HomeMy Public PortalAbout6263 AVON AVE_Electrical_6/1/1979_outlets, appliances, service amp r
76A663 CE 806 NF 6/78 APPLICATION OR ELECT CAL PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
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FOR APPLICANT TO FILL IN JOB
New Residential Bldgs &Pools EACH NO FEE ADDRESS
1 &2 Family Sq Ft $' — $ LOCALITY 6 ( `
Multi family Sq Ft — NEAREST`- "
CROSS ST
Residential Swimming Pools OWNER OR r
FIRM NAME {
Outlets Rec 7 Light Sw MAIL
�j First 20 ADDRESS
Total No Additional CITY Tel No
PLAN CHECK
APPLICANT
' v
Lighting Fixtures First 20 ADDRESS
Total No Additional CITY ~i -Tel No Z Y
Fixed Appliances Not Over 1 HP PERMIT a
Range_Heater_D W APPLICANT
Oven—Dryer_W M— ADDRESS 7 a
Top _FAU — W H CITY T 'S
S
Hood_Fan _Other LICENSE OR
Disp -Room Air Cond REG NUMBER Class
' IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA
Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO
Size&Type HP KW KVA or KVAR COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING ELECTRICAL WIRING
Up to 1 Incl _ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0
_ Over 1 to 10 Incl LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF V
Over 10 to 50 Incl CALIFORNIA OR THAT I AM THE LEGA OWNER OF THE ABOVE IN
DESCRIBED RESIDE WRC R E Y 0
Over 50 to 100 Inc d IPERMITEE
Over 100 SIGNATURE f
N
Services DISTRICT NO`' P ESS D BY}
0 200 Amp Under 600V /t
201 1000 Amp Under 600 V J (�
Over 1000 Amp or Over 600 V Z
O_
Temp Power Pole&Appurtenances ~
� Q i
Sign with One Branch Circuit 0
Additional Sign Branch Circuits
INSPECTION >
INFORMATION
Misc Conduits&Conductors ON REVERSE i
Other(See Complete Fee Schedule) Z SIDE L94 7 1 8 A
Z
g # o oro o o2
d
` i 5
PERMIT FEE (Sub Total) 2&00
PLAN CHECKING FEE Ione Fourth Permit Feel t y Z 00028005O
PERMIT ISSUING FEE , c 0601 —79
J
TOTAL FEE }>
INSPECTION FFIINNAjLEED IX
date
7
WORKERS COMPENSATION DECLARATION 76A663 10/8" APPLICATION FOR ELECTRICAL PERMIT
1 hereby affirm that I have a certificate of,consent to self insure i CE 806G
orsa certificate of Workers Compensation Insurance or+a certified COUNTY OF LOS ANGELES L BUILDING AND SAFETY
copy thereof (Sec 3800 Lab C) '
PolicyjNo Companyf
FOR APPLICANT TO FILL IN i JOB K
❑, 'EACH NO FEE ADDRESS fa t +� u M IJ +
Certified copy is hereby furnished New Residential Bldgs & Pools
❑ —
Certified copy is filed with the county budding mspe'ctionr 1 ,& 2 Family Sq Ft $ $ LOCALITY
, _
department Multi family Sq Ft CROSS NEARESST �rd7 �, wr P.r�
Residential Swimming Pools OWNER OR f -'
'Date Applicant �^
,.,,9 F FIRM NAME
" CERTIFICATE OF EXEMPTION FROM WORKERS Outlets RecLight ++Z✓Sw cp MAIL
�� {
COMPENSATION INSURANCE , - Y 7 w ADDRESS a`+ y d a v /
+ (This section need not be completed'if the work involved by,the First 20 e CITY `y m g �/ + `f Tel No s n
permit is for one hundred dollars ($100)or less) Total No Additional t r
y r + + PLAN CHECK
I certify that in the performance of the work for which this permit = APPLICANT a +0
is issued I shall not employ any person in any manner so as to 5
�{ ADDRESS
become subject to the Workers Compensation Laws Lighting{Fixtures f First 20 F
Additional
r Total No CITY TeI No
Dater�� Applicant' "''r �� ��'tlh+ Fixed Appliances Not Over 1 HP ¢ 7ePERMIT i
NOTICE R TO APPLICANT If after' making btithis Certificate of k 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 Ovent Dryer W M ' ADDRESS
provisions or this permit shall be deemed revoked Top FAU WH If ' am
LICENSED CONTRACTORS DECLARATION Hood Fan Other— , CITY Kt 1 ,; r } Telt No~
� r
I hereby affirm that I am licensed under provisions of Chapter 9 ` LICENSE OR ti r
DiSp Room Air Cond REG NUMBER rj �/ Class
(commencing with Section 7000) of Division 3 of the Business and ai
Professions Code and m license iS in full force and effect ''' DISTRICT NO PROCESSED BY t �`
y Power Apparatus& Large Appliances
Size&Type HP KW KVA or KVAR ' y °+ +� >•" W 1 ,
License Number rid r' ' �' Lic Class C- Up to 1 Incl FINAL r -J
Over 1 to 10 Incl DATE f t VALIDATION
Contractor r Date �� " Over 10 to 50 Incl FINAL
{ I am exempt under Sec + Over 50 to 100 Inc ° BY
, � i
B&PC for this reason Over 100 O
Services Swbd MCC& Panelboards ► 11V
_i J Date ` 0 200 Amp Under 600 V a c
Signature j" -�+E ^f ��7 '`�� �i9L" 201 1000 Amp Under 600 V o * +
Over 1000 Amp or Over 600 V
h ❑ Exemption for Reg Malnt Elect
i
SINGLEFAMILYTemp Power Pole & Appurtenances
HOME OWNER BUILDER DECLARATION Sign with One Branch.Circuit hh�� �-(
I hereby affirm that I-ani exempt from the Contractors License Lawl' T . " `„ —1 r --- 1� �#sq
K
+ for the following reason (Section 7031,5 Business and Professions Sign Branch Circuits t
t + F
Code) ' Additional
❑ r Misc Conduits &Conductors
I as owner of the property will do the work and the structure � a �
m y
( is not Intended orOther(See Complete Fee Schedule
„offered for sale (Section 7044 Business = p ) �
and Professions Code) ,
3 CONSTRUCTION LENDING AGENCY 1 a s a b + Re
i 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)
a CIV C) "
PLAN CHECKING FEE
t Lenders Name
II J PERMIT ISSUING FEE
e
Lenders Address.
I certify that I have read this application and Sstate that the above TOTAL FEE
r information Is correct I agree to comply with all County ordinances ar `
and State laws regulating Electrical iwirmg and hereby authorize
representatives of this County to enter upon the above mentioned A ti "+ y�
y property for inspection purposes ` ' 'SEE REVERSE FOR EXPLANATORY LANGUAGE
' '
s y i
f r / i �•e r f Z �- 1* ` + r
Signature of Permittee f Date
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