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HomeMy Public PortalAbout10619 FAIRHALL ST_Electrical__ . COUNTY OF LOS ANGELES APPLICATION FOR PERMIT DEPARTMENT OF COUNTY ENGINEER ELECTRIC • � ' DIVISION OF BUILDING & SAFETY r • WILLIAM J. FOX, COUNTY ENGIJ!IF.F1I FOR LI NT T ' ILL•IN DISTRICT NO. GROUP (ZONE`'� CP�ERMIT NO. ELECTRICIA l 5 T I 'f ADDRESS RECEIVED BY READY FOR' DATE ISSUED f�� FIRST INSPECTION 2 �� CITY EL: -NO"r .y ''✓'!• L i COUNTY LICENSE NO. EXPIRES BUILDING ADDRESS ♦'! / raau��a• ��.�+►7 NUMBER EACH FEE LOCALITY LIGHT-OUTLETS NEAREST RECEPTACLES CROSS T. / WALL SWITCHES OWNER TOTAL OUTLETS, i Sc $ MAIL , ELEC. RANGES 25 ADDRESS -- _ ELEC._HEATERS 25 CITY--== _ TEL., NO. FIXTURES MISC. - - :I HEREBY ACKNOWLEDGE, .THAT I HAVE READ THIS NUMBER OF LIGHT CIRCUITS APPLICATION AND STATE THAT THE ABOVE IS 'CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OFRECEPTACLE CIRCUITS - AND STATE LAWS'REGULATING ELECTRICAL WIRING. MOTORS I CERTIFY THAT. 1 POSSESS THE ABOVE VALID LOS NuI,�6ER HORSEPOWER FEE Y. - ANGELES COUNTLICENSE, OR I AM THE LEGAL OWNER New Mvo. HP oven I INC. EACH OF THE RESIDENTIAL P RTY D CRIB AB V LESS $ .25 SIGNATURE OF .I/2 •2 .50 PERMITTER - 2 ' s 1.00 - INSPECTION RECORD - 5 . •15 1.50 - 15 50 2.50 - 50 200 5.00 200 500 10.00 .J .500 1000 15.00 Q OVER 1000-' 1f 20.00 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. APPROVALS _ NO. NO. LAMPS " FOR EACH PERMIT: DATE INSPECTOR'S NAME WIRING, $1.00 J� CONDUIT FIXTURES - ,$I,pp / WIRING SUPPLEMENTARY .50 FIXTURES - • �JJ . POWER /W I • 1 P s<:/:1 - TOTAL FEE'.,, $ `1 UTILITY CO, NOTIFIED / - FINAL .76A 063 oesy SA. 4-62 •' '1 1�. WORKERS'COMPENSATION DECLARATION 20-0019 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT, CE-80 affirm that I have a certificate of consent to self 3 O CE-806G j , r a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or ertified copy tyhereyof[[(Sec 3800, La C ) ' Po.g1 W C, r 'C.ommpany t FOR APPLICANT TO.FILL IN SOB ❑Certified copy is hereby furnish rJlo New Residential Bldgs. & Pools EACH NO FEE ADDRESS 1 , Certified copy is filed with the county building inspec- 1 & 2-Family, Sci Ft. $ — $ LOCALITY do department. - Multi-family Sci Ft — NEAREST CROSS ST Residential Swimming Pools Date Applica OWNER OR i FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RecLight 2' Sw 2 MAIL COMPENSATION INSURANCE First 20 ADDRESS (This section need not be completed if the work involved by Total No._� Additional CIT T j, the permit is for one hundred''dollars ($100)or less.) 10 v2% I certify that in' the performance of the work for which this PLAN CHECKAPPLICANT permit is issued, I shall not employ any person in any manner Lighting Fixtures First 20 ADDRESS so as to become subject to the Workers'Compensation Laws. Additional _ Total No.—� CITY Tel. No Date Applicant Fixed Appliances Not Over 1 HP NOTICE TO.APPLICANT- If, after making this Certificate of PERMIT Exempiion, you should become subject to the Workers' Range— Heater—D W. _ APPLICATION - -Com ensation provisions of_the-Labor_Code,. ou_must_forth-_ Oven — Drver W.M.— P P you--must"_� � _ _y _-- _ ADDRESS l with comply with such provisions or this permit shall be Top FAU —W.H — T —--- -_ -- -- -- ---- = - deemed revoked Hood — Fan —Other— CITY ` Tel. a LICENSED'CONTRACTORS DECLARATION LICENSE pp__ I hereby affirm that I am licensed under provisions of Chapter 9. Disp — Room Air Cond. REG. NUMBER tCJ ��Q Class. s (commencing with Section 7000)of Division 3 of the Business Power Apparatus & Large Appliances DISTRICT NO. PR ESSED BY and Professions Code,and my license is in full force and effect. f` CL 1 Q Size &Type HP, KW, KVA, or KVAR 0 License Number Lic. ss Up to 1 Incl FINA��,� n U Over 1 to 10 Incl. DAT 7 VALIDATION IM Contract Over 10 to 50 Incl FINAL ❑ I am exempt under Sec. Over 50 to 100 Inc BYU LLl Over 100 B.BP C. for this reason /l CL , Services, Swbd., MCC&'Panelboards , U Date- Z 0-200 Amp. Under 600 V — Signature 201 - 1000.Amp. Under 600 V - ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Mamt Elect. SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp. Power Pole &Appurtenances 2 I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit ACCT. Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code) _ 330717.25,__.. 17..:5 Misc. Conduits &Conductors 1 ITEMS I, as owner of the property, will do the work and the , structure is not intended or'offered for sale(Section 7044, Other (See Complete Fee Schedule)_ ® (i I r� �. 25 Business and Professions Code)" CONSTRUCTION LENDING AGENCY , CHECK 17.25 j hereby affirm that there is,a construction lending agency for CHANGE. .��1 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 0000-0001 v/31/$9 ' Lender's Address PERMIT ISSUING FEE 5421 1 AM11:2 ,I certify that I have read this application and state that the TOTAL FEE f a 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 abomofPer:mitte&e ��� urposes Q SEE REVERSE FOR EXPLANATORY LANGUAGE O g gnature Date / " 5 ©s