HomeMy Public PortalAbout5015 FRATUS DR_Electrical__ ."WORKER'S COMPENSATION DECLARATION 20-0019 DPW(112 91)
76A663 APPLICATION FOR ELECTRICAL PERMIT
I h¢o by affirm that I have a certificate of consent to self Insure,
or a certifica2o,T Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
copy thereof(Sec 3808 Lab C) Jk
Policy No Company FOR APPLICANT TO FILL IN 'JOB ��
ADDRESS
Certified copy is hereby furnishedNew Residential Bldgs &Pools NO EACH FEE
$ $ LOCALITY
❑ Certified copy is filed with the county building Inspection 1 &2 Family,Sq Ft _ NEAREST t C^
department Multi-family Sq Ft CROSS ST
Date Applicant
Residential Swimming Pools ASSESSOR
MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec Light 1-7_S. �O FlPMNER OR
NAME
COMPENSATION INSURANCE First 20
MAIL
(This section need not be completed If the work Involved by the � ADDRESS
permit is for one hundred dollars($100)or less) Total No Additional
1 certify that In the performance of the work for which this permit CITY Tel No
Is Issued, I shall not employ any per�inner PLAN become sublect,to the Workers' Lighting Fixtures First 20 APPLICANTK1 OC1Total No Additional
/ ADDRESSDate [ AppllcanRESIDENTIAL APPLIANCES NOT OVER 3 HP f
NOTICE TO APPLICANT If, aking this rtificate of CITY Tel No •-33
Exemption, you should become lect t thes' Compensation OTHER APPLIANCES NOT OVER 3 HP
provisions of the Labor Code, you must forthwith comply with such PERMIT
provisions or this permit shall be deemed revoked Power Apparatus&Large Appliances APPLICANT
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW KVA,or KVAR ADDRESS
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl
(commencing with Section 7000) of Division 3 of the Business and CITY Tel No
Professions Code,and my license is in full force and effect Over 10 to 50 Incl
LICENSE B S.5`1 Classe
Over 50 to 100 Incl _� 0'
REG NUMBER d
Over 100 DISTRICT NO P SSED BY O
License Number �Jy —�Llc Class v~ / V
S ces,Sw�bdQ,M�4��CJ/$f/5yelboards �du cc
Contractor to ✓ _ �3 9 Amp Under 600 V FINAL DATE 0
❑ 400-1000 Amp Under 600 V -7--1�J VALIDATION V
I am exempt under Sec Over 1000 Amp or Over 600 V FINAL W
B&P C for this reasonBRANCH CIRCUIT FEES BY
Date 15A,or 20A,120V,Lighting or Recept Z_
1 To 10 Branch Circwts
Signature 11 To 40 Branch Circuits
El
41 Or More Branch Circuits _
Exemption for Reg Maint Elect 15A,20A,208V To 277V Lighting Br Circuits
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
for the following reason (Section 7031 5, Business and Professions Additional Sign Branch Circuits
Code)
t�
❑ I, as owner of the property, will do the work and the structure Mlsc Conduits&Conductors a
Is not Intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) E_{3 Ns� 60 o 65
and Professions Code) HE*V,
CONSTRUCTION LENDING AGENCY r_ tey3CE
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
Lenders Name
PERMIT ISSUING FEE 1
Lender's Address / / n
I certify that I have read this application and under penalty of purlury 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
Ives o t i ounty to enter upon the above mentioned property
I Inspec n p es SEE REVERSE FOR EXPLANATORY LANGUAGE
�-SI E OF PERM!TT DATE
76A663 Des SA 11-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTR T NO. GROUP I ZONE PERMIT NO.
ELECTRICIAN2'''29-3
RLCEIVED BY READY FOR DATE ISSUED
ADDRESS 5134 N. Acacia St. FIRST INSPECTION
CITY San Gabs TEL ND.AT 68583
COUNTY LICENSE NO 1104 EXPIRES ADDRESS
5015 Fratus Drs
PERMIT FEES
NUMBER EACH FEE LOCALITY TempleLOCALITY Temple City
LIGHT OUTLETS NEAREST
/ CROSS ST.
RECEPTACLES
WALL SWITCHES OWNER Be Es Turner
TOTAL O �fUTLETS Sc $ 0 MAIL
ELEC RANGES 25 ADDRESS
ELEC HEATERS 25 CITY TEL. NO.
FIXTURES 5
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MISC 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 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWERFEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
NEW MvO. HP OVER INC EACH ry OF THE RESIDENTIAL PROP DESCRIBED ABOVE.
�4
I2 s LESS $ .25 :eSIGNATURE OF
'/2 2 .SO
PERMITTEE.
2 _ s 1 DD INSPECTION RECORD
5 13 1 5O
15 50 250
60 200 Soo _
200 500 1000 J
— ay
5O0 1000 1500
Z- O
OVER 1000 20 00 —
M G BET/FREQ CHANGER-HP Q'
WELDERS'AC-KVA
GENERATORS - KW
TRANSFORMERS - KVA
TEMP MOTORB (75% OF ORIS)
MOVED MOTORS (75% of ORIS)
MISC
SIGNS
NO NO TRANS ( APPROVALS
NO NO—LAMPS I
FOR EACH PERMIT DATE INSPECTORIB NAME
WIRING $1.00 CONDUIT 10
FIXTURES $1.00 WIRING ..� l �'b;,'s2 he A--1
SUPPLEMENTARY 50 FIXTURES
Q POWER /
TOTAL FEE $ UTILITYCO NOTIFIED a /1ilr� 9
FINAL I ��