HomeMy Public PortalAbout10780 BLACKLEY ST_Electrical__ w
COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Department of County Engineer ELECTRIC
'��
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOX. County Engineer
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZON PERMIT NO.
ELECTRICIAN 2 6
RECEIVED BY JREADY FOR DATE ISSUED
ADDRESS /? FIRST INSPECTION D
CITY TEL NO. ),
vv COUNTY LICENSE NO. EXPIRES BUILDING
PERMIT FEES FEE ADD REBS
9 u
NUMBER EACH L(3CALITY !"
LIGHT OUTLETS NEAREST Li
CROSS ST.
RECEPTACLES /� h �'
WALL SWITCHES OWNER e/
TOTAL OUTLETS Sc III MAIL A y�
ELEC. RANGES 25 ADDRESS
IELEC. HEATERS 25 CITY TEL. N
I FIXTURES 5
1 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MIBC. APPLICATION AND- STATE THAT THE ABOVE 113 CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOB
NUMBER HORSEPOWERFEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
NEW MVD. HP OVER IMC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
%2 6 LESS $ .25 SIGNATURE OF
%2 a .50 PERMITTEE
a s 1.013 INSPECTION RECORD
5 15 1.50
15 So •2.50 jLd��P�'� r�4',A d*'/ i� le A UT1tl�)►. ►ev
50 zoo 5.00
200, 500 10.00 -.1
500 1000 15.00 Z
OVER 1000 20.00
__MOV_ ED_MOTORB (75% OF aRIM.)
M.P. BET/FRED. CHANGER-HP O
WELDERS: AC-KVA
GENERATORS - KW
TRANSFORMERS - KVA
Misc.
SIGNS
NO. NO.TRANS
- APPROVALS
NO. NO. LAMPS
FOR EACH PERMIT:
DATE INSPECTOR'S NAME
WIRING ®1.00 CONDUIT ,.
FXXXTURES $1.00 WIRING
)SUPPLEMENTARY .50 16-k FIX TUREB
~POWER
TOTAL FEE $ UTILITY CO.NOTIFIED
FINAL
76A663 DBS#5A �f (
WORKERS'COMPENSATION DECLARATION 78-663 10/81
CE-60sG _APPLICATION FORELECTRICAL 'PERMIT
'�1 her&Paiffirmthat I have a certificate of consent to self insure, o
or a tertifi66175.6f Workers' Compensation Insurance':or:a'certified COUNTY OF LOS ANGELES. BUILDING AND SAFETY
copy thereof(S b.C) ?� ,� / , . -
Policy No Company / LC1�r�t► FOR APPLICANT TO FILL IN JOB �1 /�:
❑ ' Certified co is hereb furnished' EACH. NO: FEE, 'ADDRESS 9C /5Cf
pY y , :, New Residential Bldgs:'&Pools'
Certified`copy•is filed,with ahe county bu. (Itlin y 1 & 2,Family;Sq Ft $ — $' LOCALITY
C ;
g'.inspection.'
• dep rtmeni,r Multi-family Sq Ft. — NEAREST
jJ CROSS ST
_ ;Date Applicant
Residential Sw+mming�Pools, , _
' , �,-;, -OWNER OR- r
� r'►'d 1 , , w.I"4, 'FIRM NAME. .,�
CERTIFICATE OF,EXEMPTION,FROM,WORKERS' Outlets:RGght '� 3w — �+ :u 3'•�; � t AIL
ec
COMPENSATION INSURANCE + .. ADDRESS - /J
First 20:
•(This;section:rieed.not,be completed,ff the work;iriJblved,by'the,. Total No Additional CITY :'C�'f Tel No
permit'is for,one hundred'dotlars�($100)or less.)
'PLAN C14ECK
I certify that in the performance of the,work for.which•thjs permit.' 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 "PERMIT
u NO,TICE''TO''APPLICANT. If; .after -making this,,,;Certificate of'':
Exemption,you SF 06ld become subject to the Workers'Compensation: _ Range_ Heater_ D_W. APPLICANT �,�' ��6
provisions of,the,Laboe Code, you:must.forthw+th comply`'withauch Oven' _ Dryer _ W.M._ ADDRESS
provis+ons.:or this:permd shall be deemed revoked',
To —,FAU W.H.
> _ .... w .:`•• P ' CITY /V(�!✓ Tel`No.'3 5 7 5?1/
LICENSED CONTRACTORS DECLARATION Hood Fan Other_
"•,.I hereby affirm,that'I•am.licensed underrprovisions of',Chapter'9 Di p. — Room Air Cond. " _ LICENSE ORGGZ z Class G Z
•(commencing with Section 000) of Division 3 of.the,Business and P. REG NUMBER 'J a:' 2�` C
Professions Code;and my,license is 6'fuil force and effect: DISTRICT NO
Power Appar '&.Large.
atusAppliances ;} PROCES BY
/,
Size& Type HP,KW,KVA,or KVAR
License Number" P 2 Z Lic Clas
Up to 1 Incl. FINAL. U
Over 1 to 10 Incl.,', DATE "
Contractor Date . r' VA �ATION O,
Over'10 to 50 Incl FIN- V
❑• lam'exempt under Sec. Over 50 to-100 Ind . gr
B.&PC for this reason Over 100 jr 0-
Services,Swbd,,MCC'&"'Panelboards Z
-Date' 0-200•Amp,Under 600 V `
-4 Signature' 20.1 - 1000 Amp.Uhder 600 V
' Over 1000 Amp or Over 600 V'
❑, Exemption for Reg Maint Elect: ° '' 9 5 617 A
SINGLE FAMILY ' •' ' Temp Power Pole& Appurteriances :
HOMEOWNER-BUILDER DECLARATION "� # o o Io,o
Sign with One Branch Circuit'
I hereby affirm'that I am exempt from'the Contractor's.License Law r, ,
for the following reason(Section 7031 5, Business and 11
Professions Adddiorial Sign Branch Circuits' a o34,7 5,
'Code). }, : '
❑ - Mise:Conduds,8 Conductors ` o o 0 3 4,''7 5 5
I,as owner,of the property,will do the work and the structure,•
is not ihtended or-offered for sale (Section 7044, Business
'°'' Other (See Complete Fee Schedule) , Y .(�,5 O 9='$8
and Professions Code).
CONSTRUCTION-LENDING"AGENCY
AI 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 i (Sub-Total)
Civ'C).
a v PLAN-CHECKING FEE"
Lenders Name - x
PERMIT ISSUING FE_E.
'Lender's Address %
I certify that I'have`read this'appl+cat+on and state that the above,', TOTAL FEE,
information is correct. I-agree to comply'with,all County ordinances
and State'law regulating Electrical wiring, and hereby authorize. "
representati of this C unty to enter upon tfie above_mentioned'
property inspect /rppose
• (/`r ` Jl1� ! �O' SEE•REVERSE FOR EXPLANATORY LANGUAGE _
nature of ermittee Date
COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
DEPARTMENT OF COUNTY ENGINEER ELECTRIC 1
� DIVISION OF BUILDING & SAFETY
WILLIAM J. FOR, COUNTY ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
/ ELECTRICIAN �/ S
ADDRESS RECEIVED BY READY FOR DATE ISSUED
i FIRST INSPECTION
CITY TEL. NO.
COUNTY LICENSE NO. EXPIRES BUILDING
PERFEES ADDREPERM
NUMBER EACH FEE. C ^
LOCALITY
LIGHT OUTLETS NEAREST
RECEPTACLES CROSS ST. .//^+ Q��( /► / ,` p
WALL SWITCHES ^x OWNER
TOTAL OUTLETS J Sc $
MAIL O G
ELEC. RANGES 25 ADDRESS OCIA
ELEC. HEATERS 25
FIXTURES 5 CITY 1 TEL.
MISC. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
NUMBER OF LIGHT CIRCUITS APPLICATION AND STATE THAT THE ABOVE IS CORRECT
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.
I/z B LESS $ .25
SIGNATURE OF e:�� J,
I/2 2 .50 PERMITTE
2 s 1.00 INSPECTION RECORD
5 15 1.50
15 50 2.50
s0 200 5.00
200 Boo 10.00 J
500 1000 15.00 Z
OVER 1000 20.00
M.G. SET/FREQ. CHANGER-HP
WELDERS: AC-KVA 0
GENERATORS-KW
TRANSFORMERS-KVA
TEMP. MOTORS (75% OF ORIG.)
MOVED MOTORS (75% OF ORIG.)
MISC. I
SIGNS
NO. NO. TRANS.
NO. NO. LAMPS APPROVALS
' FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING $1.00 l,7D CONDUIT
FIXTURES $1.00 WIRING
SUPPLEMENTARY :50 FIXTURES
POWER
TOTAL FEE .$ UTILITY CO. NOTIFIED
FINAL
76A 669 DBS# 8A. 4-92
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