The URL can be used to link to this page

Home My Public Portal About9180 FORTSON DR_Electrical__ DSS SA 25M SETa 2-47 ' DEPARTMENT OF BUILDING AND SAFETY MPI.ICATION FOR PERMIT COUNTY OF LOS ANGELES Ei LECTIC WM. J. FOX CHIEF ENGINEER a NAME DISTRICT NO. GROUP__ZONE PERMIT NO. ADDRESS6 .^2 n` J� � _ CITY TEL.NO. RECEIVED BY READY FOR DATE ISSUED �t n 1 ryl� FIRST INSPECTIONCOUNTY ( W CERT.NO. (% a d 6 !� EXPIRES APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB DESCRIPTION OF WORK ADDRESS b r 4 Y/ NUMBER OF OUTLETS ON CIRCUITS LOCALITY Of Q-4, LOCATION BY ROOMS NEAREST LIGHT OUTLETS SW.I PLUGS FI7[T CROSS ST. CIRCUIT A B C D E F G H K NAME Z MAIL 3 ADDRESS O CITY TEL.NO. 1 AM THE LEGAL POSSESSOR- OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION.. / 4(=7 7-77 ELECTRICIAN. 1 AFI THE"GAL OWNER OF THE PROPERTY DESCRIBED ABOVE OWNER. CORRECTIONS J Z E3 TOTAL NO. OF OUTLETS $ APPROVALS NO. OF FIXTURES $ i DATE INSPECTOR'S NAME NO. OF MOTORS H.P. $ CONDUIT / I ol NO. OFSIGNS' TRANS. $ WIRING NO. OF RANGES DITHEA ERS $ FIXTURES MISCELLANEOUS $ POWER �� PERMIT FEE $ ! UTILITY CO.NOTIFIED i/y„� 1 A J.1i TOTAL FEE® °!I FINAL /1'/ / l s/ / r "" K PERS DEPARTMENT OF BUILDING AND SAFETY APPLICA�'I®N FOR SAFETY COUNTY OF LOS ANGELES lux CTR C WM. J. FOX CHIEF ENGINEER NAME DIST`RICT NO. GROUP �Z//ONE PERMIT NO. U ADDRESS s^ / [ / RECEIVEDBY READY FOR DATE ISSUED WU CITY TEL.NO. ~ rFIRST INSPECTION / ry COUNTYW CERT.NO. CO (p Q EXPIRES APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY DESCRIPTION OF WORD ADDRESS $ NUMBER OF OUTLETS ON CIRCUITS LOCALITY LOCATION BY ROOMS NEAREST LIGHT OUTLETS SW. PLUGS FIiT CROSS ST. CIRCUIT A B C D E F Jr. I H a: NAME L�Lt Z MAIL 7 3 ADDRESS O CITY TEL.NO. 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFI/C�T�EOF QUALIFICATION- ELECTRICIAN. I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED B AOVE OWNER. .( 0 CORRECTIONS J Q Z p cl LY • I TOTAL /!��/ NO. OF OUTLETS $ ��'C1 APPROVALS - r NO. OF FIXTURES. $ DATE INSPECTOR'S NAME NO. OF MOTORS H.P. $ CONDUIT NO. OF SIGNS TRANS. $ WIRING NO. OF RANGES OR HEATERS $ FIXTURES MISCELLANEOUS $ POWER I 1 ' l. .PERMIT FEE � •$ yJ UTILITY IAy,, /: �. TOTAL FEE �'i•O -.0 FINAL WORKERS'COMPENSATION DECLARATIONto/Bt APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of CE-806 consent to self CE-806G insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES C BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C ) / Policy No Company FOR APPLICANT TO FILL IN JOB 1 10 �i Certified copy is hereby furnished. New Residential Bldgs /`&•Pools EACH NO FEE ADDRESS �(1 01, ❑ Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY ,4 tion department Multi-family Sq. Ft. _ 'NEAREST • Ir CROSS ST Date Applicant Residential Swimming Pools OWNER OR FIRM NAME ,� 1 /+i �� A �/(! (� �C�(J�✓� - CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL Outlets: Rec •Light Sw._ COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work-involved by Total No AddiFirst tional CITY Tel No the permit is for one hundred dollars ($100)or less.) PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compens t' n Laws. Lighting Fixtures First 20 ADDRESS ' Total No. Additional �1.. CITY Tel No. Date Applicant 1=% tJ Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT- If, after making this Certificate of Exemption, you should become subject to the Workers' Range_ Heater_D.W — APPLICANT U —� �lylc> Compensation provisions of the Labor Code, you must forth, Oven _ Dryer — W M._ ADDRESS with comply with such provisions •or this permit shall be Top _ FAU —W H. — j deemed revoked. CITYr Tel. No n ^� LICENSED CONTRACTORS,DECLARATION Hood _ Fan _Other_ � C= C/ Disp _ Room Air Cond. LICENSE OR47 Class. (commencing with Section 7000) of Division 3 of the BusinessDISTRICT NO PROCESS BY c and Professions Code,and my license is in full force and effect. Power Apparatus 8 Large'Appliances Size 8 Type HP, KW, KVA,.or KVAR lo O License Number4 3,1M9 Lic Class CIOUp to 1 Incl FINAL +��J �C�1. pate /— � IM Over 1 to 10 Incl DATE // VALIDATION Contractor Over 10 to 50 Incl / ❑ 0 FINAL 1 am exempt under Sec. Over 50 to 100 Inc. BY ! LU Over 100 d a y) B&P.0 for this reason ► � �� Date Services, Swbd., MCC.B Panelboards 0 - 200 Amp Under 600 V / Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp or Over 600 V SINGLE FAMILY Temp. Power Pole 8 Appurtenances `'6 9 9,LO HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit W + 0 0 0 o o 2 1 hereby affirm that I am exempt from the Contractor's License AddiTional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and Professions Code)- 2 0 0 25. 5 0 [DI, as owner of the property, will do the work and the Mi Conduits 8 Conductors --- • structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ ► 0'0 0 2 5 5 0 u 7044, Business and Professions Code). 1,2 1 —8 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 PERMIT FEE (Sub-Total) (Sec 3097, Civ. C.). PLAN CHECKING FEE Lender's Name O S Lender's Address PERMIT ISSUING FEE I certify that I have read this application and state that the TOTAL FEE V above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby horize representatives of this County to enter upon the a e ment o d pror for inspection purposes SEE.REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT ' I hereby affirm that I have a certificate of consent to self insure, 76A663 or a certificate of Worker's Compensation Insurance, or a certif d COUNTY OF LOS ANGELES DEPT. OF'PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof,kSec.,3800 Lab. C.) •. Policy No. Company L FOR APPLICANT TO FILL IN JOB V O ADDRESS 'Certified copy is hereby furnished New Residential Bldgs &,Pools NO EACH FEE fTL • -, : _ $ $ LOCALITY_ � ❑. Certified co is filed with the count bp ms tion 1 &2-Family,Sq Ft PY• Y 9 P _ NEAREST department. Multi-family Sq.Ft CROSS ST Residential Swimming Pools ASSESSOR Date AppliMAP-BOOK (/ PARCEL CERTIFICATE OF EXEMPTION FROM WORKER �� s OWNER O COMPENSATION INSURANCE Outlets.Rec._Light Sw /p FIRM NA First 201:5_� (This section need not be completed if the work involved by the MAIL r permit is for one hundred dollars($100)or less.) Total No Additional �a ADDRESS I certify that in the performance of the work for which'this permit CITY 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 Lighting Fixtures�� First 20 APPLICANT Total No Additional ADDRESS Date ApplicantRESIDENTIAL 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 Appliancesr APPLICANT O IA e Q no LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS/ YD s I hereby affirm that 1 am licensed under provisions of Chapter 9 Over 3 to 10 Incl. CITY C)/� Tel No /�L{ (commencing with Section 7000) of Division 3 of.the Business and Professions Code,and my license is in full force and effect Over 10 to 50 Incl - LICENSE OR Class d Over 50 t0 100 Ind. REG NUMBER O 77 Over Over 100 DISTRICT NO Pfi SSED BY V License Number Lic Class y r Services,Swbd,MCC&Panelboards �a ZZ•L��-�� Contract v Date 1 0-399 Amp Under 600 V FINAL DATO ❑ 1 am exempt under Sec 400-1000 Amp Under 600 V 9^ � 9 Over 1000 Am O 600 V VALIDATION W P or ver FINAL d - B.&P.C.for this-reason BRANCH CIRCUIT FEES BY, Date. 15A,or 20A, 120V,Lighting or Recept z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Exemption for Reg Maint. Elect 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp Power Pole&Appurtenances _ ,., i, HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit AC•�IT s� I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits 33 Code) (J•_ ITEMS T to ElEt I, as owner of the property,will do the work and the structure Misc.Conduits&Conductors i I i S Is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) TOTAL m0 and Professions Code). CHECK CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the (;HAHf7E .00 performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) CIV.C.) - PLAN CHECKING FEE DCIOO-0001 6/24/97 Lender's Name PERMIT ISSUING FEE a 0Q5 1 A v;lr� Lender's Address - I certify that I have read this application and under penalty of purjury state TOTAL FEE that the above infor n iscorrect I agree to comply with all County ordinances and ate laws reg ting Electrical wiring,and hereby authorize representatl this ty ter upon the above-mentioned property for polTection ses SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF PEIMITIF.Ee DATE '