HomeMy Public PortalAbout5210 DALEVIEW AVE_Electrical__ CUB BA 25M SETS 7-47
DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES ELECTRIC
���I� [�
M. J. FOX CHIEF ENGINEER
= DISTRICT NO: GROUP I ZONE PERMIT NO.
NAME
U ADDRESS
K
V 'RECEIVED BY READY FOR DATE,i55UED
47 CITY TEL.NO. j FIRST INSPECTION 1•
,I COUNTY
I�
CERT.NO. EXPIRES
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
JOB
DESCRIPTION OF WORT{ ADDRESS 4J 2'f ✓
NUMBER OF OUTLETS ON CIRCUITS LOCALITY '�;2 ,�dRCAD
LOCATION BY ROOMS
NEAREST
LIGHT OUTLETS Isw. PLUGS FIIT CROSS ST
CIRCUIT A B I C_ D E F IG lH X NAME 12- L
!= Z MAIL
}+ ADORES so
O /�//JJ ,I C
CITY ��/� I/J TEL NO.r/OAU d 3
1 AM Tke LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION..
ELECTRICIAN.
1 AM THE LEGAL OWNER OP DESCRIBEm
ABOVE
OWNER.
CORRECTIONS
_ J
.Q
Z
K �
O
TOTAL
NO. OF OUTLETS Z $ O APPROVALS
A
NO. OF FIXTURES $ i fJ .DATE INSPECTOR'S NA//''ME
NO. OF MOTORS H.P. $ CONDUIT J 4w
NO. OF SIGNS TRANS. S WIRING /
NO. OF RANGES OR HEATERS 'S FIXTURES
MISCELLANEOUS $ POWER /
PERMIT FEE UTILITY CO.NOTIF ED I
TOTAL FEE S / FINAL
WORKER'S hveacertificate
COMPENSATION DECLARATION 76A663 DPW(12.91) APPLICATION FOR ELECTRICAL PERMIT LI
6A663
I hereby affirm thatl 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.) s _
Polley NO. Company FOR APPLICANT TO FILL IN JOB
ADDRESS
F71 J �Q �F vj E••✓
Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE
: $ $ LOCALITY
ft Certified copy is filed with the county building inspection 1&2-Family,Sq.Ft.
department NEAREST Multi-family Sq. Ft. CROSS ST.
Date ApplicantResidential Swimming Pools ASSESSOR .
MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM•WORKERS* OWNER OR
COMPENSATION / '(_/
Outlets:Rae'_Light Sw. FIPM NAME 4-1154
INSURANCE -
First 20 MAIL
(T malt i for need not d completed d toe work involved by the Total No. Additional ADDRESS
permlC is for one hundred dollars(S 100)orless:)
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 se as In PLAN CHECK.
become subject to the Workers'CompensationLaws. Lighting Fixtures First 20 APPLICANT
Total No. Additional
/spy � ADDRESS
Date ��a�- Applicanl{e{�-f"� L zit f'y�• RESIDENTIAL APPLIANCES NOT OVER.3 HP.
NOTICE,TO APPLICANT: If, after making this Certificate of CITY Tel.No.
Exemption,you should became subject to the Workers'.Compensation OTHER APPLIANCES NOT OVER 3 HP. _
provisions of the Labor Code, you must forthwith comply with.such - PERMITucANT
provisions or this permit shall be deem a d'revoked. Power Apparatus&Large Appliances APP
LICENSED CONTRACTORS DECLARATION - Size&Type HP,KW,KVA,or KVAR ADDRESS.-A-7_4_,5? B. �e 1a
1 oereby affirm that I am li 6risedlunder provision5'of Chapter 9 Over'3 to-00 Incl /
(commencing with Section 7000) of Division 3 of the Business and CITY MoN Rov.1 r.A 9�f� T.I.No1g7 3)6-3-
Professions
)3o3'
Professions-.Code, and my license is in full force and effect. "Over 10 to SO Incl. r }
Over 50 to 100 Inc 1. REG NNUMBER S6 js0$�SE aass.0-i0
II--_���q a
License Number �� V r/ L Lie Class G�� Over 100 DISTRICT NO ` PR C 5E0 BY 0
Services,SWbd.,M P eae the rtls t�•Q t.1��.���
Contractor I E✓ c L:�R,\ Date S R'$-�� 0 393 Amp. Under 600 V l e.. FINAL p
DATE
400- 1000 Amp.Under 600 V7
El VALIDATION I am exempt under Sec. _ 7`J V
Over 1000 Amp.or Over 600 V FINAL L d
• B.&P.C.for IhirreasonBRANCH CIRCUIT FEES BY ,
A�
ate: 15A,or 20A. 120V,Lighting or Recept -_ Z
I To 10 Branch Circuits
S"gnature. �� 11 To 40 Branch Circuits -
041... 41 Or More Branch Circuits n
Exemption for Reg.Maint Elect. 15A,20A,208V To 277V Lighting Br.Circuits L
SINGLE FAMILY Temp. Power Pale&Appurtenances F1C.C.T.a
HOME OWNER-BUILDER DECLARATION n with One Branch Circuit �' r -" - I �
I hereby affirm that I am exempt from the Contractor's License Law Si g 33033 61.+55
for the fallowing reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits
Code): 1 1 TTMS
❑ 1, as owner of the property, will do the work and the structure Misc.Conduits.&Conductors
TOTAL - 61 . 65
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) cc tt
and Professions Code). ® CHECK -- C=1.z]5
- CONSTRUCTION LENDING AGENCY w CHANGE .[Ia
Thereby 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.) O)�01 -OOIl1 5j?F/9
PLAN CHECKING FEE ,,_....... - _ _
Lender's Name _ - - - _- - Q 4 �.r=
PERMIT ISSUING FEE Q=g• 1 AM v•��
Lender's Address
I certify that I have read this application and under penalty of purjury state TOTAL FEE 4
that the above information is correct. I agree to comply with all County -
ordinances and State laws regulating Electrical wiring,and hereby authorize
representatives4theunry to enter upon the above-mentioned propertyor inspection pr SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNATURE OF PE DATE