HomeMy Public PortalAbout9849 VAL ST_Electrical__ 6A663-CE80612-58 APPLICATION FOR ELECTRIC PERMIT 4
COUNTY OF LOS ANGELES _
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A.LAMBIE,COUNTY ENGINEER
CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY /
FOR APPLICANT TO FILL IN NEAREsT. �' ! ✓ '�- `��'`
PERMIT FEES CROSS
ITEM NUMBER EACH FEE OWNER -
OUTLETS: S s MAIL �r
LIGHTS RECEPT. SW. .IO / "f, ADDRESS r
LIGHTING FIXTURES .10 CITY TEL.NO.
ELEC.RANGES CLO.DRYERS ELECTRICIAN 'r^h/liL%� ��+= -" �- •� "
WATER HEATERS .50 ADDRESS ' 'J 49
,� :// •\�
ELEC.SPA . DISHWASHERS
AG TEL.NO.
_CE HTRSDISHWSCITY
_ .I.• ,,; /✓%--cr'"
GARBAGE DISPOSE AUTO-
�_... . STATE i
WASHERS STA.COOKING UNITS .25 LICENSE NO.
MOTORS: OVER INC. H.P. DISTRICT-NO. GRO1UP ZUNE PROCESSED BY
O— 1/2 .25 �� K
1/2- 2 .50 INSPECTION RECORD
2— 5 1.00
5— 15 1.50
15— 50 2.50
50—200 5.00
SIGNS: NO.TRANS.
NO.LAMPS
SERVICE 0-600V 1.00
SERVICE OVER 600V 5.00
MISC.
WIRING PERMIT 1.00 j
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .50
TOTAL FEE S i APPROVALS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT
ELECTRICAL WIRING. WIRING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM THE LF.GAL OWNER OF THE ABOVE
DESCRIBED RES IDEN7IAlrPROPERTY POWER
SIGNATURE "i. �!/� � UTILITY CO.NOTIFIED
OF PERMITTEE_
FINAL
)F VALIDATION- ARTHUR C. VEIT,
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
l7, 5
OS'COMPENSATION DECLARATION t 76A663 10781
- yRKERCE-806G APPLICATION FOR ELECTRICAL PERMIT
�I Hdrefirm that I have a certificate of consent to self insure,
Or a'certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES I BUILDING AND SAFETY
copy-%thereof(Sec.380011-9b.C.). l�1 i
Poli '140. Company IM-1a /`�i1n 1 I FOR APPLICANT TO FILL IN JOB
4Certified copy is hereby furnished. EACH IVO. FEE ADDR.EBS
New Residential Bldgs.&Pools
❑ 1 &2-Family,Sq.Ft.. $ _ $ LOCALITY
Certified copy'is filed with the county uildin inspection
department. Multi-family Sq.Ft. NEAREST
000 Residential Swimming Pools CROSS ST'
Date Applicant OWNER OR
FIRM NAME O
CERTIFICATE OF EXEMPTION FROM WOR RS' /� MNL
Outlets:Rec 14 Light Sw. –
' COMPENSATION.INSURANCE �' Is-- ADDRESS C06 F—. e
(This,section need not be completed if the work Involved by the First 20 CITY Tel.N
permit is for one hundred dollars($100)or less.) Total No. Additional G. 0
1 certify that in the performance I of the work for which this permit PLAN)CHECK
E K
is issued, I shall not. r employ.any person in any man so as to 1•
become subject to the Workers'Compensation Lighting Fixtures First 20' 6 ' ADDRESS
Total No. Additional CITY Tel.No.
Date• XVA Applicant IFixed Appliances Not Over 1•HP PERMIT
NOTICE TO APPL.I ANT: If, after making this C ificate. of
Exemption,you should.become subject to'the Workers'Cd pensation Range_ Heater_ D..W. APPLICANT C +
provisions of the Labor Code,you must forthwith comply with such. Oven — Dryer W.M'._ ADDRESS d
provisions or this permit shall be.deemed revoked. Top _ FAU W.H. _ 2.13
CITY j9Tel'.No.
LICENSED CONTRACTORS DECLARATION Hood — Fan Other_
I hereby affirm that I am licensed under provisions of Chapter 8 LICENSE OR
• •Disp. — Room Air Cond. REG..NUMBER' 6 Clasa�
(commencing with Section 7000)of Division 3 of the Business and
Professions Code:and my license.Win full force and effect. Power Apparatus&Large Appliances DISTRICT NO. \� P CES3 BY
Size&Type HP,KW,KVA,or KVAR v • 0 Q
License Number SSG Lic.Class. 4 Up to 1Incl. FINAL 4� 9 V
Over 1 to 10 Incl. DATE j�/ j VALIDATION �
Contractor to Over 10 to 50 Incl. G
FINAL A
❑ I am exempt un( Over 50 to 100 Inc. BY ` 0.
tj 6
B:&P.C.for this reason Over 100 V1
,Services,Swbd.,MCC&Panelboards
Date: 0.200 Amp::Under 600 V
Signature 201 - 1000 Amp.Under 600 V
❑ Over 1000 Amp.or Over 600 V ,
Exemption for Reg.Maint.Elect.
SINGLE FAMILY Temp.Power Pole&Appurtenances +2'
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit �a/+�•
I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits ACC o r
for the following reason(Section 7031.5,Business and Professions
Code): 3307 S4 0 5t�
Misc.Conduits&Conductors 1 1
1,as owner'of the'property,will do the work and the structure ,
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _
and Professions Code). loop TOTAL 54 o 51131
CONSTRUCTION LENDING AGENCY CHECK 5+¢.50
1 hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued(Sec.3097, PERMIT TEE (Sub Total) MANGE 000
Civ.C.).
PLAN CHECKING FEE
Lender's Name 6 10MO—Mi 7/24/89
' PERMIT ISSUING FEE C/
Lender's Address j� a "337 1 AM11°05
I•certify that I have read this application and state that the above TOTAL FEE I/
information is correct.I agree to comply with all County ordinances '
and State laws regulating Ey olm and hereby authorize
I representatives of this n to enter upo he above-mentioned f `
property for inspec' purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE i
Signature of Permittee Date