HomeMy Public PortalAbout5453 BALDWIN AVE_Electrical__ 7GA663 DBS 5A 3-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY ELECTRIC i
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR A PLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO,
ELECTRICIAN
RECEIVED BY READY FOR DATE ISSUED
ADDRESSi�r �iE t .�t��-s, / �. FIRST INSPECTION
CITY ��l�'-�J ?f_-,✓` j T
�
COUNTY LICENSE NO. ! EXPIRES BUILDING —Z-t �� `
PERMIT FEES ADDRESS /�1C/ =
NUMBER EACH FEE LOCALITY
LIGHT OUTLETS �._ NEAREST Com` '
RECEPTACLES /'18'
o CROSS ST. ��
WALL SWITCHES I .❑WNE /(A / 2�
TOTAL OUTLETS SC $ / [} MAIL ,
ELEC. RANGES // 8s ADDRESS
ELEC. HEATERS / 25Z•S'
CITY TEL.
NO.
FIXTURES J 5 1 HEREBY ACKNOWLEDGE THAT IHAVE 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 HORSEPOWERFEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
NEW MVD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
a
LESS $ 25 SIGNATURE OF / / ) I V -x
'/2
'/2 2 .50
PERMITTE
2 5 1'130 INSPECTION RECORD
5 is 1.50
is so 2.50
s0 200 5.00
200 500 10.00 J
500 1DOO 15.00 Z
OVER 1000 20.00 [�]
M.G. SET/FREQ. CHANGER-HP 0!
WELDERS:AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF ORIS-)
MOVED MOTORS (75% OF ORIG.)
MISC.
SIGNS
NO. NO.TRANS.
APPROVALS
NO. NO. LAMPS
DATE INSPECTOR'S NAME
FOR EACH PERMIT:
WIRING $1.00 (� 4 Q CONDUIT
Q ',
FIXTURES $1.00 WIRING
SUPPLEMENTARY .50 FIXTURES
L POWER
TOTAL FEE $ UTILITY CO.NOTIFIED
FINAL
WORKERS'COMPENSATION DECLARATION CEA663 10/81 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have,.a certificate of consent to self insure, CE=aosG
or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec.3800,Lab.C.)
FOR APPLICANT TO FILL IN
Policy N0. JOB Company ADDRESS
Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE
1 &2-Family,Sq.Ft. $ — $ LOCALI
Certified copy is filed with the county building inspection — NEAREST
department. Multi-family Sq.Ft. CROSS ST.
Date Applicant Residential Swim Ing Pool
C` OWNER OR
SrJ FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Re"c Light 7.Sw. MAIL
COMPENSATION INSURANCE First 20 ADDRESS
(This section need not be completed if the work involved by the Z CITY , el.No.
permit.is for one hundred dollars($100)or less.) Total No. _,! - Additional
I certify that in the performance.of the work for which this permit �, ,, / PLAN CHECK
.APPLICANT
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 ADDRESS
Additional
Total No. CITY - Tel.No.
Date Applicant Fixed Appliances Not Over 1 HP
NOTICE TO APPLICANT: If, after making this Certificate of PERMIT
Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APPLICANT
.provisions of the Labor Code,you must forthwith comply with such Oven Dryer J__ W.M._ ADDRESS
provisions or this permit shall be deemed revoked. Top FAU W.H.
LICENSED CONTRACTORS DECLARATION CITY
Hood Fan Other_
Tel.No.
�
;1 hereby affirm that I am licensed under provisions of Chapter 9LICENSE OR
Disp. Room Air Cond. 00 REG.NUMBER Class.
(commencing with Section 7000) of Division 3 of the Business and
Professions Code,and my license is in full force and effect. Power A DISTRICT NO. P OC D Y
Apparatus&Large Appliances _
Size&Type HP,KW,KVA,or KVAR Q
License Number Lic.Class Up to 1 Incl.I 4 FINAL V
Over 1 to 10 Incl. DAT (Owl�E
ContractoDate V� O
r Over 10 to'50 Incl.
❑ FINAL
I am exempt under Sec. Over 50 to 100 Inc. BY a
BAP.C.for this reason Over 100 U)
Services,Swbd.,MCC&Panelboards010. Z
Date: 0-200 Amp.Under 600 V
Signature 201 - 1000 Amp.Under 600 V
F-1Exemption
1000 Amp.or Over 600 V
Exemption for Reg.Maint.Elect.
SINGLE FAMILY Temp.Power Pole&Appurtenances 2
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit t
I hereby affirm that I am exempt from the Contractor's License Law A CT° r
for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits
.3307 68.411.
I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors d ��
IsEi'l
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) ,
and Professions Code). TOTAL 68. 40 jy
� CONSTRUCTION LENDING AGENCY
CHECK•F1ECK V V a 40
I hereby affirm that there is a construction lending agency for the CHANGE [I'I
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) °
Civ.C.).
PLAN CHECKING FEE
Lender's Name . 10110-11311 1 4,J `?f' l�
PERMIT ISSUING FEE
Lender's Address
9994 1 Ar. 8:14
1 certify that I have read this application and state that the above TOTAL FEE
4 10
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
prop Y f ection purpose s. C. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signa Permit a Date