HomeMy Public PortalAbout5923-5923 1/2 RENO AVE_Electrical__ '6A666-Ca006 6.66 APPLICATION F®R ELECTRIC PERMIT
1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING w
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER
CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY 71
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES cRoss sr.
ITEM_ NUMBER I EACH FEE OWNER
OUTLETS: $ $ MAIL
LIGHTS RECEPT. SW. .10 ADDRESS
LIGHTING FIXTURES .10 CITY TEL.NO.
ELEC.RANGES CLO.DRYERS ELECTRICIAN
WATER HEATERS .80 ADDRESS SQ
ELEC.SPACE HTRS. DISHWASHERS CITY
GARBAGE DISPOSERS AUTO.- STATE
WASHERS STA.COOKING UNITS .28 LICENSE NO.
MOTORS: OVER INC H.P. DISTkC NO. '—f,
�I Z QNE I PROCESS BY
0— I/a .28 !/
l2— 2 .BO INSPECTION RECORD
2— s 1.00 ,
5— 18 1.80
Is— SO 2.80
50-200 8.00
SIGNS: NO.TRANS.
NO.LAMPS
SERVICE 0-800V 1.00 d d
SERVICE OVER 600V 8.00
MISC.
WIRING PERMIT 1.00 Q Q
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .50
TOTAL FEE 8 2 cj p
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT
ELECTRICAL WIRING.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR WIRING
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL OPMnlr POWER
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTE
FINAL
9vATION ARTHUR C.VEIT,
CK a GASH SUPERVISING ELECTRICAL ENGINEER
UCO 5 0 7 8%col JAfa 12 2 A 2.0 010
WORKERS'COMPENSATION DECLARATION I78010/81 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of conseNt to sl insure, CE-806G
or a certificate of.Workers' Compensation Insurance, r a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
cop 0NoDV1 `.10P C.) C5 Insurance
Noll oddd JJ Company a FOR APPLICANT TO FILL IN JOB
ADD 47-
❑ Certified
EACH NO. FEE ADDRESS
Certified copy is hereby furnished. New Residential Bldgs.&Pools LOCALITY ,
Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. $ _ $
epart ent Multi-family Sq.Ft. NEAREST /
Date .�T✓ Applicant �^' ���/ CROSS O
Residential Swimming Pools. OWNER T.
40 C2
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rao—Light_Sw.— MAIL
COMPENSATION INSURANCE ADDRESS
First 20
(This section need not be completed if the work Involved by the Total No. Additional CITY Tel.No.
permit is for one hundred dollars($100)or less.)
I certify that in the performance of the work for which this permit PLAN CHECK
APPLICANT
is issued, I shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws.. , Lighting Fixtures First 20 ADDRESS
Total No. Additional CITY Tel.No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT. If, after making this Certificate of
Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. APPLICANT .
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 J Tel.No01/
LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_
I. hereby affirm that. I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR Class.
(commencing with Section 7000)of Division 3 of the Business and REG.NUMBER U
Professions Code,and my license is in full force and effect.f� Power Apparatus&Large Appliances DISTRICT NO. 17 P SED BY d
License Number
/�'"Lic.Class G✓ Size&Type Up to iVIncVA,or KVAR FINAT V
Over 1 to 10 Incl. DATE IX
/ VALIDATION O
Contractor�� Date Over 10 to 50 Incl. FINAL U
❑ I am exempt under Sec. Over 50 to 100 Inc. BY OW.
B.&P.C.for this reason 100Is " fJ7
r00Tdr• nd"U"e�"b00 V ds p ► Z
Date: O
Signature p.Under 600 V 3303 � e�0
Over 1000 Amp.or Over 600 V
❑ Exemption for Reg.Maint.Elect. 1 YTErS
SINGLE FAMILY Temp..Power Pole&Appurtenances TOTAL 65 o 6ED
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits CKECK f5°60
for the following reason(Section 7031.5,Business and Professions
Code): CWGE .00
El 1,as owner of the property,will do the work.and the structure Misc.Conduits&Conductors
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _
and Professions Code). ► GM—W01 10/31/$5
CONSTRUCTION LENDING AGENCY 3082 1 AN11e23
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 O
Lender's Address
I certify that I have read this application and state that the above TOTAL FEE
information correct.I agree comply with all County ordinances
anJStatVws regu g e rical wiring, and hereby authorize
reesof s o t to enter upon the above-mentioned
prons tion sea, SEE REVERSE FOR EXPLANATORY LANGUAGE
gn u of Permi Date