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Home My Public Portal About10224 RANDWICK DR_Electrical__ c-/TY Vo` C-17->r SA663—CE806 5-62 APPLICATION FOR ELECTRICAL PERMIT — :s COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING -BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER - 1% WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO. FILL IN CROSS ST. 4 RECEPT. TOTAL NO. EACH FEE LIGHT OUTLETS FIRST 20 ffi 2O $ OWNER NJ MAIL -fit, ADD'L 10 ADD@ESS SWITCH. OVER 20 CITY L.NO. TOTAL LIGHTING )RST 20 / .20 FIXTURES 1 ADO'L 1O ELECTR[CI OVFR 20 RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS. GARB.DISP. STA.COOK CITY ` TEL.NO. DISHWASH, AUTO.-WASH.` t STA / _ SPACE HTRS. STA.APP.(Y.H.P.MAX .50 LlCEN E NO. (D MOTORS: VER NOT OVER H.P. DISTRICT NO. GROUP ZONE I PROCESSED BY 0 1 11.00 7--S 1 3 1.50 INSPECTION RECORD 3 B 2.0011 8 18 2.50 O 1.s so 3.00 V so 100 5.00 O 1— NO.TRANS• V SIGNS: NO.LAMPS a iA SERVICE 0-.600V-NOT OVER 200A 1.00 Z SERVICE 0-60OV-OVER 200 A. 2.00 SERVICE OVER 600V 5.00 MISC. PERMIT ISSUING FEE 2.00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI ATION 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 ,�r2/l!3 /.-':� =-G'•� Y 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED S ANGELE��Vl NTY AND STATE O FIXTURESCALIFORNIA OR THAT IM THE EGALER O T AB POWER DESCRIBED RESIDENTIAL R P SIGNATURE UTILITY CO.NOTIFIED ' �iZZZ : OF PERMITTEE - AI FINAL ,-4LIDATION ARTHUR C. VEIT / \ MO CASH SUPERVISING ELECTRICAL ENGINEER \��uCo 9 6 9 9:u AN 16 2 0 1 7.0 0'" ti .� 1A?JRKERS'COMPENSATION DECLARATION i ZOA019DPW 3/W APPLICATION FOR ELECTRICAL PERMIT J:si *affirm that I have a certificate of consent to self c"ee� Insure, or 0 iestAcpte of Workers'Compensation InsuranceIr , , COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a c��rtifiecopy thereof(Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB s ❑ ertified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS ❑C rtified copy is filed with the count building $ — $ LOCALITY py ' y g inspec- 1 8 2-Family, Sq. Ft. do department. Multi-family Sq. Ft. NEAREST Date Applicant I Residential Swimming Pools CROSS ST. 7ADDRE E RTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ COMPENSATION INSURANCE (This sectio need not be completed If the work involved by First 20 Tel. No. the permit i for one hundred dollars($100)or less.) Total No. Additional / KI certify that i the performance of the work for which this permit is issue I shall not employ any person in any manner Lighting Fixtures First 20 ADDRESS so as to becom subject to the Workers'Compens n La Additional 710Date Applicant tal•No. CITY Tel. No. NOTICE TO APPLI NT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT290 Exemption, you sh Id become subject to the Workers' Range— Heater—D.W. _ APPLICATION Compensation provisi ns of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS . with comply with suc provisions or this permit shall be Top — FAU —W.H. — deemed revoked. CITY Tel. No Hood Fan —Other— LICENSED CO ACTORS DECLARATION LICENSE OR I hereby affirm that I am lic sed under provisions of Chapter 9 Disp. — Room Air Cond. — Class. REG. NUMBER : 3 f (commencing with Section 00)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PROCESSED BY } and Professions Code,,and my 'cense is in full force and effect. .� �• � �, Size&Type HP, KW, KVA, or KVAR Q e r�s O License Number &.�. Lic. ClassD Up to 1 Incl. FINAL U sv /� Over 1 to 10 Incl. DATE ��'' 0 VALIDATION 0 Contractor Date Over 10 to 50 Incl. FINA / F- IDI am exempt under Sec. Over 50 to 100 Inc. BY i W B.&P.C. for this reason Over 100 �r //��.c Q. Services, Swbd., MCC&Panelboards � $ � Z f 0-200 Amp. Under 600 V Signature � 201 - 1000 Amp. Under 600 V ' g ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V u C - 625C'-';, SINGLE FAMILY Temp. Power Pole&Appurtenances 0 6 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 Additional Sign Branch Circuits Professions Code): ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ , Business 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 PERMIT FEE (Sub-Total) (Sec. 3097, 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 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 above- ntioned ty r inspection u ppoo s. SEE REVERSE FOR EXPLANATORY LANGUAGE gnature of Permi tee Uo ®' WORKER'S COMPENSATION DECLARATION 20.0019 DPW(12-91) A76A683 APPLICATION FOR ELECTRICAL PERMIT u 'I hefeby affirm that I have a certificate of consent to self'Insure, or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING.AND SAFETY DIV. copy thereof.,Sec.3800 Lab.,C.) Policy No. Company FOR APPLICANT TO FILL IN JOB (� � �• Q,Q�A-E{�._7'7�C'� �i�., Certified copy Is hereby furnished. New Residential Bldgs.&Pools NO. ADDRESS EACH FEE LOCALITY ❑ 1&2-Family,Sq.Ft. � _ $ $ Certified copy is filed with the county building inspection "LS NEAREST department. Multi-family Sq.Ft , caoss ST.. Date Applicant Residential Swimming Pools ASSSOR !O MASEP BOOK a7 G=4 PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' 5-Light f Sw. OWNER OR COMPENSATION INSURANCE Outlets:Rec. /�D ?�/ a FIRM NAME First 20 O/`7" MAIL (This section.need not be completed If the work involved by theADDRESS permit is for'one hundred dollars($100)or.less.) Total No. Additional t a'�� I certify that in the performance of the work for which this permit CITY QLt� � Tel. is issued, I shall not employ any person in any manrl& so as to become subject'to the Workers'Com .ensatI Ns, Lighting Fixtures r� First 20 APPLICANT NT p Total No._132 Additional APPLICANT Gr ADDRESS- Date DDRESS•apt g �,� c•w 't-�� Date• « Applicant RESIDENTIAL APPLIANCES NOT OVER.3 HP. NOTICE T APPLICANT: If., after ma' ng this Certificate of CITY '� i,� Tel.No.3S-x o�0 Exemption,you should.Become subject to a Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. - provisions of thi'Labor Code,you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT LICENSED-CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or WAR ADDRESS SA'Lyj j ' fav I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000)of Division 3 of the Business and CITY Tel.No. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR >_Over 50 to 100 Incl. REG.NUMBER lZ C�ese. O (� Over 100 DISTRICT NO. SSED BY V License Number ��CC��-�1 Lic.Class t`'` Services,Swbd.,MCC&Panelboards •�� C� O Contractor• `VUz)G% '�Date « Z 0-399 Amp.Under B00 V DATE V ❑ I am exempt under Sec. 400-1000 Amp.Under 600 V — ACC AL_DATION UJ Over 1000 Amp.or Over 600 V FINAL...,.,.. t -,n. -B.&P.C.for this reason BRANCH CIRCUIT FEES BY 33177 p '�Z Date: 15A,or 20A,120V,Lighting or Recept. 9 I 1 To 10 Branch Circuits Signature TOTAL 9 11 To 40 Branch Circuits TOTAL 66.53 41 Or More Branch Circuits r. 65.T3 ❑ Exemption for Reg.Maine.Elect. 15A,20A,208V To 277V Lighting Br.Circuits CHECK SINGLE FAMILY Temp.:Power Pole&Appurtenances CHANGE 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 i Code): 0000-0001 12118- fit ' .❑ I,as owner.of.the property,will do the work and the structure Mtsc.Conduits&Conductors 7143 1 Aft 8 40 ? 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 pe..rformance of the work for which this permit is issued (Sec.3097, PERMIT FEE (Sub-Total) Chi.C.) PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have.read this application and under penalty of purjury state TOTAL FEE that the above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring,and hereby authorize AIns f this County to er upon the above-mentioned property rpoSEE REVERSE FOR EXPLANATORY LANGUAGE !iIITTEED&TE. r