HomeMy Public PortalAbout6240, 6242, 6246 BURTON AVE_Electrical__ OBS6SA95S-5A 9-55 APPLICATION FOR ELECTRIC PERMIT �.
DIVISION Of BUILDING AND SAFETY.
Deportment of County Engine,•
County of Los Angeles
WM.J. FOX, COUNTY ENGINEER -
CASSATT D. GRIFFIN. SUPT OF BUILDING
LOCALITY VGI • � ��f
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES CROSSST.
NUMBER EACH FEE
OWNER
LIGHT OUTLETS 1
RECEPTACLES MAIL ADDRESS
61--41-4` 4-b// `I1
ADDRESS f_') L
WALL SWITCHES
TOTAL OUTLETS 5¢ S CITY TEL. NO. GO 4
ELEC. RANGES 25 ELECTRICIAN
ELEC. HEATERS 25 ADDRESS
KW EA CITY TEL. NO,
FIXTURES 5 LICENSE NO.
NUMBER AF LIGHT CIRCUITS- - PEMM
- DISTRICT NO. I GPf P I ZONE' I READI FOR.INSPECTION
NUMBER OF RECEPTACLE CIRCUITS S �31T_� R
'MOTORS
NUMBER HORSEPOWER FEE INSPECTION RECORD
NEW MVD. HP OVER INC. EACH '
B LESS S .25
_ 12 2 .50
2 5 1.00
_ 5 15 1.50
15 50 2.50
50 200 5.00
MISC.
NO.SIGNS NO.TRANS. .
NO.SIGNS -NO. LAMPS
FOR EACH PERMIT:
WIRING $1.00
FIXTURES S1.00
SUPPLEMENTARY .50 APPROVALS
TOTAL FEE 5 2- ISO DATE INSPECTORS SIGNATURE
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY —
WITH ALL COUNTY 'ORDINANCES AND STATE LAWS REGULATING WIRING
ELECTRICAL WIRING.
I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND. STATE OF
CALIFORNIA OR THAT 1 AM T0tlA.EGAL OWNER OF THE ABOVE POWER
DESCRIBED RESIDENTIAL PROPE TY.
SIGNATURE _ / UTILITY CO..NOTIFIED 2r
OF PERMITTEE C� FINAL
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION A. C. VEIT.CHIEF ELECT. INSPECTOR
1x08 8 9 =s; OCT 13 2 2 2 0 ..
o
WORKERS'COMPENSATION DECLARATION, CE-806 ,10/81
CE-8066 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self
insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof (Sec. 3800, Lob. C.)&0_01f T_
Policy No 573� Company 6✓ +9LAl� FOR APPLICANT TO FILL IN JOB /
Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO, FEE ADDRESS 0 /H
Certified copy is filed with the county building inspec- I & 2-Family, Sq. Ft. If — S LOCALITY 'S IWA19V f.
tion department Ma11i-family Sq. Ff. — 'NEAREST
CROSS ST.
Residential Swimming Pools OWNER OR
Date Applicant - FIRM NAME N
ER FICATE OF EXEMPTION FRO WORKERS' Outlets: Rec�Light�Swl— -MAIL I '
COMPENSATION INSUR CE First 20 ADDRESS o O. UR H
(This section need not be completed if the work involved by Total No. ) Additional CITY Q - Tel. No.
the permit is for one hundred dollars ($100)or less.) CITY
I certify that in the performance of the work for which this PLAN APPLICANT
permit is issued, I shall not employ any person in any manner
so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
Total No. 6r Additional
CITY Tel. No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of 17 U���S
` Exemption, -you should' become subject–to--the'Workers' Range Heater_D.W. �' -'---"– -- --"---_-�"
APPLICANT
Compensation provisions of the Labor Code, you must forth- Oven Dryer � W.M4;W• .ADDRESS (�
with comply with such provisions or this permit shall be Top / FAU —W.HiSZ:k• . No. �0 1295
deemed revoked. Hood L Fan _ Other_ CITY �/ O(/�NA Te
LICENSED CONTRACTORS DECLARATION OICENSE OR
1 hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. REG, NUMBER Class.8—
(commencing with Section'7000) of Division 3 of the Business DISTRICT NO. PROCE D BY
and Professions Code,and my license is in full force and effect. Power Apparatus & Large Appliances d
Q//J I Size&Type HP, KW, KVA, or KVAR'
In
nse Nu er Lic. Class U_ IUp Io 1 Incl. FINA _,E,,fit,,, ee��-- �� Over 1 to 10 Incl. DATE VALIDATION Qractor �/ fX/� •3 Date o7,r+[jjOver 10 to 50 Incl. FINAL 1-
I
I am exempt under Sec.— ll // Over 50 to 100 Inc. BY ��- �i_e_U W
B.&P.C. for this reason Over 100 N
Services, Swbd., MCC 8 Ponelboards D Z
Date: 0 -200 Amp. Under 600 V
Signature 201 - 1000 Amp, Under 600 V '
EJ
Over 1000 Amp. or Over 600 V
Exemption for Reg. Mainz. Elect.
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 Additional Sign Branch Circuits p 4 $'.�'b A
Law for the following reason (Section 7031.5, Business and
Professions Code): i
Misc. Conduits& Conductors o e a e - 2
I, as owner of the property, will do the work and the
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ D 2jri 5 575
J
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY _ o o e,5.5 7 5 3,
I hereby affirm that there is a construction lending agency for 0.8,3 O–8 3
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 40 .5Z
Lender's Address
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 out rize representatives of this County to enter upon "
the above ianed roperty for inspection purposes.
' SEE REVERSE FOR EXPLANATORY LANGUAGE
Si o ure of Per t ---� -