HomeMy Public PortalAbout5106 SERENO DR_Electrical__ GGEbAS BB • APPLICATION FOR ELECTRIC PERMIT 1
,,DMSION OF WELDING AND SAFETY
• Depmtwnt of County Enginew
COnOfy O} LD• ASM BUILDING
WM J FO COUNTY NGINEER ADDRESS 5106 Sereno,
GlSATT D GRIFFIN SuP T of BUILDING
LOCALITY Tei leCit
FOR Ar=LIC T TO FILL IN
PERFEES NEAREST
CROSS ST
NUMBER EACH FEB M
LIGHT OUTLETS OWNER 1'Yauger
RECEPTACLES MAIL
ADDRESS
WALL SWITCHE6
TOTALOUTLETa 2950 4 CITY TEL NO
ELEC RANGES 25 ELECTRICIAN nQnrhin
_ELEC HEATERS '2B ADDI C
NW EA CITY X TEL NO
FIXTURES B LICENSE NO
NUMBER OF LIGHT CIRCUITS - DISTRI NO GROUP YGDY lOY INtIYCi IOY
NUMBER OF RECEPTACLE CIRCUITS
MOTORS
NUMBER HORSEPOWER FEE INSPECTION REI:.ORD
----F---- HP OVER I INC EACH 1Ll IC
B L— 25
2 EO
2 IS 1 00
6 IE 1 BO
ID OO 2 BO
EO 200 B DO
MISC
NO SIGNS NO TRANS -
NO SIGNS NO LAMP
FOR EACH PERMIT
WIRING st DO
FIXTURES 1 00
SUPPLEMENTARY SO APPROVALS
TOTAL FEE Is DATE INSPECTOR S SIGNATURE
1 HEREBY ACKNOWLEDGETHAT I HAVE READ THIS APPLICATION CONDUIT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING CGlot
ELECTRICAL WIRING
I HEREBY CERTIFY THAT 1 AM PR REGG TE AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS Ay UNTY / TATE OF
CALIFORNIA OR THAT 1 AM C itER HE ABOVE POWER
DESCRIBED RESIDENTIAL PR
SIGNATURE UTILITYCO NOTIFIED She //II
OF PERMITTEE FINAL SCm rY
WILLIAM J.FOX,COUNTY ENaWEER VALWATION A C VEIT.CHIEF ELzOT INSPECTOR
L&4857A AM 9 2 3.90 a
WORKERS CI have COMPENSATIONDECLARATION
of
aiq�„3/�, APPLICATION FOR ELECTRICAL PERMIT Q
�re�of6rm that I have a cerhhcote oT consent to self ��
insure or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES Y , DEPT OF PUBLIC WORKS
or a certified copy thereof (Sec 3800 Lab C )
Policy No Company FOR APPLICANT TO FILL IN JOB
❑Certified copy is hereby furnished New Residential Bldgs 8 Pools EACH NO FEE ADDRESS
60 ffer-
Certified copy is filed with the county budding mspec 1 &2-Family, Sq Ft $ — f LOCALITY (� �+• .
eon department Multifamily Sq Ft — NEAREST
Residential Swimming Pools CROSS ST
NE
Date.Applicant FIRM NAME eta
CERTIFICATE OF EXEMPTIONec_
�FROM WORKERS Outlets RLight_Sw_ MAIL
COMPENSATION INSURANCE i ADDRESS !Z71-
First 20
C(Thlt section rmmd not be compltttd If the work Involved by 1 CITU Tel No _
Pecmlt Isifor one hundred dollars; ($I88)or Itss) Total No Additional al ( PIAN�� L
I certify that in the performance of the work for which this a t -1 ') i, PLANC HE T
permit is issued I shall not employ any person in any manner
so as,to ome subject to the Workers Compensation Laws Lighting Fixtures First 20 ADDRESS
' 11II-_� Additional
Date I Appbcantar"Al�4IAV5,w Total No CITY Tel No
Fixed Appliances Not over 1 HP PERMIT
NOTtCe TO PPUCANT If; after making this Certificate of
Exemption, you should become subject to the Workers R°^ge— Heater- - D W-- �_ APPLICATION i Tait p/..�
Compensation provisions of the Labor Code, you must forth- Oven ' -Dryer `W M — - - _ ADDRESS_40
with comply with such provisions or this permit shall be T FAU —W H �
Sdeemed revoked _ Hood Fan —Other—_ - ' CITY_SA -Tel-No -
LICENSED CONTRACTORS DECLARATIONLICENSE OR"
affirm I hereby arm that I am licensed under provisions of Chapter 9 Dup -- Room Au Canal REG NUMBER -^"' Class C,.- i
(commencing with Section 7000)of Division 3 of the Business Power Apporotus 8 Large Appliances _ DISTRICT NO P D BY i Y
and Professions Code,and my license is in full force and effect -O. - D_
/s Size 8 Type HP, KW KVA or KVAR 1 _ Q !/ 0
License Number,cUc ClassIL Up to 1 Incl - - FINAL / '- -'� i U
VALIDATION 0
Over 1 to 10 Incl DATE ( Ir
Contractorw ±2:50161.y'+ 0 r __
Over 10 to 50 Incl FINA —-- ( h"
am exempt under Sec Over 50 to 100 Inc gY Q
B 8P C for this reason Over 100 ) d
• Services, Swbd , MCC 8 Panelbourds .. ,
°t 0-200 Amp Under 600 V
Signature, _ 201 - 1000 Amp Under 600 V - •-� - '
F-1Exemption for Reg Moint Elect I� If Over 1000 Amp or Over 600 V'
^I
SINGLE FAMILY r r j
HOME OWNER-BUILDER DECLARATION Temp Power Pole 8 Appurtenances _ _ 2
Sign with One Branch Circuit a
I hereby affirm that g r exempt from the Connector s,License d Additional Sign Branch Circuits A.�T.sr I '
Law for the following reason (Section 7031 5 Business and g .. .� ._
Professions Code) I ,1 _ 7 j I 331.1M
Mtsc Conduits 8 Conductors I
❑ I as owner of the property will f o the worki nlr the . 1 ITEMS
structure is not intended or offered for sale(Section 704.x, OUlher (See Complete Fee Schedule}_ - - J
Business and Professions Code) TOTAL-h 31-00
CONSTRUCTION LENDING AGENCY LHEGK i , . 31.00
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) .03
(Sec 3097, Gv C ) 1
i - f PIAN CHECKING FEE ' " Of �} ,
Lenders Name 1I _ - - - 3 ii v 4l
PERMIT.ISSUING FEE - —
Lender s Address 11 _ _ .4 ,711 I- - -- - - -8026 - 11 19110 O6
I certify that I have read this application and state that the
TOTAL FEE a7 s r 1
above information is correct I agree to comply with all County - ..�- _ {'• . _- - _
ordino ces and State w regulating Electrical wiring and
_ L
he authoratrve f this County to enter upon
9.j n
I ove- lid p _r inspection purpo
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date its