HomeMy Public PortalAbout8912 GARIBALDI AVE_Electrical__ a
7ewef3-c>s8 0e.fo-ee APPLICATION FOR ELECTRIC PERMIT 1
$VII.DING AND SAFETY DIVISION
Dep,orbnc2t of County Eugh-sc 13UILDINa /1
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UGH Z— RIOlrTAOL� •wtTaxEs OWNER
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TOTAL OUTLM .10
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SaRVICX OVNR 600V 5.00
WIRING PKRUrT 1.00 -'
FUCTURN PK"rT 1.00
SUPPL.M ENTARY PIUMFT '.Do APPROVAIS
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LIC>abtD AS RODUM BY LOB /IAGELSS COUNTY AND STATE OF
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UTILITY CO. NOTIFIED
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76AS63 DBS SA 7-51 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY ELECTRIC 1
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
ELECTRICIAN
RECEIVED BY READY FOR DATE ISSUED
ADDRESS -t'"- - FIRST INSPECTION
CITY TEL. NO.
COUNTY LICENSE NO. ' EXPIRES BUILDNG
ADDRESS ru. �; 'dt �•-'" ,`r ! �
PERMIT FEES
FEE
NUMBER EACH LOCALITY
_LIGHT OUTLETS NEAREST
RECEPTACLES / .LCROSS ST.
WALL SWITCHES r� OWNER
TOTAL OUTLETS SC $ MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 25 CITY TEL. NO.
FIXTURES 5 I 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 Z._ AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWERFEE AMBELE13 COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
NEW MvD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERT-(DESCRIBED ABOVE.
!/9 i LE56 $ .25 SIGNATURE OF
I/2 2 .50 PERMITTEE
2 s 1.00 INSPECTION RECORD
5 15 1.50
15 5o 2.50
_ 50 200 5.00
_ 200 500 10.00 J
500 1000 15.00 Z
OVER 1000 20.00 (g
_ M.G. SET/FREQ. CHANGER-HP Q'
WELDERS:AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA _
_ TEMP. MOTORS (75% OF ORIG.)
MOVED MOTORS (75% OF ORIG.)
MISC.
SIGNS
NO. NO.TRANS. APPROVALS
NO. NO. LAMPS
FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING $1.00 CONDUIT
FIXTURES _ $1.00 WIRING -
SUPPLEMENTARY .50 FIXTURES C'
POWER
TOTAL FEE $ UTILITY CO.NOTIFIED /
FINALS _ -
WORKERS'CoMPE1JSAnON DECIARAnON 76AW I"l
hereby affirm that I have a certificate of consent to self CE-BD6G APPLICATION- FOR ELECTRICAL PERMIT
Insure, or a certiflcate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
,gr�,�dgrflfle�dtcopy'thherre'of (Sec. 3800, b. C.)
PII 0 N8.y�Af 12,/Com rt d 7 Z Hr FOR AMXANT TO Al IN JOB '
❑� !fled copy Is hereby furnished. New Residential Bldgs.$ Pools EACH NO. FEE ADDRESS �z � R 1 Q�� � ✓G
Certified copy Is filed with the county bulldiN Iruipec- 1 8 2-Family, Sq. Ft. _ — f LOCALITY -YAPL C
tion ret. Multi-family Sq. Ft. — T
i Resldenrial Swimming PoolsOWNER OR
Date ApplicantCROSS ST.
ham+ Y y o
^ ' F RM NAS r A Z
CE CA OF EXEMPT! FROM WORKERS' A�'-' L I,B D/
COMPENSATION INSURANCE Outlets: Rec_ 11ght�Sw
(This sect n need not be cor. luted If the wai lmfroly by Total No
First CITY C Irr £ &� Tel. No.
the permh Is for on+hundred dollars ($100)of leis.) Additional
I certify that In the performance of the work'for which this AApp LAN o-NT
permit Is Issued, I shall not employ any person-In any manner
so as to become subject to the Workers Compensatlon Laws. Ughting Fixtures First 20 ADDRESS
Additional
Total No. � CITY Tel. No:
Date ATpllcahl, Fixed Appllaoces Not Over 1 HP P6tMff
NOTICE TO APPLICANT: If, after rrdking this.Certificate of APPLK"' L� Co 5 r, D
Exemption, you should become subject to the Workers' Range— Heater_D.W.- — /
Compensation provisions of the Labor Code, you must forth- Oven —Dryer —W,ML— ADDRESS
With Comply with such provisions or this permlt shall be Top — FAU —W.H.
deemed revoked. CITY d.� '
LATel. No. f
_Q �
LICENSED CONTRACTORS DECLARATION Hood _ Fan —Ctther�
I Hereby affirm that I am licensed Under provlsl"of Chapter 9 Dlsp. — Room Air Cond. �OMBgR Clans.
(commencing with Section 7000) of Division 3 of the Buslnees Power Apparatus&Large Appliances DISTRICT NO. PROCESSED BY
and Professions Code,and my license is In full force and effect.
7d� J7 / Size8 Type HP,KW, KVA, or KVAR-- O u
License Num ALIc. Cltv&
Z' Up to 1 Incl. FINAL
4dr Over 1 to 10 Ind. DATE VALIDATION
Conirattor Date T Over 10 to 50 Incl.
❑ FINAL G
I am exempt under Sec Over 50 To 100 Inc. BY
B.IiP.C, for this reason Over 100
Date: Services, Swbd., MCC 8 Panelboards ►
0 -200 Amp. Under 600 y
Signature 201 - 1000 Amp. Under 600 V
Over 1000 Amp. or Over 600 V
f_} Exemption for Reg. Malnt. Elect.
SINGLE FAMILY Temp. Power Pole 8 Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit f,3 8.9.6 A
I hereby affirm that I am exempt from the Contractors License
Law for the following reason (Section 7031.5, Business and Additional Sign Branch ClrculTs �} o 0 0•Io] o 2
Professions Code): I o�o,2V2 5
❑ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors 00,0'2 Q'2'5 E
structure Is not Intended or offered for safe (Section Other (Sqe Complete Fee Schedule.)` , r' 1
7041, Business and Professions Code) 10 R.31 —84-
CONSTRUCTION
84-
CONSTRUCTION LENDING AGENCY
I hereby afflrm 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 FIE
Lenders Name-
PERM R ISSUING FEE
Lenders Address
I certify that I have rood this applltation and state that the I TOTAL FEE
above Informatlon 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
rtheave-mentioned property for inape4ilon pun
�/� SEE REVERSE FOR E"LANATORY LANGUAGE
natyre of Ittee
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