HomeMy Public PortalAbout4933 FRATUS DR_Electrical__ WORKERS'COMPENSATIONDECLARATION WA663 - `APPLICATION FOR ELECTRICAL PERMIT
CE 80BG (2 80) M"
I hereby affirm that I have a certificate of consent to self' COUNTY OF LOS ANGELES BUILDING AND SAFETY
insure, or a certificate of Workers'Compensation'Insurance,or
_ a certified copy thereof(Sec 3800,Lab C)
FOR APPLICANT TO FILL IN JOB
Policy No Company ADDRESS
New Residential Bldgs &Pools EACH NO FEE
Certified copy is hereby furnished 1 &2-Family,Sq Ft $ — $ LOCALITY
Certified copy ts,filed with the county building inspection Multi-family Sq Ft CROSS ST
department Residential Swimming Pools OWNER OR
FIRM NAME ,? J
Date Applicant /Outlets Rec 5Light�Sw -2— , Sd d ADDRESS
First 20
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No Additional CITYo Tel No
t, COMPENSATION INSURANCE
PLAN CHECK d
APPLICANT 0
(This section need not be completed if the work involved ' S 0d U
by the permit is for one hundied dollars ($100) or less) Lighting Fixtures First 20 ADDRESS
Total No 2 Additional _ cc
I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No
permit is issued, I shall not employ any person in any manner PERMIT b'`
so as to become subject to the Workers'Compensation Laws Range_ Heater D W APPLICANT W
LU
/ CL
Oven Dryer=W M ADDRESS to
_
Date Apphcan Top FAU W H- - CITY Tel No ?
Hood Fan —Other_ ..((
NOTICE TO APPLICANT If, aft ma ng this Certifica of Disp _ Room Air Cond�_ i S LICENSE OR
Exemption, you should becom subject to the W kers' REG NUMBER Class
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO PROCES ED BY
with comply with such provisions or this permit shall-be Size&Type HP, KW, KVA,or KVAR
deemed revoked S, Q
_ Up to 1 Incl
+ Over 1 to 10 Incl FINAL
DATE
LICENSED CONTRACTORS DECLARATION VALIDATION
Over 10 to 50 Incl
I hereby affirm that I am licensed under provisions of Chapter- Over 50 to 100 Inc FINAL
9 (commencing with.Section 7000)of Division 3 of the Busi Over 100 BY
ness and'Professions Code, and my license is in full force and
effect Services
0-200 Amp Under 600 V Sol
f`
License Number Lic Class 201-1000 Amp Under 600 V
Contractor Date Over 1000 Amp or Over 600 V
HOME OWNER-BUILDER DECLARATION Temp Power Pole&Appurtenances
I hereby affirm that I am exempt from the Contractor's Sign with One Branch,Circuit
License Law for the following reason (Section 7031 5, Bust Additional Sign Branch Circuits
ness and Professions Code)
z
- Misc Conduits& Conductors 1026A
0 I, as owner of the property, will do the work and the Other(See Complete Fee Schedule).--- #'o 0,0 1,0 0 2
structure is not intended or offered for sale (Section
7044, Business and Professions Code)' 2 o o129.50
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency 0 0 0 2 9.5 0 Fi
for the performance of the work for which this permit is PERMIT FEE (Sub-Total) �O,S b
issued (Sec 3097,Civ C) 091.03-8,
9,03-8 1
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee)
Lender's-Address }
PERMIT ISSUING FEE
I certify that I have read this application and state that the TOTAL FEE
above`information is correct'l agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
Itheove-me ed property f r-inspection purposes SEE.,REVERSE FOR EXPLANATORY LANGUAGE
01
Signal o ermittee Date
C
l
1 76A663 DBS SA 11-SO APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
r CA WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
ELECTRICIAN C hei r Q { W, ?4LI dp^-
RECEIVED BY READY FOR DATE ISSUED
/�
ADDRESS ` g 7 /�p' -;v, Yd , h
Y� L) FIRST INSPECTION
/�
CITY 774 �{'1'! �t•iO P_I TEL N0 ��$-y�g,I
/� :5--
COUNTY LICENSE NO. �® y EXPIRES /-3®^ f?I BUILDING 9 3 y
PERMIT FEES ADDRESS ®s al/�/
FEE LOCALITY p -e -M j ( 4C L
NUMBER EACH e ,,�Ip�A ! )
LIGHT OUTLETS ^^' CROSS T. �J s Y` 1 �C I`C�
NEAREST
RECEPTACLES O'er
WALL SWITCHES F7 OWNER nC/ )"W 1, /�. J ��1. C/ W
TOTAL OUTLETS ^D Sc _$ ,� Y,I) MAIL y e (?/'D ��l� f U
ELEC RANGES T 25 0AA� �; _ ADDRESS Y !72 Q U
ELEC HEATERS ! 25 hS� CITY Je-1.►/1 {! ClCs / t. TEL. NO � -4 -7y1 Z
FIXTURES 5 �� 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MISC APPLICATION AND STATE THAT THE ABOVE IB 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 HORSEPOWERFEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
NEW MVD HP OVER INC EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
I/2 3 LESS $ 25 SIGNATURE OF
_ '/2 2 .50 PERMITTEE_" '�� �i
2 s 1 00 INSPECTION RECORD
5 is 1 50
15 60 250
_ 50 200 500 _
200 500 10130 J
_ 500 1000 15 OC Z
OVER 1000 2000
M G SET/FREQ CHANGER-HP
WELDERS:AC-KVA D
GENERATORS - KW
TRANSFORMERS - KVA
TEMP MOTORS X75% OF ORIG
MOVED MOTORS (75% OF ORIG.)
MISC
SIGNS
NO NO TRANS
APPROVALS
NO NO LAMPS
DATE INSPECTOR'S NAME
FOR EACH PERMIT
WIRING $1 00 U CONDUIT
FIXTURES $1 00 L D WIRING /D
SUPPLEMENTARY s0 FIXTURES
POWER
TOTAL FEE $ 0 UTILITY CO NOTIFIED
/` FINAL