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HomeMy Public PortalAbout9405 BLACKLEY ST_Electrical__ 7'A663-':ry )6,1_7 f., APPLICATION FOR ELECTRIC L PEi'Mlf' +,rCrUNTY OF LOS ANGELES DEPARTMENT AND SAFETY DIVISION BUILDING ADDRESS y9�s- s LOCALITYNEARE FOR APPLICANT TO FILL IN CROSS ST OUTLETS NO EACH I FEE r L OWNER JVZ RECEPT /U $ $ MAIL LIGHT TOTAL FIRST 20 ADDRESS Z5 CITY C/ TEL NO Z IS SWITCH �_ OVER 20 V 10 ,,.. PLAN CHECK LIGHTINGTOTAFIRST 20 25 APPLICANT VER 20 ADDRESS FIXTURES L O 10 RESIDENTIAL APPLIANCES CITY TEL NO PERIT RANGE DRYER-4WTR HTR APPLICANT , L-)1 LDe� STA COOK DISP F A U ADDRESS SPACE HTR AIR COND CITY TEL NO CLOTHES WASH _J__DISHWASH ^ LICENSE NO CLASS FAN OTHER C;21100 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND HEATERS, ETC HP KW KVA ELECTRICAL WIRING SIZE & TYPE OVER TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 - L 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF d CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO 1 - 1O 300 RESIDE N, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY SIGNATURE 10 - 50 500 D a, OF PERMITTEE CJS � O 50 - 100 1000 DISTRICT NO LASS ZON,f� R CES ED 100 - 500 1500 'J`�/ N SIGN GAS SIGN AND ONE CIRCUIT 500 NOTES ? TUBE, OR MARQUEE ADDITIONAL CIRCUITS 100 SERVICE NOT OVER 600 VOLTS OR200AMP 300 1 13 (� APPROVALS DATE INSPECTOR'S SIGNATURE SERVICE OVER 600 VOLTS OR200AMP 1000 TEMP POWER POLE TEMPSERVICE,POLE, &APPURTENANCES 500 UNDERSLAB WORK TEMP LIGHT OR RECEPT SYSTEM IL 300 ROUGH CONDIUT WIRING FIXTURES PERMIT FEE (SUB TOTAL) POWER AUTHORIZED I J UTILITY CO NOTIFIED w� PLAN CHECK FEE FINAL / PERMIT ISSUING FEE 300 TOTAL FEE `�� PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION(DCK M 0 CASH L ,,o " 5 4" sEP 13 2 D 1 45 0- SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 76A663 DBS SA 11-49 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY, COUNTY OF LOS ANGELES ELECTRIC 1 WILLIAM J. FOX, CHIEF ENGINEER FOR APPLI-CANT TOFILL IN DISTRICT O. GROUP ZONE PERMIT NO. " ELECTRICIAN /A/ d 1 /-IA /i/ fl, / may' RECEIVED BY READY, FOR DATE ISSUED ADDRESS ��� ! �� FIRST INSPECTION CITY 1��- , TEL. NO d 0:3-i-012- V7 6" IV( W COUNTY LICENSE NO. 11, EXPIRES �� V BUILDING PERMIT FEES _ ADDRESS NUMBER OUTLFTS EACH FEE LOCALITY r • LIGHT Sc $ NEAREST CROSS ST. _/.�....� � RECEPTACLES 5 D � FIXTURES 5 u OWNER WALL SWITCHES s p MAIL ELEC. RANGES 25 ADDRESS ELEC HEATERS 25 CITY TEL NO MISC I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS NUMBER OF CIRCUITS INSTALLED TOTAI APPLICATION AND STATE THAT THE ABOVE IS CORRECT LIGHTS RECEPTACLES AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES MOTORS AND STATE LAWS REGULATING ELECTRICAL WIRING NUMBER HORSEPOWERFEE I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS NEW MVD. HP OVER INC EACH ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER I/2 b LESS 25 OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE $ -J %2 2 sO SIGNATURE OF 2 5 100 PERMITTEE s is 1 so INSPECTION RECORD is so 250 so 200 5 CO� 200 500 10 Do 500 1000 15001 J OVER 1000 201301 Q _Z M G. SET/FREQ CHANGER-HP O WELDERS AC-KVA GENERATORS - KW I O TRANSFORMERS - KVA TEMP. MOTORS (75% of oRlr) MOVED MOTORS (75% OF ORIG) M ISC SIGNS TYPE NO TRANS TYPE NO LAMPS APPROVALS FOR EACH PERMIT DATE INSPECTOR'S NAME WIRING $1 OO CONDUIT FIXTURES $1.00 / �7 WIRING SUPPLEMENTARY 50 FIXTURES POWER TOTAL FEE $ 40 UTILITY CO NOTIFIED FINAL P6Aee3 CE809460 APPLICATION FOR ELECTRICA► PERMIT 'Q COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A.LAMBIE, COUNTY ENGINEER ADDRESS WILLIAM A JENSEN, SUP'TOF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST PERMIT FEES CRO"sr OWNER I T E M NUMBER EACH FEE MAIL 1 C OUTLETSi $ $ ADDRESS LIGHTS RECEPT SW 10 LI TING FIXTURES 10 CITY TEL NO U . ELEC RANG CLO DRYERS FELECTRIC N WATER H EATERS s0 JO ADDRESS / ELEC SPACE HTRS DISHWASHERS CITY GARBAGE DISPOSERS AUTO. STATE WASHERS STA COOKING UNITS 25 LICENSE NO MOTORS OVER INC H P DISTRIg.TN0_e I GROUP ZON PR CES D Y o — I/2 2s 1/2 — 2 so INSPECTIO ECORD 2 s loo 5 15 ISO 0 IB so 2 BO —SO — 200 500 0 NO TRANS U.1 sIGNs D_ NO LAMPS Z SERVICE 0.600V 100' DO SERVICE OVER 600V goo MISC WIRING PERMITr_ __00s_000_ &-7FIXTURE PERMITSUPPLEMENTARY PERMIT TOTAL FEE $ 5Q 1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT ELECTRICAL WIRING WIRING 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT I AM THE LEGAL OW R OF THE ABOVE IA DESCRIBED RESIDENTIAL PROPER POWER y SIGNATURE UTILITY CO NOTIFIE �3 / R. OF PERMITTE FINA �� VALIDATIQN. ARTHUR V CK Mo CASH SUPERVISING ELECTRICAL ENGINEER L�F.o 1 9 2 2 t 2 a 2.50 s= olrx_Lam/ WORKER S'COMPENSATION DECLARATION CE806G (280) APPLICATION FOR ELECTRICAL. PERMIT `fl I hereffy''iaffirm that I have a certificate of consent to self COUNTY OF LOS ANGELES �`�' ;7BUILDING AND SAFETY, insure, or a certificate of Workers'Compensation Insurance,of / a certified copy thereof(Sec 3800,Lab C) FOR APPLICANT TO FILL IN JOBI r Policy No Company EACH NO FEE ADDRESS o� CV � New Residential Bldgs &Pools f�/ — 4 Certified copy is hereby furnished 1 &2-Family,Sq Ft $ $ LOCALITY � / �m LIE C1 r OMulti-family Sq Ft NEAREST Certified copy is filed with the county building inspection Residential Swimming Pools CROSS ST F department OWNER OR aa �� FIRM NAME J IS0As � Date Applicant Outlets Rec_LLi ht A Sw � Q AIL g First 20 �! ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' Total No Additional COMPENSATION INSURANCE I CITY L ��T Tel No U0 } PLAN CHECK tL (This section need not be completed if the work involved APPLICANT U by the permit is for one hundred dollars (5100) or less) Lighting Fixtures First ADDRESS Total No � Additional cc 1 certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No 0 permit is issued, I shall not employ any person in any manner PERMITW so as to become subject to the Workers' Compensation Laws Range_ Heater_D W APPLICANT` �� IP--Pe d Oven _ Dryer_W M ADDRESS N Date Applicant Top _ FAU _W H _ Z Hood Fan _Other_ CITY Tel No NOTICE TO APPLICANT If, after making this Certificate of Disp _ Room Air Cond_ LICENSE qJR— Exemption, you should become subject to the Workers' REG NkIVRPR Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO P SED BY with comply with such provisions or this permit shall be Size&Type HP, KW, KVA,or KVAR deemed revoked ` Q . t_ Up to 1 Incl CIO 12 INAL LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl DATE VALIDA IDN Over 10 to 50 Incl I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc FINAL 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 BY ness and Professions Code, and my license is in full force and effect Services 0-200 Amp Under 600 V License Number Pc Class 201-1000 Amp Under 600 V Contractor Date Over 1000 Amp or Over 600 V v HOME OWNER BUILDER DECLARATION Temp Power Pole& Appurtenances I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit, License Law for the following reason (Section 7031 5, Busi- Additional Sign Branch Circuits ness and Professions Code) , Misc Conduits& Conductors 1 3 1,3 A I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— structure is not intended or offered for sale (Section # o o o 0 o 2 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY 2 0 o 1 9.00 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is PERMIT FEE (Sub-Total) 0 0 0 1 9,Q 0 i:� issued (Sec 3097,Civ C) Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) 07, 1 7—8 Q Lender's Address PERMIT ISSUING FEE I certify that I have read this application and state that the TOTAL FEE J 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 enter upon the above mentioned pr rty for ins cti rposes SEE REVERSE FOR EXPLANATORY LANGUAGE 0 Signature of rmrttee Date vY r WORKERS' COMPENSATION DECLARATION - 10/81 CE-806G APPLICATION FOR ELECTRICAL PERMIT Thereby affir*q,that I have a certificate of consent to self insure, C or a-'certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec 3800 Lab C) Policy NO Company FOR APPLICANT TO FILL IN, JOB EACH • NO FEE. ADDRESS 7/ Certified,ed copy s hereby furnished r New Residential Bldgs & Pools ,.� El Certified _ $ LOCALITY / Certified 'copy is filed with the county building inspection 1 & 2-Family,Sq Ft NEAREST department ' Multi-family Sq Ft CROSS ST Date Applicant • Residential Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec— Light — Sw t MAIL COMPENSATION INSURANCE ADDRESS , (This section need not be completed if the work involved byAhe First 20 Additional CITY Tel No Total No permit Is for one hundred dollars($100)'or less) , ,• � ` I certify that in the performance of'Ahe work for which this-permit _APPLICANT CHECK is issued,.l shall not employ any person in any manner so as to - i - ,become subject to the Workers'Compensate Laws, Lighting Fixtures First 20 ADDRESS 'j Total No Additional � CITY ` Tel No , Date —719 Applicant Fixed Appliances Not Over 1 HP ' NOTICE TO APPLICANT If, after making, this Certificate of PERMIT APPLICANT S /J Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D W (. 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 WH _ CITY Tel N,A �6j i LICENSED CONTRACTORS DECLARATION Hood Fan Other_ ' I hereby affirm that I am,licensed under provisions of Chapter 9 Disp —Room Air Cond LICENSE OR f" Class —�Q (commencing with Section 7000) of Division 3 of the Business and REG NUMBER J Professions Code,and my libense,is in`full force and effect Power Apparatus& Large Appliances DISTRICT NO _ PROCESSED BY py Size&Type HP,KW,KVA,or KVAR �vv o / License Number�K ,r3E�Lic Classf Up to 1 Incl + FINAL J V pOver 1 to 10 Incl DATE // `�1`7 VALID Contractor Date _ Over 10 to 50 Incl - U ❑ FINAL I am exempt under Sec Over 50 to 100 Inc BY W B&PC for this reason Over 100 , Cn Z Services,Swbd,MCC&Panelboards e 0- 200 Amp Under 600 V c w- Signature IV 201 - 1000 Amp Under 600 V ❑ Over 1000 Amp or Over 600 V Y Exemption for Reg Mamt Elect 2 ` SINGLE I FAMILY Temp Power Pole& Appurtenances sCT°' HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit Fid rt I hereby affirm that I am exempt from the Contractors License Law 307 for the following reason(Section 7031 5,Business and Professions Additional Sign Branch Circuits 33V *- Code) I " 1 ITEMS �t ❑ Misc Conduits &Conductors TOTAL �� I,as owner of the property,will do the work and the structure " is not intended or offered for sale (Section,7044, Business Other (See Complete Fee Schedule) tt! and Professions Code) CHER CONSTRUCTION LENDING AGENCY, CHAI�'�E °�� F• , r , , I hereby affirm that there is a constructiondending agency for the performance of the work for which this permit is issued(Sec 3097, PERMIT FEE (Sub-Total) " Civ C) �y�t 1/30/89 PLAN CHECKING FEE e OO""-C ►01 M V Lenders Name , 0",a 1 AM 8:50 ., ti PERMIT ISSUINGiFEE - - •- n Lend'er's Address n I certify that I have lead this application and state that the above TOTAL FEE, a, .• 0 v information is correct I agree to comply with all County ordinances , and State laws regulating Electrical wiring, and hereby authorize representatives of'this County,o enter upon the above-mentioned prop5oi, for in ection purpo SEE REVERSE FOR EXPLANATORY LANGUAGE , 1_3c9 , ignature of Permittee Date WORKERS'COMPENSATIONDECLARATION CE806G (280) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereofec 3800, ab C) ?-3rilp 32ID `ZFOR APPLICANT TO FILL IN JOB / Policy No Company EACH NO FEE ADDRESS o New Residential Bldgs &Pools Certified copy is hereby furnished 1 &2-Family,Sq Ft $ — $ LOCALITY Multi-family Sq Ft NEAREST ertified copy is filed with the county building inspection - CROSS ST department Residential Swimming Pools JA WNER OR IRM NAME Date Applicant Outlets Rec...LLight Sw AIL First 20 DDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' Total No Additional ITY Tel No COMPENSATION INSURANCE } LAN HEC a (This section need not be completed if the work involved PPLICANT U by the permit is for one hundred dollars ($100) or less) Lighting Fixtures First io DDRESSAdditionalTotal No O I certify that in the performance of the work for which thisFixed Appliances Not Over 1 HP ITY Tel No U permit is issued, I shall not employ any person in any manner PERMIT so as to become subject to the Workers' Compensation Laws Range_ Heater_D W APPLICANT Gil Oven _ Dryer_W M ADDRESS g Date Applicant Top _ FAU _W H Z pp Hood Fan _Other_ CITY Tel No Q NOTICE TO APPLICANT If, after making this Certificate of Disp _ Room Air Cond Exemption, you should become subject to the Workers' REG NUMBER L Class Ci Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO . PROCE ED BY with comply with such provisions or this permit shall be Si a&Type HP/ yV A,or KVAR deemed revoked J�f3`SI'�P t}p to 1 incl tel" FINAL s� �°/° � LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl DATE VALIDATION Over 10 to 50 Incl INAL I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc BY 9 (commencing with Section 7000) of Division 3 of the Busi Over 100 J ness and Professions Code, and my license is in full force and effectJ Services v I Ci36 0-200 Amp Under 600 V License Number 3`t 3 i 3 7 Lic Class 201-1000 Amp Under 600 V 17 9-3 r Contractor � Date Over 1000 Amp r or Over 600 V HOME OWNER-BUILDER DECLARATION Temp Power Pole&Appurtenances G 4 27,7 A I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit Additional Sign Branch Circuits # 0 0 0 0 0 2 License Law for the following reason (Section 7031 5, Busi- i ness and Professions Code) 2 0 0 1 525 Misc Conduits&Conductors � F] 1, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— 0 0 - 1 S2 5�. structure is not intended or offered for sale (Section "' 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY O a O 5 H 3 - I hereby affirm that'there is a construction lending agency for the performance of the work for which this permit is. PERMIT FEE (Sub-Total) issued (Sec 3097,Civ C) Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE I certify that I have read this applicatiowand state that the TOTAL FEE ` above information is correct I agree to comply with all County 16 ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon t ab ve entioned property or i spection purposes 'SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permitt a Date