HomeMy Public PortalAbout4919 WILLMONTE AVE_Electrical__ me=-Csaoee..e APPLICATION FOR ELECTRIC PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING �� �r,Lrr10r1�7E�
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
CASSATT D. GRIFFIN,SUPT OF BUILDING .�1
LOCALITY / +
FOR APPLICANT TO FILL IN CROSS TT. tC//.� ��L/.Sh�•
PEmv= FEES /
ITEM .NUMBER I EACH FEE OWNER iG
OUTLE S• •yy $ $ MAIL
LIGHT RECEPT/�SW. .i0 O ADDRESS
LIGHTING FIXTURES 10 CITY TEL.NO.
ELEC.RANGES CLO.DRYERS ELECTRICI , �
WATER HEATERS .130 ADDRESS-1f6 i v-�-cats.!Fd4- "
PACE HTR DISHWASHERS CITY TEL.
asgHAGS DISPOSE AUTO.- STATE �/
WASHERS STA.COOKING UNITS .25 LICENSE NO. /lJ^ O , o
MOTORS: OVER INC. H.P. DISTRICT NO. I GROUP Z NE IP ESSED BY
0— 1/2
- 2 so INSPECTION RECORD
2— 5 1.00
1.50
Is— 50 2.50
50-200 5.00
SIGNS: NO.TRANS. r ,
NO.LAMPS „S %' 11
SERVICE O-SOOV 1.00 f
SERVICE OVER GOOV 5.00
MISC.
WIRING PERMIT 1.00
FIXTURE PERMIT 1.00 ! ��
SUPPLEMENTARY PERMIT 50
TOTAL FEE
I. HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS 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 7 G J✓✓Y.....�-'�_
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR _
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF Z I
CALIFORNIA OR TH T 1 AM TiE LEG WNER OF THE ABOVE FIXTURES
DESCRIBED RESID AL ROPERTY POWER �q
SIGNATURE UTILITY CO.NOTIFIED
OFFERMI
TT
FINAL ®y r
!e �ATION bUPARV ARTHURC.VEIT,
CK MQ. CASH UPERYISiNG ELECTRICA4 ENGINEER
L/
WORKER'S COMPENSATION DECLARATION 20.6619 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT
I hereby�atfi/m thea I have a certificate of consent to self insure, 76A663
or a certificate q(worker's Compensation. Insurance,or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy tFjereof(Sec X3800 Lab.C.)
i
POIICy NO. a Company FOR APPLICANT TO FILL IN JOB
ADDRESS ` e
❑ Certified co is hereby furnished. NO. EACH FEE
copy Y New Residential Bldgs.&Pools _ $ $ LOCALITY �`. 1
❑ Certified copy is filed with the county building inspection 1.&2-Family,Sq.Ft.
department. Multi-family Sq.Ft. CROSSSST..
Date Applicant Residential Swimming Pools ASSESSOR
MAP BOOK pAG� % 1ARCEUQ0`Z
CERTIFICATE OF EXEMPTION FROM WORKERS' � ol, OWNER OR
COMPENSATION INSURANCE Outlets:Rec. Light Sw. c FIRM NAME
��// First 20 'd � � MAIL
(This section need not be completed if the work Involved by the Total No.__(__I— Additional ADDRESS
permit Is for one hundred dollars($100)or less.)
I certify that In the performance of the work for which this permit CITY T.I.No.
is issued, I shall not employ any person in any manner so as toPUN CHECK
become subject to the Workers'Compensation Laws. Lighting Fixtures First o APPLICANT
Total No. Additional
Date,2 rn'1 Applicant � `o ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of RESIDENTIAL APPLIANCES NOT OVER 3 HP. CIN Tel.No.
Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP.
provisions of the Labor Code;you must forthwith comply with suchPERMIT
provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS
I,hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl.
(commencing with Section 7000)of Division 3 of the Business and C13-44e, I•N • �„
Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. d
LICENSE OR gg Class.
Over 50 to 100 Incl. REG.NUMBER "'PA0 "'�
License Numbel6_:;U9_ Z LIC.Class. Over 100 DISTRICT NO. !' PROCESSED BY V
7� Services,Swbd.,MCC&Panelboards
Contractor / ���� Date 0-399 Amp.Under 600 V DATE U
❑ 400-1000 Amp.Under 600 V VALIDATION LLI
I am exempt under Sec. Over 1000 Amp.or Over 600 V FINAL IL
B.&P.C.for this reason BRANCH CIRCUIT FEES BY tY)
Dat ` 15A,or,20A,120V,Lighting or Recept.
Z
1 TO 10 Branch Circuits
Signature 11 To 40 Branch Circuits
41 Or More Branch Circuits
Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits 2
z
SINGLE FAMILY Temp.Power Pole&Appurtenances �' $•
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ANT.Q
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits 3301 59.111
Code):
❑ Misc.Conduits&Conductors 1 ITEMS
I,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) ® TOT A( 59- 10
and Professions Code).
CHECK 59.
10
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the CHAlNIGE e011
performance of the.work for which this permit is issued(Sec. 3097, PERMIT FEE (Sub-Total)
Civ.C.)
PLAN CHECKING FEE 2/1//93
Lender's Name 1
PERMIT ISSUING FEE I 8242 1 AMIie 18
Lender's Address TOTAL FEE '
I certify that I have read this application and under penalty of purjury state
that the 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 above-mentioned property
for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNATURE OF PERMITTEE DATE