HomeMy Public PortalAbout6206 RENO AVE_Electrical__ r6A663 CE-81M(11..78) APPLICATION R ELECTRICAL PERMIT
COUNTY OF LOS ANGELES BUILDING'AND SAFETY
FOR APPLICANT TO.FILL IN JOB
EACH NO. FEE _ADDRESS 4
�/_.. .__.
New Residential Bldgs.&Pools LOCALITY �..�.+-�
1 &2-Family,Sq.Ft. $ . .025 — $ ✓ 1�
Multi-family Sq:Ft. ' .02 — NEAREST ,
CROSS ST. 17
Residential Swimming Pools 25.00 -OWNER OR Q -s
.FIRM'NAME ", ,PS r /L
Outlets:Rec-ALLightSW.;_ MAIL. ♦- _
First 20 50 Q. ADDRESS '0
TotalNo.. Additional .30 CITY, ��,.� Tel.,No. Y .
PLAN CHECK ,
APPLICANT-
Lighting Fixtures F,irst.20 •50 ADDRESS
�— Additional .30
Total.No. CITY Til:-No.
Fixed Appliances Not Ovdt I HP PERMIT �-
Range_Heater_D.W,
APPLICANT �32F.T
Oven—Dryer_.W.M.— ' ADD.R'ESAS._ /'
Top•_FAU —W — CIT Tel.
Tel.
Hood_Fan —Other LICENSE OR
Disp._Room Air Cond. 2'50 REG.NUMBER,_A�®76 Class.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI.CA-
PowerApparatus&•Large Appliances . TION 4ND STATE THAT THE ABOVE IS CORRECT AND AGREE.TO
'COMPLY WITH ALL COUNTY-ORDINANCES AND STATE LAWS
Size&Type HP;KW,KVA,yr KVAR 2.50 REGULATING ELECTRICAL WIRING.
Up to 1'Incl. I HEREBY.CERTIFY"THAT.I'AM PROPERLY REGISTERED AND/OR' Ij
Over 1 to 1-0 Incl. 5.00 LICENSED AS REQUIRED BY LOS ANGELES'-COUNTY AND STATE OF
Over 1.0 to 50 Incl: 12.50 CALIFORNIA OR THAT„L AM THE,LEGAL OWNER OF THE.ABOVE -®
25.00 DESCRIBED•RESIDE TIAL PROPERTY.
Over 50 to 100 Inc. '+
PE MITEE.
Over 10:0 40.00 —SIGNAT[IRV .
Services DISTRICT NO.. SSED
0=200 Amp.Under 600 V 12.50 a ✓
201.1000 Amp. Under 600 V
25.00
Over 1.000 Amp.or Over'600'V 50.00,. _
Te.m Power Pole&.A urtenances 10.00 yy�� G�• 7 .- 37)P'•' PP 10.00 3 4
Sign w.ith.One Branch Circuit /
Additional•Sign BranchCircuits
2,00 , .INSPECTION
W
Misc.Conduits& 10:00 INFORMATION
ON- ON REVERSE' x
Other!See Complete Fee Schedule!
SIDE u _96560A
.. _ _ • .0 O O O 02
+ 20o2950
PERMIT FEE (Sub-Total)
0 -29505
PLAN CHECKING FEE !One-Fourth Permit Feel C 0
PERMIT ISSUING FEE - . $7.00 . r,.'C:-•C 0 9. 1 1 :—7 9
TOTAL FEE ESQ F
INSPECTION F NALE � �-• '
date: q � By g. tl�'/ 'ts'i s es
WORKERS'COMPENSATION DECLARATION 16A663. 10/81 i
I'liereblr;affirm ;tifat :I havl?'a�•certi��ate of. consent to self
CE-8066 APPLICATION 'FOR E`�ECTRICAL PERMIT
i.nsure,"of a certi.ficlite+of W�o rkOrs'Compensation Insurance, , :COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a.certified copy thereof(Sec. 3800; Lab. C.) I.
❑ y. Company FOR APPLICANT TO.FILL IN ( JOB
B : '•l
Polio No.
Certified copy is hereby furnished. New Residential Bldgs. &.Pools EACH NO. FEE I DRESS. e.
❑ Certified copy.is filed with the county building inspec- 1 &'2-Family.;'Sq. Ft. $ — $ LOCALITY'
tion department. Multi-family Sq. Ft. — NEAREST
Residential.Swimming.Pools CROSS ST, `
Date. Applicant OWNER
CERTIFICATE OF EXEMPTION FROM WORKERS' 9 MAIL NAM
E.
Outlets: Rec Li ht Sw.
COMPENSATION INSURANCE ADDRESS: '
his section need not be completed if the work-Involved b +' First ti -
Y „ Total No. CITY Tel. No.
the permit-is for one hundred dollars(;100)or less.) Additional � -�r' .
PLAN CHECK
I certify that in the performance of the work for which this 'I APPLICANT
permit is issued, I.shall notemploy any person in any manner
so as to become subject to the Workers'Compensation Laws.
, Lighting Fixtures First.20 �U ADDRESS
'.r e .i /' ( / onal
'Total No. ! Additi S CITY
Fixed.Appliances,N of Over 1 HP n PERMIT
NOTICE TO APPLICANT: If, -after making, this Certificate of +
Te
I
Date plicaNo.
Exemption; you should become subject to the Workers' Range_ Heater_D.W. APPLICANT
Compensation provisions of the Labor Code, you must forth- Oven _Dryer . W.M. ADDRESS +t
with comply with .such provisions or this'permit shall be Top _ FAU W.H.
deemed revoked. Hood _ Fan _.Other_ CITY® ° .Tel, li -2
LICENSED CONTRACTORS DECLARATION LICENSE OR
)hereby affirm that I am licensed under provisions of Chapter 9 p — Room Air _ - REG'.'NUMBER Clcss��
Dis oom • Cond
(commencing with Section 7000)of_Division 3 of the Business ! DISTRICT NO. P ED BY
Power Apparatus&Large Applliiances 1 {
grid Professions Code,and my licerise.is:in full force and effect.. p l
.� �/ Size&Type HP, KW, KVA, or KVAR' �� Ur/ 0
License Number-159-9 Tom¢ /�Lic. Class Up to 1 Incl. FINAL
Over 1'to 10 Incl. Z 2 O
� / /� DATE
CorltractoAztuj `�//�rA2:. zev^ VALIDATION
lam exempt-under Sec. Over'50 to 100 Inc. BOver 10 to 50.Incl. Y A DW„
B.&P.C. for this reason Over'100 •I ,
Date: Services', Swbd., MCC&,Panelboards 71
0 -200 Amp.:Under 600.V
Signature. 201 - 1000 Amp. Under 600 V '
❑ Over 1.000 Amp. or Over 600 V
Exemption for Reg. Maint.Elect. �
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 7039..5, Business and
Professions Code):
ED I., as owner of the property, will do the work:and the Misc. Conduits&Conductors A57• 3 A ,
structure is not intended or offered for-sale (Section Other.(See Complete.Fee Schedu.le)_ #.0 a 0 0.0 2
7044, Business and Professions Code). PP
CONSTRUCTION LENDING AGENCY I o 0 4 4,2 5
1 hereby affirm that there is a construction lending agency for 0 0 0 4 Q.2 5 5
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
'(Sec; 3097, Civ. C6). .
PLAN CHECKING FEE I (122."86'
Lender's..Name
PERMIT ISSUING.FEE Q
Lenders Address I.
I certify that I have read this application and..state that the TOTAL FEE L
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 inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE -
,Cm7/ ��
Signature of Permittee 01 Date