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HomeMy Public PortalAbout10653 FAIRHALL ST_Electrical__ COUNTY OF LOS ANGELES - APPLICATION FOR PERMIT DEPARTMENT OF COUNTY ENGINEER ELECTRIC 1 DIVISION OF BUILDING & SAFETY _ ` WILLIAM J. FOX, COUNTY ENGINEER FORANT, ILL IN DISTRICT NO GROUP ZONE PERMIT No ELECTRICIAN'S RECEIVED BY READY FOR DATE ISSUED ADDRESS l FIRST INSPECTION CITY L NO ` A � COUNTY LICENSE NO EXPIRES BUILDING /s PERMIT FEES ADDRESS (J NUMBER EACH FEE LOCALITY LIGHT OUTLETSNEAREST RECEPTACLES CROBBST WALL SWITCHES OWNER r TOTAL OUTLETS r 5c -. MAIL ELEC RANGES 25 ADDRESS J ELEC HEATERS 25 FIXTURES S CITY 7� TEL NO MISC I HEREBY ACKNOWLED E THAT t HAVE READ THIS 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 HORSEPOWER FEE ANGELES COUNTY LIC E OR 1 AM HE LEGAL O R New MVD HP OVER INC EACH THE RESIDENTIAL O TY DE9nw IBED OV _ 1 '� :W///,/// I/a 6 Less $ 25 SIGNATURE OF I/2 2 5o PERMITTE 2 5 1 00 INSPECTION RECORD 5 15 1 so 15 5o 2 50 5o _200 5 00 ' 200 500 10 00 50Z0 1000 1s 00 OYER 1000 20 00 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 W NO NO TRANS APPROVALS NO NO LAM FOR EACH PERMIT DATE INSPECTOR'S NAME WIRING - $1 00 '� CONDUIT FIXTURES $1 00 WIRING SUPPLEMENTARY 50 FIXTURES OWER tl w11 TOTAL FEE r l f$ UTILITY CO NOTIFIED AV 1 AL ITIY"V v 76A 669 DBS# SA 4-112 I 1 WORKER S COMPENSATION DECLARATION 76A663 DPW(12 91) APPLICATION FOR ELECTRICAL PERMIT LJ 76A663 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 there ec 3800 Lab C) 'l JOB Policy NO Company �w FOR APPLICANT TO FILL IN ADDRESS ©� Certified copy Is hereby furnished New Residential Bldgs &Pools NO EACH FEE LOCALITY �J Certified co Is filed with the count building inspection 1 &2 Family Sq Ft — $ $ � L,/ PY Y 9 P � NEAREST department Multi family Sq Ft CROSS ST Residential Swimming Pools ASSESSOR Date — Applicant MAP BOOK PAGE PARCEL A, CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec —/—Li ht-4 Sw � OWNER OR � / COMPENSATION INSURANCE g �iO FIPM NAME /\� /V First 20 a MAIL (This section need-not be completed if the work involved by the ADDRESS 1d�7`� i��G'G� « 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 rl CITY G!' Tel No is Issued I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers' Compensation Laws I Lighting Fixtures First 20 APPLICANT Y Total No Additional ADDRESS Date Applicant ` NOTICE TO APPLICANT If, after making this Certificate of RESIDENTIAL APPLIANCES NOT OVER 3 HP CITY Tel No Exemption,you should become subject to the Workers Compensation OTHER APPLIANCES NOT OVER 3 HP provisions of the Labor Code yyou must forthwith comply with such PERMIT C) provisions or this permit shall be deemed revoked Power Apparatus&Large Appliances APPLICANT ; LICENSED CONTRACTORS DECLARATION Size&Type HP KW KVA or KVAR /D ADDRESS �� 7Z I hereby affirm that 11 am licensed under provisions of Chapter 9 Over 3 to 10 Incl o (commencing with Section 7000) of Division 3 of the Business and CITY jU2 Tel No 7 ?�� Professions Code and my license is in full force and effect Over 10 to 50 Incl LICENSE OR �- t - rl Over 50 to 100 Ind REG NUMBER LJ ���U Class -!'[) } License Number LIC Class C ~/W Over 100 DISTRICT NO SSED BY Q _ (�, Servl��)w�bdLfM�CC�&PPaannelboards — ��e, _/ o �� Date I ` / 6�399�{tF(p Uffd � DATE F- Contractor F- 400 1000 Amp Under 600 V ❑ I am exempt under Sec _ Over 1000 Amp or Over 600 V FINAL VALIDATION d BY B&P C for this reason BRANCH CIRCUIT FEES Date 15A or 20A 120V Lighting or Recept Z_ 1 To 10 Branch Circuits Signature 11 To 40 Branch Circ U s ❑ 41 Or More Branch Circuits Exemption for Reg Mamt Elect 15A 20A,208V To 277V Lighting Br Circuits _ SINGLE FAMILY Temp Power Pole&Appurtenances HOME OWNER BUILDER DECLARATION �3�r s hereby affirm that I am exempt from the Contractors License Law Sign with One Branch Circuit for the following reason (Section 7031 5, Business and Professions Additional Sign Branch Circuits ITr-ri is Code) _ TITAI 87 60 as owner of the property,will do the work and the structure Misc Conduits&Conductors I is not intended or offered for sale(Section 7044 Business Other(See,Complete Fee Schedule) I_iii `l v!oi(! and Professions Code) `HANGS CONSTRUCTION LENDING AGENCY t;�t I hereby affirm that there is a construction lending agency for the M f _ performance of the work for which this permit Is Issued (Sec 3097 PERMIT FEE (Sub Total) rfp/ Civ C) - PLAN CHECKING FEE s,!s7 Lender s Name !� ,PERMIT ISSUING FEE p��p Lender's Address TOTAL FEE g� I certify that I have read this application and under penalty of purjury state that the above information is correct I agree to comply with all County ordinances and State laws regulating Electrical wiring and hereby authorize repres nta es of this County to enter upon the above mentioned property - for ins o purposes j SEE REVERSE FOR EXPLANATORY LANGUAGE Z SIGNATURE OF PERM TEE DATE