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Home My Public Portal About9451 BLACKLEY ST_Electrical__ 76A663C- CE806B 12,75 APPLICATION FOR ELECTRICAL PERMIT BUILD6/G AND SAFET DIVISION I FOR APPLICANT TO FILL IN JOB FResidentialdential Bldgs &Pools EACH NO FEE ADDRESS inaily Sq Ft $ — $ LOCALITY CCA emily Sq Ft — NEAREST CROSSSTtial Swimming Pools OWNER OR FIRM NAMEight, Switch &Receptacle MAI L ADDRESS nal CITY Tel No PLAN CHECK APPLICANT ixtures First 20 ADDRESS Additional CITY Tel No PERMIT Fixed Appliances Not Over 1 HP APPLICANT Range Heater D W Oven Dryer W M ADDRESS .ry1/jfL Q Top FAU W H CITY Tel No Hood Fan LICENSE OR / y Disp A C REG NUMBER Q V Col Class U - 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY Oti Power Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING r~7 Size&Type HP, KW, KVA,or KVAR ELECTRICAL WIRING LLI o.. Up to 1 Incl 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR N z Over 1 to 10 Incl LICENSED AS REQUIRED BY LOS ANGELES C UN AND STATE OF CALIFORNIA OR THAT 1 AM THEI EGAL O N OF THE ABOVE Over 10 to 50 Incl DESCRIBED RESIDENTIAL PROP T Over 50 to 100 Incl PERMITEE Over 100 SIGNATURE DISTRICT NO 77f_Z44& Services 0-200 Amp Under 600 V � d �� 201 - 1000 Amp Under 600 V APPROVALS DATE INSPECTOR'S Over 1000 Amp or Over 600 V SIGNATURE TEMP POWER POLE Temp Power Pole&Appurtenances UNDERSLAB WORK Sign with One Branch Circuit Additional Sign Branch Circuits ROUGH CONDUIT (Other) W R I NG FIXTURES POWER'AUTHORIZED PERMIT FEE (Sub-Total) UTILITY CO NOTIFIED PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL ' PERMIT ISSUING FEE NOTES ITOTALFEE '7CGI PLAN CHECK VALIDATION CK M CASH PERMIT VALIDATION CK Mo CASH 76A663-CES06 12/75 F_fy\A" l e G" � APPLICATION FOR ELEG'f RICAL PERMIT COUNTY OF LOS ANGELES c (- DEPARTMENT OF COUNTY ENGINEER JOBS BUILDING AND SAFETY DIVISION F2R APPLICANT TO FILL IN LOCALITY New Residential Bldgs& Pools EACH NO FEE NEAREST 1 & 2 Family, Sq Ft $ 025 — $ CROSS ST WNER OR Multi-family Sq Ft 02 — ORM NAM Residential Swimming Pools 20 00 MAIL �� ADDRESS Outlets Light, Switch & Receptacle CIT Tel No First 20 50 PLAN CHECK Additional 30 APPLICANT ADDRESS Lighting Fixtures FCITY Tel No First 20 50 Additional 30 PERMIT APPLICAN � ) Fixed,Appliances Not,Over 1 HP ADDRESS J —�•�_ Range_Dryer_D W CITY / (yam, Tel No031 OZ j r/ Oven=Dryer_W M LICENSE OR_ Top _ FAU _WH REG NUMBER �'I Class Hood_ Fan ___ I HEHE81 ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION Disp_A C ___ 200 AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING Power Apparatus& Large Appliances Size & T e HP, KW, KVA, or KVAR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR yp f LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF Up t0 1 Incl 2 OO (�� CALIFORNIA OR THAI I AM THE LEGAL OWNER OF THE ABOVE d 5 00 DE rRIrED RESIDENTIAL PROPERTY O Over 1 to 10 Incl U Over 10 t0 50 Incl 10 00 PERMITEE 20 00 SIGNATURE N Over 50 to 100 Incl pe Over 100 3000 DISTRICT NO PRIOC SSED BY G Services Q W 0- 200 Amp Under 600 V 1250 IN PECTOR'S 9L CA 201-1000 Amp Under 600 V 2500 APPROVALS DATE SIGNATURE Over 1000 Amp or Over 600 V 5000 TEMP POWER POLE o UNDERSLAB WORK Temp Power Pole& Appurtenances 1000 Sign with One Branch Circuit 1000 ROUGH CONDUIT Additional Sign Branch Circuits 200 WIRING (Other) FIXTURES POWER AUTHORIZED UTILITY CO NOTIFIED / FINAL PERMIT FEE (Sub-Total) NOTES � IMG b�•� �' PLAN CHECKING FEE (One-Fourth Permit Fee) PERMIT ISSUING FEE $600 dD TOTAL FEE / PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION CK MO CASH ? 3 0 e=jm 30 -2 0 8:0 0 sib SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE Y WORKERS'COMPENSATION DECLARATION -863 to si APPLICATIONTOR ELECTRICAL PERMIT - I hereby affirm that I have a certi$cat@�of'consmnt to ff sure,} 7CE-8o6G or a certificate of Workers' CAmpensation 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 , Certified copy is hereby furnished + New,Residential Bldgs & Pools .,EACH(• NO FEE ADDRESS, �l RI acle. , r Certified,copy is filed•with•,the county building inspection "^` i'& 2-Family,Sq'Ft — department , �� LOCAL p 'S Multi-family Sq Ft NEAREST, "t . � CROSS ST', " Date Ap'phcant " �� Residential Swimr6ng Pools " - OWNER OR I C 7 FIRM NAME �° H 5 _ �- CERTIFICATE OF,EXEMPTION FROM,WORKERS'• ° g Sw : = ' MAIL r - , Outlets Rec Li ht COMPENSATION INSURANCE 9, 0 ADDRESS first '(This section need not be completed If the work Involved by the CITY' Tel No _permit Is for,one hundred dollarsN$100)or less) s Total No Additional,', dditional,20 , +" Q— ir{Gr * I certify that in the performance of the+work for which this permit PLAN CHE ' s `IS issued, I shall not employ an ,. APPLICANT p y` y person in any,manner so„as to , become subject to the Workers' Compensation'Laws + ” Lighting Fixture First 20 ADDRESS „ Additional : _ w e t • Total No CITY Tel No 9` Date L Applicant ��(jg '� �:LItC ? 1 Rxed Appliances Not Over,1 HP, PERMIT NOTICE AP LICANT If, after making 'this Certificate of APPLICANT L L' ec /t'6 V Exemption,you should become subject to the Workers Cornpensation F Range_ Heater_'DW r provisions of the Labor Cade, you must forthwith comply with such Oven Dryer W M i ' W ADDRESS ` , e provisions or this permit shall be deemed revoked i Top FAU WH - LICENSED CONTRACTORS DECLARATION °t Hood —' Fan _ CITY Tel No �' ] , Other_ 1 hereby affirm that I am licensed,under provisidns'yof"Chapter 9in r)o REG NUMBERZR Y Z ' r Disp Room Air Cond ° - ` &e �� Class (JD- (commencing with'Section 7000)'of Division 3 of the Business and - " Professions Code,,and my license is'm`full force and effect DISTRICT NO' PROC ED BY Power,Apparatus& Large'Appliances_„ - �./4 Size& Type HP,KW,'KVA,or KVAR Q License`NumberW-13-6 i Lic Class ' C-- I - Up to'1 Incl FINAL _ Over 1 to 10 Incl DATE C VALIDATION Q Contractor L L i��r�L`Date - , " • ' Over 10 to 50 Incl y ❑ FINAL I am exempt under'Sec _ _ Over 50 to 100 Inc BY W B$PC for this'reason, Over 100� _ �� Services,Swbd,MCC& Panelboards 4 z Date 0- 200 Amp Under 600 V ®Y, Signature �� 201-- 1000 Amp Under 600 V * a F ' - ' Over 1000 Amp'or Over 600 V- ' { Exemption,for Reg Maint Elect • 7, 'SINGLE FAMILY ` j Temp Power Pole& Appurtenances' r 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit s• y 1 �, A { K•-I'hereby affirm that I am exempt from`the Contractor's License Law, •V Addihonal`Si n Branch Circuits ' for the following reason(Section 7031 5, Business and Professions'� g I's, = ` _ r' 9< < i� ! Code) , ' x , - „ 3307 Misc Conducts & Conductors t• r' I,as owner of the property,will do the-work and the structure �, ' r -r, - ''; , � ' .. , is not intended or offered for sale (Section 7044, Business Other (See Complete Fee Schedule),._ i f ``p ','TO and Professions Code) v ' I u CONSTRUCTION LENDING AGENCY �,•. y e _y _xt' CH C - utliVr " Oct, I he}eby'affirm,that•there is a,construction lending agency for the .1 eVl performance of the work for which this permit is issued(Sec 3097,' PERMIT-FEE' ,meq i w (Sub-Total) Civ C) C� r^r {'+ 3 a - PLAN CHECKING FEE r<,11_q4 , :=+-Ar1 ` i , r�' ! Lenders Name° " C•i . ; 11 1' l �li� ' PERMIT'ISSUING'FEE+ ,qp 0� it 7;tt_ Lender's Address �¢ ` - k +, A66 I certrfy that I have read this application and state that the above 1 TOTAL'FEE ►-� = 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 (r `` /' v property for inspection purposes SEE REVERSE FOR EX,47Y LANGILIA IQ•'t _ , ' w^"\ ,- ' � 1'd � , '• r 1 ' i V fig; ' J , Signature of Permittee r —T Date , i- +_� '=" �s ,