HomeMy Public PortalAbout5137 DOREEN AVE_Electrical__ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
e' Department of County Engineer
DIVISION OF BUILDING & SAFETY
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WILLIAM J. FOX, County Engineer
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP /[yZ�-ONE I PERMIT NO.
ELECTRICIAN
V- RECEIVED BY READY FOR DATE 186UED
ADDRESS .901A q� FIRST INSPECTION /q
CITY TEL NO. 71f, 'IR 9-
3 /a �j I
COUNTY LICENSE NO. EXPIRES BUILDING J I Do Vr
PERMIT FEES ----- --
FEE �n
NUMBER EACH LOCALITY /7rJLIGHT /
RECEPTACLES COUTLETS NEAREST Cy- �y
ROSS 9T. r C.
'
RECEPTACLES
WALL SWITCHES 3 OWNER Al ,-q . R(D I I SO
TOTAL OUTLETS G/T ScS _ MAIL (,
ELEC. RANGES 25 ADDREESS S I3 M/.. De r e e. h
ELEC. HEATERS I 55 sCITY 1rQ Viet O Cels)t\ TEL NO.Flo-et N 41
FIXTURES 5
I HEREBY fACKNOWLED4 THAT I HAVE READ THIS
MISC. 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 I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NHMOER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
NEw MVD. HP OVER IHc. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
A LESS S .2S SIGNATURE or a
I/2 2 .50 PERMITTEE.*LlL4�yV�lIVW 1
I �
2 5 1.00 INSPECTIOW RECORD
_ s Is 1.50 _
15 so 2.50
_ 5o 200 s.OD
200 500 10.00 „1
500 1000 IS.CO Q
- Z
OVER 1000 20.00
M.G. BET/FRED. CHANGER-HP
WELDERS:AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF CRIS.)
MOVED MOTORS (75% OF URID.)
MISC.
SIGNS
N0. NO.TRANS.L
NO. NO. AMPS APPROVALS
FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRINO 51.00 0� CONDUIT
FIXTURES 51.00 ein WIRING
FIXTURES
SUPPLEMENTARY .50 Fq
POWER
TOTAL FEE IS ij
-
/( UTILITY CO. NOTIFIED
O� iINAL 1����7"f� 19Mi.�s/Lw✓/
7.663 OBS#SA 2-53
WORKERS'COMPENSATION DECLARATION -663 10/81et
CE-906G 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.3800.Lab.C.) - -
Policy No. Company FOR APPLICANT TO FILL IN , JOB
❑ - EACH. NO. FEE ADDRESS
Certified copy is hereby furnished. New Residential Bldgs.&Pools
❑ 1 8 2-Family, Sq.Ft. S = $ LOCALITY
Certified copy is filed with the wuntY building inspection
department. Multi-family Sq.Ft. NEAREST ,
GROSS ST.
Date Applicant Residential Swimming Pools OWNER OR 1
• - _ FIRM NAME _ p
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Ree_ Light _Sw. — MAIL
COMPENSATION INSURANCE - ADDRESS' -
(This section need not be completed if the work involved by the First 20, CITY Tel.No.
permit is for one hundred-dollars($100) or less.) Total No. Additional
I certify that in the performance of the work for which this permit - APPLICANT K
is issued, I-shall not employ any,person in any man so as lo,
`becom sub'dct to the Workers'ColQ�n anon La , Lighting Fixtures First 20' ADDRESS.
Additional '
Total No. - CITY - T No.
at Appl Fixed Appliances Not Over 1 HP
TICE ,TO -PPL CANT: If, after .making this Certificate of PERMIT
;Exemption,you should become subject to the Workers'Compensation Range_ Heater_ DW. APPLICANT
provisions of the Labor Code, you must forthwith comply with such Oven Dryer W.M. _ ADDRESS r
provisions or this permit shall be deemed revoked. I Top FAU _ W.H. - CITY Tel.No.
LICENSED CONTRACTORS DECLARATION - Hood Fan _ Other_
I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR '
(commencing with Section 7000)of Division 3 of the Business and Disp. Roam Air Cond. Class. ..
REG.NUMBER
Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances ' DISTRICT NO. ^ �, i PROCESS
Size & Type HP, KW,KVA,or KVAR S`- t0/ aT0
License Number Lie.Class Up to 1 Incl. FINAL - U
Over 1 to 10 Incl. DATE
Contractor Date - VALIDATION 0
Over 10 to 50 Incl.
❑ I am exempt under Sec. Over 50 to 100 Inc. gy U
- - - Over 100 ) d'
8.8 P.C. for this reasonIn
Services,Swbd.,MCC &.Panelboards
Date: - 0-200 Amp.Under 600 V 1/ '-
Signature _ 201--9000 Amp.Under 600 V -
❑ Over 1000 Amp.or Over 600 V
Exemption for Reg.Maint.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 Law -
for the following reason (Section 703 1.5,Business and Professions Additional Sign Branch Circuits _ 82 Q,6 A
a _ •#te,o,o:e,e 2
Misc.Conduits & Conductors - - •,1 o - 2550
I,as owner,of the property,will do the work and the structure l
Is not Intended or offered for sale (Section 7044, Business Other (See Complete Fee Schedule2 5„rj 0,�
) D- _ ^-
and Professions Code).
1030e87
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
' PERMIT ISSUING'FEE ((l V
Lender's Address
I certify that I have read this application and state that the above TOTAL FEE J I/
information is correct.I agree to comply with all County ordinances ,
and laws regulating Electrical wiring, and hereby authorize
rep sent ives of this Count !o enter upon the above-mentioned
pr erty or inspecti u 0 SEE REVERSE FOR EXPLANATORY LANGUAGE _
S azure o Permit e
"ate