HomeMy Public PortalAbout10250 RANDWICK DR_Electrical__ IA663_CES06 5_62 .APPLICATION FOR ELECTRI. AL PERMI,
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING O
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 S 20 S �, OWNER
LIGHT n MAIL
SWITCH. ADD'L 10 ADDRESS `�
OVER 20
TOTAL CITY L.NO.
LIGHTING 1 FIRST20 .20
FIXTURES 1 �'5 AOD'L
OVER 20 ,10 ELECTRICI
RANGES CLO.DRYERS WTR.HTRB. 1.00 ADDRESS
GARB.DISP. BTA.COOK
CITY TEL.NO.
D18HWA8H. , AUTO.-WASH. / STATE
SPACE HTRB. STA.APP.('h N.P.M -17 .50 . LICENSE NO.
MOTORS: OVER NOT OVER H.P. f DISTRICT G , P Z P ED Y
O 1 1.00 D
I 5 1.50 INSPECTION E. D
8 a 2.00
a to 2.50 at
15 so 5.00 0
so too 5.00 m
• O
SIGNSe NO.TRANS. V
NO.LAMPS
W
D.
SERVICE 0.600V-NOT OVER 200A 1.00 U)
Z
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 19
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S.SIGNATURE
AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY CONDUIT / fi
WITH ALL-COUNTY ORDINANCES.AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR d
LICENSED AS REQUIRED BY LOS ANGELS COON Y ANO S TE OF FIXTURES BS�� -Ir s �Y�"�h� CJ
CALIFORNIA OR THAT THE LEGA OWN O T ABOVE
DESCRIBED RESIDENTIAL1 O POWER G' ,
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTEE L
FINAL.
LIDATJON ARTHUR C. VEIT +'f
/ CICa MO CASH ' SUPERVISING ELECTRICAL ENGINEER
�� LA60 9 2 8 71421 JA14 9 2 D 17.2 ON
)P 'S COMPENSATION DECLARATION 20.0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT
I h�feby'affirmm that that Ihave a certificate of consent to self insure, 76A663
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 '
ADDRESS t�i�,:. c 1Qs4 Nlj w G K
Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY %
❑ Certified co is filed with the count building inspection 1 &2-Family,Sq.Ft. _ $ $
PY Y 9 P NEAREST Lc,,-L; �1 �2L),! C� ��
department. Multi-family Sq.Ft. CROSS ST. A
Date Applicant Residential Swimming Pools ASSESSOR
MAP BOOK PAGEPARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec. Light Sw. OWNFIRM NAME I—A ell/1 /C C)4,A A+
COMPENSATION INSURANCE _
(This section need not be completed If the work Involved by the First 20 MAIL s`{•/0C
permit is for one hundred dollars(5700)or less.) Total No. Additional ADDRESS
I certify that in the performance of the work for which this permit CITY Tel.No.
is issued, I shall not employ any person in any manner so as to ,t
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANTK IN 5 A C
Total No. Additional
`Ifs r �� V/- G/N ADDRESS
Date Applicant q
NOTICE TO APPLICANT: If, after making this Certificate of RESIDENTIAL APPLIANCES NOT OVER 3 HP. VIM CITY G' LeiVLdTel.No. _f&A
Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. 72
provisions of the 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 KVAR ADDRESS
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. /ami
(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 Cass d
Over 50 t0 100 InCI. REG.NUMBB ER
License Number Lic.Class G a-0 Over 100 DISTRICT NO. PFPWSED BY V
11
Services,
Services,Swbd.,MCC&Panelboards !J it
Contractor -�u �K Data 0-399 Amp.Under 600 V FINAL O
El400-1000 Amp.Under 600 V DATE ~
I am exempt under Sec. U -2r4? VALIDATION V
Over 1000 Amp.or Over 600 V FINAL 4.,
LU
B.&P.C.for this reason BRANCH CIRCUIT FEES BY 15A,or 20A,120V,Lighting or Recept. ZDate: 2
9 1 To 10 Branch Circuits
Signature ' 11 To 40 Branch Circuits
❑ % 41 Or More Branch Circuits
Exemption f Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits _
SINGLE FAMILY Temp.Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION n•:.'.7 _
I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit ` cr jo�_
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits =r�'�s:
Code): T=:ec
I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors !ff ��
Is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) '"'TL " e
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) / lJ
Civ.C.) _
PLAN CHECKING FEE LUL
Lender's Name : •,:'i r • a r='
PERMIT ISSUING FEE -1-r' A
Lender's Address TOTAL FEE
I certify that I have read this application and under penalty of purjury state
that the 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 ins ,bion purpos /:---� t�/� SEE REVERSE FOR EXPLANATORY LANGUAGE
r/'✓7i
S NATURE OF PERMITTEE' DATE