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HomeMy Public PortalAbout9707 BLACKLEY ST_Electrical__ 76A663-CE80610/72 APPLICATION FO ELEC CAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER ADDRESS 7O �(� L BUILDING AND SAFETY DIVISION LOCALITY ( Q /e C� t NEAREST l / ,Q FOR APPLICANT TO FILL IN CROSS ST. 4 p / C' 4)ec /T VP ` OUTLETS NO EACH FEE OWNER OR j /1 _ $ 5 FIRM NAME V y {`.17 +"Cf e RECEPT.� MAIL ADDRESS ? % LIGHT TOTAL FIRST 20 CITY —Ie [� C �"' TEL. NO. rj-fCc.� SWITCH ��, OVER 20 tp PLAN CHECK Ho'V RER 20 ST 20 ,a2- 25 _ •J APPLICANT LIGHTING TOTAL ADDRESS .FIXTURES • •10 .. RESIDENTIAL APPLIANCES CITY TEL. NO., PERMIT RANGE—DRYER WTR. HTR APPLICANT $• STA. COOK DISP. F.A.U. ADDRESS SPACE HTR. AIR COND. CITY' TEL. NO. ICNSE OR CLOTHES WASH. DISHWASH. REG•NUMBER \CLASS. FAN OTHER 100 1 HEHEBI ACKNOWLEDGE THAT' I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS 'RATING WITH-ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC HP KW. KVA. ELECTRICAL WIRING. SIZE & TYPE OVER TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF O - 1 100 CALIFORNIA OR THAI I AM THE LEGAL OWNER OF THE ABOVE7,,, 1 - 10 300 DE S CRIDE- RE ENTIAL P PE$L,Y p_ PERMITEE U 10 - 50 500 SIGNATURE O 50 - 100 1000 C~� DISTRIVr N QPROC SED BY W 100 - 500 1500 Z SIGN, GASSIGN AND ONE CIRCUIT 500 APPROVALS` vvv DATE INSPECTOR'S SIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 100 TEMP. POWER POLE SERVICENOTOVER600VOLTS OR200AMP 300 UNDERSLAB WORK Aft - 1 SERVICE OVER 600 VOLTS OR 200 AMP 10.00 ROUGH CONDUIT TEMPSERVICE, POLE, &APPURTENANCES, 5.00 WIRING , TEMP'LIGHT.OR RECEPT. SYSTEM 300 FIXTURES POWER AUTHORIZED ' UTILITY CO. NOTIFIED FINAL PERMIT FEE (SUB TOTAL) NOTES: PLAN CHECK FEE PERMIT ISSUING FEE 300 3 o C) TOTAL FEE d PLAN CHECK VALIDATION CK. M 0. CASH PERMIT VALIDATION CK M 0. CASH 4 1 5�JtiN 10 2 D 6a7 d e J_ SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE v 76A663-C.E 806 3-69 1 . APPLICATION FOR ELECTRICA PERMIT 'COUNTY OF LOS ANGELES DEPART'MENY OF-COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS et-1 0 110 JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDINGLOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. J NO. EACH FEE n $ $ OWNER `. E C I �_P_ KING-AST RECEIPT. MAIL `, FIRST 20 .20 jo a ADDRESS 0 �• /�3Ll (_KLE 7 LIGHT TOTAL e� t c C OVER 20 .10 CITY �-1�({ CITYTEL.N0. SWITCH PLAN CHECK LIGHTING TOTAL FIRST 20 ,20 APPLICANT FIXTURES OVER 20 ,10 ADDRESS CITY TEL.NO. RANGE -DRYER_WTR. HTR. CONTRACTOR STA. COOK_DISP. _F.A.U. SPACE HTR. AIR CONO. ADDRESS CLOTHES WASH._DISHWASH. CITY TEL.NO. FAN OTHER 1.00 LICENSE NO. CLASS. MOTORS,TRANSFORMERS RATING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION IND. HEATERS, ETC. HP. KW. KVA. AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY SIZE TYPE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. 0 - 1 1.00 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATEOF 1 - 10 3.00 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO O RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. U 10 - 50 5.00 SIGNATURE ad 450 - 100 10.00 OF PERMITTEE G 100 - 500 15.00 DISTR�T NO. GROU ZONE PRO E ED d N SIGN,GAS SIGN AND ONE CIRCUIT 3.00 �� `•' Z TUBE, OR — MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES: SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 SERVICE OVER 600 VOLTS OR 200 AMP 5.00 TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE TEMP. POWER POLE UNDERSLAB WORK ROUGH CONDUIT WIRING PERMIT,FEE (SUB TOTAL) FIXTURES POWER AUTHORIZED PLAN CHECK FEE (50% PERMIT FEE) PERMIT ISSUING FEE 2.00 UTILITY CO.NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL TOTAL FEE D JOSEPH C. ROOHAN SUPERVISING ELECTRICAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION �' M.O. CASH f 6('_ 4 0 3 4� 14AR1 1 2 D 4.60;` -- SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE C. 76A663-CE80610-59 APPLICATION FOR ELECTRIC PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING �07� �� �/�� BUILDING AND SAFETY DIVISION ADDRESS / !� JOHN A. LAMBIE. COUNTY ENGINEER —�rT WILLIAM A.JENSEN. SUPT of BUILDING LOCALITY FOR APPLICANT TO FILL IN c AREsT. l/ / PERMIT FEES OWNER 1 T E M NUMBER EACH FEE OUTLETS: $ MAIL ADDRESS LIGHTS RECEPT. SW. 1O LIGHTING FIXTURES 10 CITY TEL.NO. ELEC.RANGES CLO.DRYERS ELECTRICIAN C 1/(�✓c G WATER HEATERS / .50 o ADDRESS 7L✓ ELEC.SPACE HTRS. DISHWASHERS LL CITY 'r 6f2l9xTEL. NOT i GARBAGE DISPOSERS AUTO.- STATE //'/ •y-� _/Q WASHERS STA.COOKING UNITS .25 LICENSE NO. -11667 {p (Q MOTORS: OVER INC. H.P. DISTRICT O. G1������P N PR ESSED BY O— 1/2 .25 Q I : 1/ l 1/2- 2 .50 INSPECTION RECORD 2— 5 1.00 5— 15 1.50 15— 50 2.50 50-200 5.00 NO.TRANS. SIGNS: NO.LAMPS SERVICE 0-600V 1.00 � SERVICE OVER 600V 5.00 misc. k WIRING PERMIT LOO 1 FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT .50 TOTAL FEE S �J 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT ELECTRICAL WIRING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR WIRING LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT 1 AM G WNER OF THE ABOVE DESCRIBED RESIDENTIAL /PPERTY. POWER SIGNATURE I UTILITYCO.NOTIFIED OF PERMITTEE FINAL ®F - DATION ARTHUR C.VETT. cK Mo CASH SUPERVISING ELECTRICAL ENGINEER ULO 2 7 5 E NOV 0 2 D 2 S 0 I :'WORKERS'COMPENSATION DECLARATION 76-663 10,61 CE-806G APPLICATION FOR ELECTRICAL PERMIT I hereby_aifwirrri that I-have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof'(Sec 380C.Lab C) + Policy No! Company FOR APPLICANT TO FILL IN JOB El . Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS ❑ 1 & 2-Family, Sq.Ft $ _ $ LOCALITY Certified copy is filed with the county building inspection A l: department Multi-family Sq Ft NEARECROSS ST ST �, (� l�+Il q` ,1 VG TOD,- Date Applicant Residential Swimming Pools OWNER OR -� FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec Light Sw MAIL ���r, COMPENSATION INSURANCE ADDRESS V (This section need not be completed if the work involved by the Aust 20 Total No Tel No. Additional CITY permit is for one hundred dollars($100)or less.) �C, PLAN CHECK I certify that in the performance of the`work for which this permit APPLICANT is issued, I hal not employ y person in a4'c ,become su lett o the Wgt�gr �ompensationLighting Fixtures First 20 ADDRESS 11((//,9 AdditionalTotal No CITY Tel No Date ApplicantFixed Appliances Not Over 1 HIPNOTICE O APPLICANT. If, after making PERMIT Exemption,you should become subject to the WRange_ Heater_ DW. APPLICANT` Provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W M ADDRESS � provisions or this permit shall be deemed revoked Top — FAU _ W H. CITY Tel No LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ I hereby affirm that I am licensed under provisions of Chapter 9 Disp Room Air Cond. LICENSE OR t- t Class (commencing with Section 7000) of Division 3 of the Business and REG NUMBER "' Professions Code,and my license is in full force and effect Power Apparatus& Large Appliances DISTRICT NO�� PROCESSED BY � a •'- Size& Type HP,KW,KVA,or KVAR 0 License Number 6 x6e0o I Lit Class Up to 1 Incl FINAL U ����,�,,{//� _ Over 1 to 10 Incl DATE � Contractor �JEMQkL Date VALIDATION 0 ❑ Over 10 to 50 Incl FINAL _ I" I am exempt under Sec / Over 50 to 100 Inc. BY W B&P C for this reason Over 100 N Services,Swbd;MCC & Panelboards / ® Z Date 0- 200 Amp Under 600 V r Signature 201 - 1000 Amp Under 600 V. Over e1000 Amp or Over 600 V Exemption for Reg.Maint Elect. SINGLE FAMILY Temp Power Pole & Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 1 I hereby affirm that I am exempt from the Contractor's License Law h Circuits n B Sign Branch for the following reason(Section 7031 5, Business and Professions AdditionalACCT, Code) 3-1107 �{,ti!f's El Misc Conduits& Conductors P I,as owner of the property,will do the work and the structureM { T is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) 1 � °`1 and Professions Code). lot. TOTAL 31 4 00 F - - CONSTRUCTION LENDING AGENCY {.IlE`_K I hereby affirm that there is a construction lending agency for the �-r performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) �^ �•hAhl`3t oiLi Civ. C) PLAN CHECKING FEE iT, ender's Name PERMIT ISSUING FEE �?C_ der's Address M 0. � !1 1 A'! �.4210 tify that I have read this application and state that the above TOTAL FEE ation is correct. I agree to comply with all County ordinances to laws regulating Electrical wiring, and hereby authorize tiv'bs of this County to enter upon the ove entioned ..or insp urpos SEE REVERSE FOR EXPLANATORY LANGUAGE Permittee 1 WORKERS',COMPENSATION DECLARATION CE-806 APPLICATION '.FOR ELECTRICAL PERMIT f consent t elf COUNTY OF LO -ANGELS ' I IN AN SAFETY I hereby affirm,that I have a certificate o s t o s $ S � � _ BU LD G AND . insure, or a certificate of Workers'Compensation Insurance,or / a certified copy thereof(Sec. 3800, Lab.,C.) FOR APPLICANT TO FILL IN JOB (� © 7 ^ /� Policy No. Company EACH NO. FEE ADDRESS, 7 ihu91( l _ New Residential Bldgs.&Pools Q Certified copy'is hereby furnished. 1 &2-Family,Sq. Ft. 765 $ — $ LOCALITY �.� � Multi-family Sq. Ft. — NEAREST 40 ' Certified copy is filed with the county building inspection Residential Swimming Pools CROSS ST, ❑ department. F OWNER OR FIRM NAME 70 Date Applicant Outlets Rec if24--ight' Sw.� s� o2O rd irst 20 ADDRESS 7f7 h lic CERTIFICATE OF EXEMETION FROM,WORKERS' Total No Additional 1 30 CITY��+-� �' Tel No. as 5,-goo a COMPENSATION INSURANCE `*1 PLAN CHECK/ (This section 'need not be completed if the work involved APPLICANTU ' by, the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First aoDRESs O onal O Total No. Additio ^ ^ _ n I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY ( Tel No. permit is issued,'I shall not employ any person in any manner PERMIT W so as to become subject to the Worker ' Compensation Laws. Range_ Heater_D.W. APPLICANT 0 M Oven _ Dryer-W.M. ADDRESS 7 6 7 /4 G z r�9 Date.ya-V_ VApplicant Top FAU _W.H. CITY—� �� �4 Tel No. �OC c}6O(p //4__ Hood — Fan _Other_ , J` '/ NOTICE TO APPLICANT: f, ter making this Certificate of Disp. _ Room Air Cond._ LICENSE OR Exemption, you should ome subject to the Workers' REG. NUMBE Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCES ED BY with- comply with such provisions or this permit shall beSize&Type HP,KW,'KVA;or KVAR deemed revoked. C)(( Up to 1 Incl, FINAL LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATE ` Over 10 to 50 Incl. VALIDATION I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL 9 (commencing with Section 7000 of Division 3 of the Busi- v BY ( g ) Over 100 , ness and Professions Code, and my license is in full force and effect. Se'rvicea License Number Lia Class 0-200 Amp. Under 600 V 201-1000 Amp. Under 600 V Contractor Date Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit License Law for-the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits ness and Professions Code): :2,1,5 2 1 A Misc.Conduits&Conductors I as owner of the property, will do the work-and the Other (See Complete Fee Schedule)— #.o.0 0 0 0 2 structure is,not intended or offered for sale (Section 7044, Business and Professions Code). 2,° -6,Q CONSTRUCTION LENDING AGENCY a• I hereby affirm that there;is a"construction lending agency 0-0 0 2 5,(,Q,s for the performance of the work for which this permit is PERMIT FEE (Sub-Total) , issued(Sec. 3097,Civ.C.): - Q •� 3-'8 Lender's Name PLAN CHECKING FEE (One-Fourth,Permit Fee) Lender's Address PERMIT ISSUING FEE I certify that I have read this application and state that the TOTAL FEE (� above information is correct.I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this'Counfy to enter upon the above-mentigned property for inspection.purposes. SEE REVERSE-FOR EXPLANATORY LANGUAGE , S' ature of,Permitfee Date