HomeMy Public PortalAbout8810 ELM AVE_Electrical__ 12-43 25M MPLICATION FOR PERWr
DEPARTMENT OF BUILDING AND SAFETY ELYLI/tSESYCI� FOR 1
COUNTY OF LOS ANGELES
WM_J. FOX aCgHIEF ENGINEER.
NAME ``6� v � ��y DISTRICT NO. GROUP ZONE PERMIT NO.
® �tR rl
U-a, ADDRESS ( � Ci�..fi � �� o� e� � s� �� /
U CITY ..+ '7Z TEL.NO. 'I L P�''C-3 RECEIVED BY READY FOR DATE ISSUED
t� / // A^ FIRST INSPECTION �L- ,•
W COUNCERT.NO. �n / EXPIRESIlT
APPLICANT FILL IN HEAVILY OUTLINE�D.PORTION ONLY i{�Z
(DESCRIPTION OF WORK DDRESS
NUMBER OF OUTLETS ON CIRCUITS LOCALITY
LOCATION BY ROOMS NEAREST
LIGHT OUTLETS SW. PLUGS FIZT CROSS ST. A
FCIR�CUIT A B C D E F G H a NAME ` �i�_fP �r! tom'Z.
_ W MAIL .
1� a�
l �. ADDRESS / sJ'V1� b2tP^ ..
A O CIN -31.: TEL.NO.
AM THE LEGAL POSSESSOR OF THE ABOVE LOS
t' ANGELES.COUNTY C TIEICATE OF QUALIFICATION.-
.]AN
ON ��
ELECTRICIAN. ��
0 1 AM THE LEGAL OWINER OF THE PROPFRTY DESCRIBED
ABOVE l
OWNER.
CORRECTIONS
J
Q
_Z
6
IY
O
TOTAL
NO. OF OUTLETS 7 $ R,S APPROVALS
NO. OF FIXTURES $ DATE INSPECTOR'S NAME
NO. OF MOTORS H.P. $ CONDUIT '� r
NO. OF SIGNS TRANS. $ WIRING
v
ENO. F RANGES OR HEATERS $ FIXTURES
LLANEOUS $ POWER
T FEE f�i(/ $ as UTILITY CO.NOTIFIED
FEE �JS Z !R FINAL
j�.
WORKERS'COMPENSATIONDECLARATION CE-806G (2-80)
CAPPLICATION FOR ELECTRICAL PERMIT
CE-806
I hereby affirm that I have a, certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY
insure, or a certificate of Workers'Compensation Insurance,or r
a certified copy thereof(Sec. 3800,Lab.C.)
FOR APPLICANT TO FILL IN JOB
Policy No. Company New Residential Bldgs.&Pools EACH NO. FEE ADDRESS
Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY
Multi-family Sq. Ft. — NEAREST
O Certified copy is filed with the county building inspection Residential Swimming Pools CROSS ST
department. OWNER OR
FIRM NAME
Date Applicant Outlets: Rec._Light Svv. MAILO
First 20 ADDRESS 6 L _
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY I� Tel No. 6 }
L
COMPENSATION INSURANCE O.
PAN CHECK CL
(This section need not be completed if the work involved APPLICANT U
Additional
by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First ADDRESS
Additional cc
I certify that in the performance of the work for which this Fixed' Appliances Not Over 1 HP CITY Tel No.
permit is issued, I shall not employ any person in any manner PERMIT
so a
so as to become subject to the W rkers' Compensati Laws. Range_ Heater_D.W. APPLICANT y
Oven _ Dryer_W.M. ADDRESS1. Z
Top _ FAU _W.H.._
E �' �sf z
Date Applicant CITY ` Tel No.
Hood _ Fan —Other_ ✓1'1-io
NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond._ LICENSE OR
Exemption, you should become subject to the Workers' REG. NUMBER & 3 Class C�- O
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROLE SED BY
with comply with such provisions or this permit shall be Size&Type HP,KW, KVA,or KVAR
deemed revoked. Up to 1 Incl. D ~
FINAL '
Over 1 to 10 Incl. DATE
LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. VALIDATION
hereby affirm that"I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL
BY
I Aj \
9 (commencing with Section 7000) of Division 3 of the Busi- Over 100
ness and Professions.Code, and my license is in'full force and
effect. Services
License NumberLic.Class C �� 0-200 Amp. Under 600 V `� Sd
201-1000 Amp. Under 600 V
Contractor I Date�/ 3�O Over 1000 Amp.or Over 600 V \
HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances
Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's
License Law for the following reason (Section 7031.5, Busi-
ness and Professions Code):
Misc.Conduits&Conductors 3 Q�.�,
❑_I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)—
structure is not intended or offered for sale (Section t o 0 0 0 o 2
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY 2 0 c 1 9. 50
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is PERMIT FEE (Sub-Total) b c o c 1 Lj, r U
issued (Sec. 3097,Civ.C.).
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) O, 2 3 o F
Lender's Address PERMIT ISSUING FEE
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 a thorize representativesoft is County to enter upon
the ab a-men 'oned property for i s ection purposes.
SEE'REVERSE FOR EXPLANATORY LANGUAGE
ignature of P rmittee Date
76A663 DBSSA 11-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN
DISTRICT NO. GROUP I ZONE PERMIT NO.
uA
ELECTRICIAN —
RECEIVED BY READY FOR DATE ISSUED
-]
ADDRESS 4'�°, yr FIRST INSPECTION ' e �
CITY TEL. NO. ` - ` 1
COUNTY LICENSE NO. EXPIRES BUILDING _
ADDRESS
PERMIT FEES
FEE
NUMBER EACH LOCALITY
LIGHT OUTLETS NEAREST
CROSS ST.
RECEPTACLES —
WALL SWITCHES OWNER
TOTAL OUTLETS 5C $ MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 25 – CITY TEL. NO.
FIXTURES + 5 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MISC. I 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 I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWERFEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
NEW MvD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
6 LESB $ .25 SIGNATURE OF
_ I/p 2 .50 PERMITTED -
2 5 1.00 INSPECTION RECORD
_ 5 15 1.50
_ 15 BO 2.50 ---
50 200 5.00
200 5013 J
500 1000 15.0.90
OVER 1000 20.00 Z z
_ M.G. SET/FREQ. CHANGER-HP
WELDERS: AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF ORIG.) `--
MOVED MOTORS (75% OF ORIG.) —_
MISC.
SIGNS
NO. NO.TRANS. I APPROVALS
NO. NO. LAMPS
DATE INSPECTOR'S NAME
FOR EACH PERMIT:
WIRING $1.00 CONDUIT
WIRING
_FIXTURES $1.00
SUPPLEMENTARY .50 FIXTURES
POWER
TOTAL FEE 1 UTILITY CO. NOTIFIED
�'._ FINAL