HomeMy Public PortalAbout4921 FIESTA AVE_Electrical__ D8 5 A 12 43 25M I
—DEPARTMENT OF BUILDING AND SAFEAPPY,ICATION FOR I'ERNdT� V`
TY
COUNTY OF LOS ANGELES ELECTRIC
nWMM/J FOXQCHfEF)ENGINEER A
Q NAME�S j/�^J Q DISTRIC^NO GROUP ZONE PERMIT NO
U.. ADDRESS / �FC�
WCITY S(_ " /17/TESL NO`S �— RECEIVED READY FOR DATE ISSUED
COU FIRST INSPECTION
w CERT NO VV { EXPIRES
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
JOB
DESCRIPTION OF,WORK ADDRESS
1
NUMBER OF OUTLETS ON CIRCUITS LOCALITY
LOCATION BY ROOMS
CROSS
EST
LIGHT OUTLETS SW PLUGS FIXT �
ST / ja LAI :v, �r
CIRCUIT A B C D E F G JH W NAME
Z MAIL
3 ADDRESS
�
O CITY /j' TEL NO
1 AM THE LEGAL POSSESSOR qF LOS
ANGELES COUNTY CERTIFICATE OFN
�� Q
1 AM THE LEGAL OWNER- 4Jf IirTH6 BEDABOvBCORRECTIO
J
Q
_Z
L7
<Y
O
TOTAL / I
NO OF OUTLETS $ �J r APPROVALS
NO OF FIXTURES $ o U DATE INSPECTOR S NAME
NO OF MOTORS H P ffi CONDUIT
NO OF SIGNS TRANS ffi WIRING
NO OF RANGES OR HEATERSffi FIXTURES
MISCELLANEOUS $ POWER
PERMIT FEE /i i, ffi i �S UTILITYCONOTIFIED
FINAL
�n
TO FEE ` V 7
76A663 CE 806R 9/76 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER JOB
l BUILDING AND SAFETY DIVISION ADDRESS taw J vG
FOR APPLICANT TO FILL IN %'
New Residential Bldgs &Pools EACH NO FEE NEAREST
$ 025 — $ CROSS ST
«1 &2 Family Sq Ft
Multi family Sq Ft 02 — OWNER OR
FIRM NAME
Residential Swimming Pools 2000 MAIL
�� ADDRESS
Outlets Rec� �/
Light `_'Sw 1 !) CITY Tel No
First 20 50 PLAN CHECK
Total No Additional t 30 APPLICANT
ADDRESS
e t
Lighting Fixtures I First 20 CITY Tel No+ 50 � .-
Additional 30 PERMIT
Total No APPLICANT !!
Fixed Appha es Not Over 1 HP it ADDRESS V��
*/ 1
Range_bleater_%W CITY ����r� Tel No VV,42 7
Oven_✓Dryer !—W M_ LICENSE OR
,,\ Top —CAU —W H / 5-D REG NUMBER Class
Hood_Fan _Other— -71 C 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
Disp Room Air Cond 2�� THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDIN
ANCES AND STATE LAWS REGULATING ELECTRICAL WIRING
Power Apparatus&Large Appliances }
Size&Type HP KW KVA or KVAR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS
I REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM
Up to 1 Ind 2 00 THE LEGAL OWNER OF THE ABE,D�ESC IBED RESIDENTIAL PROPERTY
Over 1 to 10 Incl 5 00
Over 10 to 50 Incl 1 10 00 1 PERMITTEE
Over 5010 100 Inc 2000 SIGNATURE V
AC
Over 100 3000 1, DISTRICT NO OCES ED BY O
d V
Services �
0 200 Amp Under 600V 12 50 Y INSP TOR S
201 1000 Amp Under`600 V 2500 APPROVALS DATE .—SIGNATURE_ Z
Over 1000 Amp or Over 600 V 5000 TEMP POWER POLE
Temp Power Pole&Appurtenorces
1000
JFIXTURES
NDERSLAB WORK
Sign with One Branch Circuit 1000 OUGH CONDUIT I
2 00 IRING
Additional Sign Branch Circuits
i1J,tr
Misc Conduits&Conductors 15 00 4 -
v ,
Other(See Complete Fee Schedule) OWER AUTHORIZED s+
UTILITY CO NOTIFIED
FINAL
`+
PERMIT FEE (Sub Total) NOTES
PLAN CHECKING FEE (One Fourth Permit Feel c
PERMIT ISSUING FEE 1 $600 } 1�
TOTAL FEE +
PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION ` CK �M 0 * CASA
c
° ) i
r ,
7 9 0 JUL d 5
®,
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE v v �'4�T6� �
WORKER S COMPENSATION DECLARATION 720 00196A663 DPW(12 91) APPLICATION FOR ELECTRICAL PERMIT
,,-. � � 76A663
I hereby affirWi that�-hjnve a certificate of consent to self iCsure
or a certificate of Worker s Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
copy thereof(Sec)38800 Lab C)
Policy Nor` 3�' Company �' FOR APPLICANT TO FILL IN ADDRESS
❑
Certified copy is hereby furnished New Residential Bldgs &Pools NO EACH FEE h
��77// � — $ $ LOCALITY u
•�eertified co is filed with the count building inspection 1 &2 Family Sol Ft
copy y 9 P NEAREST
departm nt/G Multifamily Sq Ft CROSS S7 LA
Date ! Applicant Q/ 12 ��"� Residential Swimming Pools ASSESSOR
MAP BOOK PAGE PARCEL
CERTIFICA E OF EXEMPTION FROM WORKERS Outlets Rec _Light Sw OWNER OR r
COMPENSATION INSURANCE g FIPM NAME
First MAIL
(This section need not be completed if the work involved by the Total No Additional ADDRESS
permit is for one hundred dollars($100)or less)
I certify that in the performance of the work for which this permit CITY + Tel Nojig _ �J
is issued I shall not employ any person in any manner so as to PLAN CHECK s
become subject to the Workers Compensation Laws Lighting Fixtures First 20 APPLICANT
Total No Additional
ADDRESS
DateApplicant RESIDENTIAL APPLIANCES NOT OVER 3 HP
NOTICE TO APPLICANT If after making this Certificate of CITY Tel No
Exemption you should become subject to the Workers Compensation OTHER APPLIANCES NOT OVER 3 HP
provisions of the Labor Code you must forthwith comply with such PERMIT
provisions or this permit shall be deemed revoked Power Apparatus&Large Appliances APPLICANT
LICENSED CONTRACTORS DECLARATION Size&Type P KW KVA or KVAR ADDRESS 3 O
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl ' \
(commencing with Section 7000) of Division 3 of the Business and CITY � QV Tel No ��53
Professions Code and my license is in full force and effect Over 10 to 50 Incl �''7
It
LICENSE B 6-S�Z 2 Class C`tC
,.ter^ d I Over 50 t0 100 Incl REG NUMBER o 0-
i
i ?� � / Over 100 DISTRICT NOP SSED BY Q
License Number O V Lic Class
Services Swbd MCC&Panelboardscc
��
Contractor iG � Date 0 399 Amp Under 600 V FINAL DATE 0
❑-' - 400 1000 Amp Under 600 V Z-1/ ��
I am exempt under Sec VALIDATION V
Over 1000 Amp or Over 600 V FINAL W
B&P C for this reasonBRANCH CIRCUIT FEES BY co
Date 15A or 20A 120V Lighting-or Recept Z
1 To 10 Branch Circuits
Signature • 11 To 40 Branch Circuits
F-141 Or More Branch Circuds
Exemption for Reg Maint Elect 15A 20A 208V To 277V Lighting Br Circuits f
SINGLE FAMILY Temp Power Pole&Appurtenances ia
HOME OWNER BUILDER DECLARATION _ ANT g
I 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 �`�W�T 34.�_
Code) - - 1ITEMS
❑ 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) TKAL 35zt- -43
and Professions Code) _ _ CHUM �4 `t3
L 1
CONSTRUCTION LENDING AGENCY �f s
I hereby affirm that there is a construction lending agency for the (,H4NGE .00
performance of the work for which this permit is issued (Sec 3097 PERMIT FEE (Sub Total) -
Civ C)
01300-0001 1/27/9—,
Lender s Name
PERMIT ISSUING FEE 73-t4 1 P012.'2b
Lender s Address r - -
I certify that I have read this application and under penalty of purjury state TOTAL FEE
that the 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 above mentions property
for inspe ion pposes / SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNATURE OF P DATE