HomeMy Public PortalAbout5939 RENO AVE_Electrical__ 76A r'CE,806 8-62 APPLICATION FOR - UCTRICAL PERMr1'
COUNTY OF LOS ANGELES -
.DEPARTMENT OP COUNTY ENGINEER BUILDING. `
BUILDING AICD SAFETY DIVISION ADDRESS s
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 8 OWNE :T
LISIiT _ MAIL '
A D D'L "ADDRESS
SWITCH. OVER 20 .10 � - --
LIGHT.IN.G TOTAL FIRST 20 :20 CITY. TEL.NO:
FIXTURES VER 2
OVER 20 .10 ELECTRICIAN '
RANGE CLO.DRYERS WTR.HTRB. 1.00 ,.ADDRESS
GARB:DISP. STA:COOK
:CITY TEL.NO.
DISHWASH. AUTO.-WASH. STATE
SPACB HTRB. BTA.APP.(V$:H.P.MAX.) .SO
LICENSE NO.
MOTORS: OVER NOT OVER H.P. DISTRICT N r GR UP ZONE PROCESSED BY
0 1. 1.00 F (moo LoAea
1 8 1.so 6117 ,161-3
INSPECTION RECORyD
8 S 2.00 {' 611 f� Z.
8 1s 2.50 + i�
15 So 8.00 f '�
so 100 .5.00 p O
Li � l S ff V
NO.TRANS. �
SIGNS: NO.LAMPS L✓=�_. O
SERVICE 0.600V-NOT OVER 200A 1.00�' ��iliy( A W
SERVICE 0.600V-OVER 200 A. 2.00
SERVICE OVER 600V .5.00 Z
MISC. J.;yi /i•r-L.�r'r S� t it `�✓ it
PERMIT ISSUING FEE 2.00 p
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE r$
I HEREBY ACKNOWLEDGE THAT I HAVE.READ THIS APPL CAT ON _ APPROVALS 13ATE INSPECTOR'S 81GNATURH
:AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY. CONDUIT
WITH ALL!COUNTY ORDINANCES AND STATE LAWS REGULATING _ (� -
BLECTRICAL WIRING. WIRING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR - ( //
LICENSED,AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES .E,J
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE '
DESCRIBED.RESI`DEYTIALyLPPROPERTY. ! POWER I f�P �y/
SIGNATURE Y/ 4 UTILITY CO.NOTIFIED AN�
�L I / L-9
OF PERMITTEE/llvvv FINAL
VALID T=-__N, ARTFILIR C. VEIT
CK M CASH SUPERVISING ELECTRICAL ENGINEER
A
WORKERS'COMPENSATION DECLARATION 76A663CE-806 ,OSB, APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self CE-806G
insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof(Sec. 3800, Lab. C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB
ADDRESS 93
Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE
❑ 1 8 2-Family, S Ft. $ — $ LOCALITY-C� Qg
Certified copy is filed with the county building inspec- Y. q•
tion department. Multi-family Sq. Ft. — NEAREST
10
CROSS ST. X
Residential Swimming Pools OWNER O ��
Date Applicant •�•
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RecL _Light�Sw.� Y MAIL
COMPENSATION INSURANCE ADDRESS J46-%4.& /a�
First 20
(This section nood not be completed if the work Involved by Total No. Additional CITY �, Tel. No. ,��
the permit is for one hundred dollars($100)or less.)
PLAN CHECK
I certify that in the performance of the work for which this APPLICANT
permit 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
I Total No. Additional Additional CITY Tel. No.
ate pplicant •�• Fixed Appliances Not Over 1 HP PERMIT
A
OTICE TO AP LAIf, after making this Certi icate of APPLICANT
Exemption, you should become subject to the Workers' Range_ Heater—D.W. —
Compensation provisions of the Labor Code, you must forth- Oven —Dryer _W.M.— ADDRESS
with comply with such provisions or this permit shall be Top _ FAU —W.H. —
deemed revoked. Hood _ Fan _Other_ CITY Tel. No.
LICENSED CONTRACTORS DECLARATION LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER Class.
(commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PROCE ED BY
and Professions Code,and my license is in full force and effect.
Size&Type HP, KW, KVA, or KVAR O
License Number Lic. Class Up to 1 Incl. FINAL W
ag
Over 1 to 10 Incl. DATE VALIDATION
Contractor Date Over 10 to 50 Incl.
It—
FINAL
❑ I am exempt under Sec. Over 50 to 100 Inc. BY
A.
Over 100 VA
B.&P.C. for this reason
Date Services, Swbd., MCC&Panelboards ►
0 -200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600 V
❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V
SINGLE FAMILY Temp. Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
Law for the following reason (Section 7031.5, Business and
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 Other(See Complete Fee Scheduje)_ ►
7044, 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 Q
Lender's Name PERMIT ISSUING FEE
Lender's Address
1 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 nd State laws regulating Electrical wiring, and
hereby au orize r esentatives of this County to enter upon
th abo a io pro y for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
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Sig e P i tee ate
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