• NO.LAMPS �O-
SERVICE 0-6OOV-NOT OVER 200A 1.00 r Q .��
Lu
SERVICE O-SOOV•OvER 200 A. 2.00 C
N
SERVICE OVER 600V 5.00 ?
MISC.
PERMIT ISSUING FEE 2.00 Q�
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE rri
1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS A LICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
1 ,HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY L08 ANGELES COUNTY AND STATE OF FIXTURES'
CALIFORNIA OR THAT I .AM THE LEGAL OWNER OF THE ABOVE.
DESCRIBED REBIDIA RTY. POWER
SIGNATURE UTILITY CO.NOTIFIED A in
OF PERMITT
FINNAL 1wu
('CKON AR HUR . VEIT
CKMO CASH SUPERVISING ELECTRICAL ENGINEER
�,t�o
6 8 5 7:0" tiJt 2 D 4.E",;-
y
t,. NV rrh.th'COMPENSATION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT
N hereby affirri'i,that I h5ve a certificate of consent to self CE-8066
insp're, 60a certificate of Workers'trompensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
•or a certified copy thereof(Sec. 3800;Lab. C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB •
Certified copy is hereby furnished. EACH NO. FEE ADDRESS d'C�ii?i �ar
New Residential Bldgs. 8 Po ,%
copy county g inspec- y, q. LOCALITY
Certified co is filed with the coup buildin 1 &2-Fara S Ft. $ — $
tion department. Multi-family Sq. Ft. — NEAREST
Residential Swimming Pools
CROSS ST.
Date Applicant � 'OWNER OR
FIRM NAME tp
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._-
COMPENSATION INSURANCE t DDRESS
(This section need not be completed If the work:Involved by First 20Total No. Additional CITY �a Tel. No.
the permit is for one hundred dollars($100)or less.) PLAN CHECK
I certify that in 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 1 ADDRESS
Total No. Additional
CITY Tel. No.
Date � pplicant '� Fixed Appliances'Not Over 1 HP PERMIT
NOTICE O APPLICANT: If, after making this Ce ifIcate oI L-
f APPLICANT
Exemption, you should become subject. to the Workers' Range_ Heater_D.W. LLL_b
Compensation provisions of the Labor Code, you must forth- Oven —Dryer _W.M.— ADDRESS
with comply with such provisions or this permit shall be Top _ FAU —W.H.
deemed revoked. Hood _Fan _Other_ CITY Tel. No.CONTRACTORS DECLARATION LICENSE OR
I p. _ Room Air Cond. Class.hereby affirm that I am licensed'under provisions of Chapter 9 DisREG. NUMBER C•—[s/
(commencing with Section 7000)of Division 3 of the Business power Apparatus:&Large Appliances DISTRICT NO. PROCESSEDIL
BY 0�.
and Professions Code,and my license is in full force and effect, Type `)(�
Size&T e HP, KW, KVA, or KVAR- (Ja
License Number- "I —Lic. Class C" tO Up to 1 Incl. FINAL �
Over 1 to 10 Incl. DATE - 7 0 11DATION
Contractor �—• �/t�-� •%��'rgate Over 10 to 50 Incl.
FINA W
I am exempt under Sec. Over 50 to 100 Inc. BY O:
B.&P.C. for this reason Over 100
z
Services, S.wbd.,MCC&Ponelboards '
668�3A
Date: 0 -200 Amp. Under 600 V �
Signature 201 - 1000 Amp.. Under 600 V # 0 0 0 0 0 2
Over 1000 Amp. or Over 600 V
Exemption for Reg. Maint. Elect. -( - - 7524
SINGLE FAMILY Temp. Power Pole&Appurtenances o 0 0 _
HOME OWNER-BUILDER DECLARATION 7 5 2 4 5
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 Additional Sign Branch Circuits 0317-87
Professions Code):
ElI, as owner of the property, will do the work and the Misc. Conduits&Conductors
structure is not intended or offered for safe (Section Other(See Complete Fee Schedule)_ ,
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency-forthe performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE 10
Lender's Address r
I certify that l have read this application and`state that the TOTAL FEE. .
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
the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
c
Signature of Permittee Y 1 Date