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HomeMy Public PortalAbout6453 TRELAWNEY AVE_Electrical__ ).A,N(i .Oe le/Tel APPLICATIO -FOR EL TRICAL PERMIT COUNTY OF LOS ANGELESGp BUILDIINNG AN SAFETY FOR APPLICANT TO FILL IN ADDRESS Js New Residential Bldgs 6 Pools EACH NO FEE 182 Family Sq H S 025 — S LOCALITY L/ r Multi family Sq Ft 02 NLARtbi T Resldennal Swimming Po25 00 ols WN IRM NA SC/9-ole G,�D,0!5oZ Outlets Rec_Light_Sw -2- MAIL First 20 50 - ADDRESS Total No Additional 30 CITY L Tel No PLAN CHECK APPLICANT Lighting Fixtures First 20 50 ADDRESS Addnlonol 30 _ Total No CITY Tel No Fixed Appliances Not Over 1 HP "MITE = G Range_Heater_D W Oven—Dryer_W M_ ADDRE 0 _ Top —FAU — WH — CITY�r 9rxoe Tel g' a�� Hood_Fon —Other— LICENSE OR Dnp _Room Au Cond 250 REG NUMBE 6 Class C.Io I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA Power Apporatus&Lorge Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO Sae A.Type H KW, KVA or KVA COMPLY WITH ALL COUNTY-ORDINANCES AND STATE LAWS 2 50 REGULATING ELECTRICAL WIRING pro 1 In<I � I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AN �j Over 1 to ID ImIZ(7 500 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF Over 10 to 50 Ind 1250 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE Over 50 to 100 Inc 25 DO DESCRIBED RESIDENTIAL PROPERTY PERMITEE r Over 100 4000 _ SIGNATURE Services - DISTRICT NO E ED BY 0 200 Amp Under 600V 1250 U a 201 1000 Amp Under 600 V 2500 v Over 1000 Amp or Over 600 V 5000 Temp Power Pole&Appurtenances 1000 i Sign with One Branch Circuit 1000 3`G Additional Sign Branch Circuits 200 INSPECTION M,s1000 INFORMATION 2 2 8 3 3 A Other CSee City 8 ConductorsaSchedule)— ON REVERSE Other($ee Complete Fee Scheduler_ SIDE = ge . . . e2 2 • • 2800 PERMIT FEE (Sub Total) PLAN CHECKING FEE (One Fourth Permit Feel O 0220-79 F PERMIT ISSUING FEE $700 O TOTAL FEE > INSPECTION FINALED dote By IIICCC m+ ',%e WORKERS COMPENSATION DECLARATION 76A663 ID/Bt APPLICATION FOR ELECTRICAL PERMIT I hereby affirm'tho�i I hove a certificate of consent to self CE 806G'insure �r a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec 38DO Lab C ) Poli<y No Company FO[APPLICANTTO FILL IN AA[RESS /_ 3 ❑ Certified copy is hereby furnished New Residential Bldgs 8 Pools EACH NO FEE K� IJCertified copy is fled with the county building inspec 1 8 2-Family Sq Ft S — f LOCALITY P tion department Multi-family Sq Ft — NEAREST DoteOWNER /b NLS Residential Swimming Pools CROSS ST Appbcant n� LL/� FIRM N� c CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec—LLrght,�Sw �_ / 'll MAIL COMPENSATION INSURANCE /� First 20 2V �' ADDRESS ' I 22 (This section need not be completed N the work Involved by Total No� Additional CITY Tel Nog4:r_ J the perrnit is for one hundred dollars (5100)or Ins) I certify that in the performance of the work for which this PIAN CHECKAPPLICAM permit is issued I shall not employ any person in any manner so as to b o=omm�e sss lbj`ect iD the Workers Compensotro ws Lighting Fixture/s ' First 20 ADDRESS 7 PP / Q'.I'ea��//i^ Total No-4- 1 Additional Dote pplicont 1... 74— CITY Tel No Fixed Appl+an<es Not Over 1 HP PERMIT NOTICE O A LICANT If after making this the Wokficate of Range— Heater_D W _ APPLICANT Exemption you should become subject to the Workers 0 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 —WH deemed revoked Flood _ Fon OtherCITY Tel No LICENSED CONTRACTORS DECLARATION _ — LICENSE OR hereby affirm that I am Learned under provision of Chapter 9 Dup _ Room Air Cond REG NUMBER Class (commencing with Section 7000) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO PROCIE >- Size Professions Code and my license is in full force and effect /1 r Size 8 Type HP KW KVA or KVAR �/ o License Number Lic Class Up to 1 Ind FINAL Over I to 10 Ind DATE Contractor Date Over 10 to 50 Incl F G ❑ 1 am exempt under Sec Over 50 to 100 Inc au 0 8P C for this reason Over 100 Z Dote Services, Swbd , MCC 8 Ponelboords 1 0 200 Amp Under 600 V v Signature 201 1000 Amp Under 600 V ❑ Over 1000 Amp or Over 600 V Exemption for Reg Nwint Elect SINGLE FAMILY Temp Power Pole 8 Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit • ' 8 a 7 5 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5 Business and Additional Sign Branch Circuits is is is 83755 froIessions Code) Q/j,2 —8 5 I, as owner of the property will do the work and the Just: Conduits 8 Conductor ► structure is not intended or offered for sole (Section Other (Sea Complete Fee Schedule)_ 70" Business and Professions Code) CONSTRUCTION LENDING AGENCY I hereby off irm 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 Civ C ) PLAN CHECKING FEE Lender s Name Lenders Address PERMIT ISSUING FEE Q I certify that I have read this application and stale that the TOTAL FEE above information n correct I agree to comply with all County ordinances and State laws regulating Electrical wiring and hereby authorize repres tives of this County to enter upon 1bg above mentioned op rtn y for ipection p roosts c SEE REVERSE FOR EXPLANATORY LANGUAGE _ c Srgnoture c Permi ftee Date