HomeMy Public PortalAbout9342 BLACKLEY ST_Electrical__ 76AG63-CESOG-11-S7 O"Il• ` L'C TIO N • O O ELECTRIC 0 E9 CY®iIT �1
COUNTY OF LOS ANGELES �f
DEPARTMENT OF COUNTY ENGINEER nBUILDING `�
BUILDING AND SAFETY DIVISION ADDREss
C1910HN A. LAMBIE. County Engineer
AMT D. GRIFFIN, Supt of Budding' LOCALITY l ,Lt'1 ( •,
NEAREST /✓f �p //�_ .
FOR APPLICANT TO FI LL IN
PERMIT FEES a
/ / ,'py
ITEM NUMBER EACH FEE OWNER �LCi�4,
OUTLETS
S �/ 7 MAIL
LIGHTS/ RECEPT.(t SW. .10 ADDRESS
LIGHTING FIXTURES .10 CITY TEL. NO.
ELEC.RANGES CLO.DRYERS ( ELECTRICIAN
WATER HEATERS ' •� /
� ELEC.SPACE HTRS. DISHWASHERS 50 ADDRESS/ ':;l __
.�r �"[ >fr 1.J-�L•t,�fZ.�'� ,!
GARBAGE DISPOSERS AUTO.- CIT _ .`C���G•l�-� �Y�L-� EL. NO aD
<c'
�'. WASHERS STA.COOKING UNITS � .25 �� LICENSE NO.
MOTORS: OVER INC. H.P. '� -
® DISTRICT NO. JqRC)UP� ZONE READY FOR INSPECTION
.25
I/2 — 2 .50
INSPECTION RECORD
2 — 5 1.00 p
5 — 15 1.50 .. '' J /
15 — 50 2.501cr?
e �n
so— 200 5.00t
y
NO.TRANS.
SIGNS: NO.LAMPS
SERVICE 0-600V 1.00 [�Q
SERVICE OVER 600V 5.00
MISC.
- WIRING PERMIT 1.00
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .50
TOTAL FEE g �.� 7� APPROVALS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. , WIRING 4! `- 1I E t
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF F
CALIFORNIA OR THAT_1— M THE LEGAL OWNER OF THE ABOVE POWER
DESCRIBED RESIDENjTAL OPE TY. /
J `
• SIGNATURE / � - UTILITY CO.NOTIFIED
OF PERMITTE [RC2 °
FINAL
o ATION ARTHUR C.VEIT.
C mo CASH - SUPERVISING ELECTRICAL ENGINEER
A !ro2-g o 66; HAA 2 2 A
12-05
WORKERS'COMPENSATION DECLARATION 76-663 tc/Bt
CE-806G fl
APPLICATION FOR ELECTRICAL PERMIT
I'hereby'affirm"that-I have a certificate of consent.to self insure,
or a certificate of Workers`�-aompensation Insurance3or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof (Sec.3800,Lab. C.)
Policy No Company FOR APPLICANT TO FILL IN JOB
Certified copy is hereby furnished. New Residential Bldgs.& Pool
EACH NO. FEE ADDRESS
❑
F11 & 2-Family,Sq.Ft. $ _ $ LOCALITY
Certified copy is filed with the county building inspectionNEAREST
department. Multi-family Sq.Ft. CROSS ST. 17 G �
Date Applicant Residential Swimming Pools OWNER OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec2:1–/LightSw. ADDRESS
MAIL
COMPENSATION INSURANCE
(This section need not be completed if the work involved b the First 20
permit is for one hundred dollars ($100)or less.)
y Total No. Additional CITY Tel.No. 7
that in the performance of the work for which this permit PLAN CHECK
I certify P p 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
NOTICE TO APPLICANT: If, after making this Certificate of
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 W.M._ ADDRESS
provisions or this permit shall be deemed revoked. Top — FAU W.H.
LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ CITY Tel.No.
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE Class.
(commencing with Section 7000) of Division 3 of the Business and REG.NUMBB ER
Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. ar �!�PROCES D BY
Size& Type HP,KW,KVA, or KVARi O
License Number Lic.Class Up to 1 Incl. FINAL U
Over 1 to 10 Incl. DATE' A=`t= \ O
VALIDATION
Contractor Date U
Over 10 to 50 Incl. FINAI' \ ~
❑ I am exempt under Sec. Over 50 to 100 Inc. BY _ k W
Over 100 �-
B.&P.C.for this reason Services,Swbd.,MCC& Panelboards 00.
4 Z
Date: 0- 200 Amp.Under 600 V
Signature 201 - 1000 Amp.Under 600 V
❑ Over 1000 Amp.or Over 600 V
Exemption for Reg.Maint.Elect.
SINGLE FAMILY Temp.Power Pole& Appurtenances r
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
1 hereby affirm that I am exempt from the Contractor's License Law ��;� e
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits °1r
Code): 3307 6223.30
❑ I,as owner of the property,will do the work and the structure Misc.Conduits & ConductorsOther(See Complete Fee Schedule) ITEMS
is not intended or offered for sale (Section 7044, Business —, --,
and Professions Code). ® TOTAL 63
CONSTRUCTION LENDING AGENCY CHECK 63.33D
I hereby affirm that there is a construction lending agency for the CHANGE00
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) °t
Civ.C.).
PLAN CHECKING FEE
Lender's Name 4.1001-0001 61 8/7(1
PERMIT ISSUING FEE ,
Lender's Address 1169 ? AM `e 14
1 certify that I have read this application and state that the above TOTAL FEE
information is correct. I agree to comply with all County ordinances
and State laws regulating Electrical wiring, and hereby authorize
represent es of this CoV to enter upon the above-mentioned
proper or inspe oses SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Perm tee Date