HomeMy Public PortalAbout9469 BLACKLEY ST_Electrical__ COUNTY OF Los ANGELES APPLICATION FOR PERMIT
Department of County Engineer1
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOX, County Engineer
FOR APPLICANT TO FILL DISTRICT NO. C3ROUP ZONE PERMIT NO.
ft
ELECTRICIAN MCR STREET
ADDRESS 3 PARK,C+ ' RECEIVED BY READY FOR DATE ISSUED
FIRST INSPECTION
CITY F• 7- EL. NO.
COUNTY LICENSE NO. Vql-/-EXPIRES BUILDING
PERmrr $ ADOREH6
FEE
NUMBER EACH LOCALITY
LIGHT OUTLETS NEAREST
RECEPTACLES CROSS ST.
WALL SWITCHES OWNER
TOTAL OUTLETS Sc >s MAIL
ELEC. RANGES 25 -ADDRESS _
ELEC. HEATERS 25 CITY TEL. NO.
FIXTURES 5 '
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
MISC. :2T APPLICATION AND STATE THAT THE ABOVE 19 CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS' AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS I CERTIFY THAT I P BEGS THE ABOVE VALID LOS
NUMBER HORSEPOWER FEE ANGELES COUNTY LIC E, OR 1 A^ THE LEGAL OW^R
NEW MVD. HP OVER INC. EACH OF THE RESIDENTIAL ti0PERTY DE CRIBE ABOVE.
V2 6 LEBB $ .25 SIGNATURE OF
1/2 2 .50 PERMITTEE-
2 5 1.00 INSPECTION RECORD
s is 1.50
is 50 2.50
50 200 5.00
200 500 10.00 J
500 1 000 15.00 �� Q
OVER 1 000 20.00
M.G. BET/FREQ. CHANGER-HP
WELDER9: AC-KVA
O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (7S% OF DRi G.) -
MOVED MOTORS (75% CIF DRIG.)
MISC.
SISNS
NO. NO.TRANS.
NO. NO. LAMPS 'APPROVALS
FOR EACH PERMIT: J A A _ DATE INSPECTOR'S NAME
WIRING !$1.00 CONDUIT
FIXTURES SLOG WIRING
SUPPLEMENTARY ,50 FIXTURES
POWER
TOTAL FEE UTILITY CO.NOTIFIED /J
FINAL / d
76A663 DBS#5A 2-53
WORKERS' COMPENSATION DECLARATION' -663 ,0�8,
C 'APPLICATION FOR ELECTRICAL,PER
I hereby affirm that I have,a certificate of consent to self insure,
CE-806G
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 _ - ,
n EACH NO FEE, -ADDRESS.-,
Certified copy is hereby furnished New Residential Bldgs,& Pools - r_
= $ _ $ LOCALITY -
Certified copy is filed with the,county budding inspection 1 &`2-Family, Sq Ft — `
department Multi-family Sq Ft' NEAREST
CROSS ST z Residential Swimmmg'Pools OWNER OR L b G M ,
Date Apphcant,f rY t FIRM NAME L
,CERTIFICATE,OF EXEMPTION FROM WORKERS' Outlets Rec~— Light S,w MAIL
COMPENSATION INSURANCE'- t + •• = ADDRESS
. v
-,(This section need not be completed if the work involved by'the , First 201, ?•'•
r: � CITY, %•,L - Tel No�
permit is for,one hundred dollars($100)or less) ti, Total No Additional
? - PLAN CHECK - -
,I certify that in the,performance of the.work for'which this permit 'd APPLICANT mss•,
is issued,'] shall-not•employ,any person,in any manner.,so as to ; ,
'become subject to the Woikers'Compensation,Laws Lighting Fixtures First 201-. ADDRESS
Additional h
_ cn Total No CITY Tel No
Date -o l Applicant Fixed,Appliances Not Over 1 HP' PERMIT
''NOTICE TO: APPLICANT If,, after; makingy this.,Certificate of >'
• Exemption,you,should become subject to the Workers'Compensation Range_ Heater= DW' APPLICANT ;
provisions of the Labor Code,^you must•forthwith"comply,with`such Oven Dryer _ WM ADDRESS, �.
provision§or this permit shall be deemed revoked`, Top FAU W H { _
q' CITY, Tel,No
LICENSED CONTRACTORS DECLARATION t Hood Fan '_ Other_
12hereby affirm that,] am licensed under provisions of Chapter 9 "' ' LICENSE OR;,
Disp Room Air Cond " Class',
(commencing with'Section 7000) of•Division 3 of the,Business and - r ; REG NUMBER
Professions Code,and m license is m,full force and effect - • i DISTRICT'NO PROCESSED
y , Power Apparatus&'Large,.Appiiances ,1
Size& Type HP,KW,KVA,or KVAR l U
License Number Lic ClassFINAL'
Up to 1 Incl
Over 1 Ito 10 Incl DATE _ VALIDATI Q
Contractor Date Over 10 to 50 Incl F-
FIN W
I am exempt under Sec Over 50 to 100 Inc BY W
B&PC for this reason Over-100 n'
rA
Z.
+ + Services,Swbd;MCC&'Panelboards
' Date
- r••, 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 a,
SINGLE FAMILY' Temp Power Pole& Appurtenances
HOME OWNER-BUILDER DECLARATION w; Sign,with One Branch Circuit
I hereby affirm that l am exempt from the'Contractors License Law
s Additional Sign Branch Circuits "
for the following reasom(Section 7031 5,.8usiness and•Profession
r Code)
' + ` MEl
isc�Co" I*ts &:Conductors x''' ^ • ,.,
I,"as owner of the property,will do the work and the structure, Other(See Complete Fee Schedule) �}
-is not,intended or offered for sale (Section 7044, Business' _ • - , r
and Professions Code) RME poll.'
ZI,CONSTRUCTION LENDING AGENCY IC• T°T
~Q7
]•hereby affirm that there is a construction lending agency for .the 33
performance+of the work for which this permit is issued(Sec 3097, PERMIT FEE (Sub-Total) . ' P-,
c1 ITEMS'
�� c)
PLAN CHECKING FEE TIDAL
Lender's Name t + .7�°V�
{ PERMIT ISSUING.FEE iCASH V
Lender's Address hoCp�
,I certify that I have read this application and state that the above TOTAL FEE „ �•HI�H�F.
information is correct I agree to comply with all County ordinances r
and State laws regulating,Electrical wiring, and hereby authorize '
representatives of this`County to enter upon the above-mentioned 1110/39 ,
grope for inspection purpose ,SEE REVERSE.F,OR,EXPLANATORY LANGUAGE ,0300 1 AN 1 .27
ignature of Permittee, Date'