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Home My Public Portal About4874 ARDSLEY DR_Electrical__ D.B.S.SA 25M SETS 70-47 A/1DP1 1 A'1®tTION FOR PER= <lDEPARTMENT OFBUILDING AND SAFETY � � I COUNTY OF LOS ANGELES J. F04 CHIE ENGt EER RSG DISTRICT NO._ GROUP ZONE PERMIT NO. 2 Q NAME T Z / U . rS r"' ADDRESS 4ARVEY CALIF. PHONE AT 4-U27 UCITY TEL.NO. RECEIVED BY FIRST INSPECTION WREADY FOR TE ISSUED .J COUNTY 1 7`C.� 'LS 7��' W CERT.NO. EXPIRES �/ APPLICANT FILIAN WEAVII.Y OUTLINED PORTION ONLY JOB DESCRIPTION OF WORD ADDRESS � NUMBER OF OUTLETS ON CIRCUITS LOCALITY LOCATION BY ROOMS NEAREST LIGHT OUTLETS SW. PLUGS FWt CR SST. wy�g� CIRCUIT A B C D E F G H � NAME � Z MAIL Ll ADDRESS ova - O CITY TEL.NO. 1 AM THE LEGAL POSSESSOR—OF N ABOVE, LOS ANGELES COUNTY CERTlFOF UA FICAT ELECTRICIAN. I AM THE LEGAL OWNER QR THS PROPERTY DESCRIBED ABOVE 11�� OWNER. CORRECTIONS J Q _Z 2 R O / / r OTAL NO. OF OUTLETS $ APPROVALS NO. OF FIXTURES 57:f DATE INSPECTOR'S NAME NO. OF MOTORS H.P. $ CONDUIT NO. OF SIGNS TRANS. $ WIRING i NO. OF RANGES OR HEATERS $ FIXTURES MISCE ANEOUS $ q ® POWER PERMIT FEE UTILITY CO.NOTIFIED c TO A F' E uo FIN L + 1 } COUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of County Engineer ELECTRIC 1 DIVISION OF BUILDING & SAFETY WILLIAM J. FOX, County Engineer FOR APPLICANT TO FILL IN DISTRICT NO. OUP ZONE PERMIT NO. � Rf�a ELECTRICIAN R C IVED BY READY FOR DAT I D ADDRESS FIRST INSPECTION � '/ �� CITY TEL NO. COUNTY LICENSE NO. EXPIRES BUILDING PERMIT FEES ADDRESS FEE NUMBF.R EACH LOCALITY LIGHT OUTLETS NEAREST CROSS ST. RECEPTACLES _ WALL SWITCHES TOTAL OUTLETS _ Sc $ MAIL ELEC. RANGES 25 ADDRESS ELEC. HEATERS 25 CITY TEL. NO. FIXTURES 5 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. MOTORS I CERTIFY THAT I POSSESS THE ABOVE VALID LOS NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER NEW MVD. HP OVER I INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. -- '/2 & LESS $ .25_ —__ SIGNATURE OF I/2 2 .50 PERMITTEE -- --- 2 5 1.00 INSPECTION RECORD 5 15 1.50 _ 15 50 2.50 50 200 5.00 _ 200 Boo 10.00 J Soo 1000 15.00 Q Z OVER 1000 20.00 M.G. SET/FREQ. CHANGER-HP WELDERS: AC-KVA O GENERATORS - KW TRANSFORMERS - KVA_ TEMP. MOTORS (75% OF ORID-) MOVED MOTORS (75% OF ORIG.) _ MISC. SIGNS NO. NO.TRANB. APPROVALS NO. NO. LAMPS I ---- FOR EACH PERMIT: D _ INSPECTOR'S NAME WIRING $1,00 CONDUIT FIXTURES _ $1.00 WIRING SUPPLEMENTARY ,50 FIXTURES "POWER TOTAL FEE Y UTILITY CO.NOTIFIED FINAL 76A663 DBS#SA 2-53 WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91)76A663 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, y o.. `or a certificatd of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLICAWORKS BUILDING AND SAFETY DIV. copy thereof(Sec. 3800 Lab. C.) ! Policy'No. Company FOR APPLICANT TO FILL IN JOBS ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE $ $ LOCALITY ❑ Certified co is filed with the count building inspection 1 &2-Family,Sq.Ft. PY Y 9 P — NEAREST C f department. Multi-family Sq. Ft. CRosS S7. v Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec. Light SW. OWNER OR COMPENSATION INSURANCE — ghi FIRM NAME— First 20 MAIL (This section.need not be completed if the work involved by the Total No. 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' Tel.No.IV d Q 0 s issued, I shall not employ any person in any manner so as to D PLAN CHECK become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. I Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOT•ICE.TO APPLIOANT: If, after making this Certificate of CITY 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 such PERMIT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP K/VyVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 1 / 3 to 10 Incl. (commencing with Section 7000) of Division 3 of the Business and CITY Tel.No. Professions Code, and my license is in full force and effect. Over 10 to 50 Incl. LICENSEClass. } Over 50 t0 100 Incl. REG.NUMBB ER Q. Over 100 DISTRICT NO. P ESSED BY 0 License Number Lir,.Class �O (/ V Services,S*MCC&Panelboards Q Ir Contractor Date 0`- 13 Amp.Under 600 V FINAL DATE 0 El I am exempt under Sea 400-1000 Amp.Under 600 V ~ Over 1000 Amp.or Over 600 V FINAL Over LU B.&P.C.for this reason BRANCH CIRCUIT FEES BY Date: 15A,or 20A, 120V,Lighting or Recept. Z_ 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits El 41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Sr.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances A».;•.-: HOME OWNER-BUILDER DECLARATION y L.„•a=1r. I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits _ _� :- Code): rst d &C t d Conuis Conductors - I, as owner of the property,will do the work and the structure Misc. --p_�• �o is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). - CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ.C.) PLAN CHECKING FEE €f' t-`�`=§'}-= --7 Lender's Name �, s -_ PERMIT ISSUING FEE r%�'r Ar, f`=':�1 Lender's Address C7 I certify that I have read this application and under penalty of purjury state TOTAL FEE 0� 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 en up the above-mentioned property for insp c ion pu ses. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNA O RI, TEE DATE