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Home My Public Portal About9410 BLACKLEY ST_Electrical__ Y, `t• � 4 v ._. :.yam ..,i .�«..�- n�. .,.zl„. 76A663`E-806(11'"8 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY_ ~ ',~ FOR APPLICANT TO FILL IN JOB CPl��O New Re`sidenhal Bldds`&Pools ` EACH-- NO - FEE- ADDRESS 1 &2 Family,Sq Ft $ 025 — $ LOCALITY _ L- Multifamily Sq Ft _ 02 — NEAREST Residential Swimming Pools 25 00 CROSS ST a. OWNER OR 1 ®, FIRM NAME I- Outlets Rec Light ' Sw MAIL First 20 50 is ADDRESS' O 30 CITY, �ya el No a r, Total No Additional �� - C ? PLAN CHECK a - 7 .APPLICANT Lighting Fixtures First 20 50 ADDRESSS 1 T -Additional 30 _ r- _ Total No CITY Tel No Fixed Appliances Not Over 1 HP - i -PERMIT - Rarige_Heater-11D W APPLICANT Oven_Dryer_,W M ADDRESS ' Top _FAU — WH CITMOW &ff IV Tel No Hood_�Fan _Other_ LICENSE OR Class' Disp,_Room Air Cond 2 50 REG NUMBER _ _ _ I HEREBY ACKNOWLEDGE THAT I HAVE READ TJAE A Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT ANO Size&7 M ° ' `' ' COMPLY WITH ALL COUNTY ORDINANCES AND' S A' ype HP, KW KVA,or KVAR 2 50 REGULATING ELECTRICAL WIRING Up to 1 Incl I HEREBY CERTIFY THAT I AM PROPERLY REGISTER --y Over 1 to 10 Incl" 5 00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AF Over 10 to 50 Incl- 12 50 CALIFORNIA OR THAT AM THE LEGAL OWNER OE, , 0 25 00 DESCRIBED RESIDENTIAL PROPERTY p.. Over 50 to 100 Inc PERMIT EE 'Over 100 40 00 - SIGNATURE, y�Services- - - P "DISTRICT"NO PRO0 200 Amp^Under 600V , 12 50 201`1000 Amp Under 600"V - 25 00 Y Over 1000 Amp or Over 600 V 50 00 r t Z O Temp Power Pole&Appurtenances 10 00 - • asa �r-,"u'-Q Sign with One Branch Circuit 10 00 � Additional Sign Branch Circuits . _ 2 00 INSPECTION _ > 2 7 A r ' 1 INFORMATION '# o o of o o 2 Misc Conduits&Conductors 'ON REVERSE'S" "'u Other(See Complete Fee Schedule); SIDE- .. - Z 2,- ° 1u 1,0 d O O O 1 L eO 0 V. r 1,29=79 PERMIT FEE r'` '(Sub Totah ti �' ` PLAN CHECKING FEE (One Fr ourth,Pemrt Feel _ '�r r ' _O J PERMIT ISSUING FEE $700 wri •� Q TOTAL FEE 0 > r INSPECTION FINALED LU date ' By 16A663C-'0E80(.B IZ/;8+ APPLI ATION FOR ELECTRICAL PERMIT A - BUILDING AN S FETY DIVISION FOR APPLICANT TO FILL IN JOB �� 1�CrK New Residential Bldgs & Pools EACH NO FEE /� �, 1 &2 Finaily Sq Ft $ — $ LOCALITY �" Multi famil Sq Ft — NEAREST y CROSS ST Residential Swimming Pools WRA M EE c /Z,JJ I C.C_ Outlets Light, Switch & Receptacle 1� 00 ADDRESS /7/%Q ` kL c First 20 1 / T Additional CITY7,�/y/ /� tel/ Tel No 2, PLAN CHEC Lighting Fixtures APPLICANT First 20 3 2-U ADDRESS Additional CITY L Tel No PERM Fixed Appliances Not Over 1 HP APPLICANT ✓ i✓�/ f1 G r•.� Range Heater_ D W ADDRESS Oven Dryer W M Top FAU WH CITY H /,�_ (^ T Tel No 2 g6-7q,37 � Hood Fan REG NUMBER OLA.)AJ� Class CD Disp A C I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY U Power Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING W Size&Type HP, KW, KVA,or KVAR ELECTRICAL WIRING 11 I � 00 Up to 1 InclZ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR Over 1 to 10 Incl LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE Over 10 to 50 Incl DESCRIBED RESIDE TIAL PROPERTY Over 50 to 100 1 ncl PIGNATLI Over 100 SIGNATURE DISTRICT NO ROCPs SED Y Services , 0-200 Amp Under 600 V l 201 - 1000 Amp Under 600 V APPROVALS DATE I ECT Over 1000 Amp or Over 600 V SIGNATUURREE TEMP POWER POLE Temp Power Pole&Appurtenances UNDERSLAB WORK Sign with One Branch Circuit Additional Sign Branch Circuits ROUGH CONDUIT (Other) WIRING /z_q--77 FIXTURES POWER AUTHORIZED PERMIT FEE (Sub-Total) UTILITYCO NOTIFIED PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL Z b Cl '16: /Z�(3 PERMIT ISSUING FEE - NOTES67"1// If f TOTAL FEE _ 6 � PLAN CHECK VALIDATION CK MO CASH PERMIT VALIDATION CK MO CASH 0,'6 6 ti,vav 0 2 1 1.`? C) A WORKER'S COMPENSATION DECLARATION 20 DPW(12 91) APPLICATION FOR ELECTRICAL PERMIT 76A663 I hereby affirm tti'at I have a certificate of consent to self insure, 76A663 or a ceitificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof(Sec 3800 Lab C) Policy NO Company FOR APPLICANT TO FILL IN JOB ADDRESS El V li 7 Certified copy is hereby furnished New Residential Bldgs &Pools NO EACH FEE $ $ r LOCALITY ❑ Certified copy Is filed with the county building Inspection 1 &2 Family,Sq Ft department Multifamily Scl Ft NEAREST CROSS ST Date Applicant Residential Swimming Pools ASSESSOR PP MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec Light g Sw ®27 l� FIRMOWN NAME 1 COMPENSATION INSURANCE t First 20 MAIL (This section need not be completed if the work involved by the Total No Additional ADDRESS 51 permit is for one hundred dollars($100)or less) I certify that In the performance of the work for which this permit CITY T is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers'Compensation Laws Lighting Fixtures First 20 APPLICANT Total No Additional J n 1e1 Date Applicant ADDRESS (�jr RESIDENTIAL APPLIANCES NOT OVER 3 HP NOTICE TO APPLICANT If, after making this Certificate of CITY ..Q-� Tei � Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP provisions of the Labor Code, you must forthwith comply with such APPLICANT IT provisions or this permit shall be deemed revoked Power Apparatus&Large Appliances LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS / I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl (commencing with Section 7000) of Division 3 of the Business and CITY e N Professions Code,and my license is in full force and effect Over 10 to 50 Incl LICENSECl Over 50 t0 100 Incl REG NUMBER a Over 100 DISTRICT NO P SED BY License Number Lic Class n Services,Swbd MCC&Panelboards �c/� T_ 0 399 Amp Under 600 V FINAL o Contractor Date DATE 1— ❑ I am exempt under Sec 400-1000 Amp Under 600 V VALIDATION W Over 1000 Amp Or Over 600 V FINAL a B&P C for this reason BRANCH CIRCUIT FEES BY Date 15A,or 20A, 120V,Lighting or Recept Z Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits 2 Exemption for Reg Maint Elect 15A,20A,208V To 277V Lighting Br Circuits ,'- SINGLE FAMILY Temp Power Pole&Appurtenances ACCT.V HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit J�?tt��tt3V+� �.�7n 1 hereby affirm that I am exempt from the Contractors License Law e is for the following reason (Section 7031 5, Business and Professions Additional Sign Branch Circuits dee1 ITEMS C---o---lll ) w I, as owner of the property,will do the work and the structure Misc Conduits&Conductors TOTAL 39 . 75 Is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , CHECK o J� 7c \ and Professions Code) n CONSTRUCTION LENDING AGENCY CHANGE .00 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) /,:;L 90 1 7/11/96Civ C) A PLAN CHECKING FEE 7375 1 AM 8,30 Lender's Name PERMIT ISSUING FEE Lender's Address /} I cert%y that I have read this application and under penalty of purlury state TOTAL FEE v/ that the 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 property for i�trposek SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNA RE OF PER111pt DATE