HomeMy Public PortalAbout5522 SARA MAR LN_Electrical__ 7GAR6 1051 APPLICATION FOR ELECTRIC PERMIT 1
SUWMG AND SAFETY DIMON
Dapartm°nittT� ABQd County Enfflmw BUILDING
ADDRESS Sara Mar Lane
JOHN A LAM91E COUNTY ENGINEER T.C.
CASSATT D. GRIFFlN SUP T OF BUILDING LOCALITY
NEAREST
FOR APPL_ ICP1NTFOsFILL IN CROSS
LIGHTS �crrRACLEI YWITCHEB OWNER M henna
NUN BER 1 T[Y EACH P[[ MAIL
ADDRESS
TOTAL OUTLETS � IO �
[LHC TANGO WATER HATERS O CITY TEL NO
CLOTHRE DRYERS no ELECTRICIAN G E Corbin Elec. O
ELEC SPACE HUTERS, TAT I COO■ /�
IRB DENTS GARBAGE 01 "SIMS
ADDRESS S Curtis Ave*,
AOT. MASHERS DUHWASHER 26
LIGHTING FIXTURES to CITY Alhambra TEL NOGi-44530
MOTORS STATE 11 Z —ClO
LICENSE NO
HORSEPOWER
H P I OVER INC DISTRICT NO I GRO RHADT IGH IESP[RION
K G LEGS YS I
Y so RFSPEIMON RECORD
Y 6 100
D 15 1 60
15 Bo 250
60 200 500
Elea
SIGNS NO TRANS
No LAMro
SERVICE 0.600V too
SERVICE OVER 600V 6 DO
WIRING PBRMIT 1 00
FIXTURE PERMIT 100
SUPPLEMENTARY PERMIT 6o APPROVAIS
TOTAL FEE DATE INSPECTORS SIGNATURE
1 HEREBY ACKNOWLEDGE THAT I RAYS BEAD THIS APPLICATION
AND STATE THAT THE DIVA IS LAND S AND AGR E COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND ST NS REGULATING
ELECTRICAL TITERS WIRING
1 HEREBY CERTIFY THAT I AN REGI E NB/OR FIXTURES
LICENSED AS REQUIRED BY LO U ATATL OF
CALIFORNIA OR THAT 1 AY THE..ABOV POWER
DESCRIBED RESIDENTIAL
SIGNATUREUTILITY CO NOTIFIED
OF PaRMITTIl FINAL I
r
JOHN AeMBIE. A�pN ARTHUR C VEIT
YNTY 6NGINEIIR CN IS CASH SUPOLVISING ELECTRICAL ENOINOM
0014 0 1 4;:; JUL i .5 0 In
7AGOS CEO 06 T,, APPLICATION FOR ELECTRIC PERMIT 1
BUUMING AND SAFETY�Engin Deparbnml of Coup....M...GQ BUILDING
COantp of Los AIIQsIM ADDRESS 522 Sara mar Lane
JOHN A LAMBIB. COUNTY ENGINEER 'Tj le Cit Calif.
CASSATT D GRIFFlN aUPT OF BUILOINO LOCALITY )
NEAREST
FOUR APrPLICs4_NT TO FILL IN CKOSS aT
NUMBER F� OWNER
1 LIGHT OUTLETS MAIL
ADDRESS J
Z RECEPTACLES
15 WALL SWITCHES F!8 CITY NO
53 TOTAL OUTLETS ® ae f ELECTRICIANG, E. CORB N ELEC. CO
ELEC RANGES 25 ADDRESS 800 SO Curtis Ave
eLEC HEATERS 25 c1TYAnarnbr C lif. TML. NO Cull 2
KW EA STATE 1132 C 10
FIXTURES a LICENSE NO
MOTORS DISTRIC O GROU ZONE RUDT FOR INSPECTION
NUMBER HORSEPOWER FEE
N!w Nv0 HP OVER INC EACH
K .L.1a 2a INSPECTION RECORD
2 50 1 1
2 a 100 —
a 15 1 50
la so 250
a0 200 1500
MISC
NO SIGNS NO TRANS
NO SIGNS NO LAMPS
FOR EACH PERMIT
WIRING PERMIT !I 00 00 -
FIXTURE PERMIT 111 00
SUPPLEMENTARY DO APPROVALS
TOTAL FEE 6 I DATE INSPFATOR SSIGNATURE
IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE S REGULATING WIRING
ELECTRICAL WIRING FIXTURES
I HEREBY CERTIFY THAT I AM PR REGI ED ND/OR
LICENSED A9 REQUIRED BY LOS UK A D ATE OF ' '
CALIFORNIA OR THAT I AM ER OF E ASbvE POWER
DESCRIBED RE51DENTIAL UTILITY CO NOTIFIED S
SIGNATURE ...
OF PERMITTE FINAL 1
OUNTY ENOINBER / , , IDATION SUPERVISING ARTHUR C.VELIECTRICAL ENGINEER
NO WH
LACo 8 4 7�3-- MAY 2 3 2 765 n
.. VWORKERS COMPENSATION DECLARATION 69 t9,Bt APPLICATION FOR ELECTRICAL PERMIT
I herebyy uCEB
off
m that I have o certificate of consent to self � 06G
insure or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY
ypprf)ad c9py thereof (Sec 3800 Lab C )
CCT /� �� � _
Ocy No /10_1 � Nr�— FOR Al/l1CANT ro rr1 IN ADDRESS
Certified copy is hereby furnish d New Residential Bldgs 8 Pools EACH NO FEE
r� Altc-
1 8 2-FomJ Ft f — f LOCALITY
0a tson ded copy is filed with the county bwlcbng impec Y SQ nIEA IT
hon department Multrfamdy Sq Ft —3 CROSS Residential Swimming Pools "NE"
T
Date Applicant n
FIRM NAME Z
CO
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec IL
Light_Sw
COMPENSATION INSURANCE ADDRESS
(This soc1lon neod not Iso coni INod If fho work Involved First 20
P �' Total No Additional CITY Tel No
the jsormlf is for ons hundred dollen($100)or lou) RAN 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 becomeaubject to the Workers Compensation Laws Lighting Fixtures First 20 ADDRESS
Total No Additional
CIN Tel No
Date Applicant Fixed Appliances Not Over I HP PERMO e A
NOTICE TO APPLICANT If after making this Certificate of PERIT /✓/I�!/ //� �/LY
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 / Al
with comply with such provisions or this permit shall be Top _ FAU _WH _
deemed revoked CI Y�y. 1 (7jp`
Tel No,),Y(
Hood _ Fan _Other_ UCE OR
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 Dup _ Room Air Cond REG NUMBER 49.373 Class
(commencing with Section 7000) of Division 3 of the Business power Apparatus 8 Large Appliances DISTRICT NO PROCE B a
and Professions Code,and my license ism full force and effect 0 O
.�� [� '7 Size 8 Type HP, KW KVA, or KVAR U
License Numbbe�eefr. lu� Uc Class V ` Up to I Incl FINAL
Contractor L--f/ VArO � Dat° -2-IJ-17 —�—
Over I to IO Incl DAA VALID F-
Over 10 to 50 Incl FIN LU
❑ I am exempt under Sec Over 50 to 100 Inc BY N
B YP C for this reason Over 100 _ Z
Date Services, Swbd MCC 8 Panelboards
0 -200 Amp Under 600 V
Signature 201 - 1000 Amp Under 600 V
❑ Exemption for Reg MaOver 1000 Amp or Over 600 V '
mt Elect �
SINGLE FAMILY Temp Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
7 4 5 3 A
I hereby affirm that I am exempt from the Contractor s License , e •
Law for the following reason (Section 7031 5 Business and Additional Sign Branch Circuits f#• • a a 2 5
Professions Code) • 1 8 2 5
13I as owner of the property will do the work and the Mix Conduits &Conductors
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)— , 0 7 1 3-L687
7044 Business and Professions Code)
CONSTRUCTION LENDING AGENCY
I hereby off um 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, Ctv C ) ,
PLAN CHECKING FEE
Lender s Name
PERMIT ISSUING FEE
Lenders Address
I 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 and State laws regulating Electrical wiring and
hereby authorize reprew tahves of this County to enter upon
the above m Ironed pro or inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
�17 92
ignature of Permittee Date