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HomeMy Public PortalAbout9640 CRAIGLEE ST_Electrical__ 76A663 DBS 5A 3-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES ELECTRIC A WILLIAM J. FOX, CHIEF ENGINEER FOR AP LICANT TO FILL IN DISTRICT N GROUP ZONE PERMIT ND. ELECTRICIAN S RECEIVED BY READY FOR D TE ISSUED ADDRESS �r. FIRST INSPECTION /� CITY TEL NO. COUNTY LICENSE. NO. D EXPIRES BUILDING PERMIT FEES ADDRESS NUMBER EACH FEE LOCALITY LIGHT OUTLETS b NEAREST RECEPTACLES G CROSS ST. _ e WALL SWITCHES OWNER/��.' 4. X4 - TOTAL OUTLETS Sc $ MAIL ELEC. RANGES - 25 ADDRESS ELEC. HEATERS 25 CITY TEL. NO. FIXTURES 6 ' I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE IS 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 i POSSESS THE ABOVE VALID LOS NUMBFEE ER HORSEPOWER ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER NEw Mvo. HP OVER INC. EnoHOF THE RESIDENTIAL PROPER/TY DESCRIBED ABOVE. S LESS $ .25 SIGNATURE OJ %2 2 .50 PERMITTED .; 2 S. 1.00 INSPECTION RECORD 5 15 1.50 15 50 2.50 50 200 6.00 200 500 10-00 J Q 500 t OOO 15.00 a OVER 1000 20.00 j9 M.G. SET/FREQ. CHANGER-HP K WELDERS:AC-KVA O GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (75% or ORIS.) MOVED MOTORS (75% of ORIG.) MISC. SIGNS NO. NO.TRANS. APPROVALS NO. NO. LAMPS FOR EACH PERMIT: DATES INSPECTOR'S NAME (J CONDUIT WIRING $1.013 FIXTURES $1.00 U WIRING y /� SUPPLEMENTARY .50 FIXTURES POWER TOTAL FEE $ LS UTILITY CO.NOTIFIED 0--S-1 ( L FINAL .. WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) 76A663 wl (�y (APPUCAT�®IIYI FOR ELECT ICA PERNT � (J I hereby affirm that I have.a certificate of consent to self insure, or a certificate 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. Company FOR APPLICANT TO FILL IN' - JOB q0 ADDRESS CA /e Q 17 Certified copy is hereby furnished. New Residential Bldgs.&Peols NO. $ EACH $ FEE LOCALITY i '� 1 &2-Family,Sq.Ft. Tt'hi�Le Certified Copy is filed with.the County building Inspection NEAREST department. Multi-family Sq.Ft. CROSS ST. Date' Applicant Residential Swimming Pools. ASSESSOR AP gSOR J-� /+ • ��M 1 PAGE PARCEL WNE OR CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec.�Light w.II", G FIRM NAME COMPENSATION INSURANCE �a -�rp_ First 20 AIL ' (This section need riot be completed if the work involved by the Total No. Additional 'oe °ADDRESS permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITY Tel.No. is issued, I shall not employ any person in any manner so as to PLAN CHECK become su b'ect to,the Workers'Compensation Laws. Lighting Fixtures I First 20 APPLICANT- Total No. Additional Idab ii ADDRESS Date �O Applicant 1 RE IDENTIAL AP LIAN S NOT OVE 3 HP. NOTICE TjQ,•AP LICANT: If, after making this Certificate of �J$ c,(�p / r CITY Tel.No. Exemption,you s ould become subject to.the Workers' Compensation =QfHE�APPIrfANC OT VE 3 HP. 7 provisions of the Labor Code, you must forthwith comply with Such PPPUF.PMITCANT (y� provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances ' J!� LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS (� jt&j�_ 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 CITY d Tel.No._Wl / D/ Professions Code, and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR l /�� �v v } Class. Over Over 50 to 100 InCI. REG.NUMBER License Number LicjClass a ��/ -Over 100 DISTRICT NO. P��529q ,9�,SSED BY O O t/ Services,Swbd.,MCC&Panelboards , cc _W4 2Q 0-399 Amp,Under 600 V FINAL O Contractor _ - DATE } ❑ Aoe 400-1000 Amp.Under 600 V I am exempt under Sec. -A VALIDATION W Over 1000 Amp.or Over 600 V FINAL d B.&P:C.for this reason BRANCH CIRCUIT FEES BY Z Date: 15A,or 20A,120V,Lighting or Recept. _. 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits - ❑ 41 Or More Branch Circuits Exemption for'Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances L 4S_( HOME OWNER-BUILDER DECLARATION ' l a s I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit ...... 17.430 a t-- 430 for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits = ' Code): - " ITEMS••1. I, as owner of the property,will do the work and the structure Misc.Conduits&Conductors ,. Y E � � is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) D TOTAL AL ., 175 a '30 and Professions Code). r�rCHK -,5 -10 CONSTRUCTION LENDING AGENCY - {' ... . . ... ,. i i 0) NAhI(� e) I hereby affirm that there is a construction lending agency for.the G performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) �. Civ.C.) PLAN CHECKING FEE 00013-0001 07/20i i::r Lender's Name PERMIT ISSUING FEE }(79 1 1 a55-' Lender's Address �©��1 I c,,.rtify that I have read this application and under penalty of purjury state TOTAL FEE ` ,O v that the 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 y for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE C ,� �•,g3 �� �� SI ATU F PERMITTEE DATE