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HomeMy Public PortalAbout6334 TRELAWNEY AVE_Electrical__ eAeea-ceeoe o-ax APPLICATION FOR E CTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER rL.!7..,,TY7 BUILDING AND SAFETY DIVISION JOHN A LAMBIE. COUNTY ENGINEER WIWAM A JENSEN. SUP T On 0UI WING NEAREST PPLI ANT T FILL IN CROSS ST n.LLP TOTAL No CH OUTLETS FIRST 20 2O S OWNER LIGHT •� z Q NAIL 0'1 WR2 Q ADDRESS SWITCH 3311 Ov[R 20 10 TOTAL 2p O CITY TE O LIGHTING FIRST 20 � _ FIXTURES vD�20 1G ELECTRICIANS AA RANOES CLO D1IYEIU WTR NTES Too Q ADDR 6 Z MR• DI•P Al-- STA COOK TEL No DIWWAW Ir AUTO WAW GTATE Z SPACE STA.APP (YAHP no LICENSE NO MOTORS. OVEN NOTGVER HP DISTRICT O G UP ONE P ESSED B o 1 too 1 3 1 So INSP ION RECORD — 3 B 200 d '7 S 16 280 16 SO 300 L R S A 7. . So 100 Soo \ (•(•/ O SIGNS, No TRANS \ No LAMP• SERVICE O 600V Nm OWN 200A 100 y Z SERVICE 0600V OYoe 200 A 200 SERVICE OVER SOOV 600 MISC PERMIT 16BUING FEE 200 Q SUPPLEMENTARY PERMIT ISSUING FEE 100 TOTAL FEE S 1 HLRt•Y ACKNOWLEDGE THAT 1 HAV[ READ THIS APPLI TION APPROVALSI "IN 1 • IGIIA AND STATE THAT THE ABOVE 1• CORRECT AND AGIR.E TO COMPLY CONDUIT / J WRII ALL COUNTY ORDINANCES AND RATE LAWS REGULATING ELECTRICAL WIRING WIRING 1 HO10Y CERTIFY TNAT 1 AM PROPERLY REGISTERED AMO/OR I 1 V LICENSED N NEOUIR[D By LOS ANGELES COUNTY AND RATE m FIXTURES CALIFORNIA ON %MAT 1 AM THE LA:GAL OWNER OF THE • AOW DE•CRO RESIDENT P POW[R SIGNATURE UTILITYCO NOTIFIED OF PERM ITTE FINAL g)LIDATION ARTS O VEW MO CASH SUPERVISING WECTRICAL ENGINEER LAC05268C; OCT 8 2 A 2130~ KERS COMPENSATION DECLARATION �19 DPW_�� APPLICATION FOR ELECTRICAL PERMIT O r I vh.46y firm that I have a certificate of consent to self aaoec insure or a certificate of Workers' Compensation Insurance COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS w a celtlfled cop_ y tFj�{.s(om 3800-la Pob /N6nD l�(� Company J_ �� "i FOR APPDGNT TO FILL W JOB 3 $4 /� Certified copy is hereby furnished New Residential Bldgs 6 Pools EACH NO FEE '�� / ` ®.E9RLJ ified copy is filed with the county building inspec 18 2 Family Sq Ft S = S LOCALITY G hon deponment Multi-family Sq Ft NEAREST OT(Ijy,F Residential Swimming Pools COWNERS Dote Apphcom OR p ♦ FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec_Light_Sw_ ♦ MAIL COMPENSATION INSURANCE Fust ADDRESS (This sadlon need not be completed d the work in"hred by Total No Additional CITY Tel No the permit Is for one hundred dollars ($100)or Ins ) ♦ PIAN 1 certify that in the performance of the work for which this PLAN CHECK AM 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 Additional Date Applicant Total No CITU Tel No Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT If after making this Certificate of Exemption, you should become subject to the Workers Range— Heater—DW — APPLICATION — e Compensation provisions of the Labor Code you must forth Oven — Dryer —W M — ADDRESS .2_ with comply with such provisions or this permit shall be Top — FAU —W H — deemed revoked Hood — Fan —Other— CITY el N LICENSED CONTRACTORS DECLARATIONLICENSE OR I hereby affirm that I am licensed under provmore of Chapter 9 Disp L iR�IF Au Cond �� REG NUMBER v Class (7111 4D (commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO - / PROCESeDBY �T and Profess.om,Code and my license is in full force and effect e, Size 8 Type HP KW ICVA w KVAR �.J t lJ b O Ucense Number I,r Class Up to 1 Incl FINAL _� A 727 Over 1 to IO Ind DATE VA TION ¢O Contractor �/��r,�Dote Over 10 to 50 Incl H OFINA 0 I am exempt under Sac Over 50 to 100 Inc BY/y/ W B 8P C for this reason Over 100 O_ Services Swbd , MCC 8 Ponelboords N Date 0-200 Amp Under 600 V U Signature 201 1000 Amp Under 600V D Exemption for Reg MaiOver 1000 Amp or Over 600 V Maim Elect SINGLE FAMILY Temp Power Pole 8 Appurtenances HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor s license Law far the following reason (Section 7031 5, Business and Additional Sign Branch Circuits '�0 2 7 9 A Professions Code) # e e e e e '2 i I, as owner of the property will do the work and the Misc Conduits 8 Conductors I --- 29..0,0 structure is not intended or offered for sole(Section 704, Other (See Complete Fee Schedule)_ , -,- - 29005 Business and Professions Code) CONSTRUCTION LENDING AGENCY O 7 2 61t-8 S I hereby affirm that there is a construction lending agency for the performance of the work far which this permit is issued PERMIT FEE (Sub Total) (Sec 3097, Civ 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 mf mat n is correct I agree to comply with all County ordma sand State laws regular g Electncol wrong and 4robor¢e repro ryes humy raenter uponmention rope yfinspurposesEE REVERSE FOR EXPLANATORY LANGUAGE f Permmee Dote �� ®s