HomeMy Public PortalAbout10120 RANDWICK DR_Electrical__ VSA689-CE808 10-82 R EAPPLICATION FOL CTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS eC
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN.SUP'T OF BUILDING LOCALITY '
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
REcEPT. ` TOTAL NO. EACH FEE
OUTLETS FIRST 20 �I w $.2O $ p OWNER
LIGHT �C�/ MAIL
SWITC R. � ADD'L ADDRESS
OVER 20 .1O
TOTAL CITY TEL.NO.
LIGHTING FIRST 20 .20
FIXTURES ADD'L .10 ELECTRICIAN
OVER 20
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS
A&HL.DISP.T STA.COOK CITY TEL.NO.
DISHW AUTO.-WASH. STATE
SPACE HTRS. A.APP.(ya H.P.Ma 50 LICENSE NO. ir
el. jsMOTORS, OVER NOT OVER H.P. DISTRjCTp. GROUP ZONE P ESSED BY
O 1 1.00 RA T
1 a 1 11.50 INSPECTION REC RD
s a 2.00
4ji-chs76 :� dt
a
B 1 s 2.50 O
1s so 3.00 11 A�u-
so 1005.00 d
SIGNS: 0
'z ► /N-
NO.TRANS.
NO.LAMPS h
SERVICE 0-600V-Nor OVER 200A 1.00 L Ip ) C.-w v-sm. h"C� [ L
SERVICE 0-600V-OVER 200 A. 2.00
SERVICE OVER 600V 5.00 u
MISC.
PERMIT ISSUING FEE 2.00 o-(-
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE $
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE// INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT / "(p
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING A. -,AAA
_ 1 HEREBY CERTIFY THAT 1 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 PROPERTY. POWER
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTEE
FINAL
LIDATION ARTHUR C. VEIT
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
LAC 1.4 4 7Q MAY 1.1 2 D 13.6 0 r c
I
WORKERS'COMPENSATIONDECLARATION , CE-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY
insure,or a certificate of Workers'Compensation Insurance,or ( C
a certified copy thereof(Sec.3800,Lab.C.) `
FOR APPLICANT TO FILL IN JOB
Policy No. Company New Residential Bldgs.&Pools EACH NO. FEE ADDRESS
Certified copy is hereby furnished. 1 &2-Family.Sq. Ft. $ — $ LOCALITY
O
Certified copy is filed with the county building inspection I Multi-family Sq. Ft. NEAREST Residential Swimming Pools CROSS ST -4.xdepartment. OWNER OR
FIRM NAME '
Date Applicant Outlets: Rec._Light Sw. ADDRESS
First 20
CERTIFICATE OF EXEMPTION FROM WORKERS'
Total No. Additional CITY
COMPENSATION INSURANCE PLAN CHECK a
APPLICANT O
(This section need not be completed if the work involved Lighting Fixtures First 20 L)
by the permit.is for one hundred dollars ($100) or less.) Additional ADDRESS O
Total No.
I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No.
permit is issued, I shall not employ any person in any manner PERMIT W
so as to become subject to the , orkers'Compensation Laws. Range_Heater D.W. APPLICANT tl
�,�,.-) vven Dryer_W.M._ ADDRESS to
dam / Win' — FAU —W.H...— y
Date Applic ld
CITY Tel No. �7
Hood _ Fan _Other_
NO CE TO APPLICANT: If, after making this Certificate of Disp. _Room Air Condom c � LICE EOR `
E mption, you should become subject to the Workers' REG.NUMBER Z Class C /Q
Compensation provisions of the Labor Code, yop must forth- Power Apparatus&Large Appliances DISTRICT NO. PROCESSESeBY
with comply with such provisions or this permit shall be Size&Type HP,KW,KVA,or KVAR
deemed revoked. `) •C% �G' l��� ,�
Up to 1 Incl.
FINAL � /, ✓ /
LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATE VALI DATIOP'
Over 10 to 50 Incl. r''
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL
9 (commencing with Section 7000)of Division 3 of the Busi- Over 100 BYL�-
ness and Professions Code, and my license is in full force and
effect. Services
Js
License Number Mc.Class / . K_200 Amp Under 600,/ r/r .�;�
201-1000 Amp.Under 600 V ��
ContraciLfA I KZi Date Over 1000 Amp.or Over 600 V
HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances
I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit
License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits
ness and Professions Code):
Misc.Conduits&Conductors
I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)— 11-6 1,6 i1
structure is not intended or offered for sale (Section
7044,Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency % o o 2 h F 0
for the performance of the work for which this permit is PERMIT FEE (Sub-Total)
issued(Sec.3097,Civ.C.). „ „ .-I- 'z
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee)
l `' 9
Lender's Address ' )
PERMIT ISSUING FEE � Z
I certify that I 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 bove-mentioned pfoperty for inspection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE
Signal of ermittee Date /