HomeMy Public PortalAbout10060 RANDWICK DR_Electrical__ BA663-CESOO10-62 APPLICATION FOR ELECTRICAL P RMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING D yy
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
RECEPT. TOTAL NO. EACH FEE
OUTLETS FIRST 20 D $.20 $ OWNER
LIGHT MAIL
SWITCH. oVER,20 .10 b ADDRESS
Lia-
OTAL lTJ CITY TEL.NO.
LIGHTINGFIRST 2O .20 VFIXTURES ADD'LELECTRICIAN
OVER 20 •10
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS go-Ae -
GeRn n+ae. STA.COOK /A
CIT TEL.NO.
DISHWASH_ AUTO.-WASH. STATE
SPACE HTRS. ATA.Aaa.n&N.P.MAX.) ,50 cA
LICENSE NO.
MOTORS, OVER NOT OVER H.P. DISTR CT NO. GROUP NE ESSED BY
O 1 1.00
I s 1.50INSPECTION R CORD
s a 2.00 ::rfq v D 7rl h enom.
8 15 2.50 / o ,Al,, f 0
15 50 5.00 �rIYI�` pg
50 100 5.00 O
SIGNS- NO.TRANS.
NO.LAMPS H
z
SERVICE 0-600V-NOT OVER 200A 1.00
SERVICE 0-600V-OVER 200 A. 2.00
SERVICE OVER 600V 5.00
MISC.
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE
IN ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATISIG
ELECTRICAL WIRING. WIRING r
1N.
1HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OP FIXTURES
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. POWER
SIGNATURE UTILITY CO.NOTIFIED ' 7itei `'1'�I'''
OF PERMITTEE // _4q,,,,
FINAL ,'L,� � �(�}�jf
V LIDATION ARTHUR C. VEIT V
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
CK MO CASH
LACO,1 8 0 0 P. IMAY 19 2 0 13.60- 1-1
ON
I her,�by affi m�RIKER'haveMa cerStificlate oDECLARATION
col nsentOto self insure, 7663 DPW(.12-91) APPLICATION FOR ELECTRICAL PERMIT lJ
or a'certificate of Worker's Compensation Insurance,or a certified COUNTY OF LOS ANGELES -,MPT:4F PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec.3800 Lab:C.)
Policy No. Company FOR APPLICANT TO FILL IN ADDRESS
(a bRwDwic*_ DR
Certified copy is hereby furnished. New Residential Bldgs.&Pools NO.1 EACH FEE LOCALITY
$ $Ft
S
il
Famy, q. . —
Certified copy is filed with the county building inspection 1&2- _ NEAREST
department. Multi-family Sq.Ft. CROSS ST.
Date Applicant Residential Swimming Pools ASSESSOR.
MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rea._Light Sw. FI N OR
ME
COMPENSATION INSURANCE
First 20 MAIL
(This section need not be completed if the work Involved.by the Total No. Additional ADDRESS
permit is for one hundred dollars($100)or less.)
00
I certify that in the performanceof the work for which this permit CITY 19(nPLIP
is issued, I shall not employ any person in any manner so as to PLAN CHECK
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT
Total No. Additional ADDRESS
Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE'TO APPLICANT: If, after making this Certificate of CITY Tel.Na.
Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP.
provisions of the Labor Code.,you must.forthwith,comply with such PERMIT
P Y APPLICANT .
provisions or this permit shall.be deemed revoketl. Power Apparatus&Large Appliances
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS t O® D
I hereby affirm that I am licensed under provisions of Chapter 8 Over 3 to.10 Incl. �
(commencing with Section 7000)of Division.3 of the Business and CITo ` Tel.No.
Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. JF
Over 50 to 100 Incl. REGNSL.NUOR Class' ^ d
Or 100 DISTRICT NO. y SEED BY V
License Number LID.Class
s
'0-398!fp & d 0 V C^a
Contractor - Date FINAL 0
DATEI,....
❑ 400-1000 Amp.Under 600 V — VALIDATION V
I am exempt under Sec. Over 1000 Amp:or Over 600 V FINAL U 1
a
B.&P.C:for this reason BRANCH CIRCUIT FEES BY co
Date: 15A,or 20A,120V,Lighting or Recept. Z
1 To 10 Branch Circuits
Signature 11 To 40 Branch Circuits.
❑ 41 Or More Branch Circuits
Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits ACCT n a
SINGLE FAMILY Temp.Power Pole&Appurtenances
3�3 #jo('j�
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Law 1 ITEMS
for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits
Code):
. TOTAL 65-60
I,as owner of the property,will c
do the work and the structure Misc.Conduits&Conductors' 6 .b0
is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) CHECK L
and Professions.Code). CHANGE =00
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the
performance of the work for which this peimit is issued (Sec. 3097, PERMIT FEE (Sub-Total), Q 0000-0001 5/31/96
Civ.C.)
PLAN CHECKING FEE 6690 1 AM11:16
Lender's Name
PERMIT ISSUING FEE p� 7.3o
Lender's.Address /
I certify that I have read this application,and under penalty of purjury state TOTAL FEE (O�-
that the above information is correct. I agree to comply with all County
ordinances and State laws regulating'Electrical wiring,and hereby authorize j
representatives of this County to enter upon the above-mentioned property
r ins ection purp es. SEE REVERSE-FOR EXPL NATORY N AGE
SIGNATURE O PERMI DATE