HomeMy Public PortalAbout4928 SERENO DR_Electrical__ vuw asp eA 11-+s APPLICATION FOR PE PM
DEPARTNI£NT OFNG AND SAFETY ELECTRIC i
COUNTY OFF LOS LOS ANGELES
WILLIAM J. FOX, Cesar ENGINEER
FOR APPLICANT TO FILL IN DISTRl:rO. GROUP I Z NE PERMIT NO.
ELECTRICIAN F• 1'tOII
�I IZ L Sq!
ADDRESS 604 Aoe.oifl St. rI READY nlD(B,P�[OfiTION DAT[ ISSUED
CITY San Oa • TCL NOP+ 68588 R [riED BV v
COUNTY LICENSE NO 1104 EXPIRED ADDRESe 9g2 S. Sereno, Temple City
M— FEES
NUMBER OUTLETS EACH r[[ LOCALITY Temple City
5 LIGHT Bo 25 NEAREST
15 RECEPTACLES B 75 QR--BY
5 rlxTunce 5 25' OWNER E. B. Hapney
8 WALL SWITCHES a 40 MAIL
2 ELIEQ RANGES 25 50 ADDRESS
1 [LEC HEATERS 25 25 CITY TEL. NO
MISO I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
NUMBER OF CIRCUITS INSTALLED/
TOTAL APPLICATION AND STATE THAT THE ABOVE le OORRZCT
LIGHTS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
MOTORS AND STAT[ LAWS REGULATING ELECTRICAL WIRING
NUNEE,1 HORSEPOWER FE[ i CERTIFY THAT I POSSESS THE ABOVE VALID LOS
Ntw Mw NP QV[R Ina tADH I ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
YA . 25 OF THE RESIDENTIAL PROPERTY DESCRIBED ASOYE
12 6 1 00 BIO MIIrTETURE Q
P[ 1 _
e
is I so INSPECTION RECORD
Ie
so 2513
eo SOD Soo
=0 Soo I G 013
SOO moo IB OD -1
OVER IDOD 2000 _
M 0 SET FRE QHANGER-HP G
WELDERS AC-KVA Q'
GENERATORS - KW D
TRANSFORMERS - "A
TEMP MOTORS (75 or onlo)
MOVED MOTORS (75 of 0,110)
M
SIGNS
TYPE NO.TRANS
TYPE NO LAMPS APPROVALS
FOR EACH PERMIT DAT[ INSPECTOR'S NAM[
WIRING Sl.® 1100 1 CONDUIT
rIXTURES 81 130 1 00 WIRING
-SUPPLEMENTARY50 FIXTURES
4 40 POWER
TOTAL FEE • UTILITY CO NOTIr1ED
FINAL is
tWfirm that
COMPENSATION DECLARATION CE W6 IaiBt APPLICATION FOR ELECTRICAL PERMIT q
I hereby affirm that I have a certificate of consent to self ��' (J
nsvrd or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY
or o certified copy thereof (Sec 3800 Lab C )
Policy No Company FOR APKICANT TO RUL
IN JOB
NO FEE MX7RE55 1 'L a
Certified copy is hereby furnished New Residential Bldgs 8 Pools EACH
❑ nk-
1 8 2-Family Ft $ = f LOCALITY Te ���
Cerobed copy Is filed with the county building mspec Y SQ
bon department Mule family Sq F NEAREST p
Residential Swimming Pools CROSS ST O S d B(0
Date Applicant - _ OWNER OR
CERTIFICATE OF EXEMPTION FROM WORKERS Z_Sw \ F
IRM Outlets Rec MAIL NAME
COMPENSATION INSURANCE LightADDRESS Str-CAA Dr
. -'(This section need not be completed If the work Insolwd by ���/�
First 20 CIN Tel N
the permit Is for one hundred doltars($I00)or loss) Total No/-10-- Additional T' e C ( d
AN CHECK
I comfy 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
7 First 20 ADDRESS
Total No Additional CITY Tel No
Dote Applicant Fixed Appliances Not Over I HP PERMIT
NOTICE TO APPLICANT If offer making this Certificate of APPLICANTExemption 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 — CITY Tel No
deemed revoked Hood _ Fan _Other_
LICENSED CONTRACTORS DECLARATION LICENSE OR
I hereby off um that I am licensed under provisions of Chapter 9 Disp Room Air Cord REG NUMBER Coss
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO SSED BV r
and Professions Code and my license is in full force and effect Power Apparatus 8 Large Appliances
Sue 8 Type HP, KW KVA or KVAR O
License Number Lic Close Up to 1 Incl FINAL /7
VA
�(//j
Over I to 10 Incl DATE / LIDA O
Contractor Dote❑ Over 10 to 50 Inc[ U FI y W
am exempt under Sec Over 5010 100 Inc BY 7YsS�.Z. a
B 8P C far this reason Over 100 r to
Services Swbd MCC 8 Ponelboards 3 Q,5 0( s s Z
Data 0 -200 Amp Under 600 V s s - 34,505
Signature 201 - 1000 Amp Under 600 V
❑ Exemption for Reg Morns Elect Over 1000 Amp or Over 600 V O a 2 8-r 8 6
SINGLE FAMILY Temp Power Pole 8 Appurtenances
HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit
I hereby off um that I am exempt from the Contractor s License Additional Sign Branch Circuit '
Law for the following reason (Section 7031 5 Business and
Professions Code) -
❑ 1 as owner of the Mow Conduits 8 Conductors
property will do the work and the Other See Complete Fee Schedule
structure is not and
Professions
or offered for sale (Section ( P )— ,
7044 Business and Profineons 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, Gv 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 TOTAL FEE
above information is correct I agree to comply with all County
ordinances and State jaws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
the above mentioned property w�.. for
orr inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE '
ZZ,
Signature of Permittee "Dole
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