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Home My Public Portal About10915 WILDFLOWER RD_Electrical__ J ' IBAGGS-0E806-6-37 APPLICATION FOR ELECTRIC PE,RMITi •1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGIIdEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A.LAMBIE,COUNTY ENGINEER rJ " CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY J FOR APPLICANT TO FILL IN CRROSSS. G r "" EY ' l PERM FEES OWNER LIGHTS RECEPTACLES SWITCHES NUMSERI ITEM EACH FEE MAIL ADDRESS TOTAL OUTLETS ELEC. RANGES, WATER HEATERS, CITY TEL.NO. CLOTHES DRYERS .50 ELEC. SPACE HEATERS,STAT'Y. COOK- ING UNITS, GARBAGE DISPOSERS, ADDRESS AUTO WASHERS, DISHWASHER .2& LIGHTING FIXTURES .10 CITY TEL.NO STATE MOTORS LICENSE NO. Ga/ HORSEPOWER H.Pt OVER INC. DISTRICT NO. GR UP READY FOR INSPECTION Va a LESS .25 - 2 •50 INSPECTION RECORD 2 s 1.00 5 18 Lad IS SO 2.50 SO 200 8.00 MISC. SIGNS NO.TRANS NO.LAMPS SERVICE O-SOOV 1.00 SERVICE OVER SOOV 5.00 WIRING PERMIT 1.00 �- FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT -50 TOTAL FEE / APPROVDATE• INSPECTOR'S SIGNATURE$ / I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION • AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING LOA,ELECTRICAL WIRING. WIRING / A, 1 HEREBY CERTIFY THAT I AM PROP LY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRpim, LOS AA GE S COU TY D TATE OF CALIFORNIA OR THATE LE L OW ETR E ABOVE POWER DESCRIBED RESIDENTIYY. IGNATURE UTILITY CO.NOTIFIED �•'� � �plq. OF P.ERMITTE o ��y�q J FINALA. Im TY ENGINEER VALIDATIONARTHUR C.SUPERVISING ELECTRICAL ENGINEER , CK MO CASH ��04099- NOV 7 2 10.10 M WORKERS'COMPENSATION DECLARATION 26•0019DPW 3/87 APPLICATION ®� ��■ A�� PERMIT ,bereby affirm that I have a certificate of consent to self cE f1t� O nsure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS r a certified copy thereof(Sec. 3800, Lab.C.) olicy No. Company FOR APPLICANT TO FILL IN JOB ❑Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS /�1411-1-41-111Za ❑Certified co is filed with the county building LOCALITY copy ' ty g inspec- 1 &2-Family, Sq. Ft. $ -- $ . tion department. Multi-family Sq. Ft. NEARCEASES T. Date Applicant Residential Swimming Pools OWNER OR CERTIFICATE OF EXEMPTION FROM WORKERS' o' FIRM NAME itlD C4_dfMe J Outlets: Rec_3 Light�Sw._ MAIL COMPENSATION INSURANCE First 20 s ADDRESS (This section need not be completed if the work involved by Total No. Additional O O CITY��jl�et �.°�7' Tel. No. 1/. the permit is for one hundred dollars($100)or less.) VZz I certify'that in the performance of the work.for which this PLAN CHECKAPPLICANT permit is issued,I shall not employ any person in any manner so as to become subject to the Workers'Compensatio WS. Lighting Fixtures First 20 ADDRESS i 3 ' Additional Dated z?9r Applicant Total No. CITY Tel. No. Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after melting this Certificate of Exemption, you should become subject to the Workers' Range— Heater—D.W. — APPLICATION 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 —W.H. — deemed revoked. Hood — OthCITY Tel. No. Fan —Other—LICENSED CONTRACTORS DECLARATION Dos — Room Air Oth _ LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 P• REG. NUMBER Class. (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PR CESSED BY >_ and Professions Code,and my license is in full force and effect. Il Size&Type HP, KW, KVA, or KVAR ,�� y O License Number Lic. ClassU d Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE VALIDATION 0 Contractor Date ( 0 Over 10 to 50 Incl. , FINAL ❑ I am exempt under Sec. Over 50 to 100 Inc. BY IU B.&P.C. for this reason Over 100 Il Date: Services, Swbd., MCC 8 Panelboards Z 0-200 Amp. Under 600 V A Signature 201 - 1000 Amp. Under 600 V ❑ ( Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances I hereby affirm that I am exempt from the Contractor's License 'Sign with One Branch Circuit stLS_, a3 Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits y� Professions Code): L,.3%1D 7 IMisc..Conduits&Conductors I, as owner of the property, will do the work and the I.Other See Complete Fee Schedule)— Business k I j_f�o _. structure is not intended ar offered for sale(Section 7044, ( P )— TOTAL 5-6 E Business and Professions Code). :O.r•;' __ a CEDE CONSTRUCTION LENDING AGENCY orf ilr.ri. +.r a bl 7 I hereby affirm that there is a construction lending agency for 9� 4 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 1 21/';-s PERMIT ISSUING FEE Lender's Address F'TOTAL FEE titlI certify that I have read this application and state that the above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and j hereby authorize repre ntatives of this County to enter upon thee a rty for Ins ction purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE R�T7- i ig re of Per tee Date ®' u+�ssh �eWO12KERS'COMPENSATION DECLARATION =rS4� NBt APPLICATION FOR ELECTRICAL PERMIT I herp_by affirm that I have a certificate of consent to self CE-ti06G j insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof(Sec. 3,800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB.FEE ADDRESS ®� Certified copy is hereby furnished. i New Residential Bldgs. 8 Pools EACH NO.❑ 125' 15. U);1A&9ejC LOCALITY �Q� �Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ _ $ J tion department. Multi-family Sq. Ft. NEAREST CROSS ST. Q,A Yl. Residential Swimming,Pools OWNER T. ' Date Applicant FIRM NAME 1tNavd d � ( "Ifni'1 CERTIFICATE OF EXEMPTION FROM WORKERS' MAfL Outlets: Rec Li ht Sw. ADDRESS COMPENSATION INSURANCE j g O $ First 20 (This section need not be completed if the work involved by I Total No. Additional CITY v11 'e 6� Tel. No."41 o? the permit is for one hundred dollars($100)or less.) PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ any person in any manner so as to become subject to the'Work s'Compe=61 Lighting Fixtures First 20 ADDRESS Additional oTotal No. CITY Tel. No. Date pplicanfFixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT Lu e ir Exemption, you should become subject to the Workers' Range— Heater_D.W. — ail 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 —W.H. — CITY Tel. No. deemed revoked. Hood — Fan —Other— LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REG.NUMBER Class. (commencing with Section 7000)of Division 3 of the BusinessDISTRICT NO. PROCES BY and Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances IL Size&Type HP, KW, KVA, or KVAR' O License Number Lic. Class ' Up to 1 Incl. FINAL (J 09 Over 1 to 10 Incl. DATE � VALIDATIO Contractor DateOver 10 to 50 Incl. ❑ FINAL I am exempt under Sec. j Over 50 to 100 Inc. 'BY UA B.&P.C. for this reason ' I Over 100 Services, Swbd.,MCC&Panelboards Date: 0 -200 Amp. Under 600 V �J w Signature 201 -.1000 Amp. Under 600 V Over 1000 Amp. or Over 600 V ❑ Exemption for Reg. Maint. Elect. � 10 9. 8 A SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit # c 0 0 0 0.2 1 hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and -'92550 Professions Code): ❑ I., as owner of the property, will do the work and the Misc. Conduits&Conductors o 0 0 2 5,5 0 5 structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ 7044, Business and Professions Code). 1.20-84 CONSTRUCTION LENDING AGENCY 1 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) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name 't S. PERMIT ISSUING FEE f/ ' 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 upon the ove-mention d property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE I1-Ad-0- 1 nature of Permittee Date q