HomeMy Public PortalAbout9721 VAL ST_Electrical__ TaAaaa CE•G;?0-62 APPLICATION FOR ELECTRIC L PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER ffADDR
G .yBUILDING AND SAFETY DIVISION e �cJOHN A LAMBIE COUNTY ENGINEER
WILLIAM A JENSEN SUP i oP 11lIILDING Y EMMMMMP C O ST 7�—
TOTAL No inn I PUOUTLETS •IReT 20 p 2O B R fawlTCN ADD SDv[n 0 10TOTAL •� TEL NOLIGHTING Ia•T 20 20 QFIXTURES ADD L 10RICIAN Dv[R 20RANO" CLO GAYER• WTR HTRC 100 S J J ICJ ,S
"M DICK STA COOK
CITY (!;Oa
THL NO
OI•fIWAa AUTO WAa STATE
SPACE IITM RA APP (Y[N• MAK ) SO LICENSE NO {-fN Jr. l
MOTORS. ova NOTOVa HP DI ICT NG P Orr
P D
O 1 1 00rCL
1 — a ISO INSPECTION R ORD
9 — e 200
B — IB 2 5
18 SO 900
SO too 500
SIGN& No TRAMS
No LAMPS
SERVICE O SOOV NOT mum 200A 100
SERVICE O SOOV Ova 200 A 200
SERVICE OVER SOOV 500
MISS
PERMIT ISSUING FE! 12 00 Q
SUPPLEMENTARY PERMIT ISSUING FEE 1 o0
TOTAL PEE s
1 HER"Y ACKNOW"OOC THAT 1 HAVE HEAD TNTC APPLICATIONAPPROVALS DATR INSPECTOR
AMD STATE THAT THE ABOVE IS CORRI CT AND AORa TO COMPLY CONDUIT
WTI ALL COUKTT ORDINANC" AND •TATE LAWS REGULATING
ELECTRICAL WIRING WIRING
1 HaOY CERTIFY THAT 1 AM PROP[RLY REO..E ANO/OR
C
U19KO AS R[OUIRKO •Y W U AMO STATE OF FIXTURES
CA SIGNATURE
OR THAT 1 THE [ OF THC ABOVE
D"CIT RZO Ra1DElTIAL P POWER
OF PERMIM UTILITY CO NOTIFIED .�
FINAL
�LI O CAS ARTHUR C VER
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
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]0A06]CEBO°10°I APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER eu1LeT i1 �! L
BUILDING AND SAFETY DIVISION w..RDIEAG l 1 ( V
JOHN A LAMBIE, COUNTY ENGINEER C
WILLIAM A JENSEN, BOP T OF BUILDING LOCALITYTq
NEAREST /� _
FOR PPLIC NT O FILL IN CROSS B'f' CvOL
1 T [ M NO I EACH FC[
ouT (PIR[r 90) 2G a O OWNER
N— EN
°[o [W MAIL
OVTL . I ='L UN ADDRESS U L
LIGHTS
10
LIGHTING PIXTURES (FIRST 20) 20 e'Q CITY TEL NO
LIGHTING FIXTURES, (AODrtIONAL) f0 i ELECTRICIAN _1
RANGES CLO ORY[RB WTR HRB Ttoo ADDRESS M
OAIm DIW STA COOK T
CITY L TEL NO 1
OISHWASN AUTO WASH MATE
SPACE HTRD STA AFF ( H■ ) SO oo LICENSE NO
MOTORa. OV[R MOTOV[R HF DIS�ii NO G ZONE P ESSED B
o — 1 100 ,Si4
1 a 1 Bo INSPECTION RECORD
a S 900 G.
---.� G.
O
a 15 1 0 �/ u
la eo Goo ,
eo 100 Boo
a16NB �N°
NG y---
o_
xo LIMP[ ,y6 �-- ��[SL Z
SERVICE 600V NOT OVD1200A 100
SERVICE O SOOV OVm1900 A 900
SERVICE OVER BOOV a 00 / / LTi `l'
MISC
PERMIT ISSUING PEE 2 00 Vr1,NAL
7j / r
SUPPLEMEN'TASY PERMIT ISSUING PER 100
TOTAL FEE IxEREEY ACKNOWL[OOK r T 1 MAVE REwD TxIS LI noNALa pAn INP[LTOw naNAANpSTATE THAT TX[ ADOY[ Ie CpRRECT A!ID waRQ ro COMFtrWITII ALL COUNTY ORDINAXCCE ANO STAT[ LAWY REGIILATNG EL[LTRIGL WIRING 1 HAY CERIIA THAT 1 wY PRORALY R[°IfIEIU(D ANp/ORYCENS[D AS M UINKG BY LOS AN"W COUNTY AND STATE OFGLIFORNIA OR TXAT 1 wM THE LEGAL OWNER OF THE ABOY[a SED REBID[NTIAL PROPERTY SIGNATURE OTIFIiD
OF PERMITTE
VALMO ARTHUR C VEIT
ELECTRICAL
CK MO BH SUPERVISING ELiGTRICAL ENGINGER
LAGp3 0 5 2% AL1915 2 U 1 190- 1;
WORK OMPENSATION DECLARATION ,7;�w3re7 APPLICATION FOR ELECTRICAL PERMIT O
� dlfiereby affv at I have a certificate of consent to self rE coat
insure ora rtificaI of Workers Compensation Insurance COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
s o,a.cerpi copy thereof (Sec 3800 Lab C )
i
Policy No Company FOR APPLICANT TO FILL IN J08
Certified py is Fby furnished New Residential Bldgs 8 Pools EACH NO FEE ADDRESS J
❑Certified copy is filed with the county building inapec 18 2 Family, Sq Ft 5 — $ LOCALITY fi L G
tion department Mulirfom ly Sq Ft — NEAREST I.R�
Residential Swimming Pools OR�ST
Date Applicont (,1...
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERSOutleh RecU' �nL$W � MAIL
—'f —Y r
COMPENSATION INSURANCE J � ght First tiiADDRESS Z {4L(This sectlon need not be completed If the work Involved by Total No 1-L— Additolnal CITY GC (F
the Permit Is for one hundred dollars ($100)or less )
RAN CHECK
1 certify that in he performance of the work for which this gPPLICAN
permit is issued, I shall not employ any person in any manner Lighting Futures First 20 ADDRESS
so cis to bet e s lect to the Workers Com cation Laws
Total No Additional 141,
CITY Tel No
Data Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTIC TO (CANT If, after making this Certificate of APPLICATION
Exemption, you should become subject to the Workers Range— Hooter—DW
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 Hood — Fan —Other_ CITY Tel No
LICENSED CONTRACTORS DECLARATION LICENSE OR
Disp — Room Au Cand Class
I hereby affvm that I am licensed under provisions of Chapter 9 REG NUMBER
(commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO ED BY a
and Professions Code,and my license is in full force and effect
Size 8 Type HP, KW KVA or KVAR d� 0
License Number L¢ Class Up to 1 Incl FINAL U
Over 1 to 10 Incl DATE _ �J VALIDATION 0
Contractor N+te Over 10 to 50 Incl C� F_
❑ - FINA i
am exempt under Sec Over 50 to 100 Inc BY W
B 8P C for this reason Over 100 a
Services Swbd , MCC 8 Ponelboards U)Date z
0 200 Amp Under 600 V
Signature 201 1000 Amp Under 600V
❑
ExemptionOver 1000 Amp or Over 600 V
for Reg Moint Elect
SINGLE FAMILY Temp Power Pole 8 Appurtenances
HOME OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit
Law for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits
Professions Code)
❑ 1 as owner of the property will do the work and the Misc Cori 8 Conductors
structure is not intended or offered for sole(Section 7044 Other (See Complete Fee Scheduled ► ;90475A
Business and Professions Code)
CONSTRUCTION LENDING AGENCY # e�� is s 2
I hereby affirm that there is a construction lending agency for • 2 a
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) 25
(Sea 3097 Civ c ) • ' . 2025a:
PLAN CHECKING FEE c'
Lender s Name 0 $ 1 8—g g
PERMIT ISSUING FEE U
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 laws regulating Electrical wiring, and
hereby authorize representatives of this County to enter u n
the above
e-�-mentioned�propertty for inspection p rposesp SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Da4 ®s