HomeMy Public PortalAbout9553 BLACKLEY ST_Electrical__ 76A669-CE806-11-0APPL.ICATI®N F®R.=ELECTRIC PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER FNEA:REST
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BUILDING AND SAFETY DIVISION
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jjOHN A. LAMBIE. Count eer L '✓
CXSOR-Ir D. GRIFFIN.Snp t of .ui Lg
FOR APPLICANT TO FILL IN
PERMIT FEES OWNER
1 T E M NUMBER EACH FEE
OUTLETq- $ MAIL
LIGHTS RECEPT. SW. 10.1O _ �f7 ADDRESS
.
LIGHTING FIXTURES .10 yr CITY x2TEL.NO.
ELEC.RANGES CLO.DRY RS ELECTRICl/.k , -L
WATER HEATERS .50 ./
>, ELEC.SPACE HTRS. DISHWASHERS ADDRESS -�L /7—`-'
GARBAGE DISPOSERS AUTO.- CITY T O. J f7
•• WASHERS STA.COOKING UNITS 25 STATE // 1 �� `
LICENSE NO. ( CJ J
i MOTORS: OVER INC H.P. -
DISTRNO. GROUPI GROUPZONE READY FOR INSPECTION"
0 — +/z 25
+/z — 2 .50
z — 5 1.00 INSPECTION RECORD
5 — 15 1.50
15 — 50 2.50
50— 200 5.00
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SIGNS: NO.TRANS. ,
NO LAMPS
SERVICE 0-600V 1.00 o
SERVICE OVER 600V - 5.00
MISC. +• - - ,
WIRING PERMIT 1.00
TFIXTURE PERMIT - 1.00 1
SUPPLEMENTARY PERMIT 50
TOTAL FEE g Q a APPROVALS
I HEREBY ACKNOWLEDGE THAT I HAVEC-READ' THIS'APPL CATION DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT' /J
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING _
ELECTRICAL WIRING. WIRING )'/V 77'7
I HEREBY CERTIFY HAT 1 ROPERLY REGISTERQD AND/OR
LICENSED AS REQUI D' BY LO ANGELES COUNTY STATE OF FIXTURES
CALIFORNIA OR TH �1 AM E L GAL OWNER OF THE ABOVE /
DESCRIBED RESIDEN ROPER Y. I /�/4 POWER
SIGNATURE 6/ .1'/', (��,J�. UTILITY CO.NOTIFIED4r-Ar--,g—
OF
4
OF PERMITTE V
FINAL
LIDATION ARTHUR C.VETT. ;
cK Mo' CASH SUPERVISING ELECTRICAL ENGINEER
I ACO3 9 5 8 E AUG 18 2 A 7.f Q
WORKERS'eOMPEN4TION DECLARATION CE 8 6G 10/81 APPLICATION FOR ELECTRICALPERMIT,
•I heiek--Iffirm that I ha�e a certificate of consent to self
irrture, or q certificate of4Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified co t ere (Sec 3800, Lab C )
7�]��,� �►86ZB�a
Palet: No. Company tT�S? bre FOR APPLICANT TO FILL IN JOB
ADDRESS
❑ Certified copy is hereby furnished New Residential Bldgs. & Pools EACH NO FEE
❑ 1 & 2-Famil 5 Ft $ — $ LOCALITY e
Certified copy is filed with the county building inspec- y, q
NEAREST
tion department Multi-family Sq. Ft CROSS ST
4 8� Vl � Residential Swimming Pools OWNER OR /_ ^
Date Applicant,
• 'FIRM NAME '�GiAc-
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL
COMPENSATION INSURANCE ADDRESS
This section need not be completed if the work involved b First 20
( p y Total No. Additional CITY Tel. No.
the permit is For one hundred dollars ($100)or less.) lr
that in the performance of the work for which this PLAN CHECK
I certify P APPLICANT
permit is issued, I sholl'not employ any person in any manner
so as to become subject to the Workers'Compensation Laws Lighting Fixtures First 20 Q D ADDRESS
Total No. Additional
CITY Tel. No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT- If, after making this Certificate of APPLICANT� i�.. rJl/ti1V0 !
Exemption, you should become subject to the Workers' Range_ Heater D.W. —
Compensation provisions of the Labor Code, you must forth- Oven _ Dryer — W.M ADDRESS 90cs),
with-comply with -such provisions or this'permit shall be Top — FAU —W.H• l,�
deemed revoked. CITY Gv'L.✓A Tel. No. j7—'J f�(�
LICENSED CONTRACTORS DECLARATION Hood _ Fan Other— '`
Disp — Room Air Cond. (f LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 REG NUMBER 2276-7Class.
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCE r
and Professions Code, and my license is in full force and effect. Power Apparatus& Large Appliances r/ O
M Size &Type HP, KW, KVA, or KVAR f (XJ U
License Number 2SB f Lic Class_, — I
FINAL
Up to 1 Incl. DATE Q
� � Lj _/ Over ]-to 10 Incl. VALID ION l..
Contractor Date Over 10 to 50 Incl
❑ W
FINA
I am exempt under Sec. Over 50 to 100 Inc. BY CL
B.&P.0 for this reason Over 100 Z
Z •
Date- Services, Swbd., MCC& Panelboards ► —
0 -200 Amp. Under 600 V loci
Signature 201 - 1000 Amp. Under 600 V ;243-6:1 A
❑ Exemption for Reg Maint. Elect. Over 1000 Amp. or Over 600 V # 0.0,0.0 0 2
SINGLE FAMILY Temp. Power Pole & Appurtenances ; o'0 6'2 5 0
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
Law for the following reason (Section 7031 5, Business and
Professions Code)' 0 4,0-2'�8 6
E] 1, as owner of the property, will do the work and the Misc Conduits 8 Conductors
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ ,
7044, Business and Professions Code)
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
(Sec 3097, Civ C.)
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE
Lender's Address
I certify that I have read this application and state that the TOTAL FEE E6 U.
above information is correct I agree to comply with all County
ordinances and State laws re ulating Electrical wiring, and
hereby au ize represent h es of this County to enter upon
the bo enti ned ro 'r or inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature U
ermittee Date