HomeMy Public PortalAbout10864 FREER ST_Electrical__ APPLICATION FOR ELECTRIC PERMIT
nrv=0q OF BUILDING AND SAFETY
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JOHN A.�glli-CouN'[Y ENalr �
OAiJtA4 IL GRIFFIN sur^r or■unm,Ms any G 0
FOR LENT TO FILL IN NST v E
■o �� OWNER D
UGHT oLr LXTS WAJL
RXCLPTACLAS ADDREsi
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TOTAL.OuTwrrs 0 e FI FclmICIAN
ILM RANGts ADDRISs D Sr
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KW X& CITY TEL No
ATTR
FDCIumm is UCENst NO.
MOTORS pISTRIGT NO. I GROUP .ZONE I tun resn+r ums
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rva tir ovQ n+o swox HNBPE=N E=BD
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: 5O
i D 1.00
D 15 1.50
15 50 1.50
50 goo 5.00
M 1oc.
NO.SIGNS NO.TRANS.
O.s NO
FOR TACH PIRMIT•
WIRING $1.00
FIXTU R" 1.00
supmwD vrr tY 50 APPaOVAis
TOTAL FEE DATR INSPECTOR'S flamvm
I RlrR Y A OWLEDGR THAT 1 RATI RK D THIS APPLICATION
/I►►1N1D STATIC THAT THE=IS ID CORRECT AND AGREE TO COMPLY CONDUIT
rr7 ALL COUNTY ORD111A1ICES ANP STATR LAWS REGULATING
KUCTRICAL WIIIUNG. WIRING
LIITHUia�npn tC/S8 RR IFY T T APROPU T REG D /OR FIXTURES
CALIFO Lik -OR THAT I Li ROWER
DESCRIBrD REST PHRTT;
is IGNATU RE UT]L ITY CO.NOTIFIED
OF PIRRYIYTRi FINAL r
JOHN A.L.Ar CouNTY EtNG Nme D`!►T_ ATION ARTHUR C.VETT.CFUQ m-j=.
q/ MO CAAH
LG4 5 6 3N MAR 28 2 .6 0 �
19"62
pea." • APPLICATION FOR ELECTRIC PERMIT
DIYIS,ON OF BOII. ma AND SAFETY .
County cFA�IDRgZs
DING �P�'�-�
County Of L04 r�« l Y
' WM.J. FO COUNTY a<IN�CASSATT D.GRIMM.SUPT OF BUILDINGFO__ R_aWIP G TO FILL 1N NEREST / ) ./ /�
CROSM ST.
NUMo1SR EACH FIE '
LIGHT OUTLSTB OWNER
RECEPTACLES 14.+1 IL
AD D R E$S
WALL WVITCHES
TOTAL OUTLETS D
CLEC.RANGES 20 EL,ECTRICIAN
[LSC. HEATERS X ADDRE"
KW EA CITY L-NO D
FIXTURES D LICKNSIK NO.
-NUMBER OF LIGHT CIRCUITS - DISTRICT I40.
GROUP ZONE aaAnr roa Iu�acrloa
NUMBER OF RECEPTACLE CIRCUITIS J
MOTORS
NUMB HORSEPOWER FEE DfSP=ON HEMRD
HIM ry D. HP OVQI INC. [ACS
1 ■Ums 2D
vF La 6f'
2 so
It It 1.00
>!
15 1.50
1D DO 2.50
CO 200 5.00
JOE
MI
NO.SIGNS NO.-TRANS.
O.SIQNS
FO
WIRING 1.00
FIXTURES I.00
8UPPLEM RY .50 APPROVALS
TOT L FEE DATE INSPECTOR'S BIGNATURE
LAND9TATE
EBY ACKNOWLFDGR THAT I HAVE RKWD.THIS APP 1GATION CONDUIT
ATE THAT THE ABOVE Is CORRECT AND AGREE TO COMPLY
LL COUNTY ORDIN"dESAND STATE LAWS REGULATING WINING
ICAL WIRING.®Y CERTIFY THAT I AR PROPER LT RE IfTffiII MD/OR PIXTURESD AS RHOUIRHD BY 1,0! ANGELES OU TE OF
XIA OR TH�UA1T 1 THr. LOG POWER
D Rp ID61f'fIA1 P�LTY.UREUTILITYCO.NOTIFI1MRMITTEE FINAL
WILLIAM J. F COUNTY IINGINOCf VAIMAMON A.C.VEIT.CHIIIIF ELECT.INSPECTOR
LPC�4 3,8 3�R MAR 22 2 465 �'
WORKERS'COMPENSATION cateof cons CE-806 ,oie, APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self �-�G '
Inure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
rr>r a ccrtlfied copy thereof (Sec. 3800, Lab. C.)
Po❑llcy No.—Company FOR APPLICA T TO IFILL IN
Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEEADDRESS
V V
Eltion
copy Is filed with the county building Inspec- 1 b 2-Family, Sq. Ft. $ _ i LOGALrrY /�L J T
tion department. Multi-family Sq. Ft. t,�
Residential Swimming PoolsCROSS�,�OR
Date Applicant ,,fj
NAME N µ F
CERTIFICATE OF EXEMPTION FROM WORKERS' 41 � L t
COMPENSATION INSURANCE Outlets: Rec�lght Sw. /Jj q ADDRESS,
Is sec?fon rwed not be If the work fmrohnd First ti fr- ? 2
the pwmft Is fbr on*hundredtoors(;100)or loss.) Total No Additional CITY Tel. No.
I certifth
y at In the performance of the work for which this PLAN� W �J
permit Is Issued,I shall not employ any person In arty manner
so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS x 7-7 7 3
/�— Total No. Additional CITY Tel. No.
Date a Icant Fixed Appliances Not Over 1 HP pg2�
NOTICE TO APPLICANT: If, after making Is Iflcate of w R6 D ITi �S� Lit /���
Exemption, you should become• subject to the Workers' Range_ Heater_D.W. —
Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS ' F av Z
with comply with such provisions or this permit shall be Top — FAU —W.H. — CfTY % oZ� Tel. No �
deemed revoked.
LICENSED CONTRACTORS DEC7ARATI NJ Hood y Fan /—Other— ucB� oR
I hereby affirm that I am licerued under provisions of Chapter 9 Dlsp. Room Air Cond. REG NUMBER ���'��} Class. ��
(commencing with Section 7000) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. PROCESSED BY
and Professions Code,and my Ilcense Is In full force and effect. CL
�� Sim 8 Type HP, KW, KVA, or KVAR' O
License Number Lic. Class J� T Up to 1 Incl, FINAL V
Over 1 to 10 Incl. DATE /Z VALIDATION ccO
Contractor Date _ Over 10 to 50 Incl. FINAL
❑ 1 am exempt under Sec Over 50 to 100 Inc. BY
B.BP.C, for this reason Over 100 p
Date: Services, Swbd., MCC b Panelboards
0 -200 Amp. Under 600 V
Signature 201 - IOQO Amp. Under 600 V
❑ Over 1000 Amp. or Over 600 V
Exemption for Rep. Malnt. Elect. �
SINGLE FAMILY Temp. Power Pole 8 Appurtenances
HOME OWNER-BUILDER pECLARAT1ON Sign with One Branch Clrcult
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Clrcults
Professions Code):
❑ 1, as owner of the property, will do the work and the Misc. Conduits 8 Conductors
P pertor Other See Complete Fee Schedule)— , �7 5 2 8 A
structure Is not Intended or offered for saie (Section ( P )
7044, Business and Professions Code).
#.o 0 0 0 0
CONSTRUCTION LENDING AtNCY P 3 l O
I hereby affirm that there Is a construction ending agency for
the performance of the work for which this permit Is Issued PERMIT FEE (Sub-Tgtgl) y
.(Sec. 3097, Civ. C.). 0 0 0 .3 � � (D
-PLAT' CHECKING,FEE 11. 1 2-82
Lenders Name p�
PERMIT ISSUING FEE O
Lenders Address
I certify that I have read this application and state that the - TOTAL FEE
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 tQ enter upon
the above-Me oned property for Inspectlon purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
�-
SI nature of Permittee Date