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Home My Public Portal About9531 BLACKLEY ST_Electrical__ 76A663 DBB SA 11-49 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY ELECTRIC �� COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO. ELECTRICIAN — RECEIVED BY READY FOR DATE ISSUED ADDRESS / `W 'dp f FIRST INSPECTION 7 /� CITY i TEL NO. g/ /U—/ XJ COUNTY LICENSE NO. 60 EXPIREB d— BUILDING Q� � - PERMIT FEES 'ADDRESS ilp6• FEELOCALITY �J NUMBER OUTLETS EACH LIGHT 'Sc $ L../ NEAREST 16 CROSS ST. RECEPTACLES 5 FIXTURES 5 OWNER WALL SWITCHES s MAIL ADDRESS ELEC. RANGES 25 ELEC. HEATERS 25 CITY TEL. NO. MISC. I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS NUMBER OF CIRCUITS INSTALLED: TOTAL 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 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOB NEW MVD. HP OVER INC. EACH ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER %2 s EBB $ .25 OF THE RESIDENTIAL PROPER T CR ^ BOVE. I/2 2 .50 SIGNATURE OF /V� 2 B 1.00 PERMITTEE s is 1.50 INSPECTION RECORD 15 50 2.50 so 2013 s.00 200 500 10.00 Soo 1000 15.00 J Q OVER 1000 20.00 Z M.G: SET/FREQ. CHANGER-HP Q WELDERS:AC-KVA R' GENERATORS - KW O TRANSFORMERS - KVA TEMP. MOTORS (75% OR ORIG.) MOVED MOTORS (75% OF OR113.) MISC. SIGNS TYPE: NO.TRANS. TYPE: NO. LAMPS APPROVALS FOR EACH PERMIT: DATE INSPECTOR'S NAME WIRING ,$1.00 CONDUIT / , FIXTURES $1.00 WIRING C /f' Z1 SUPPLEMENTARY ,50 FIXTURES POWER TOTAL FEE $ UTILITY CO. NOTIFIED �J7 FINAL jS1WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91)76A663 APPLICATION FOR ELECTRICAL PERMIT I heraty affirm-that I have a certificate of consent to self Insure, or a certificate of Worker's-Comp"ansatlon Insurance. or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof(Sec 3800,Lab C) 4'r Policy NO Company FOR APPLICANT TO FILL IN JOB n ADDRESS r'C. Certdied copy is hereby furnished New Residential Bldgs &Pools NO EACH FEE LOCALITY _ Certified copy is fded'with the county bud1 &2-Family,Sq Ft ding Inspection — NEAREST department Multi-family Sq Ft CROSS ST ^ Date Applicant Residential Swimming Pools ASSESSOR PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec _Light Sw RRM NAME� `� " COMPENSATION INSURANCE First 20 MAIL (This section need not be completed if the work involved by the ADDRESS f permit is for one hundred dollars($100)or less.) 12 Total No Additional I certify that in the performance of the work for which this permit CITY , °._Z Tel o 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 /cif Total No Additional " ADDRESS Date Applicant = RESIDENTIAL APPLIANCES NOT OVER 3 HP NOTICE TO APPLICANT If, after making this Certificate of CITY „(},� ,�! C�� T11 No ,- 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 PERMIT Power Apparatus&Large Appliances APPLICANT ! 4 .�l provisions or this permit shall be deemed revoked LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS C I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl CITY Tel No (commencing with Section 7000) of Division 3 of the Business and ^� �, .Z g Professions Code, and my license is In full force and effect Over 10 to'50 Incl Over 50 t0 100 IRCI LICENSE OR ClassREG NUMBER d License Number Lic Class Over 100 DISTRICT NO n Q P O SED BY O sA W, I t P e1 rds !/d � -�C� U 1 v 3 9 mp Under 00 V FINAL O Contractor Date DATE ', ❑ 400-1000 Amp Under 600 V Z % ~ I am exempt under Sec VALIDATION V Over 1000 Amp or Over 600 V FINAL SLI B&P C for this reasonBRANCH CIRCUIT FEES BY 11 Date 15A,or 20A, 120V,Lighting or Recept Z 1 To 10 Branch Circuits Signature n 11 To 40 Branch Circuits ❑ 41 Or More Branch Cir.Its Exemption for Reg Maint Elect', 15A,20A,208V To 277V Lighting Br Circuits SINGLE FAMILY Temp Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Business and Professions Additional Sign Branch Circuits Code I, as owner Misc Conduits&Conductors of the property,well do the work and the structure t? g is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) ACCT.T and Professions Code) 6"303 65.-60 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the TIME T��,II 'MS65®60 performance of the work for,which this permit is Issued (Sec 3097, PERMIT FEE (Sub-Total) Civ C) (('� PLAN CHECKING FEE CHECK. 65.170 Lender's Name CHANGE s00 PERMIT ISSUING FEE - Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE el (O O�yM�ry f'00 i c that the above information Is correct I agree to comply with all County OViJtl�0001 Q/14/9:1 ordinances and State laws regulating Electrical wiring,and hereby authorize 2304 1 AM 9 e 5,4,' representatives of this County to enter upon the above-mentioned property for inspection purposes e SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURO.F PERMITTEE 1DATE!