HomeMy Public PortalAbout9963 BROADWAY_Electrical__ °Rs . 6 APPLICATION FOR PERMIT
DEPARTMENT OF BUH.DING AND SAFETY ELECTRIC
COUNTY OF LOS ANGELES
WM. J. FOX CHIEF ENGINEER
r a r NAME U� DISTRICT NO. GROUP ZONE PERMIT NO.
U ADDRESS ZSL,3 / �(/ d 67�
K _
U CITY �i TEL.NO. 3I7' EIV BY READY FOR DATE ISSUED
FIRST INSPECTION
4 COUNTY
W CERT.NO. 'y� EXPIRES Z .7A
APPLICANT FILL & HEAVILY TLINED PORTION ONLY
DESCRUMON OF WORK A1DRESS �N �_f O-fl[R v0
NUMBER OF OUTLETS ON CIRCUITS LOCALITY
LOCATION BY ROOMS '—
NEAREST
LIGHT OUTLETS SW. PLUGS FET CROSS 6T.
CIRCUIT, A B C D E F G 1H X NAME
Z MAIL
ADDRESS
/ / O CITY TEL.NO.
n I/ 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTWICALTE,015 QUALIFICATION..
' / - ELEGiPICIAN.
1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE
OWNER.
/ CORRECTIONS
ITITALif /� /r Z
1 / /1 . A
NO. OF OUTLETS $ `S APPROVALS
NO. OF FIXTURES $ .7 DATE INSPECTOR'S NAME
NO. OF MOTORS H.P. $ CONDUIT
NO. OF SIGNS TRANS. $ WIRING
NO. OF RANGES OR HEATERS $ FIXTURES
MISCELLANEOUS $ ( .POWER Opp
PERMIT FEE $ / �'� UTILITYCO.NOTIFIED G 349 7 GI
TOTAL FEE FINAL
DSS 5-A 6-46
DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PPERMCOUNTY OF LOS ANGELES ELECTRICWM. J. FOX �CHInEF ENGINEER
< NAME DISTRICT NO. GROUP I ZONE PERMIT NO.
ADDRESSREADY FOR
�� �� /J ll ' � ' • /
U CITY TEL.NO. � /$ RECEIY D BY FIRST INSPECTION DATE ISSUED
,J COUNTY
W CERT.NO. /�0 EXPIRES ,3 7
APPLICANT FILL N HfEAVILY OUTLINED PORTION ONLY .
DESCRIPTION OF WORK 'ADDRESS
NUMBER OF OUTLETS ON CIRCUITS LOCALITY C
LOCATION BY ROOMS
NEAREST
LIGHT OUTLETS lsw.I UGS FIXT CROSS ST. .y.L�1'ZAAt>
)
CIRCUIT A B I C D E I F G JH w NAME
w
Z MAIL
ADDRESS
O
CITY TEL.NO.
1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CESTIFICAIE QF QUALIFICATION..
1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
/ ABOVE
OWNER.
CORRECTIONS
_ J
Q
Z
I7
E
O
TOTAL
NO. OF OUTLETS Z s In APPROVALS
NO. OF FIXTURES $ DATE INSPECTOR'S NAME
NO. OF MOTORS H.P. $ CONDUIT
NO. OF SIGNS TRANS. $ WIRING
NO. OF RANGES OR HEATERS $ FIXTURES
MISCELLANEOUS $ POWER
PERMIT FEE 0 $ OQ UTILITYCO.NOTIFIED ^4_ (/ l 7_s
TOTAL FEE O FINAL
Wm that I have a certificate
DECLARATION CE-883 10,61 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self insure, CE-806G
or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec. 3BO0,Lab. C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB / * � I
E] Certifiedcopy is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE ADDRESS 6 rU m 7
❑ Certified copy is filed with the county building inspection 1 & 2-Family, Sq.Ft. $ — $ LOCALITY
department. Multi-family Sq.FL CROSSSST. /}Lp(yJiN 14Vi
Date Applicant Residential Swimming Poole OWNER OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec Light Sw. MAIL
COMPENSATION INSURANCE ADDRESS
(This section need not be completed if the work involved by the First 20
permit is for one hundred dollars($100)or less.) Total No. Additional CITY Tel.No.
I certify that in the performance of the work for which this permit PLAN CHECK
is issued, I shall not employ any person in any manner s0 as to APPLICANT
became subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
Additional CITY Tel.No.
Total No.
NOTIC
Date Applicant Fixed Appliances Not Over 1 HP
Exemption,
O should
become
If, after making this Certificate of PERMIT
Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. APPLICANT IL- L C—LA5C_r e I
provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M. _ ADDRESS 33T C 6U6 /-
provisions or this permit shall be deemed revoked. Top _ FAU _ W.H.
CITY o,URJ Vi g TeqVALIATION
LICENSED CONTRACTORS DECLARATION Hood — Fan Other_
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. LICENSE OR .L,/.3 n Cl ..
(commencing with Section 7000) of Division 3 of the Business and REG.NUMBER T 2—Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PROLESize& Type HP,KW,KVA,or KVAR Q
License Number 7 b y Lic.Class Up to 1 Incl. FINAL U
ELEG rDate Over 1 to 10 Incl. DATE 0
Contractor f O
❑ Over 10 to 50 Incl. IFINA F
I am exempt under Sec. Over 50 to 100 Inc. Y dS.&P.C.for this mason Over 100 Servic wbd., MCC& Panelboards10. Z
Date: 0-'200'Amp. Under 600 V
Signature 201 - 1000 Amp.Under 600 V
❑ Over 1000 Amp.or Over 600 V
Exemption for Reg.Maint.Elect.
SINGLE FAMILY Temp. Power Pole & Appurtenances ;16 8 6.4 A
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit # o e e • e '2
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 e e 2 5 5 0
R1 e e
IB.I I,as owner of the property,will do the work and the structure Misc.Conduits & Conductors e 2 5 5 0 6
is not intended or offered for sale (Section 7044, Business Other (See Complete Fee Schedule) ,
and Professions Code). U 4 13-87
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(Sec.3097, PERMIT FEE (Sub-Total
Civ.C.).
PLAN CHECKING FEE
Lender's Name /A
PERMIT ISSUING FEE c'v
Lender's Address
I certify that I have read this application and state that the above TOTAL FEE
information is correct. I agme 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
4,gLnatur.f0orfm.nrnctte.on purposes. J - SEE REVERSE FOR EXPLANATORY LANGUAGE
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