HomeMy Public PortalAbout10257 RANDWICK DR_Electrical__ SAGGS-CES06 5-62 APPLICATION FOR ELIECTRICA PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
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 R.20 R �� OWNER
LIGHT MAIL
ADD'L -10 ADDRESS
SWITCH. OVER 20
TOTAL .CITY TEL.NO.
LIGHTING l FIRST 20 .20
FIXTURES Jf ADD'L ,1O ELECTRI AN
OVER 20
RANGES CLO.DRYERS WTI.HTRS. 1.00 ADDRESS
ARE.DISP. STA.COOK i CITY TEL.NO.
DISHWASH. AUTO.-WASH. STATE
SPACE HTRH-, 8TA.APP.(%X.P.MAX .50
{/ LICENSE NO. L/
MOTORS: OVER NOT OVER H.P. DI$T�FCr,�NQ Q ZQNE PMOIS
O 1 1.00
1 s 1.50 INSPE ION RECORD
s a 2.00
S is 2.50 d
1s so 3.00 OV
so 100 s.00
NO.TRANS= O
SIGNS: NO.LAMPS LU
a
SERVICE 0.600V-Nor OVER 200A 1.00 N
Z
SERVICE O4OOV-OVER 200 A. 2.00
SERVICE OVER GOOV 5.00
MISC.
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S 8 GNA
TURIS
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 -N,
LOS ANGELES NTY ND STAT OF FIXTURES •-
CALIFORNIA OR THAT I THE LEGAL O NER T VE. '
DESCRIBED RESIDENTIAL P P POWER
SIGNATURE UTILITY CO.NOTIFIED +r� 1•.�r1X '^ J
OF PERMITTEE FINAL G 7
LIDATION ARTHUR C. VEIT�
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
ut;o 9 28 8 tZ AN 9 2 D 17.2 0,
,:t� WORKERS'COMPENSATION DECLARATION 7SA683 10181 APPLICATION FOR ELECTRICAL PERMIT
V"
Phert�irm that I. have a certificate of consent to self insure, CE-8080
or a certi)icate of Workers' Compensation Insurance, or a certified COUNTY OF LOS,ANGELES BUILDING AND SAFETY
dopy thereof(Sec.3800,Lab.C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB
ADDRESS ,3. a sid#v!G,
❑
Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH_ NO, FEE
Certified copy is filed with the county building inspection ,
1 &2-Family,Sq.Ft. $ _ $ LOCALITY
department.
Multi-family Sq.Ft. CROSSS ST 61
�G kvl JJ�
Date Applicant Residential Swimming Pools OWNER.OR LG v(I�
—,OWNER
NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' ,� ADDRESS GV "C
COMPENSATION INSURANCE Outlets:Rec—Lighf SW.
(This section need not be completed•f the work Involved by the First 20 ' �,
permit is for one hundred dollars($100)or less.)
Total No. Additional CITY Fee i t Tel:No. 207
I certify that in the performance of the work for which this permit qpp IST K
is issued, I shall riot employ any person in any manner as to
,become subject to the Workers'Comp on w Lighting Fixtures First 20 ADDRESS
Total Nd.� Additional CITY el..
Date �Z'Lr Applicant Fixed Appliances Not Over 1 HP. PERMIT
NOTICE TO APPLICANT:. If; after makin this Cert' cafe of APPLICANT
Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. _
provisions of the Labor Code,you must forthwith comply.with such Oven _ Dryer_ W.M._ ADDRESS
provisions or this permit shall be deemed revoked. Top — FAU _ W.H. _
CITY, .Tel.No.
LICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other_ a
I hereby 'affirm that I am licensed under provisions of Chapter 9DispiCd •UCENSE'OR Class
(commencing . —
with Section 7000)of Division 3 of the Business and Room Aron . REG.NUMBER
Professions Code,and my license is in full force and effect. Power Apparatus&.Large Appliances DISTRICT NO. PROCESSED BY '
Size&Type HP,KW,KVA,or KVAR
License Number Lic.Class Up to 1 Incl. FINAL 8
Over 1 to 10 Inc]. DATE �/ V ATION
Contractor. Date Over 10 to 50 Incl. 0
FI
0 I am exempt under Sec. Over 50 to 100 Inc. W
Over 100 0-
B,&P.C.for this reason. N
Services,Swbd.,MCC&Panelboards ► Z
Date: 0-2.00.Amp.Under 600.V
Signature 201- 1000 Amp.Under 600 V• ;@90 22 A
Over 1000 Amp.or Over 600 V ,
Exemption for Reg.Mairit.Elect. # 0 0 0 0 0 'Z
SINGLE FAMILY Temp.Power Pole'&Appurtenances o 0 1 a 7 Jr
HOME OWNER-BUILDER DECLARATION, Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Law 0 0 o it
h Cir
B
Sign Branch cus
for the following reason(Section 7031.5,Business and Professions Additional } 1 a 7 5 5
Code):
0223-88
Misc.Conduits&Conductors
-I,as owner of the property,will do the work and the.structure
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
performance of the work for which this permit is issued(Sec,3097, PERMIT FEE (Sub-Total)
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 above TOTAL FEE
information is correct.I agree to comply with all County ordinances
and State laws regulating Electrical wiring, and hereby authorize '
representatives of this Coun to enter upon the above-mentioned
properlyAr inspection p es. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signatu of P .rmittee Date