HomeMy Public PortalAbout10671 FAIRVIEW AVE_Electrical__ COUNTY OF LOS ANGELES - APPLICATION FOR PERMIT
DEPARTMENT OF COUNTY ENGINEER r ELECTRIC 1
DIVISION OF BUILDING � SAFETY
WILLIAM J. FOX, COUNTY ENGINEER
FOR IJ NTT LL IIV STRICT NO GROUP /Z(ONE PERMIT NO
ELECTRICIA -L /'[
ADDRE RECEIVED BY READY FOR DATE ISSUED
FIRST INSPECTION /
CITY L NO (VI dd'/G✓ �I}r'X�J�L.,.
COUNTY LICENSE NO EXPIRES -- BUILDING
PERM
s
PERMIT FEES C ADDRESS rr
NUMBER EACH FEE LOCALITY l
61
LIGHT OUTLETS /
NEAREST
RECEPTACLES CR088 ST
WALL SWITCHES OWNER
TOTAL OUTLETS Sc $ MAIL -
ELEC RANGES 25 ADDRESS
ELEC HEATERS 25
CITY TEL NO
FIXTURES 5
'MISC I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
NUMBER OF LIGHT CIRCUITS APPLICATION AND STATE THAT THE ABOVE IS CORRECT
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 NSE OR i AM THE LEGAL„OWNER
NEw MVD HP .OVER INC EACH OF THE RESIDENTIAL ROPERTJDCRISA
B
I/z a LESS $ 25 14A
SIGNATURE OF
1/2 2 50 PERM ITT
2 5 1 00 INSPECTION RECORD
5 15 1 50
15 50 2 50
50 200 5 00
200 500 10 00 J
Soo 1000 15 00 Z
OVER 1000 20 00
M G SET/FREQ CHANGER-HP
WELDERS AC-KVA 0
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
+� CONDUIT
FIXTURES r $1 00 WIRING
J
SUPPLEMENTARY 50 FIXTURES �VAAP1�
y - POWER
TOTAL FEE H $ . UTILITY CO NOTIFIED I i V
' FINAL
76A 669 DBS# 6A 4-52
I I '
WORKER'S COMPENSATION DECLARATION 20-0019 DPW 9/89
LLLJJI
I hereby affirm that I have a certificate of consent to self insure, 76A663 APPLICATION FOR ELECTRICAL PERMIT
or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LQ ANGtLES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec. 3800 Lab.C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB s �'
ADDRESS
Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE
❑ $ _ $ LOCALITY I��
Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft.
department. Multi-family Sq.Ft. NEAREST
CROSS ST.
Date Applicant Residential Swimming Pools ASSESSOR
Q MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec.-I L Light Sw. L OWNER OR �, ^ j� r M
COMPENSATION INSURANCE 70 O / FIRM NAME (,�f I t
First 20 MAIL
(This section need not be completed if the work involved by the Total No. Additional ADDRESS I a67! J�j
permit is for one hundred dollars($700)or less.) �y
I certify that in the performance of the work for which this permitTel.No.1/rl� jt�7
is issued, I shall not employ any person in any manner so as to
become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 a PLICANTK
Total No. Additional
ADDRESS
Date Applicant 15 OR 20A,120V BRANCH CIRCUITS
NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No.
Exemption,you should become subject to the Workers' Compensation 1 TO 10 INCLUSIVE EACH
provisions of the Labor Code, you must forthwith comply with such 11 TO 40 INCLUSIVE EACH PERMIT 4�
provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH IF
APPLICANT
LICENSED CONTRACTORS DECLARATION ADDRESS
I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH
(commencing with Section 7000) of Division 3 of the Business and CITY Tel.No. 0
Professions Code, and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR
Power Apparatus&Large Appliances REG.NUMBER Class.
License Number Lic.Class Size&Type HP,KW,KVA,or KVAR DISTRICT NO. PR c seD BY
Up to 3 Incl. �a*/ W
Over 3 t0 10 Ind. FINAL a
Contractor Date. clDATE ' -
Over 10 to 50 In . Z
Z
I am exempt under Sec. Over 50 to 100 Incl. VALIDATION
FINAL
B.&P.C.for this reason Over 100
BY
Services,Swbd.,MCC&Panelboards
Date: 0-200 Amp.Under 600 V
Signature 201 -1000 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 ,1
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits
Code):
I, as owner of the property,will do the work and the structure Misc.Conduits&Conductors
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) - 4
and Professions Code).
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 - - f`s�i= '_=i"•
PERMIT ISSUING FEE
Lender's Address /
I certify that I have read this application and state that the above TOTAL FEE
information is correct. I agree to comply with all County ordinances
and State laws regulating Electrical wiring, and hereby authorize
representatives of t is County to enter upon the above-mentioned
pro er for'nspectS P es. SEE REVERSE FOR EXPLANATORY LANGUAGE
:g_ 7
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SIGNAT E OF APPLICANT OR AGENT DATE