HomeMy Public PortalAbout5013 WILLMONTE AVE_Electrical__ APPLICATION FOR ELECTRIC PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING / gg�
BUILDING AND SAFETY DIVISION ADDRESS VV i 4
JOHN A. LAMBIE. COUNTY ENGINEER
WILLIAM A.JENSEN,SUP'T OF BUILDING LOCALITY
FOR APPLICANT TO FILL 1N NEAREST
A�GJl.�6s;. U Sd�,
PEMT FEES
OWNER
ITEM NUMBER EACH FEE MAIL
OUTLETS,
✓ �j $ $ ADDRESSr { 65LIGHTS SW. 13 � .10 ja
LIGHTINIXTURES J� 10 CITY oo e-' A TEL.NO. t i
ELEC.RANGES CLO.DRYERS ELECTRICIAN
WATER HEATERS 13 .50 I .4—D ADDRESS
ELEC.SPACE HTRS. DISHWASHERS CITY TEL.NO.
GARBAGE DISPOSERS / AUTO- STATE
WASHERS STA.COOKING UNITS 4 .25 LICENSE NO.
MOTORS: OVER INC. H.P. DISTRICT NZO E PWED Y
0— V2 .25 C
1/2 2 •$0 TNSP r-TTON E CO
2— 5 1.00 e
5— 15 1.80
is— 80 2.50
50-200 5.00
NO.TRANS. J �'��
SIGNS: NO.LAMPS
vJZP\e-, fvr R 4 4-
SERVICE 0-800V 1.00 `j ^�J�*
SERVICE OVER 800V 5.00
MISC.
WIRING PERMIT 1.00 00
FIXTURE PERMIT 1.00 Op
SUPPLEMENTARY PERMIT .50
TOTAL FEE I's
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT
ELECTRICAL WIRING. WIRING
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED. BY LOSES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I TH OWNER OF SH6 AHOVB
DESCRIBED RESIDENTI O MOV POWER
SOGNATU'FPERMEIITE UTILITY CO.NOTIFIED /FAZ
FiNA L-I j
�!v I.IDATION OUPERV&RTHUR C. ELE
Mo CASH UPERYISING ELECTRICAL ENC3INEER
z o.E3 I-Ry 2 0 2 A 12.10
v
ORKERS'COn.A,YENSATION DECLARATION 7,6A663 1081 /n� P LOCA ION FOR ELECTRICAL PERMIT
I here affirm that I have a G it llficate of consent to self CE-806G lril Lr u tl�sl f�
„insure„or a certificate of Workers'Compensation Insurance, i COUNTY OF LOS ANGELES BUILDING AND SAFETY
or oar .Died}copy thereof(Sec. 3800, Lob. C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB n `�
Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE• ADDRESS U
❑ A4 AIF C4 1 TV
Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $• _ $ LOCALITY ���' d
tion department. Multi-family Sq. FT. NEAREST4
Residential Swimming Pools OWNER OR
Date Applicant 4 W1 Al Z COL L
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec G2j2&ght,__VASw. MAIL
COMPENSATION INSURANCE ADDRESS
, ^^ First 20
(This section need not be completed if the work involved by Total No._l2S� Additional CITY Tel. No.
the permit is for one hundred dollars(8100)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 per n in any manner
so as to become subiect to the Workers' o pensation Law . Lighting Fixtures First 20 ADDRESS
_ Total No.- Additional CITY Tel. No.
Date �� Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, aft making this Certificate of APPLICANT i L .-Li
Exemption, you should beco a subject to the Workers' Range 'Heater—D.W.
Compensation provisions of the Labor Code, you must forth- Oven v Dryer Aetf-W.M.— ADDRESS
with comply with such provisions or this permit shall be I Top — FAU —W.H. — _ CITY/� o 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 Q Class —f a
(commencing with Section 7000)of Division 3 of the Business DISTRICT NO. PROCE D BY
and Professions Code,and my license is in full force.and effect. Power Apparatus 8 Large Appliances I /
9 ' ^ Size&Type HP, KW, KVA, or KVAR //
License Number.= � �``0 Lic: Class "f [J iUp to 1 Inci. FINAL U
4I Ce"Over 1 to 10 Incl. DATE i/n �- V DATION
Contractor Date Over 10 To 50 Incl. FINAL [/
�
I ❑ I am exempt under Sec. Over 50 To 100 Inc. BY
B.&P.C. for this reason Over 100
Zz4i
Date: Services, Swbd., MCC&Ponelboards e
0 -200 Amp.Under 600 V
Signature 201 - 1000 Amp. Under 600 V
❑
Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V
' SINGLE FAMILY Temp. Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I 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 7 8 2 2 a
Professions Code):
❑ I, as owner of the property, will do'the work and the Misc. Conduits&Conductors I o,o 0,0 0 2
structure is not intended or offered for sale (Section Other(See Complete Fee Schedule,)-
7044, Business and Professions Code). 1,0 1 Q Q o Q
i
�CONSTRUCTION LENDING AGENCYo o '� Q a Q 0 v
1 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) 2 b$7
(Sec. 3097, Civ.,C.). Q 9,
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE ol
Lender's Address
I certify that I hove'read this application and state that the TOTAL FEE 114) AA
above information is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby ouch ' e representatives this County to enter upon
the ove- a tinned ptoperty r nspection purposes.
�`� `�� SEE REVERSE FOR EXPLANATORY LANGUAGE
Si ature of Permittee Date