HomeMy Public PortalAbout4816 WILLMONTE AVE_Electrical__ 78A868•CE80812-58
APPLICATION FOR ELECTRIC, PERMIT . �.
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 sr.
ITEM NUMBER EACH FEE OWNER
OUTLETS: (( g MAIL
LIGHTS RECEPT. 1J SW. .10 ADDRESS
LIGHTING FIXTURES .i0 CITY TEL.
ELEC.RANGES CLO.DRYERS ELECTRICIA
WATER HEATERS .50 ADDRESS
ELEC.SPACE HTRS. DISHWASHERS
CITY EL.
GARBAGE DISPOSERS AUTO.- STATE
WASHERS STA.COOKING UNITS .25 1 1 LICENSE NO.
MOTORS: OVER INC. H.P. DISTRICT' GROU ZONE PR Y '
0— 1/2 .28
1/2— 2 .50. S INSPECTIO RECORD
2— S 1.00
5— 15 1.50
15— 50 2.50
50-200 5.00
4
SIGNS: NO.TRANS.
NO.LAMPS
SERVICE 0-600V 1.00
SERVICE OVER 600V 5.00
MISC.
WIRING PERMIT 1.00 .'
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT 50 j
TOTAL FEES APPROVALS `
rl
1 HEREBY ACKNOWLEDGE THAT 1 .HAVE READ. THIS.APP CA ON DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND. AGREE T COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS R ULATING CONDUIT �y
ELECTRICAL WIRING. WIRING �F IZ%_r .J h•" �+'�
1 HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED AND�OR g _
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ' FIXTURES FJ �•�`i�P �e- '�'""� ,
CALIFORNIA OR THAT IAM LEGAL OWNER OF THE ABOVE _
DESCRIBED REBID] tAL PRS E TY. POWER n
••SIGNATUREUTILITY CO.NOTIFIED- to
OF PERM ITTE ✓ -�
FINIm
AL r�"
D° d111K LIDATION ARTHUR C. V EIT.
cJt1
NO CASH SUPERVISING ELECTRICAL ENGINEER
..AA\ jai Go 19 4 9 JUN 'l 5 2 A ; 7.6 0
• W firORISERS'avea,cerSATIQN DECLARATION 78-808 10181 APPLICATION FOR ELECTRICAL PERMIT_.
CE:. 1
IiJ�reby affirm th'At I have a certificate of consent to self,jnsurt:; � :4 Iu'
or a certificate of Workers' Compensation Insurance or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
cepy th4eof(Sec.3800,Lab.C.)
Policy fqp. Company FOR APPLICANT TO FILL IN JOB 916 ill LMowrre
❑ Certified copy is hereby furnished: EACH NO. FEE : ADDRESS TD (� (,t!
,r Y New Residential Bldgs.&Pools LOCALITY
Certified copy is filed With the county building inspection 1 &2-Family,Sq.Ft. $ _ $
department. Multi-family Sq.Ft. CROSS NEAREST Si. h d GfJ/Ll� Z U 5�
Date y Applicant Residential Swimming Pools OWNER OR 0 !CA • CO A:i f-S
�p
FIRM NAME V� N
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec Z- Light—Sw.— MAIL
COMPENSATION x S T
COMPENSATION INSURANCE ADDRESS r Or
This section need not be completedFirst 20
( if the work Involved b Y the Total No. Additional CITY S�Ni Tel.No.z�T-3/rvT
' permit is.for one hundred dollars($100)or less.)
PLAN CHECK
I certify that in the.performance of the work for which this permit , APPLICANT I/6go I E(C.4 C.O 7
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 1 t-1 ADDRESS W3.53 UPT6 Al' 74V6
Total No. Additional CITY S&0,6Pa , CA '? 7/6�
Tel.No:
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of j 1 APPLICANT
Exemption,you should become subject to the-Workers'Compensation Range_ Heater D.W.
provisions of the Labor.Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS .3Z3 14-VUQTOM �''pp
provisions or this permit shall be deemed revoked. Top _ FAU _ W.H.._ CITY�dyQ�brE�'JQ C Tel.No.rrpylo
LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_
I hereby affirm that I. am licensed under.provisions of Chapter 9 LICENSE.OR
(commencing with Section 7000)of Division 3 of the Business and Disp. - Room Air Cond. l REG.NUMBER Class•
Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances i DISTRICT NO.
PROCESSED BY
Size&Type HP,KW,KVA,or KVAR '
License Number- Lic.ClassUp'to 1 Incl. FINAL 9
Over 1 to 10 Incl. DATE 3�S�" O
Contractor Date r VALIDATION
❑ Over 10 to.50 Incl. FINAL
I am exempt under Sec. ( Over 50 to 100 Inc. BY
B.&P.C.for this reason Over 100
Services,Swbd.,MCC&Panelboards Z
Date: 0-.200 Amp.Under 600 V' r �. L"
Signature 201 - 1000 Amp.Under 600 V
Over 1000 Amp.or Over 600 V
❑ Exemption for Reg.Maint.Elect.• ACCT.s
SINGLE FAMILY Temp.'Power Pole&Appurtenances 3307 15p70
HOME OWNER-BUILDER DECLARATION Sign with One Branch CircuitI ITEMS
I hereby affirm that I am exempt from the.Contractor's License Law Additional.Sign Branch Circuits
for the following reason(Section 7031.5,Business and Professions i
Code): OTAL '5 m.
70
I,as owner of the property,will do the work•and the structure Misc.Conduits&Conductors s L•HGL} 15..7 0
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ ® CHANGE .00
ii
and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby.affirm that there is a construction lending agency for the 13000-0001 8/ 80/913
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) (�
Civ.C.). 2272 1 AM 80-05z
PLAN CHECKING FEE
Lender's Name 99 22 i
PERMIT ISSUING FEE /.✓
Lender's Address
I certify that 1 have read this application and state that the above ' TOTAL FEE �(!
informationis correagree to comply with all County ordinances '
and State laws g ting Electrical wiring, and hereby authorize
representatives ounty to enter upon the above-mentioned'
property f ur oses: SEE REVERSE FOR EXPLANATORY LANGUAGE
8h/p,0I
Signature oAftifnittee D to " �. ,;-r-