HomeMy Public PortalAbout9621 BROADWAY_Electrical__ COUNTY OF LOB ANGELES I.
APPLICATION FOR PERMIT
Department o4 EngineerELECTRIC
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pIVISION OF BUILDING & SAFAFETY
WILLIAM J. FOX, County Engineer
FOR APPLICANT TO FILL IN DISTRICT NO. OROLJP ZONE PERMIT NO.
ELECTRICIAN 5 %— /JI —/ 7a
RE f.E LVED BY READY FOR ATE ISSUED
ADDRESS FIRST INSPECTION P
CITY /'/�/ TEL NO. C%),YQV'�-wl/t', (/C/_
COUNTY LICENSE NO. EXPIRES 114, BUILDING
PERMIT FEES T
- FEC _ADDRESS
NUMBER EACH LOCALITY ["Jim P 5
LIGHT OUTLETB NEAREST
ii
RECEPTACLES GRDBB BT,
XqAg
WALL SWITCHES OWNER ^I/Q
TOTAL OUTLETS SD 8 MAIL
ELEC.*RANGE9 25 ADDRESS NA�
ELEC. HEATERS 23 CITY TEL. NO. _
FIXTUREB 6
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MIBC. APPLICATION AND STATE THAT THE ABOVE IB CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOB
NUHRER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
NEw MVD. HP DYER IHc. EACH OF THE REBIDENTIAL PROPERTY DESCRIBED ABOVE.
Vz A LESS $ .25 SIGNATURE OF
I/z 2 .50 PERMv^
2 5 1.00 INSPECTION RECORD
s 15 1.sD _
_ Ts 50 2.SU _
50 200 5.00
2GG: Sao 10.00 J
saD 1ooD ts.DD Q
— 2
OVER 1000 20.00
_MOVED_MCTORS (95% OF ORIG.)
N.G. SET/FRED. CHANGER-HP O
WELDERS: AC-KVA _
GENERATORS - KW
TRANSFORMERS - KVA
MIBC.
SIGNS
NO. NO.TRAMS.
APPROVALS
NO. NO. LAMPB
FOR EACH PERMIT: DATE INSP CTOR•B NAME
WIRING $11,013 /IACONDUIT
FIXTURES $1.00 OVy WIRING
ISUPPLEMENTARY ,50 FIXTURES
POWER
TOTAL FEE $ 5r 4or UTILITY CO.NOTIFIED . fit) za %A.VP'lt,----� '
FINAL 3.a I cf,-U--
7sAssa Das#SA Cd b 12.53
w( PERS'GD IPENSATION DECLARATION 8S06G (2.801 63
CE . APPLICATION FOR ELECTRICAL PERMIT
CE
I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY
insure, or a certificate of Workers'Compensation Insurance,or
a certified copMereof(Sec. 3800, Lab.C.)
FOR APPLICANT TO FILL IN ,1pg
Policy Nn. Company New Residential Bldgs.& Pools EACH NO, FEE ADDRESS gvadwav
0 Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. S — $ LOCALITY L
❑ Multi-family Sq. Ft. — NEAR ST LVD _
Certified copy is filed with the county building inspection CROSS ST r�
department. Residential Swimming Pools OWNER OR
FIRM NAME
Datz Applicant Outlets: Rec.((// MA
y J
,LLigh[_rst MDO KESS �2 groa f/7JGf
First 20
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY TL Tel No..' S. '_0N"1 I >.
COMPENSATION INSURANCE
PLAN CHECK O.
(This section need not be completed if the work involved APPLICANT "" 0
by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 DDRESS
Additional cc
I certifythat in the Total No-4— 0
performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. ll-
permit
permit is issued, I shall not employ any person in any manner PERMITW
so as to become subject to the Workers' Compensation Laws. Range_ Heater—D.W. _ APPLICANT _ 1
Oven _ Dryer_W.M. ADDRESS N
q l� 2
Date Applicant �-.N/ uV ' r rWV`' _ Top — FAU _W.H.
Hood — Fan _Other_ CITY Tel No.
NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond.— LICENSE OR
Exemption, you should become subject to the Workers' REG. NUMBER Class
Compensation provisions of the Labor Code,'you must forth- Power Apparatus& Large Appliances DISTRICT NO PROC S BY
with comply with such provisions or this permit shall be
deemed revoked. Size&Type HP,KW, KVA,or KVAR S
Up to 1 Incl c
FINAL
Over 1 to 101ncl. DATE
LICENSED CONTRACTORS DECLARATION VAI I ATION
Over 10 to 50 Incl.
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL
9 (commencing wi[h'Section 7000)of Division 3 of the Busi- BY Over 700 '
ness and Professions.Code, and my license is in full force and
effect. Services
License Number Lic.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 DECLARATIONTemp. Power Pole& Appurtenances 9 2 8 6 0 A 2
#
Sign with One Branch Circuit '
I hereby affirm that I am exempt from the Contractor's �.� ) • • 1 S 0 o
License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits ,
ness an Professions Code): O 0 5
Misc.Conduits&Conductors $5
I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)—
structure is not intended or offered for sale (Section
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is PERMIT FEE (Sub-Total)
issued(Sec. 3097.Civ.C.).
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee)
Lender's Address PERMIT ISSUING FEE
I certify that 1 have read this application and state that the TOTAL FEE P1571
above information is correct.I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
the above-mentioned property fq Inspection purses, SEE REVERSE FOR EXPLANATORY LANGUAGE
Sig u e of Permitt D6te