HomeMy Public PortalAbout10121 BOGUE ST_Electrical__ 76A663 DBS SA 3-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND 3AFET�Y
COUNTY OF LOS ANGELES ��
WILLIAM J. FOX, CHIEF ENGINEER
A DISTRICT'NO. GROUP I ZONE PERMIT NO.
F0,R'NAPPPLLICA7T TO FILL IN
ELECTRICIAN- ` RECEIVED BY READY FOR DAT ISSUED
ADDRESS/QHY'/Q A&A FIRST INSPECTION 2p/�
7 �
CITY Dp,f� �/ TEL NO. v/
COUNTY LICENSE NO. A� a1 EXPIRES 13UILDIN13
PERMIT FEES ` ADDRESS ` ! PPP�+tyJJf✓��Z�A-�o�/
NUMBER EACH FEE LOCALITY
LIGHT OUTLETS NEAREST
RECEPTACLES
CROSS ST. /j
-
WALL SWITCHES CP OWNER
TOTAL OUTLETS 5C $ Q5 ® MAIL (/
ELEC. RANGES n 25 ADDRESS
ELEC. HEATERS p 25 _�i CITY TEL NO.
FIXTURES 5
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT
NUMBER OF LIGHT CIRCUITS (O V AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWERANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
FEE
NEW MVD. HP OVER INC. EACH OF THE RESIDENTIAL ROPERTY DESCRIED ABOVE.
110 %t & LESS $ .25 _ SIGNATURE OF
I/2 2 .50 PERMITTED
/r✓ fU
2 5 1.013 INSPECTION RECORDS
5 15 1.50
15 50 2.50
50 200 5.00
200 500 10.00 J
500 1000 I5.00 Z
OVER 1000 20.00 Q
M.G. SET/FREQ. CHANGER-HP Q'
WELDERS:AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF CRIG.)
MOVED MOTORS (75% OF CRIB.)
MISC.
SIGNS
NO. NO.TRANS.
APPROVALS
NO. NO. LAMPS
DATE INSPECTOR'S NAME
FOR EACH PERMIT: /
CONDUIT
WIRING $1.00 Q 7J
/
FIXTURES $1.00 f O WIRING �GC�
1'
SUPPLEMENTARY .50 FIXTURES
POWER
TOTAL FEE $ UTILITY CO.NOTIFIEDf
/ FINAL
V
WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT
I'I''.reby;affirm 76A663
that I have a certificate of consent to self Insure,
a corti(,,eate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec 3800 Lab. C.
Policy No.2? -q o JOB
Ompany ���^ •+��' FOR APPLICANT TO FILL IN ADDRESS
Certified copy is hereby furnished New Residential Bldgs.&Pools NO EACH FEE
❑ _ $ $ LOCALITY �
Certified copy is filed with the county building Inspection 1&2-Family,Sq.Ft NEAREST
department �r Multi-family Sq Ft. CROSS ST
Date `�% 94C Applicant QC Residential Swimming Pools MASE
l�,�//ASSSOR PAGE PARCEL
CERTIFICATE OF EXEMPTIO OM WORKER Outlets:Rec _Light Sw OWM NAME 14e C
COMPENSATION IN URANCE First 20
(This section need not be completed if the work involved by the ADDRESS
permit is for one hundred dollars($100)or less.) Total No. Additional
I certify that in the performance df the work for which this permit CITY Tel No
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
Total No Additional ADDRESS
Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel 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 suchClank
IT
p p y Power Apparatus&Large Appliances PPPLICANT A,
provisions or this permit shall be deemed revoked
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS /,504-S
I.hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl.
(commencing with Section 7000) of Division 3 of the Business and CITYOver 10 to 50 Incl Tel N / j.Q Q
Professions Code, and my license Is In full force and effect. LICENSE OR /1� �`® C 10 d
/� Over 50 to 100 Incl. REG NUMBER YY 5 C Class r`
A 7 O Over 100 DISTRICT NO P SSED BY O
License Number ra Llc.Class U
^ Services,Swbd.,MCC&Panelboardsi 0 ems'�/ �(� M
Contractor Date �V t`�—t�� 0-399 Amp Under 600 V }j DATE O
ElI a empt under Sec 400-1000 Amp. Under 600 V � �-� VALIDATION W
Over 1000 Amp.or Over 600 V FINAL a.
B&P C for this reasonBY fn
BRANCH CIRCUIT FEES
Date 15A,or 20A,120V,Lighting or Recept Z
1 To 10 Branch Circuits
Signature 11 To 40 Branch Circuits
El
41 Or More Branch Circuits
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) 02
❑ I,as owner of the property,will do the work and the structure Misc Conduits&Conductors ACtT,B
g
Is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) f1
and Professions Code) , °303 6-5.60
CONSTRUCTION LENDING AGENCY 1 ITEMS
EMS
I hereby affirm that there Is a construction lending agency for the TOTAL 65_ �
performance of the work for which this permit Is issued (Sec 3097, PERMIT FEE (Sub-Total)
Civ.C> CHECK 65.60
PLAN CHECKING FEE
Lender's Name CHANGE .00
PERMIT ISSUING FEE
Lender's Address / n tt tt
I certify that I have read this application and under penalty of purjury state TOTAL FEE 0000-0001 4/ O/9h
that the above information Is correct I agree to comply with all County t pp itt
ordinances and State laws regulating Electrical wiring,and hereby authorize 6782 1 At�ti 110=Cc
representatives of this County to enter upon the above-mentioned property
fo nspectio urpose SEE REVERSE FOR EXPLANATORY LANGUAGE
� p6. a6, C?1", •
SIGN /RE OF PERMITT DATE „